Sample records for role clinical task
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Mick, D J; Ackerman, M H
2000-01-01
This purpose of this study was to differentiate between the roles of clinical nurse specialists and acute care nurse practitioners. Hypothesized blending of the clinical nurse specialist and acute care nurse practitioner roles is thought to result in an acute care clinician who integrates the clinical skills of the nurse practitioner with the systems knowledge, educational commitment, and leadership ability of the clinical nurse specialist. Ideally, this role blending would facilitate excellence in both direct and indirect patient care. The Strong Model of Advanced Practice, which incorporates practice domains of direct comprehensive care, support of systems, education, research, and publication and professional leadership, was tested to search for practical evidence of role blending. This descriptive, exploratory, pilot study included subjects (N = 18) solicited from an academic medical center and from an Internet advanced practice listserv. Questionnaires included self-ranking of expertise in practice domains, as well as valuing of role-related tasks. Content validity was judged by an expert panel of advanced practice nurses. Analyses of descriptive statistics revealed that clinical nurse specialists, who had more experience both as registered nurses and in the advanced practice nurse role, self-ranked their expertise higher in all practice domains. Acute care nurse practitioners placed higher importance on tasks related to direct comprehensive care, including conducting histories and physicals, diagnosing, and performing diagnostic procedures, whereas clinical nurse specialists assigned greater importance to tasks related to education, research, and leadership. Levels of self-assessed clinical expertise as well as valuing of role-related tasks differed among this sample of clinical nurse specialists and acute care nurse practitioners. Groundwork has been laid for continuing exploration into differentiation in advanced practice nursing roles. As the clinical nurse specialist role changes and the acute care nurse practitioner role emerges, it is imperative that advanced practice nurses describe their contribution to health care. Associating advanced practice nursing activities with outcomes will help further characterize these 2 advanced practice roles.
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Leadership support for ward managers in acute mental health inpatient settings.
Bonner, Gwen; McLaughlin, Sue
2014-05-01
This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused.
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Oncology Nurse Navigation: Results of the 2016 Role Delineation Study.
Lubejko, Barbara G; Bellfield, Sonia; Kahn, Elisa; Lee, Carrie; Peterson, Nicole; Rose, Traudi; Murphy, Cynthia Miller; McCorkle, Michele
2017-02-01
In 2011, an oncology nurse navigator (ONN) role delineation survey (RDS) was conducted by the Oncology Nursing Society (ONS) when the role was relatively new to oncology. Results did not demonstrate a unique skill set for the ONN; however, since then, the role has expanded. ONS and the Oncology Nursing Certification Corporation partnered in 2016 to complete an RDS of ONNs to redefine the role and determine the need for an ONN certification examination. A structured RDS was conducted using a formal consensus-building process. A survey was developed and released to examine the specific tasks, knowledge, and skills for the ONN as well as to determine which role possesses more responsibility for the tasks. The ONN role is evolving, and more was learned about its key tasks, including differences in the responsibilities of the ONN and the clinical or staff nurse. However, the RDS did not find an adequate difference in the knowledge required by the ONN and the clinical or staff nurse to support the need for a separate ONN certification.
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Walker, Judith; von Bergmann, HsingChi
2015-03-01
The purpose of this study was to explore the use of cognitive task analysis to inform the teaching of psychomotor skills and cognitive strategies in clinical tasks in dental education. Methods used were observing and videotaping an expert at one dental school thinking aloud while performing a specific preclinical task (in a simulated environment), interviewing the expert to probe deeper into his thinking processes, and applying the same procedures to analyze the performance of three second-year dental students who had recently learned the analyzed task and who represented a spectrum of their cohort's ability to undertake the procedure. The investigators sought to understand how experts (clinical educators) and intermediates (trained students) overlapped and differed at points in the procedure that represented the highest cognitive load, known as "critical incidents." Findings from this study and previous research identified possible limitations of current clinical teaching as a result of expert blind spots. These findings coupled with the growing evidence of the effectiveness of peer teaching suggest the potential role of intermediates in helping novices learn preclinical dentistry tasks.
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Andersen, Pia; Lindgaard, Anne-Mette; Prgomet, Mirela; Creswick, Nerida; Westbrook, Johanna I
2009-08-04
Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards. Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions. Assessment of the physical attributes of three devices-stationary PCs, computers on wheels (COWs) and tablet PCs-was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. The majority (93.1%) of observed nursing tasks were conducted using generic COWs. Most nursing tasks were performed in patients' rooms (57%) or in the corridors (36%), with a small percentage at a patient's bedside (5%). Most nursing tasks related to the preparation and administration of drugs. Doctors on ward rounds conducted 57.3% of observed clinical tasks on generic COWs and 35.9% on tablet PCs. On rounds, 56% of doctors' tasks were performed in the corridors, 29% in patients' rooms, and 3% at the bedside. Doctors not on a ward round conducted 93.6% of tasks using stationary PCs, most often within the doctors' office. Nurses and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. The choice of device was related to clinical role, nature of the clinical task, degree of mobility required, including where task completion occurs, and device design. Nurses' work, and clinical tasks performed by doctors during ward rounds, require highly mobile computer devices. Nurses and doctors on ward rounds showed a strong preference for generic COWs over all other devices. Tablet PCs were selected by doctors for only a small proportion of clinical tasks. Even when using mobile devices clinicians completed a very low proportion of observed tasks at the bedside. The design of the devices and ward space configurations place limitations on how and where devices are used and on the mobility of clinical work. In such circumstances, clinicians will initiate workarounds to compensate. In selecting hardware devices, consideration should be given to who will be using the devices, the nature of their work, and the physical layout of the ward.
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Andersen, Pia; Lindgaard, Anne-Mette; Prgomet, Mirela; Creswick, Nerida
2009-01-01
Background Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. Objective We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards. Methods Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions. Assessment of the physical attributes of three devices—stationary PCs, computers on wheels (COWs) and tablet PCs—was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. Results The majority (93.1%) of observed nursing tasks were conducted using generic COWs. Most nursing tasks were performed in patients’ rooms (57%) or in the corridors (36%), with a small percentage at a patient’s bedside (5%). Most nursing tasks related to the preparation and administration of drugs. Doctors on ward rounds conducted 57.3% of observed clinical tasks on generic COWs and 35.9% on tablet PCs. On rounds, 56% of doctors’ tasks were performed in the corridors, 29% in patients’ rooms, and 3% at the bedside. Doctors not on a ward round conducted 93.6% of tasks using stationary PCs, most often within the doctors’ office. Nurses and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. Conclusions The choice of device was related to clinical role, nature of the clinical task, degree of mobility required, including where task completion occurs, and device design. Nurses’ work, and clinical tasks performed by doctors during ward rounds, require highly mobile computer devices. Nurses and doctors on ward rounds showed a strong preference for generic COWs over all other devices. Tablet PCs were selected by doctors for only a small proportion of clinical tasks. Even when using mobile devices clinicians completed a very low proportion of observed tasks at the bedside. The design of the devices and ward space configurations place limitations on how and where devices are used and on the mobility of clinical work. In such circumstances, clinicians will initiate workarounds to compensate. In selecting hardware devices, consideration should be given to who will be using the devices, the nature of their work, and the physical layout of the ward. PMID:19674959
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Boughen, Melanie; Sutton, Jane; Fenn, Tess
2017-01-01
Background: Traditionally, pharmacy technicians have worked alongside pharmacists in community and hospital pharmacy. Changes within pharmacy provide opportunity for role expansion and with no apparent career pathway, there is a need to define the current pharmacy technician role and role in medicines optimisation. Aim: To capture the current roles of pharmacy technicians and identify how their future role will contribute to medicines optimisation. Methods: Following ethical approval and piloting, an online survey to ascertain pharmacy technicians’ views about their roles was undertaken. Recruitment took place in collaboration with the Association of Pharmacy Technicians UK. Data were exported to SPSS, data screened and descriptive statistics produced. Free text responses were analysed and tasks collated into categories reflecting the type of work involved in each task. Results: Responses received were 393 (28%, n = 1380). Results were organised into five groups: i.e., hospital, community, primary care, General Practitioner (GP) practice and other (which included HM Prison Service). Thirty tasks were reported as commonly undertaken in three or more settings and 206 (84.7%, n = 243) pharmacy technicians reported they would like to expand their role. Conclusions: Tasks core to hospital and community pharmacy should be considered for inclusion to initial education standards to reflect current practice. Post qualification, pharmacy technicians indicate a significant desire to expand clinically and managerially allowing pharmacists more time in patient-facing/clinical roles. PMID:28970452
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Boughen, Melanie; Sutton, Jane; Fenn, Tess; Wright, David
2017-07-15
Traditionally, pharmacy technicians have worked alongside pharmacists in community and hospital pharmacy. Changes within pharmacy provide opportunity for role expansion and with no apparent career pathway, there is a need to define the current pharmacy technician role and role in medicines optimisation. To capture the current roles of pharmacy technicians and identify how their future role will contribute to medicines optimisation. Following ethical approval and piloting, an online survey to ascertain pharmacy technicians' views about their roles was undertaken. Recruitment took place in collaboration with the Association of Pharmacy Technicians UK. Data were exported to SPSS, data screened and descriptive statistics produced. Free text responses were analysed and tasks collated into categories reflecting the type of work involved in each task. Responses received were 393 (28%, n = 1380). Results were organised into five groups: i.e., hospital, community, primary care, General Practitioner (GP) practice and other (which included HM Prison Service). Thirty tasks were reported as commonly undertaken in three or more settings and 206 (84.7%, n = 243) pharmacy technicians reported they would like to expand their role. Tasks core to hospital and community pharmacy should be considered for inclusion to initial education standards to reflect current practice. Post qualification, pharmacy technicians indicate a significant desire to expand clinically and managerially allowing pharmacists more time in patient-facing/clinical roles.
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Running Memory for Clinical Handoffs: A Look at Active and Passive Processing.
Anderson-Montoya, Brittany L; Scerbo, Mark W; Ramirez, Dana E; Hubbard, Thomas W
2017-05-01
The goal of the present study was to examine the effects of domain-relevant expertise on running memory and the ability to process handoffs of information. In addition, the role of active or passive processing was examined. Currently, there is little research that addresses how individuals with different levels of expertise process information in running memory when the information is needed to perform a real-world task. Three groups of participants differing in their level of clinical expertise (novice, intermediate, and expert) performed an abstract running memory span task and two tasks resembling real-world activities, a clinical handoff task and an air traffic control (ATC) handoff task. For all tasks, list length and the amount of information to be recalled were manipulated. Regarding processing strategy, all participants used passive processing for the running memory span and ATC tasks. The novices also used passive processing for the clinical task. The experts, however, appeared to use more active processing, and the intermediates fell in between. Overall, the results indicated that individuals with clinical expertise and a developed mental model rely more on active processing of incoming information for the clinical task while individuals with little or no knowledge rely on passive processing. The results have implications about how training should be developed to aid less experienced personnel identify what information should be included in a handoff and what should not.
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Validating competence: a new credential for clinical documentation improvement practitioners.
Ryan, Jessica; Patena, Karen; Judd, Wallace; Niederpruem, Mike
2013-01-01
As the health information management (HIM) profession continues to expand and become more specialized, there is an ever-increasing need to identify emerging HIM workforce roles that require a codified level of proficiency and professional standards. The Commission on Certification for Health Informatics and Information Management (CCHIIM) explored one such role-clinical documentation improvement (CDI) practitioner-to define the tasks and responsibilities of the job as well as the knowledge required to perform them effectively. Subject-matter experts (SMEs) defined the CDI specialty by following best practices for job analysis methodology. A random sample of 4,923 CDI-related professionals was surveyed regarding the tasks and knowledge required for the job. The survey data were used to create a weighted blueprint of the six major domains that make up the CDI practitioner role, which later formed the foundation for the clinical documentation improvement practitioner (CDIP) credential. As a result, healthcare organizations can be assured that their certified documentation improvement practitioners have demonstrated excellence in clinical care, treatment, coding guidelines, and reimbursement methodologies.
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Colgrove, Yvonne M; VanHoose, Lisa D
2017-01-01
Doctor of physical therapy (DPT) student learning about role delineation of physical therapist assistants (PTAs) is essential to ethical and legal practice. Survey assessment of three DPT student cohorts compared collaborative interprofessional case-based learning with PTA students to traditional curriculum delivery strategies. Control cohorts were assessed one time. The intervention group was assessed pre-intervention, immediately post-intervention, and after completing a full-time clinical experience. The case-based learning covered 46% of survey content, allowing for the assessment of content-specific material and potential learning through collaboration. Following the educational intervention, the intervention group improved significantly in areas inside and outside the case-based study content, outscoring both control groups on 25-34% of the survey items. Following the clinical experience, the intervention group declined answer accuracy for patient evaluation and treatment implementation, suggesting unlearning. Improvement in the administrative section was observed after the clinical experience. Perceptions of the tasks within the PTA role were diminished while tasks outside the scope of practice appeared clarified following the clinical experience. While case-based collaborative intraprofessional learning proves effective in student learning about the PTA role, changes following the clinical experience raise questions about the influence of the clinical environment on learning and the practical application of recently learned knowledge.
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Banducci, Sarah E.; Daugherty, Ana M.; Fanning, Jason; Awick, Elizabeth A.; Porter, Gwenndolyn C.; Burzynska, Agnieszka; Shen, Sa; Kramer, Arthur F.; McAuley, Edward
2017-01-01
Objectives. Despite evidence of self-efficacy and physical function's influences on functional limitations in older adults, few studies have examined relationships in the context of complex, real-world tasks. The present study tested the roles of self-efficacy and physical function in predicting older adults' street-crossing performance in single- and dual-task simulations. Methods. Lower-extremity physical function, gait self-efficacy, and street-crossing success ratio were assessed in 195 older adults (60–79 years old) at baseline of a randomized exercise trial. During the street-crossing task, participants walked on a self-propelled treadmill in a virtual reality environment. Participants crossed the street without distraction (single-task trials) and conversed on a cell phone (dual-task trials). Structural equation modeling was used to test hypothesized associations independent of demographic and clinical covariates. Results. Street-crossing performance was better on single-task trials when compared with dual-task trials. Direct effects of self-efficacy and physical function on success ratio were observed in dual-task trials only. The total effect of self-efficacy was significant in both conditions. The indirect path through physical function was evident in the dual-task condition only. Conclusion. Physical function can predict older adults' performance on high fidelity simulations of complex, real-world tasks. Perceptions of function (i.e., self-efficacy) may play an even greater role. The trial is registered with United States National Institutes of Health ClinicalTrials.gov (ID: NCT01472744; Fit & Active Seniors Trial). PMID:28255557
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Maas, Marjo J M; van Dulmen, Simone A; Sagasser, Margaretha H; Heerkens, Yvonne F; van der Vleuten, Cees P M; Nijhuis-van der Sanden, Maria W G; van der Wees, Philip J
2015-11-12
Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously published randomized controlled trial showed that PA was more effective than the usual strategy "case discussion" in improving adherence to a low back pain guideline. Peer assessment aims to enhance knowledge, communication, and hands-on clinical skills consistent with guideline recommendations. Participants observed and evaluated clinical performance on the spot in a role-play simulating clinical practice. Participants performed three roles: physical therapist, assessor, and patient. This study explored the critical features of the PA program that contributed to improved guideline adherence in the perception of participants. Dutch physical therapists working in primary care (n = 49) organized in communities of practice (n = 6) participated in the PA program. By unpacking the program we identified three main tasks and eleven subtasks. After the program was finished, a questionnaire was administered in which participants were asked to rank the program tasks from high to low learning value and to describe their impact on performance improvement. Overall ranking results were calculated. Additional semi-structured interviews were conducted to elaborate on the questionnaires results and were transcribed verbatim. Questionnaires comments and interview transcripts were analyzed using template analysis. Program tasks related to performance in the therapist role were perceived to have the highest impact on learning, although task perceptions varied from challenging to threatening. Perceptions were affected by the role-play format and the time schedule. Learning outcomes were awareness of performance, improved attitudes towards the guideline, and increased self-efficacy beliefs in managing patients with low back pain. Learning was facilitated by psychological safety and the quality of feedback. The effectiveness of PA can be attributed to the structured and performance-based design of the program. Participants showed a strong cognitive and emotional commitment to performing the physical therapist role. That might have contributed to an increased awareness of strength and weakness in clinical performance and a motivation to change routine practice.
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Competence of novice nurses: role of clinical work during studying
Manoochehri, H; Imani, E; Atashzadeh-Shoorideh, F; Alavi-Majd, A
2015-01-01
Aim: Clinical competence is to carry out the tasks with excellent results in a different of adjustments. According to various studies, one of the factors influencing clinical competence is work experience. This experience affects the integrity of students' learning experience and their practical skills. Many nursing students practice clinical work during their full-time studying. The aim of this qualitative research was to clarify the role of clinical work during studying in novice nurses' clinical competence. Methods: This qualitative content analysis performed with the conventional approach. All teaching hospitals of Hormozgan University of Medical Sciences selected as the research environment. To collect data, deep and semi-structured interviews, presence in the scene and manuscripts used. To provide feedback for the next release and the capacity of the data, interviews were transcribed verbatim immediately. Results: 45 newly-graduated nurses and head nurses between 23 and 40 with 1 to 18 years of experience participated in the study. After coding all interviews, 1250 original codes were derived. The themes extracted included: task rearing, personality rearing, knowledge rearing, and profession rearing roles of clinical work during studying. Conclusion: Working during studying can affect performance, personality, knowledge, and professional perspectives of novice nurses. Given the differences that may exist in clinical competencies of novice nurses with and without clinical work experience, it is important to pay more attention to this issue and emphasize on their learning in this period. PMID:28316703
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Frost, Timothy P; Adams, Alex J
2017-11-01
As the role of the clinical pharmacist continues to develop and advance, it is critical to ensure pharmacists can operate in a practice environment and workflow that supports the full deployment of their clinical skills. When pharmacy technician roles are optimized, patient safety can be enhanced and pharmacists may dedicate more time to advanced clinical services. Currently, 17 states allow technicians to accept verbal prescriptions called in by a prescriber or prescriber's agent, or transfer a prescription order from one pharmacy to another. States that allow these activities generally put few legal limitations on them, and instead defer to the professional judgment of the supervising pharmacist whether to delegate these tasks or not. These activities were more likely to be seen in states that require technicians to be registered and certified, and in states that have accountability mechanisms (e.g., discipline authority) in place for technicians. There is little evidence to suggest these tasks cannot be performed safely and accurately by appropriately trained technicians, and the track record of success with these tasks spans four decades in some states. Pharmacists can adopt strong practice policies and procedures to mitigate the risk of harm from verbal orders, such as instituting read-back/spell-back techniques, or requiring the indication for each phoned-in medication, among other strategies. Pharmacists may also exercise discretion in deciding to whom to delegate these tasks. As the legal environment becomes more permissive, we foresee investment in more robust education and training of technicians to cover these activities. Thus, with the adoption of robust practice policies and procedures, delegation of verbal orders and prescription transfers can be safe and effective, remove undue stress on pharmacists, and potentially free up pharmacist time for higher-order clinical care. Copyright © 2016 Elsevier Inc. All rights reserved.
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Fresson, Megan; Dardenne, Benoit; Geurten, Marie; Meulemans, Thierry
2017-11-01
Numerous studies have shown that stereotype threat (ST) reduces older people's cognitive performance, but few have studied its impact on clinical cognitive outcomes. Our study was designed to further examine the impact of ST on the clinical assessment of older subjects' cognitive functioning, as well as the moderating role of fear of Alzheimer's Disease (AD) (or 'dementia worry'). Seventy-two neurologically normal (MMSE > 26) participants aged between 59 and 70 completed a set of neuropsychological tasks in either an ST or a positive condition (condition in which negative stereotypes were invalidated). Regression-based path analyses showed that only participants who expressed moderate or high fear of AD underperformed on executive tasks in the ST condition compared to their counterparts in the positive condition. Moreover, in the ST condition, participants' performance on executive tasks was more impaired (relative to normative data) than in the positive condition. However, ST had no effect on memory and attention performance. Our results showed that ST can cause older people to perform at pathological levels on executive tasks. Results highlight the need for clinicians to be cautious when conducting neuropsychological assessments of older people who express high levels of dementia worry.
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Kannry, Joseph; Sengstack, Patricia; Thyvalikakath, Thankam Paul; Poikonen, John; Middleton, Blackford; Payne, Thomas; Lehmann, Christoph U
2016-01-01
The emerging operational role of the "Chief Clinical Informatics Officer" (CCIO) remains heterogeneous with individuals deriving from a variety of clinical settings and backgrounds. The CCIO is defined in title, responsibility, and scope of practice by local organizations. The term encompasses the more commonly used Chief Medical Informatics Officer (CMIO) and Chief Nursing Informatics Officer (CNIO) as well as the rarely used Chief Pharmacy Informatics Officer (CPIO) and Chief Dental Informatics Officer (CDIO). The American Medical Informatics Association (AMIA) identified a need to better delineate the knowledge, education, skillsets, and operational scope of the CCIO in an attempt to address the challenges surrounding the professional development and the hiring processes of CCIOs. An AMIA task force developed knowledge, education, and operational skillset recommendations for CCIOs focusing on the common core aspect and describing individual differences based on Clinical Informatics focus. The task force concluded that while the role of the CCIO currently is diverse, a growing body of Clinical Informatics and increasing certification efforts are resulting in increased homogeneity. The task force advised that 1.) To achieve a predictable and desirable skillset, the CCIO must complete clearly defined and specified Clinical Informatics education and training. 2.) Future education and training must reflect the changing body of knowledge and must be guided by changing day-to-day informatics challenges. A better defined and specified education and skillset for all CCIO positions will motivate the CCIO workforce and empower them to perform the job of a 21st century CCIO. Formally educated and trained CCIOs will provide a competitive advantage to their respective enterprise by fully utilizing the power of Informatics science.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Lopez-Tarjuelo, J
Purpose: To initiate a discussion on the current and evolving role of Medical Physicists based on author’s professional and research experience in patient safety and quality control. Methods: Several professionals of the departments of Medical Physics and Radiation Oncology, chiefly devoted to clinical tasks, began a research program on patient safety and quality control in a framework provided by the implementation of intraoperative radiotherapy (IORT). We performed studies on virtual simulation for IORT, in vivo dosimetry, failure mode and effect analysis (FMEA), statistical process control (SPC), and receiver operating characteristics of dosimetric equipment. This was done with the support ofmore » our research foundation and different grants while continuing with our departmental clinical routine involving about 1600 annual treatments with two linacs and different brachytherapy techniques. Results: We published 5 papers in international journals in the last two years. This author conducted a doctoral research which resulted in a dissertation in 2015. The extra time spent after treatments was essential to succeed. Funding and support achieved via our foundation played a crucial role; but this would have not been possible without punctual external mentoring and partnership. FMEA conclusions were able to be implemented only with staff commitment; however, conclusions concerning equipment cannot be easily communicated to manufacturers. These tasks required extra training in the appropriated methods. Conclusion: Research needed the support of a dedicated foundation, which would have been very difficult to obtain with the sole participation of our departments. FMEA and SPC results may need engagement of staff and manufacturers, respectively, hard to achieve without strong recommendations or even a regulatory framework. All these fields need evolution of Medical Physicists’ roles and additional training. Devotion to both clinical tasks and research could be unfeasible for Medical Physicists in the clinical setting without the appropriate rearrangement of their schedules and tasks. Supported by grants IPT-300000-2010-3 and PI11/01659. ERDF funds and Spanish Government.« less
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Linking information needs with evaluation: the role of task identification.
Weir, C. R.
1998-01-01
Action Identification Theory was used to explore user's subjective constructions of information tasks in a primary care setting. The first part of the study involved collecting clinician's descriptions of their information tasks. These items were collated and then rated by another larger group of clinicians. Results clearly identified 6 major information tasks, including communication, patient assessment, work monitoring, seeking science information, compliance with policies and procedures, and data integration. Results discussed in terms of implications for evaluation and assessing information needs in a clinical setting. PMID:9929232
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Adding Value to the Health Care System: Identifying Value-Added Systems Roles for Medical Students.
Gonzalo, Jed D; Graaf, Deanna; Johannes, Bobbie; Blatt, Barbara; Wolpaw, Daniel R
To catalyze learning in Health Systems Science and add value to health systems, education programs are seeking to incorporate students into systems roles, which are not well described. The authors sought to identify authentic roles for students within a range of clinical sites and explore site leaders' perceptions of the value of students performing these roles. From 2013 to 2015, site visits and interviews with leadership from an array of clinical sites (n = 30) were conducted. Thematic analysis was used to identify tasks and benefits of integrating students into interprofessional care teams. Types of systems roles included direct patient benefit activities, including monitoring patient progress with care plans and facilitating access to resources, and clinic benefit activities, including facilitating coordination and improving clinical processes. Perceived benefits included improved value of the clinical mission and enhanced student education. These results elucidate a framework for student roles that enhance learning and add value to health systems.
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Cotter, Jack; Bartholomeusz, Cali; Papas, Alicia; Allott, Kelly; Nelson, Barnaby; Yung, Alison R; Thompson, Andrew
2017-01-01
Social and role functioning are compromised for the majority of individuals at ultra-high risk of psychosis, and it is important to identify factors that contribute to this functional decline. This study aimed to investigate social cognitive abilities, which have previously been linked to functioning in schizophrenia, as potential factors that impact social, role and global functioning in ultra-high risk patients. A total of 30 ultra-high risk patients were recruited from an established at-risk clinical service in Melbourne, Australia, and completed a battery of social cognitive, neurocognitive, clinical and functioning measures. We examined the relationships between all four core domains of social cognition (emotion recognition, theory of mind, social perception and attributional style), neurocognitive, clinical and demographic variables with three measures of functioning (the Global Functioning Social and Role scales and the Social and Occupational Functioning Assessment Scale) using correlational and multiple regression analyses. Performance on a visual theory of mind task (visual jokes task) was significantly correlated with both concurrent role ( r = 0.425, p = 0.019) and global functioning ( r = 0.540, p = 0.002). In multivariate analyses, it also accounted for unique variance in global, but not role functioning after adjusting for negative symptoms and stress. Social functioning was not associated with performance on any of the social cognition tasks. Among specific social cognitive abilities, only a test of theory of mind was associated with functioning in our ultra-high risk sample. Further longitudinal research is needed to examine the impact of social cognitive deficits on long-term functional outcome in the ultra-high risk group. Identifying social cognitive abilities that significantly impact functioning is important to inform the development of targeted intervention programmes for ultra-high risk individuals.
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Evidence-Based Clinical Recommendations for the Administration of the Sequential Motion Rates Task
ERIC Educational Resources Information Center
Icht, Michal; Ben-David, Boaz M.
2018-01-01
The sequential motion rates (SMR) task, that involves rapid and accurate repetitions of a syllable sequence, /pataka/, is a commonly used evaluation tool for oro-motor abilities. Although the SMR is a well-known tool, some aspects of its administration protocol are unspecified. We address the following factors and their role in the SMR protocol:…
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Holbein, M E Blair; Berglund, Jelena Petrovic; O'Reilly, Erin K; Hartman, Karen; Speicher, Lisa A; Adamo, Joan E; O'Riordan, Gerri; Brown, Jennifer Swanton; Schuff, Kathryn G
2014-06-01
The objective of this study was to provide recommendations for provision of training for sponsor and investigators at Academic Health Centers. A subgroup of the Investigational New Drug/Investigational Device Exemption (IND/IDE) Task Force of the Clinical and Translational Science Award (CTSA) program Regulatory Knowledge Key Function Committee was assembled to specifically address how clinical investigators who hold an IND/IDE and thus assume the role of sponsor-investigators are adequately trained to meet the additional regulatory requirements of this role. The participants who developed the recommendations were representatives of institutions with IND/IDE support programs. Through an informal survey, the task force determined that a variety and mix of models are used to provide support for IND/IDE holders within CTSA institutions. In addition, a CTSA consortium-wide resources survey was used. The participants worked from the models and survey results to develop consensus recommendations to address institutional support, training content, and implementation. The CTSA IND/IDE Task Force recommendations are as follows: (1) Institutions should assess the scope of Food and Drug Administration-regulated research, perform a needs analysis, and provide resources to implement a suitable training program; (2) The model of training program should be tailored to each institution; (3) The training should specifically address the unique role of sponsor-investigators, and the effectiveness of training should be evaluated regularly by methods that fit the model adopted by the institution; and (4) Institutional leadership should mandate sponsor-investigator training and effectively communicate the necessity and availability of training.
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Rothrauff-Laschober, Tanja C; Eby, Lillian Turner de Tormes; Sauer, Julia B
2013-01-01
When mental health counselors have limited and/or inadequate training in substance use disorders (SUDs), effective clinical supervision (ECS) may advance their professional development. The purpose of the current study was to investigate whether ECS is related to the job performance of SUD counselors. Data were obtained in person via paper-and-pencil surveys from 392 matched SUD counselor-clinical supervisor dyads working in 27 SUD treatment organizations across the United States. ECS was rated by counselors and measured with five multi-item scales (i.e., sponsoring counselors' careers, providing challenging assignments, role modeling, accepting/confirming counselors' competence, overall supervisor task proficiency). Clinical supervisors rated counselors' job performance, which was measured with two multi-item scales (i.e., task performance, performance within supervisory relationship). Using mixed-effects models, we found that most aspects of ECS are related to SUD counselor job performance. Thus, ECS may indeed enhance counselors' task performance and performance within the supervisory relationship, and, as a consequence, offset limited formal SUD training.
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2013-01-01
When mental health counselors have limited and/or inadequate training in substance use disorders (SUDs), effective clinical supervision (ECS) may advance their professional development. The purpose of the current study was to investigate whether ECS is related to the job performance of SUD counselors. Data were obtained in person via paper-and-pencil surveys from 392 matched SUD counselor-clinical supervisor dyads working in 27 SUD treatment organizations across the United States. ECS was rated by counselors and measured with five multi-item scales (i.e., sponsoring counselors’ careers, providing challenging assignments, role modeling, accepting/confirming counselors’ competence, overall supervisor task proficiency). Clinical supervisors rated counselors’ job performance, which was measured with two multi-item scales (i.e., task performance, performance within supervisory relationship). Using mixed-effects models, we found that most aspects of ECS are related to SUD counselor job performance. Thus, ECS may indeed enhance counselors’ task performance and performance within the supervisory relationship, and, as a consequence, offset limited formal SUD training. PMID:25061265
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A typology of specialists' clinical roles.
Forrest, Christopher B
2009-06-08
High use of specialist physicians and specialized procedures coupled with low exposure to primary care are distinguishing traits of the US health care system. Although the tasks of the primary care medical home are well established, consensus on the normative clinical roles of specialist physicians has not been achieved, which makes it unlikely that the specialist workforce is being used most effectively and efficiently. This article describes a typology of specialists' clinical roles that is based on the conceptual basis for health care specialism and empirical evaluations of the specialty referral process. The report concludes with a discussion on the implications of the typology for improving the effectiveness and efficiency of the primary-specialty care interface.
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Validating Competence: A New Credential for Clinical Documentation Improvement Practitioners
Ryan, Jessica; Patena, Karen; Judd, Wallace; Niederpruem, Mike
2013-01-01
As the health information management (HIM) profession continues to expand and become more specialized, there is an ever-increasing need to identify emerging HIM workforce roles that require a codified level of proficiency and professional standards. The Commission on Certification for Health Informatics and Information Management (CCHIIM) explored one such role—clinical documentation improvement (CDI) practitioner—to define the tasks and responsibilities of the job as well as the knowledge required to perform them effectively. Subject-matter experts (SMEs) defined the CDI specialty by following best practices for job analysis methodology. A random sample of 4,923 CDI-related professionals was surveyed regarding the tasks and knowledge required for the job. The survey data were used to create a weighted blueprint of the six major domains that make up the CDI practitioner role, which later formed the foundation for the clinical documentation improvement practitioner (CDIP) credential. As a result, healthcare organizations can be assured that their certified documentation improvement practitioners have demonstrated excellence in clinical care, treatment, coding guidelines, and reimbursement methodologies. PMID:23843769
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TU-EF-210-04: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy
DOE Office of Scientific and Technical Information (OSTI.GOV)
Farahani, K.
The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less
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[Syncope and work: role of the occupational physician and global risk stratification].
Barbic, F; Angaroni, L; Orlandi, M; Costantino, G; Dipaola, E; Borleri, D; Borchini, R; D'Adda, F; Perego, F; Borella, M; Galli, A; Solbiati, M; Scanella, E; Casazza, G; Seghizzi, P; Furlan, R
2011-01-01
Safety risk for subjects suffering from syncope while working has not been as yet addressed by occupational medicine. The present study was aimed at evaluating a new developed methodology for job tasks risk stratification in patients with syncope. During a work-shop on syncope and occupational risk, 149 occupational physicians (OP) with about 10 years of clinical experience were asked to fulfil a Visual Analogue Scale (VAS) concerning the doctor's estimated potential damage (D) to the worker and the probability of a damage to occur (P) should syncope take place during the job task. Five job tasks characterized by different risk for safety (1, driving; 2, toxic products handling; 3, job performed closed to hot surfaces o free flames; 4, surgical activity; 5, office job) were identified. OP correctly stratified the risk associated to the different job tasks in patients with syncope. Unexpectedly, task #3 was given a risk similar to that obtained in drivers. This might be of paramount clinical and social importance when patients with syncope have to return to their job tasks.
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Samei, Ehsan; Grist, Thomas M
2018-05-18
Despite its crucial role in the development of new medical imaging technologies, in clinical practice, physics has primarily been involved in the technical evaluation of technologies. However, this narrow role is no longer adequate. New trajectories in medicine call for a stronger role for physics in the clinic. The movement toward evidence-based, quantitative, and value-based medicine requires physicists to play a more integral role in delivering innovative precision care through the intentional clinical application of physical sciences. There are three aspects of this clinical role: technology assessment based on metrics as they relate to expected clinical performance, optimized use of technologies for patient-centered clinical outcomes, and retrospective analysis of imaging operations to ensure attainment of expectations in terms of quality and variability. These tasks fuel the drive toward high-quality, consistent practice of medical imaging that is patient centered, evidence based, and safe. While this particular article focuses on imaging, this trajectory and paradigm is equally applicable to the multitudes of the applications of physics in medicine. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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Martinsen, S; Flodin, P; Berrebi, J; Löfgren, M; Bileviciute-Ljungar, I; Mannerkorpi, K; Ingvar, M; Fransson, P; Kosek, E
2018-05-01
The Stroop colour word test (SCWT) has been widely used to assess changes in cognitive performance such as processing speed, selective attention and the degree of automaticity. Moreover, the SCWT has proven to be a valuable tool to assess neuronal plasticity that is coupled to improvement in performance in clinical populations. In a previous study, we showed impaired cognitive processing during SCWT along with reduced task-related activations in patients with fibromyalgia. In this study, we used SCWT and functional magnetic resonance imagingFMRI to investigate the effects of a 15-week physical exercise intervention on cognitive performance, task-related cortical activation and distraction-induced analgesia (DIA) in patients with fibromyalgia and healthy controls. The exercise intervention yielded reduced fibromyalgia symptoms, improved cognitive processing and increased task-related activation of amygdala, but no effect on DIA. Our results suggest beneficial effects of physical exercise on cognitive functioning in FM. © 2017 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.
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2011-01-01
Background Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial. Methods: Developing the intervention The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services. Results: Components of the intervention The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process. Discussion Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout. The STRETCH trial is registered with Current Control Trials ISRCTN46836853. PMID:21810242
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2010-05-01
physical environment and the social environment surrounding clinical trials. Task 6: Identify Breast Cancer Physicians in California, Florida...any of the following languages with your patients? a. Spanish b. Chinese ( Cantonese or Mandarin) c. Tagalog d. Vietnamese e. Korean f...Spanish b. Chinese ( Cantonese or Mandarin) c. Tagalog d. Vietnamese e. Korean f. Russian g. Other language(s) Yes No 1
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Clinical governance--watchword or buzzword?
Campbell, A V
2001-04-01
In the latest reform of the National Health Service great emphasis has been placed on the achievement and maintenance of quality. Mechanisms for ensuring this are being set up under the general title of "clinical governance". What is the meaning of this term? The metaphor behind the phrase is of navigation through stormy seas, but who guides the helmsman? Clinical ethics committees could have a part to play in these changes, provided their role is properly understood. Clinical governance is concerned with management according to an agreed set of aims. The task of ethics committees is Socratic rather than managerial. They should ask fundamental questions about the ethical norms of the services provided and give critical appraisal of the moral character of institutional policies. If these tasks are carried out then governance may become a watchword rather than just another buzzword.
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Maier, Claudia B; Köppen, Julia; Busse, Reinhard
2018-05-25
Countries vary in the extent to which reforms have been implemented expanding nurses' Scopes-of-Practice (SoP). There is limited cross-country research if and how reforms affect clinical practice, particularly in hospitals. This study analyses health professionals' perceptions of role change and of task shifting between the medical and nursing professions in nine European countries. Cross-sectional design with surveys completed by 1716 health professionals treating patients with breast cancer (BC) and acute myocardial infarction (AMI) in 161 hospitals across nine countries. Descriptive and bivariate analysis on self-reported staff role changes and levels of independence (with/without physician oversight) by two country groups, with major SoP reforms implemented between 2010 and 2015 (Netherlands, England, Scotland) and without (Czech Republic, Germany, Italy, Norway, Poland, Turkey). Participation in 'medical tasks' was identified using two methods, a data-driven and a conceptual approach. Individual task-related analyses were performed for the medical and nursing professions, and Advanced Practice Nurses/Specialist Nurses (APN/SN). Health professionals from the Netherlands, England and Scotland more frequently reported changes to staff roles over this time period vs. the other six countries (BC 74.0% vs. 38.7%, p < .001; AMI 61.7% vs. 37.3%, p < .001), and higher independence in new roles (BC 58.6% vs. 24.0%, p < .001; AMI 48.9% vs. 29.2%, p < .001). A higher proportion of nurses and APN/SN from these three countries reported to undertake tasks related to BC diagnosis, therapy, prescribing of medicines and information to patients compared to the six countries. Similar cross-country differences existed for AMI on prescribing medications and follow-up care. Tasks related to diagnosis and therapy, however, remained largely within the medical profession's domain. Most tasks were reported to be performed by both professions rather than carried out by one profession only. Higher levels of changes to staff roles and task shifting were reported in the Netherlands, England and Scotland, suggesting that professional boundaries have shifted, for instance on chemotherapy or prescribing medicines. For most tasks, however, a partial instead of full task shifting is practice.
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The Chief Clinical Informatics Officer (CCIO)
Sengstack, Patricia; Thyvalikakath, Thankam Paul; Poikonen, John; Middleton, Blackford; Payne, Thomas; Lehmann, Christoph U
2016-01-01
Summary Introduction The emerging operational role of the “Chief Clinical Informatics Officer” (CCIO) remains heterogeneous with individuals deriving from a variety of clinical settings and backgrounds. The CCIO is defined in title, responsibility, and scope of practice by local organizations. The term encompasses the more commonly used Chief Medical Informatics Officer (CMIO) and Chief Nursing Informatics Officer (CNIO) as well as the rarely used Chief Pharmacy Informatics Officer (CPIO) and Chief Dental Informatics Officer (CDIO). Background The American Medical Informatics Association (AMIA) identified a need to better delineate the knowledge, education, skillsets, and operational scope of the CCIO in an attempt to address the challenges surrounding the professional development and the hiring processes of CCIOs. Discussion An AMIA task force developed knowledge, education, and operational skillset recommendations for CCIOs focusing on the common core aspect and describing individual differences based on Clinical Informatics focus. The task force concluded that while the role of the CCIO currently is diverse, a growing body of Clinical Informatics and increasing certification efforts are resulting in increased homogeneity. The task force advised that 1.) To achieve a predictable and desirable skillset, the CCIO must complete clearly defined and specified Clinical Informatics education and training. 2.) Future education and training must reflect the changing body of knowledge and must be guided by changing day-to-day informatics challenges. Conclusion A better defined and specified education and skillset for all CCIO positions will motivate the CCIO workforce and empower them to perform the job of a 21st century CCIO. Formally educated and trained CCIOs will provide a competitive advantage to their respective enterprise by fully utilizing the power of Informatics science. PMID:27081413
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Zhang, Ting; Mou, Di; Wang, Cuicui; Tan, Fengping; Jiang, Yan; Lijun, Zheng; Li, Hong
2015-06-01
The central dopamine system (DA) has a significant role in the executive function (EF). The spontaneous eye blink rate (EBR) is an effective clinical and non-invasive measure, which is strongly related to the activity of the central dopaminergic system. Previous studies show significant relationships between the two main dimensions of EF (i.e., shifting and inhibition) and the central DA system as measured by EBR. However, most of these studies involve only one EF task for shifting or inhibition; whether or not these relationships are replicated by other EF tasks remains unclear. Besides, the relationship between EBR and another important EF dimension-updating-also remains unknown. The present study examined the correlation between EBR and several EF tasks that captured all the three EF dimensions: shifting, inhibition, and updating. A total of 61 healthy participants were subjected to EBR testing and EF tasks. Results showed that EBR had a different relationship with each of the three tested EF dimensions. An increase in EBR levels was related to an increase in accuracy in shifting and inhibition tasks, a decrease in shifting and inhibition cost, and a decrease in accuracy in updating tasks. These results imply that the role of the central DA system in shifting and inhibition differs from its role in updating. Copyright © 2015 Elsevier B.V. All rights reserved.
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To Switch or Not to Switch: Role of Cognitive Control in Working Memory Training in Older Adults.
Basak, Chandramallika; O'Connell, Margaret A
2016-01-01
It is currently not known what are the best working memory training strategies to offset the age-related declines in fluid cognitive abilities. In this randomized clinical double-blind trial, older adults were randomly assigned to one of two types of working memory training - one group was trained on a predictable memory updating task (PT) and another group was trained on a novel, unpredictable memory updating task (UT). Unpredictable memory updating, compared to predictable, requires greater demands on cognitive control (Basak and Verhaeghen, 2011a). Therefore, the current study allowed us to evaluate the role of cognitive control in working memory training. All participants were assessed on a set of near and far transfer tasks at three different testing sessions - before training, immediately after the training, and 1.5 months after completing the training. Additionally, individual learning rates for a comparison working memory task (performed by both groups) and the trained task were computed. Training on unpredictable memory updating, compared to predictable, significantly enhanced performance on a measure of episodic memory, immediately after the training. Moreover, individuals with faster learning rates showed greater gains in this episodic memory task and another new working memory task; this effect was specific to UT. We propose that the unpredictable memory updating training, compared to predictable memory updating training, may a better strategy to improve selective cognitive abilities in older adults, and future studies could further investigate the role of cognitive control in working memory training.
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Job analysis and student assessment tool: perfusion education clinical preceptor.
Riley, Jeffrey B
2007-09-01
The perfusion education system centers on the cardiac surgery operating room and the perfusionist teacher who serves as a preceptor for the perfusion student. One method to improve the quality of perfusion education is to create a valid method for perfusion students to give feedback to clinical teachers. The preceptor job analysis consisted of a literature review and interviews with preceptors to list their critical tasks, critical incidents, and cognitive and behavioral competencies. Behaviorally anchored rating traits associated with the preceptors' tasks were identified. Students voted to validate the instrument items. The perfusion instructor rating instrument with a 0-4, "very weak" to "very strong" Likert rating scale was used. The five preceptor traits for student evaluation of clinical instruction (SECI) are as follows: The clinical instructor (1) encourages self-learning, (2) encourages clinical reasoning, (3) meets student's learning needs, (4) gives continuous feedback, and (5) represents a good role model. Scores from 430 student-preceptor relationships for 28 students rotating at 24 affiliate institutions with 134 clinical instructors were evaluated. The mean overall good preceptor average (GPA) was 3.45 +/- 0.76 and was skewed to the left, ranging from 0.0 to 4.0 (median = 3.8). Only 21 of the SECI relationships earned a GPA < 2.0. Analyzing the role of the clinical instructor and performing SECI are methods to provide valid information to improve the quality of a perfusion education program.
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A role for locus coeruleus in Parkinson tremor
Isaias, Ioannis U.; Marzegan, Alberto; Pezzoli, Gianni; Marotta, Giorgio; Canesi, Margherita; Biella, Gabriele E. M.; Volkmann, Jens; Cavallari, Paolo
2012-01-01
We analyzed rest tremor, one of the etiologically most elusive hallmarks of Parkinson disease (PD), in 12 consecutive PD patients during a specific task activating the locus coeruleus (LC) to investigate a putative role of noradrenaline (NA) in tremor generation and suppression. Clinical diagnosis was confirmed in all subjects by reduced dopamine reuptake transporter (DAT) binding values investigated by single photon computed tomography imaging (SPECT) with [123I] N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) tropane (FP-CIT). The intensity of tremor (i.e., the power of Electromyography [EMG] signals), but not its frequency, significantly increased during the task. In six subjects, tremor appeared selectively during the task. In a second part of the study, we retrospectively reviewed SPECT with FP-CIT data and confirmed the lack of correlation between dopaminergic loss and tremor by comparing DAT binding values of 82 PD subjects with bilateral tremor (n = 27), unilateral tremor (n = 22), and no tremor (n = 33). This study suggests a role of the LC in Parkinson tremor. PMID:22287946
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Nurses in Australian general practice: implications for chronic disease management.
Halcomb, Elizabeth J; Davidson, Patricia M; Salamonson, Yenna; Ollerton, Richard; Griffiths, Rhonda
2008-03-01
The purpose of this study was to describe the demographic and employment characteristics of Australian practice nurses and explore the relationship between these characteristics and the nurses' role. Nursing in general practice is an integral component of primary care and chronic disease management in the United Kingdom and New Zealand, but in Australia it is an emerging specialty and there is limited data on the workforce and role. National postal survey embedded in a sequential mixed method design. 284 practice nurses completed a postal survey during 2003-2004. Descriptive statistics and factor analysis were utilized to analyse the data. Most participants were female (99%), Registered Nurses (86%), employed part-time in a group practice, with a mean age of 45.8 years, and had a hospital nursing certificate as their highest qualification (63%). The tasks currently undertaken by participants and those requiring further education were inversely related (R2 = -0.779). Conversely, tasks perceived to be appropriate for a practice nurse and those currently undertaken by participants were positively related (R2 = 0.8996). There was a mismatch between the number of participants who perceived that a particular task was appropriate and those who undertook the task. This disparity was not completely explained by demographic or employment characteristics. Extrinsic factors such as legal and funding issues, lack of space and general practitioner attitudes were identified as barriers to role expansion. Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to specialist management of chronic and complex disease, particularly within the context of contemporary policy initiatives.
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Wu, Alan H B; Christenson, Robert H; Greene, Dina N; Jaffe, Allan S; Kavsak, Peter A; Ordonez-Llanos, Jordi; Apple, Fred S
2018-04-01
This document is an essential companion to the third iteration of the National Academy of Clinical Biochemistry [NACB, 8 now the American Association for Clinical Chemistry (AACC) Academy] Laboratory Medicine Practice Guidelines (LMPG) on cardiac markers. The expert consensus recommendations were drafted in collaboration with the International Federation of Clinical Chemistry and Laboratory Medicine Task Force on Clinical Applications of Bio-Markers (IFCC TF-CB). We determined that there is sufficient clinical guidance on the use of cardiac troponin (cTn) testing from clinical practice groups. Thus, in this expert consensus document, we focused on clinical laboratory practice recommendations for high-sensitivity (hs)-cTn assays. This document utilized the expert opinion class of evidence to focus on the following 10 topics: ( a ) quality control (QC) utilization, ( b ) validation of the lower reportable analytical limits, ( c ) units to be used in reporting measurable concentrations for patients and QC materials, ( d ) 99th percentile sex-specific upper reference limits to define the reference interval; ( e ) criteria required to define hs-cTn assays, ( f ) communication with clinicians and the laboratory's role in educating clinicians regarding the influence of preanalytic and analytic problems that can confound assay results, ( g ) studies on hs-cTn assays and how authors need to document preanalytical and analytical variables, ( h ) harmonizing and standardizing assay results and the role of commutable materials, ( i ) time to reporting of results from sample receipt and sample collection, and ( j ) changes in hs-cTn concentrations over time and the role of both analytical and biological variabilities in interpreting results of serial blood collections. © 2017 American Association for Clinical Chemistry.
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Clinical ethics and the role of clinical ethics committees: proposals for a revival. Commentary.
Petrini, Carlo; Ricciardi, Walter
2017-01-01
The issue addressed in the paper published by the Italian National Bioethics Committee (NBC) entitled "Clinical ethics committees", is highly significant for many reasons. One of these is the fact that the ethics committees charged with assessing clinical trials have so much responsibility and such a heavy work-load that they have little time available for other tasks such as engaging directly with patients "at the bedside", as a result of which the role of committees responsible for assessing clinical cases is especially important. According to the NBC, the opinions of clinical ethics committees should be formulated jointly and are non-binding. The NBC offers practical proposals not only for the Italian context. While the Italian National Institute of Health (Istituto Superiore di Sanità - ISS) is not involved directly in treating patients, its role in providing guidance is crucial to the national health service and it has always paid special attention to these issues.
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Crist, P
1993-02-01
Occupational therapy has focused on activity as a catalyst for understanding human roles and interactions, regardless of whether disability or chronic illness is present. Parenting is an important interactional activity accompanied by specific role expectations. This investigation examined the interaction patterns of mothers with multiple sclerosis and their daughters. Thirty-one mothers with multiple sclerosis and their daughters aged 8 to 12 years were compared with 34 mothers without disabilities and their daughters aged 8 to 12 years. Videotaped mother-daughter interactions during a work task and a play task were scored by two raters for 11 different behaviors. These behaviors were collapsed into three behavioral composites--receptiveness, directiveness, and dissuasiveness--for statistical analysis. Statistical analysis revealed no significant differences between the two groups on the behavioral composites for either mothers or their daughters. The two tasks stimulated a different pattern of mother-daughter interactions. For both members of the dyad, interactions during the work task were more directive and less dissuasive than those in the play task. The clinical implication of this finding indicates the importance of understanding the influence of the task selected when observing interaction. Because of recent social and legal changes, understanding parenting and chronic illness is critical.
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Clinical governance—watchword or buzzword?
Campbell, A.
2001-01-01
In the latest reform of the National Health Service great emphasis has been placed on the achievement and maintenance of quality. Mechanisms for ensuring this are being set up under the general title of "clinical governance". What is the meaning of this term? The metaphor behind the phrase is of navigation through stormy seas, but who guides the helmsman? Clinical ethics committees could have a part to play in these changes, provided their role is properly understood. Clinical governance is concerned with management according to an agreed set of aims. The task of ethics committees is Socratic rather than managerial. They should ask fundamental questions about the ethical norms of the services provided and give critical appraisal of the moral character of institutional policies. If these tasks are carried out then governance may become a watchword rather than just another buzzword. Key Words: Governance • quality • National Health Service (NHS) • ethics committees • Socratic method NHS PMID:11314615
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Using task performance to inform treatment planning for youth with ADHD: A systematic review.
Molitor, Stephen J; Langberg, Joshua M
2017-12-01
The role that neuropsychological task performance plays in the assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) is currently ambiguous, and findings are mixed regarding whether tasks have validity for diagnosing the disorder. Irrespective of their validity for diagnosing ADHD, neuropsychological tasks could provide valuable information to mental health professionals if they can inform recommendations for treatment targets and modalities. Therefore, this review sought to synthesize the available evidence related to the use of neuropsychological task performance as a tool for informing treatment planning for youth with ADHD. Reviewed studies focused on examinations of associations between task performance and academic, social, and health outcomes, as well as response to treatment. Twenty-five relevant studies using samples of youth diagnosed with ADHD in clinical, community, and school settings were identified. Review of the evidence suggests that task performance may be useful in identifying individuals with ADHD at risk for academic impairment. However, the evidence is less compelling for identifying youth at risk for impaired social functioning or poor health outcomes. The review also found that task performance is likely useful for predicting response to treatment with methylphenidate. Across studies, evidence indicated that interpreting task performance in an integrated manner, such as a factor score or mean score, was more consistently useful for predicting outcomes of interest than interpreting performance from a single task. Implications for the use of tasks in ADHD assessments are discussed, and future directions are outlined for further examining the clinical utility of task performance. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Pedersen, Ingeborg; Nordaunet, Trine; Martinsen, Egil Wilhelm; Berget, Bente; Braastad, Bjarne O
2011-01-01
Fourteen adults with clinical depression participated twice a week in a 12-week farm animal-assisted intervention consisting of work and contact with dairy cattle. Each participant was video-recorded twice during the intervention, and the recordings were categorized with respect to various work tasks and animal and human contact. Levels of anxiety and depression decreased and self-efficacy increased during the intervention. Interaction with farm animals via work tasks showed a greater potential for improved mental health than via sole animal contact, but only when progress in working skills was achieved, indicating the role of coping experiences for a successful intervention.
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Usage Analysis of a Shared Care Planning System
Warren, Jim; Gu, Yulong; Humphrey, Gayl
2012-01-01
We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often related to task assignment and that nurses are the most active users. Directions for refinement of the SCP technology are indicated, including better integration of notes, tasks and care team notifications, as well as the central role of nurses for design use cases. Broader issues are raised about workforce roles and responsibilities for SCP, integrating patient-provider and provider-provider communications, and the centrality of care plans as the key entity in mediation of the care team. PMID:23304370
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Klein, Anke M; Flokstra, Emmelie; van Niekerk, Rianne; Klein, Steven; Rapee, Ronald M; Hudson, Jennifer L; Bögels, Susan M; Becker, Eni S; Rinck, Mike
2018-04-21
We investigated the role of self-reports and behavioral measures of interpretation biases and their content-specificity in children with varying levels of spider fear and/or social anxiety. In total, 141 selected children from a community sample completed an interpretation bias task with scenarios that were related to either spider threat or social threat. Specific interpretation biases were found; only spider-related interpretation bias and self-reported spider fear predicted unique variance in avoidance behavior on the Behavior Avoidance Task for spiders. Likewise, only social-threat related interpretation bias and self-reported social anxiety predicted anxiety during the Social Speech Task. These findings support the hypothesis that fearful children display cognitive biases that are specific to particular fear-relevant stimuli. Clinically, this insight might be used to improve treatments for anxious children by targeting content-specific interpretation biases related to individual disorders.
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CLT and CLS job responsibilities: current distinctions and updates.
Doig, K; Beck, S J; Kolenc, K
2001-01-01
This study was undertaken to address the following questions: 1. What tasks distinguish the job of a clinical laboratory scientist (CLS) from that of a clinical laboratory technician (CLT)? 2. What changes in role distinctions, have occurred for entry-level CLS and CLT practitioners over the five-year period 1993-98? 3. What tasks have been deleted from the CLT and CLS content outlines because they were not frequently performed or not considered entry-level? 4. What changes in practice are reflected in the current job analyses? A national job analysis of tasks constituting the job of clinical laboratory scientists (CLSs) and clinical laboratory technicians (CLTs) was conducted in 1998-99 as part of a standard setting process for the certifying examinations of the National Credentialing Agency for Laboratory Personnel (NCA). The job analyses relied upon mail surveys to 1200 individuals for each job level asking respondents to identify tasks significant to effective practice at job entry. The task lists resulting from statistical analysis of those surveys were examined to answer the study questions. The sample for each survey included 1200 practitioners, educators and laboratory managers selected at random from membership in professional organizations or from NCA certificant lists. Sampling was stratified to insure adequate practitioner representation. The mean rating on a four point scale for each item on the surveys was evaluated for overall significance as well as significance across geographic regions. The tasks meeting specified criteria were retained in the final task lists. Tasks were counted and their content evaluated to compare CLS and CLT job tasks. The response rates to the surveys were 33% for CLT and 21% for CLS. Reliability was judged based on average intraclass correlation coefficients of .86 and .82 for the CLT and CLS surveys, respectively. There were 952 tasks retained on the CLS content outline and 725 retained on the CLT content outline of the 1151 tasks on the original survey. Seven hundred and twenty two tasks were found on content outlines of both job levels, representing a 76% overlap. Tasks found only on the CLS outline included advanced technical tasks, a few management tasks, and more communication tasks. The jobs of CLS and CLT practitioners are distinct at job entry level with CLSs performing a broader array of technical and communication tasks as well as some management tasks. Though CLS staff uses few management skills at job entry, those tasks are performed by CLS staff in the laboratory and curricula must help prepare graduates for these tasks expected of experienced staff. CLTs perform tasks requiring problem solving and high level reasoning. CLT curricula must address the need for CLTs to perform these tasks.
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Hysong, Sylvia J; Thomas, Candice L; Spitzmüller, Christiane; Amspoker, Amber B; Woodard, LeChauncy; Modi, Varsha; Naik, Aanand D
2016-01-15
Team coordination within clinical care settings is a critical component of effective patient care. Less is known about the extent, effectiveness, and impact of coordination activities among professionals within VA Patient-Aligned Care Teams (PACTs). This study will address these gaps by describing the specific, fundamental tasks and practices involved in PACT coordination, their impact on performance measures, and the role of coordination task complexity. First, we will use a web-based survey of coordination practices among 1600 PACTs in the national VHA. Survey findings will characterize PACT coordination practices and assess their association with clinical performance measures. Functional job analysis, using 6-8 subject matter experts who are 3rd and 4th year residents in VA Primary Care rotations, will be utilized to identify the tasks involved in completing clinical performance measures to standard. From this, expert ratings of coordination complexity will be used to determine the level of coordinative complexity required for each of the clinical performance measures drawn from the VA External Peer Review Program (EPRP). For objective 3, data collected from the first two methods will evaluate the effect of clinical complexity on the relationships between measures of PACT coordination and their ratings on the clinical performance measures. Results from this study will support successful implementation of coordinated team-based work in clinical settings by providing knowledge regarding which aspects of care require the most complex levels of coordination and how specific coordination practices impact clinical performance.
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Job Analysis and Student Assessment Tool: Perfusion Education Clinical Preceptor
Riley, Jeffrey B.
2007-01-01
Abstract: The perfusion education system centers on the cardiac surgery operating room and the perfusionist teacher who serves as a preceptor for the perfusion student. One method to improve the quality of perfusion education is to create a valid method for perfusion students to give feedback to clinical teachers. The preceptor job analysis consisted of a literature review and interviews with preceptors to list their critical tasks, critical incidents, and cognitive and behavioral competencies. Behaviorally anchored rating traits associated with the preceptors’ tasks were identified. Students voted to validate the instrument items. The perfusion instructor rating instrument with a 0–4, “very weak” to “very strong” Likert rating scale was used. The five preceptor traits for student evaluation of clinical instruction (SECI) are as follows: The clinical instructor (1) encourages self-learning, (2) encourages clinical reasoning, (3) meets student’s learning needs, (4) gives continuous feedback, and (5) represents a good role model. Scores from 430 student–preceptor relationships for 28 students rotating at 24 affiliate institutions with 134 clinical instructors were evaluated. The mean overall good preceptor average (GPA) was 3.45 ± 0.76 and was skewed to the left, ranging from 0.0 to 4.0 (median = 3.8). Only 21 of the SECI relationships earned a GPA <2.0. Analyzing the role of the clinical instructor and performing SECI are methods to provide valid information to improve the quality of a perfusion education program. PMID:17972453
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The Bobath concept in contemporary clinical practice.
Graham, Julie Vaughan; Eustace, Catherine; Brock, Kim; Swain, Elizabeth; Irwin-Carruthers, Sheena
2009-01-01
Future development in neurorehabilitation depends upon bringing together the endeavors of basic science and clinical practice. The Bobath concept is widely utilized in rehabilitation following stroke and other neurological conditions. This concept was first developed in the 1950s, based on the neuroscience knowledge of those times. The theoretical basis of the Bobath concept is redefined based on contemporary neuroscience and rehabilitation science. The framework utilized in the Bobath concept for the analysis of movement and movement dysfunction is described. This framework focuses on postural control for task performance, the ability to move selectively, the ability to produce coordinated sequences of movement and vary movement patterns to fit a task, and the role of sensory input in motor behaviour and learning. The article describes aspects of clinical practice that differentiate this approach from other models of practice. Contemporary practice in the Bobath concept utilizes a problem-solving approach to the individual's clinical presentation and personal goals. Treatment is focused toward remediation, where possible, and guiding the individual towards efficient movement strategies for task performance. The aim of this article is to provide a theoretical framework on which future research into the Bobath concept can be based.
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Workplace learning through peer groups in medical school clerkships.
Chou, Calvin L; Teherani, Arianne; Masters, Dylan E; Vener, Margo; Wamsley, Maria; Poncelet, Ann
2014-01-01
Purpose When medical students move from the classroom into clinical practice environments, their roles and learning challenges shift dramatically from a formal curricular approach to a workplace learning model. Continuity among peers during clinical clerkships may play an important role in this different mode of learning. We explored students' perceptions about how they achieved workplace learning in the context of intentionally formed or ad hoc peer groups. Method We invited students in clerkship program models with continuity (CMCs) and in traditional block clerkships (BCs) to complete a survey about peer relationships with open-ended questions based on a workplace learning framework, including themes of workplace-based relationships, the nature of work practices, and selection of tasks and activities. We conducted qualitative content analysis to characterize students' experiences. Results In both BCs and CMCs, peer groups provided rich resources, including anticipatory guidance about clinical expectations of students, best practices in interacting with patients and supervisors, helpful advice in transitioning between rotations, and information about implicit rules of clerkships. Students also used each other as benchmarks for gauging strengths and deficits in their own knowledge and skills. Conclusions Students achieve many aspects of workplace learning in clerkships through formal or informal workplace-based peer groups. In these groups, peers provide accessible, real-time, and relevant resources to help each other navigate transitions, clarify roles and tasks, manage interpersonal challenges, and decrease isolation. Medical schools can support effective workplace learning for medical students by incorporating continuity with peers in the main clinical clerkship year.
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Workplace learning through peer groups in medical school clerkships.
Chou, Calvin L; Teherani, Arianne; Masters, Dylan E; Vener, Margo; Wamsley, Maria; Poncelet, Ann
2014-01-01
When medical students move from the classroom into clinical practice environments, their roles and learning challenges shift dramatically from a formal curricular approach to a workplace learning model. Continuity among peers during clinical clerkships may play an important role in this different mode of learning. We explored students' perceptions about how they achieved workplace learning in the context of intentionally formed or ad hoc peer groups. We invited students in clerkship program models with continuity (CMCs) and in traditional block clerkships (BCs) to complete a survey about peer relationships with open-ended questions based on a workplace learning framework, including themes of workplace-based relationships, the nature of work practices, and selection of tasks and activities. We conducted qualitative content analysis to characterize students' experiences. In both BCs and CMCs, peer groups provided rich resources, including anticipatory guidance about clinical expectations of students, best practices in interacting with patients and supervisors, helpful advice in transitioning between rotations, and information about implicit rules of clerkships. Students also used each other as benchmarks for gauging strengths and deficits in their own knowledge and skills. Students achieve many aspects of workplace learning in clerkships through formal or informal workplace-based peer groups. In these groups, peers provide accessible, real-time, and relevant resources to help each other navigate transitions, clarify roles and tasks, manage interpersonal challenges, and decrease isolation. Medical schools can support effective workplace learning for medical students by incorporating continuity with peers in the main clinical clerkship year.
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Cyclic Variations in Sustained Human Performance
ERIC Educational Resources Information Center
Aue, William R.; Arruda, James E.; Kass, Steven J.; Stanny, Claudia J.
2009-01-01
Biological rhythms play a prominent role in the modulation of human physiology and behavior. [Smith, K., Valentino, D., & Arruda, J. (2003). "Rhythmic oscillations in the performance of a sustained attention task." "Journal of Clinical and Experimental Neuropsychology," 25, 561-570] suggested that sustained human performance may systematically…
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Motivational Influences on Response Inhibition Measures
ERIC Educational Resources Information Center
Leotti, Lauren A.; Wager, Tor D.
2010-01-01
Psychological research has placed great emphasis on inhibitory control due to its integral role in normal cognition and clinical disorders. The stop-signal task and associated measure--stop-signal reaction time (SSRT)--provides a well-established paradigm for measuring response inhibition. However, motivational influences on stop-signal…
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Kulasegaram, Kulamakan M; Grierson, Lawrence E M; Norman, Geoffrey R
2013-10-01
Medical education research focuses extensively on experience and deliberate practice (DP) as key factors in the development of expert performance. The research on DP minimises the role of individual ability in expert performance. This claim ignores a large body of research supporting the importance of innate individual cognitive differences. We review the relationship between DP and an innate individual ability, working memory (WM) capacity, to illustrate how both DP and individual ability predict expert performance. This narrative review examines the relationship between DP and WM in accounting for expert performance. Studies examining DP, WM and individual differences were identified through a targeted search. Although all studies support extensive DP as a factor in explaining expertise, much research suggests individual cognitive differences, such as WM capacity, predict expert performance after controlling for DP. The extent to which this occurs may be influenced by the nature of the task under study and the cognitive processes used by experts. The importance of WM capacity is greater for tasks that are non-routine or functionally complex. Clinical reasoning displays evidence of this task-dependent importance of individual ability. No single factor is both necessary and sufficient in explaining expertise, and individual abilities such as WM can be important. These individual abilities are likely to contribute to expert performance in clinical settings. Medical education research and practice should identify the individual differences in novices and experts that are important to clinical performance. © 2013 John Wiley & Sons Ltd.
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Acute care clinical pharmacy practice: unit- versus service-based models.
Haas, Curtis E; Eckel, Stephen; Arif, Sally; Beringer, Paul M; Blake, Elizabeth W; Lardieri, Allison B; Lobo, Bob L; Mercer, Jessica M; Moye, Pamela; Orlando, Patricia L; Wargo, Kurt
2012-02-01
This commentary from the 2010 Task Force on Acute Care Practice Model of the American College of Clinical Pharmacy was developed to compare and contrast the "unit-based" and "service-based" orientation of the clinical pharmacist within an acute care pharmacy practice model and to offer an informed opinion concerning which should be preferred. The clinical pharmacy practice model must facilitate patient-centered care and therefore must position the pharmacist to be an active member of the interprofessional team focused on providing high-quality pharmaceutical care to the patient. Although both models may have advantages and disadvantages, the most important distinction pertains to the patient care role of the clinical pharmacist. The unit-based pharmacist is often in a position of reacting to an established order or decision and frequently is focused on task-oriented clinical services. By definition, the service-based clinical pharmacist functions as a member of the interprofessional team. As a team member, the pharmacist proactively contributes to the decision-making process and the development of patient-centered care plans. The service-based orientation of the pharmacist is consistent with both the practice vision embraced by ACCP and its definition of clinical pharmacy. The task force strongly recommends that institutions pursue a service-based pharmacy practice model to optimally deploy their clinical pharmacists. Those who elect to adopt this recommendation will face challenges in overcoming several resource, technologic, regulatory, and accreditation barriers. However, such challenges must be confronted if clinical pharmacists are to contribute fully to achieving optimal patient outcomes. © 2012 Pharmacotherapy Publications, Inc.
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The human orbitofrontal cortex monitors outcomes even when no reward is at stake.
Schnider, Armin; Treyer, Valerie; Buck, Alfred
2005-01-01
The orbitofrontal cortex (OFC) processes the occurrence or omission of anticipated rewards, but clinical evidence suggests that it might serve as a generic outcome monitoring system, independent of tangible reward. In this positron emission tomography (PET) study, normal human subjects performed a series of tasks in which they simply had to predict behind which one of two colored rectangles a drawing of an object was hidden. While all tasks involved anticipation in that they had an expectation phase between the subject's prediction and the presentation of the outcome, they varied with regards to the uncertainty of outcome. No comment on the correctness of the prediction, no record of ongoing performance, and no reward, not even a score, was provided. Nonetheless, we found strong activation of the OFC: in comparison with a baseline task, the left anterior medial OFC showed activation in all conditions, indicating a basic role in anticipation; the left posterior OFC was activated in all tasks with some uncertainty of outcome, suggesting a role in the monitoring of outcomes; the right medial OFC showed activation exclusively during guessing. The data indicate a generic role of the human OFC, with some topical specificity, in the generation of hypotheses and processing of outcomes, independent of the presence of explicit reward.
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Mapping the work-based learning of novice teachers: charting some rich terrain.
Cook, Vivien
2009-12-01
Work-based non-formal learning plays a key role in faculty development yet these processes are yet to be described in detail in medical education. This study sets out to illuminate these processes so that potential benefits for new and inexperienced medical educators and their mentors can be realised. The non-formal learning processes of 12 novice teachers were investigated across hospital, general practice and medical school settings. The research sought to describe 'what' and 'how' non-formal learning takes place, and whether these processes differ across teaching sites. Both clinical and non-clinical teachers of medical undergraduates from one inner city medical school were recruited for the study. Through semi-structured interviews and a 'concept map', participants were asked to identify the people and tasks which they considered central to helping them become more expert as educators. Results identified non-formal learning across a number of key dimensions, including personal development, task and role performance, and optimising clinical teaching. This learning takes place as an outcome of experience, observation, reflection and student feedback. Non-formal learning is a significant aspect of the development of novice teachers and as such it needs to be placed more firmly upon the agenda of faculty development.
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Ise, Natsuko; Takechi, Kenshi; Miyamoto, Toshiko; Ishizawa, Keisuke; Yanagawa, Hiroaki
2017-12-11
Clinical research plays a fundamental role in establishing new treatments. Clinical research coordinators are considered essential in clinical research, and medical professionals such as pharmacists often take on this role. Pharmacy students can be considered future candidates for this task. We used questionnaires to survey the knowledge of and attitudes toward registration trials and clinical research of pharmacy students at Tokushima University Hospital. All pharmacy students (103) to whom questionnaires were sent responded. Almost all respondents were aware of registration trials and clinical research. More than 90% were aware of the existence of clinical research coordinators, and about half (48.6%) understood their role. In clinical research terminology, most respondents were aware of informed consent and related issues, but fewer than 20% were aware of more practical things. In total, 29.1% and 40.8% of the respondents were willing to carry out and coordinate research. These findings suggest that pharmacy students have basic knowledge of clinical research and that many students are willing to carry out and coordinate clinical research. More practical exposure to clinical research may help to strengthen their future contribution. Further studies may help to determine how to provide education on registration trials and clinical research to pharmacy students.
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Doyle, Debra Lochner; Awwad, Rawan I; Austin, Jehannine C; Baty, Bonnie J; Bergner, Amanda L; Brewster, Stephanie J; Erby, Lori A H; Franklin, Cathi Rubin; Greb, Anne E; Grubs, Robin E; Hooker, Gillian W; Noblin, Sarah Jane; Ormond, Kelly E; Palmer, Christina G; Petty, Elizabeth M; Singletary, Claire N; Thomas, Matthew J; Toriello, Helga; Walton, Carol S; Uhlmann, Wendy R
2016-10-01
The first practice based competencies (PBCs) for the field of genetic counseling were adopted by the American Board of Genetic Counseling (ABGC), 1996. Since that time, there has been significant growth in established and new work settings (clinical and non-clinical) and changes in service delivery models and the roles of genetic counselors. These changes prompted the ABGC to appoint a PBC Task Force in 2011 to review the PBCs with respect to their current relevance and to revise and update them as necessary. There are four domains in the revised PBCs: (I) Genetics Expertise and Analysis (II) Interpersonal, Psychosocial and Counseling Skills (III) Education and (IV) Professional Development and Practice. There are 22 competencies, each clarified with learning objectives or samples of activities and skills; a glossary is included. New competencies were added that address genomics, genetic testing and genetic counselors' roles in risk assessment, education, supervision, conducting research and presenting research options to patients. With PBCs serving as the pre-defined abilities or outcomes of training, graduating genetic counselors will be well prepared to enter the field with a minimum level of skills and abilities. A description of the Task Force's work, key changes and the 2013 PBCs are presented herein.
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Flower, Laura; Newman-Taylor, Katherine; Stopa, Lusia
2015-01-01
Current clinical models emphasize certain cognitive processes in the maintenance of distressing paranoia. While a number of these processes have been examined in detail, the role of strategic cognition and self-focused attention remain under-researched. This study examined the deployment of cognitive strategies and self-focused attention in people with non-clinical paranoia. An experimental design was used to examine the impact of a threat activation task on these processes, in participants with high and low non-clinical paranoia. Twenty-eight people were recruited to each group, and completed measures of anxiety, paranoid cognition, strategic cognition and self-focused attention. The threat activation task was effective in increasing anxiety in people with high and low non-clinical paranoia. The high paranoia group experienced more paranoid cognitions following threat activation. This group also reported greater use of thought suppression, punishment and worry, and less use of social control strategies when under threat. No differences were found between the groups on measures of self-focused attention. This study shows that the threat activation task increased anxiety in people with high non-clinical paranoia, leading to increased paranoid thinking. The use of strategic cognition following threat activation varied dependent on level of non-clinical paranoia. If these differences are replicated in clinical groups, the strategies may be implicated in the maintenance of distressing psychosis, and may therefore be a valuable target for therapeutic intervention.
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Westbrook, Johanna I; Ampt, Amanda
2009-04-01
Evidence regarding how health information technologies influence clinicians' patterns of work and support efficient practices is limited. Traditional paper-based data collection methods are unable to capture clinical work complexity and communication patterns. The use of electronic data collection tools for such studies is emerging yet is rarely assessed for reliability or validity. Our aim was to design, apply and test an observational method which incorporated the use of an electronic data collection tool for work measurement studies which would allow efficient, accurate and reliable data collection, and capture greater degrees of work complexity than current approaches. We developed an observational method and software for personal digital assistants (PDAs) which captures multiple dimensions of clinicians' work tasks, namely what task, with whom, and with what; tasks conducted in parallel (multi-tasking); interruptions and task duration. During field-testing over 7 months across four hospital wards, fifty-two nurses were observed for 250 h. Inter-rater reliability was tested and validity was measured by (i) assessing whether observational data reflected known differences in clinical role work tasks and (ii) by comparing observational data with participants' estimates of their task time distribution. Observers took 15-20 h of training to master the method and data collection process. Only 1% of tasks observed did not match the classification developed and were classified as 'other'. Inter-rater reliability scores of observers were maintained at over 85%. The results discriminated between the work patterns of enrolled and registered nurses consistent with differences in their roles. Survey data (n=27) revealed consistent ratings of tasks by nurses, and their rankings of most to least time-consuming tasks were significantly correlated with those derived from the observational data. Over 40% of nurses' time was spent in direct care or professional communication, with 11.8% of time spent multi-tasking. Nurses were interrupted approximately every 49 min. One quarter of interruptions occurred while nurses were preparing or administering medications. This method efficiently produces reliable and valid data. The multi-dimensional nature of the data collected provides greater insights into patterns of clinicians' work and communication than has previously been possible using other methods.
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James, Pam; Bebee, Patty; Beekman, Linda; Browning, David; Innes, Mathew; Kain, Jeannie; Royce-Westcott, Theresa; Waldinger, Marcy
2011-11-01
Quantifying data management and regulatory workload for clinical research is a difficult task that would benefit from a robust tool to assess and allocate effort. As in most clinical research environments, The University of Michigan Comprehensive Cancer Center (UMCCC) Clinical Trials Office (CTO) struggled to effectively allocate data management and regulatory time with frequently inaccurate estimates of how much time was required to complete the specific tasks performed by each role. In a dynamic clinical research environment in which volume and intensity of work ebbs and flows, determining requisite effort to meet study objectives was challenging. In addition, a data-driven understanding of how much staff time was required to complete a clinical trial was desired to ensure accurate trial budget development and effective cost recovery. Accordingly, the UMCCC CTO developed and implemented a Web-based effort-tracking application with the goal of determining the true costs of data management and regulatory staff effort in clinical trials. This tool was developed, implemented, and refined over a 3-year period. This article describes the process improvement and subsequent leveling of workload within data management and regulatory that enhanced the efficiency of UMCCC's clinical trials operation.
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Registered nurse leadership style and confidence in delegation.
Saccomano, Scott J; Pinto-Zipp, Genevieve
2011-05-01
Leadership and confidence in delegation are two important explanatory constructs of nursing practice. The relationship between these constructs, however, is not clearly understood. To be successful in their roles as leaders, regardless of their experience, registered nurses (RNs) need to understand how to best delegate. The present study explored and described the relationship between RN leadership styles, demographic variables and confidence in delegation in a community teaching hospital. Utilizing a cross-sectional survey design, RNs employed in one acute care hospital completed questionnaires that measured leadership style [Path-Goal Leadership Questionnaire (PGLQ)] and confidence in delegating patient care tasks [Confidence and Intent to Delegate Scale (CIDS)]. Contrary to expectations, the data did not confirm a relationship between confidence in delegating tasks to unlicensed assistive personnel (UAPs) and leadership style. Nurses who were diploma or associate degree prepared were initially less confident in delegating tasks to UAPs as compared with RNs holding a bachelor's degree or higher. Further, after 5 years of clinical nursing experience, nurses with less educational experience reported more confidence in delegating tasks as compared with RNs with more educational experience. The lack of a relationship between leadership style and confidence in delegating patient care tasks were discussed in terms of the PGLQ classification criteria and hospital unit differences. As suggested by the significant two-way interaction between educational preparation and clinical nursing experience, changes in the nurse's confidence in delegating patient care tasks to UAPs was a dynamic changing variable that resulted from the interplay between amount of educational preparation and years of clinical nursing experience in this population of nurses. Clearly, generalizability of these findings to nurses outside the US is questionable, thus nurse managers must be familiar with the Nurse Practice Act in their country in order to ensure proper delegation of tasks to appropriate assistive personnel. It is imperative that nurse managers provide nurses with the educational opportunities necessary to develop delegation and supervision strategies to adapt to the changing RN role while adhering to differences in scope of practice. Globally, RNs are caring for increasing numbers of acutely ill patients with scarce resources ensuring an adequately trained RN/UAP team can help support optimal patient care. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.
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Legal Issues for the Medical Director.
Trulove, William G
2015-09-04
The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles-nephrology practice and the leadership of a dialysis clinic-may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment. Copyright © 2015 by the American Society of Nephrology.
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The CC chemokine receptor 5 regulates olfactory and social recognition in mice.
Kalkonde, Y V; Shelton, R; Villarreal, M; Sigala, J; Mishra, P K; Ahuja, S S; Barea-Rodriguez, E; Moretti, P; Ahuja, S K
2011-12-01
Chemokines are chemotactic cytokines that regulate cell migration and are thought to play an important role in a broad range of inflammatory diseases. The availability of chemokine receptor blockers makes them an important therapeutic target. In vitro, chemokines are shown to modulate neurotransmission. However, it is not very clear if chemokines play a role in behavior and cognition. Here we evaluated the role of CC chemokine receptor 5 (CCR5) in various behavioral tasks in mice using Wt (Ccr5⁺/⁺) and Ccr5-null (Ccr5⁻/⁻)mice. Ccr5⁻/⁻ mice showed enhanced social recognition. Administration of CC chemokine ligand 3 (CCL3), one of the CCR5-ligands, impaired social recognition. Since the social recognition task is dependent on the sense of olfaction, we tested olfactory recognition for social and non-social scents in these mice. Ccr5⁻/⁻ mice had enhanced olfactory recognition for both these scents indicating that enhanced performance in social recognition task could be due to enhanced olfactory recognition in these mice. Spatial memory and aversive memory were comparable in Wt and Ccr5⁻/⁻ mice. Collectively, these results suggest that chemokines/chemokine receptors might play an important role in olfactory recognition tasks in mice and to our knowledge represents the first direct demonstration of an in vivo role of CCR5 in modulating social behavior in mice. These studies are important as CCR5 blockers are undergoing clinical trials and can potentially modulate behavior. Copyright © 2011 IBRO. Published by Elsevier Ltd. All rights reserved.
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Cardoso, Christopher; Kingdon, Danielle; Ellenbogen, Mark A
2014-11-01
A large body of research has examined the acute effects of intranasal oxytocin administration on social cognition and stress-regulation. While progress has been made with respect to understanding the effect of oxytocin administration on social cognition in clinical populations (e.g. autism, schizophrenia), less is known about its impact on the functioning of the hypothalamic-pituitary-adrenal (HPA) axis among individuals with a mental disorder. We conducted a meta-analysis on the acute effect of intranasal oxytocin administration on the cortisol response to laboratory tasks. The search yielded eighteen studies employing a randomized, placebo-controlled design (k=18, N=675). Random-effects models and moderator analyses were performed using the metafor package for the statistical program R. The overall effect size estimate was modest and not statistically significant (Hedges g=-0.151, p=0.11) with moderate heterogeneity in this effect across studies (I(2)=31%). Controlling for baseline differences in cortisol concentrations, moderation analyses revealed that this effect was larger in response to challenging laboratory tasks that produced a robust stimulation of the HPA-axis (Hedges g=-0.433, 95% CI[-0.841, -0.025]), and in clinical populations relative to healthy controls (Hedges g=-0.742, 95% CI[-1.405, -0.078]). Overall, oxytocin administration showed greater attenuation of the cortisol response to laboratory tasks that strongly activated the HPA-axis, relative to tasks that did not. The effect was more robust among clinical populations, suggesting possible increased sensitivity to oxytocin among those with a clinical diagnosis and concomitant social difficulties. These data support the view that oxytocin may play an important role in HPA dysfunction associated with psychopathology. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Information technology resource management in radiation oncology.
Siochi, R Alfredo; Balter, Peter; Bloch, Charles D; Bushe, Harry S; Mayo, Charles S; Curran, Bruce H; Feng, Wenzheng; Kagadis, George C; Kirby, Thomas H; Stern, Robin L
2009-09-02
The ever-increasing data demands in a radiation oncology (RO) clinic require medical physicists to have a clearer understanding of the information technology (IT) resource management issues. Clear lines of collaboration and communication among administrators, medical physicists, IT staff, equipment service engineers and vendors need to be established. In order to develop a better understanding of the clinical needs and responsibilities of these various groups, an overview of the role of IT in RO is provided. This is followed by a list of IT related tasks and a resource map. The skill set and knowledge required to implement these tasks are described for the various RO professionals. Finally, various models for assessing one's IT resource needs are described. The exposition of ideas in this white paper is intended to be broad, in order to raise the level of awareness of the RO community; the details behind these concepts will not be given here and are best left to future task group reports.
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Chen, Cory K; Waters, Harriet Salatas; Hartman, Marilyn; Zimmerman, Sheryl; Miklowitz, David J; Waters, Everett
2013-01-01
This study explores links between adults' attachment representations and the task of caring for elderly parents with dementia. Participants were 87 adults serving as primary caregivers of a parent or parent-in-law with dementia. Waters and Waters' ( 2006 ) Attachment Script Assessment was adapted to assess script-like attachment representation in the context of caring for their elderly parent. The quality of adult-elderly parent interactions was assessed using the Level of Expressed Emotions Scale (Cole & Kazarian, 1988 ) and self-report measures of caregivers' perception of caregiving as difficult. Caregivers' secure base script knowledge predicted lower levels of negative expressed emotion. This effect was moderated by the extent to which participants experienced caring for elderly parents as difficult. Attachment representations played a greater role in caregiving when caregiving tasks were perceived as more difficult. These results support the hypothesis that attachment representations influence the quality of care that adults provide their elderly parents. Clinical implications are discussed.
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Dinka, David; Nyce, James M; Timpka, Toomas
2009-06-01
The aim of this study was to investigate how the clinical use of visualization technology can be advanced by the application of a situated cognition perspective. The data were collected in the GammaKnife radiosurgery setting and analyzed using qualitative methods. Observations and in-depth interviews with neurosurgeons and physicists were performed at three clinics using the Leksell GammaKnife. The users' ability to perform cognitive tasks was found to be reduced each time visualizations incongruent with the particular user's perception of clinical reality were used. The main issue here was a lack of transparency, i.e. a black box problem where machine representations "stood between" users and the cognitive tasks they wanted to perform. For neurosurgeons, transparency meant their previous experience from traditional surgery could be applied, i.e. that they were not forced to perform additional cognitive work. From the view of the physicists, on the other hand, the concept of transparency was associated with mathematical precision and avoiding creating a cognitive distance between basic patient data and what is experienced as clinical reality. The physicists approached clinical visualization technology as though it was a laboratory apparatus--one that required continual adjustment and assessment in order to "capture" a quantitative clinical reality. Designers of visualization technology need to compare the cognitive interpretations generated by the new visualization systems to conceptions generated during "traditional" clinical work. This means that the viewpoint of different clinical user groups involved in a given clinical task would have to be taken into account as well. A way forward would be to acknowledge that visualization is a socio-cognitive function that has practice-based antecedents and consequences, and to reconsider what analytical and scientific challenges this presents us with.
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Impairment in local and global processing and set-shifting in body dysmorphic disorder
Kerwin, Lauren; Hovav, Sarit; Helleman, Gerhard; Feusner, Jamie D.
2014-01-01
Body dysmorphic disorder (BDD) is characterized by distressing and often debilitating preoccupations with misperceived defects in appearance. Research suggests that aberrant visual processing may contribute to these misperceptions. This study used two tasks to probe global and local visual processing as well as set shifting in individuals with BDD. Eighteen unmedicated individuals with BDD and 17 non-clinical controls completed two global-local tasks. The embedded figures task requires participants to determine which of three complex figures contained a simpler figure embedded within it. The Navon task utilizes incongruent stimuli comprised of a large letter (global level) made up of smaller letters (local level). The outcome measures were response time and accuracy rate. On the embedded figures task, BDD individuals were slower and less accurate than controls. On the Navon task, BDD individuals processed both global and local stimuli slower and less accurately than controls, and there was a further decrement in performance when shifting attention between the different levels of stimuli. Worse insight correlated with poorer performance on both tasks. Taken together, these results suggest abnormal global and local processing for non-appearance related stimuli among BDD individuals, in addition to evidence of poor set-shifting abilities. Moreover, these abnormalities appear to relate to the important clinical variable of poor insight. Further research is needed to explore these abnormalities and elucidate their possible role in the development and/or persistence of BDD symptoms. PMID:24972487
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The cerebellum and cognition: evidence from functional imaging studies.
Stoodley, Catherine J
2012-06-01
Evidence for a role of the human cerebellum in cognitive functions comes from anatomical, clinical and neuroimaging data. Functional neuroimaging reveals cerebellar activation during a variety of cognitive tasks, including language, visual-spatial, executive, and working memory processes. It is important to note that overt movement is not a prerequisite for cerebellar activation: the cerebellum is engaged during conditions which either control for motor output or do not involve motor responses. Resting-state functional connectivity data reveal that, in addition to networks underlying motor control, the cerebellum is part of "cognitive" networks with prefrontal and parietal association cortices. Consistent with these findings, regional differences in activation patterns within the cerebellum are evident depending on the task demands, suggesting that the cerebellum can be broadly divided into functional regions based on the patterns of anatomical connectivity between different regions of the cerebellum and sensorimotor and association areas of the cerebral cortex. However, the distinct contribution of the cerebellum to cognitive tasks is not clear. Here, the functional neuroimaging evidence for cerebellar involvement in cognitive functions is reviewed and related to hypotheses as to why the cerebellum is active during such tasks. Identifying the precise role of the cerebellum in cognition-as well as the mechanism by which the cerebellum modulates performance during a wide range of tasks-remains a challenge for future investigations.
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Midline thalamic reuniens lesions improve executive behaviors.
Prasad, J A; Abela, A R; Chudasama, Y
2017-03-14
The role of the thalamus in complex cognitive behavior is a topic of increasing interest. Here we demonstrate that lesions of the nucleus reuniens (NRe), a midline thalamic nucleus interconnected with both hippocampal and prefrontal circuitry, lead to enhancement of executive behaviors typically associated with the prefrontal cortex. Rats were tested on four behavioral tasks: (1) the combined attention-memory (CAM) task, which simultaneously assessed attention to a visual target and memory for that target over a variable delay; (2) spatial memory using a radial arm maze, (3) discrimination and reversal learning using a touchscreen operant platform, and (4) decision-making with delayed outcomes. Following NRe lesions, the animals became more efficient in their performance, responding with shorter reaction times but also less impulsively than controls. This change, combined with a decrease in perseverative responses, led to focused attention in the CAM task and accelerated learning in the visual discrimination task. There were no observed changes in tasks involving either spatial memory or value-based decision making. These data complement ongoing efforts to understand the role of midline thalamic structures in human cognition, including the development of thalamic stimulation as a therapeutic strategy for acquired cognitive disabilities (Schiff, 2008; Mair et al., 2011), and point to the NRe as a potential target for clinical intervention. Published by Elsevier Ltd.
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2009-01-01
Background Many hospital departments have implemented small clinical departmental systems (CDSs) to collect and use patient data for documentation as well as for other department-specific purposes. As hospitals are implementing institution-wide electronic patient records (EPRs), the EPR is thought to be integrated with, and gradually substitute the smaller systems. Many EPR systems however fail to support important clinical workflows. Also, successful integration of systems has proven hard to achieve. As a result, CDSs are still in widespread use. This study was conducted to see which tasks are supported by CDSs and to compare this to the support offered by the EPR. Methods Semi-structured interviews with users of 16 clinicians using 15 different clinical departmental systems (CDS) at a Medium-sized University hospital in Norway. Inductive analysis of transcriptions from the audio taped interviews. Results The roles of CDSs were complementary to those of the hospital-wide EPR system. The use of structured patient data was a characteristic feature. This facilitated quality development and supervision, tasks that were poorly supported by the EPR system. The structuring of the data also improved filtering of information to better support clinical decision-making. Because of the high value of the structured patient data, the users put much effort in maintaining their integrity and representativeness. Employees from the departments were also engaged in the funding, development, implementation and maintenance of the systems. Conclusion Clinical departmental systems are vital to the activities of a clinical hospital department. The development, implementation and clinical use of such systems can be seen as bottom-up, user-driven innovations. PMID:19523198
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Lameire, N
2014-12-01
This paper summarizes the impact that wars had on the history of nephrology, both worldwide and in the Ghent Medical Faculty notably on the definition, research and clinical aspects of acute kidney injury. The paper briefly describes the role of 'trench nephritis' as observed both during World War I and II, supporting the hypothesis that many of the clinical cases could have been due to Hantavirus nephropathy. The lessons learned from the experience with crush syndrome first observed in World War II and subsequently investigated over many decades form the basis for the creation of the Renal Disaster Relief Task Force of the International Society of Nephrology. Over the last 15 years, this Task Force has successfully intervened both in the prevention and management of crush syndrome in numerous disaster situations like major earthquakes.
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2014-01-01
Background Allied health assistants provide delegated support for physical therapists, occupational therapists and other allied health professionals. Unfortunately the role statements, scope of practice and career pathways of these assistant positions are often unclear. To inform the future development of the allied health assistant workforce, a state-wide pilot project was implemented and audited. Methods New allied health assistant positions were implemented in numerous settings at three levels (trainee level, full (standard) scope and advanced scope level). Six months after implementation, 41 positions were audited, using a detailed on-site audit process, conducted by multiple audit teams. Results Thematically analysed audit findings indicated that both the full (standard) scope and the advanced scope positions were warranted, however the skills of the allied health assistants were not optimally utilised. Contributing factors to this underutilization included the reluctance of professionals to delegate clinical tasks, inconsistencies in role descriptions, limitations in training, and the time frame taken to reach an effective skill level. Conclusions Optimal utilisation of assistants is unlikely to occur while professionals withhold delegation of tasks related to direct patient care. Formal clinical supervision arrangements and training plans should be established in order to address the concerns of professionals and accelerate full utilisation of assistants. Further work is necessary to identify the key components and distinguish key features of an advanced allied health assistant role. PMID:24935749
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Multi-task functional MRI in multiple sclerosis patients without clinical disability.
Colorado, René A; Shukla, Karan; Zhou, Yuxiang; Wolinsky, Jerry S; Narayana, Ponnada A
2012-01-02
While the majority of individuals with multiple sclerosis (MS) develop significant clinical disability, a subset experiences a disease course with minimal impairment even in the presence of significant apparent tissue damage on magnetic resonance imaging (MRI). Functional magnetic resonance imaging (fMRI) in MS patients with low disability suggests that increased use of the cognitive control system may limit the clinical manifestation of the disease. The current fMRI studies tested the hypothesis that nondisabled MS patients show increased recruitment of cognitive control regions while performing sensory, motor and cognitive tasks. Twenty two patients with relapsing-remitting MS and an Expanded Disability Status Scale (EDSS) score of ≤1.5 and 23 matched healthy controls were recruited. Subjects underwent fMRI while observing flashing checkerboards, performing right or left hand movements, or executing the 2-back working memory task. Compared to control subjects, patients demonstrated increased activation of the right dorsolateral prefrontal cortex and anterior cingulate cortex during the performance of the working memory task. This pattern of functional recruitment also was observed during the performance of non-dominant hand movements. These results support the mounting evidence of increased functional recruitment of cognitive control regions in the working memory system of MS patients with low disability and provide new evidence for the role of increased cognitive control recruitment in the motor system. Copyright © 2011 Elsevier Inc. All rights reserved.
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Thureau, S; Challand, T; Bibault, J-E; Biau, J; Cervellera, M; Diaz, O; Faivre, J-C; Fumagalli, I; Leroy, T; Lescut, N; Martin, V; Pichon, B; Riou, O; Dubray, B; Giraud, P; Hennequin, C
2013-10-01
A national survey was conducted among the radiation oncology residents about their clinical activities and responsibilities. The aim was to evaluate the clinical workload and to assess how medical tasks are delegated and supervised. A first questionnaire was administered to radiation oncology residents during a national course. A second questionnaire was mailed to 59 heads of departments. The response rate was 62% for radiation oncology residents (99 questionnaires) and 51% for heads of department (30). Eighteen heads of department (64%) declared having written specifications describing the residents' clinical tasks and roles, while only 31 radiation oncology residents (34%) knew about such a document (P=0.009). A majority of residents were satisfied with the amount of medical tasks that were delegated to them. Older residents complained about insufficient exposure to new patient's consultation, treatment planning and portal images validation. The variations observed between departments may induce heterogeneous trainings and should be addressed specifically. National specifications are necessary to reduce heterogeneities in training, and to insure that the residents' training covers all the professional skills required to practice radiation oncology. A frame endorsed by academic and professional societies would also clarify the responsibilities of both residents and seniors. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.
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ERIC Educational Resources Information Center
Evans, David W.; Lewis, Marc D.; Iobst, Emily
2004-01-01
Mounting evidence concerning obsessive-compulsive disorders points to abnormal functioning of the orbitofrontal cortices. First, patients with obsessive-compulsive disorder (OCD) perform poorly on tasks that rely on response suppression/motor inhibition functions mediated by the orbitofrontal cortex relative to both normal and clinical controls.…
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TU-EF-210-01: HIFU, Drug Delivery, and Immunotherapy
DOE Office of Scientific and Technical Information (OSTI.GOV)
Ferrara, K.
The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less
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TU-EF-210-03: Real-Time Ablation Monitoring and Lesion Quantification Using Harmonic Motion Imaging
DOE Office of Scientific and Technical Information (OSTI.GOV)
Konofagou, E.
2015-06-15
The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less
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TU-EF-210-00: Therapeutic Strategies and Image Guidance
DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
2015-06-15
The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less
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TU-EF-210-02: MRg Hyperthermia
DOE Office of Scientific and Technical Information (OSTI.GOV)
Chopra, R.
2015-06-15
The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less
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Belief-bias reasoning in non-clinical delusion-prone individuals.
Anandakumar, T; Connaughton, E; Coltheart, M; Langdon, R
2017-03-01
It has been proposed that people with delusions have difficulty inhibiting beliefs (i.e., "doxastic inhibition") so as to reason about them as if they might not be true. We used a continuity approach to test this proposal in non-clinical adults scoring high and low in psychometrically assessed delusion-proneness. High delusion-prone individuals were expected to show greater difficulty than low delusion-prone individuals on "conflict" items of a "belief-bias" reasoning task (i.e. when required to reason logically about statements that conflicted with reality), but not on "non-conflict" items. Twenty high delusion-prone and twenty low delusion-prone participants (according to the Peters et al. Delusions Inventory) completed a belief-bias reasoning task and tests of IQ, working memory and general inhibition (Excluded Letter Fluency, Stroop and Hayling Sentence Completion). High delusion-prone individuals showed greater difficulty than low delusion-prone individuals on the Stroop and Excluded Letter Fluency tests of inhibition, but no greater difficulty on the conflict versus non-conflict items of the belief-bias task. They did, however, make significantly more errors overall on the belief-bias task, despite controlling for IQ, working memory and general inhibitory control. The study had a relatively small sample size and used non-clinical participants to test a theory of cognitive processing in individuals with clinically diagnosed delusions. Results failed to support a role for doxastic inhibitory failure in non-clinical delusion-prone individuals. These individuals did, however, show difficulty with conditional reasoning about statements that may or may not conflict with reality, independent of any general cognitive or inhibitory deficits. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Belief-bias reasoning in non-clinical delusion-prone individuals.
Anandakumar, T; Connaughton, E; Coltheart, M; Langdon, R
2017-09-01
It has been proposed that people with delusions have difficulty inhibiting beliefs (i.e., "doxastic inhibition") so as to reason about them as if they might not be true. We used a continuity approach to test this proposal in non-clinical adults scoring high and low in psychometrically assessed delusion-proneness. High delusion-prone individuals were expected to show greater difficulty than low delusion-prone individuals on "conflict" items of a "belief-bias" reasoning task (i.e. when required to reason logically about statements that conflicted with reality), but not on "non-conflict" items. Twenty high delusion-prone and twenty low delusion-prone participants (according to the Peters et al. Delusions Inventory) completed a belief-bias reasoning task and tests of IQ, working memory and general inhibition (Excluded Letter Fluency, Stroop and Hayling Sentence Completion). High delusion-prone individuals showed greater difficulty than low delusion-prone individuals on the Stroop and Excluded Letter Fluency tests of inhibition, but no greater difficulty on the conflict versus non-conflict items of the belief-bias task. They did, however, make significantly more errors overall on the belief-bias task, despite controlling for IQ, working memory and general inhibitory control. The study had a relatively small sample size and used non-clinical participants to test a theory of cognitive processing in individuals with clinically diagnosed delusions. Results failed to support a role for doxastic inhibitory failure in non-clinical delusion-prone individuals. These individuals did, however, show difficulty with conditional reasoning about statements that may or may not conflict with reality, independent of any general cognitive or inhibitory deficits. Copyright © 2016 Elsevier Ltd. All rights reserved.
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The cerebellum: its role in language and related cognitive and affective functions.
De Smet, Hyo Jung; Paquier, Philippe; Verhoeven, Jo; Mariën, Peter
2013-12-01
The traditional view on the cerebellum as the sole coordinator of motor function has been substantially redefined during the past decades. Neuroanatomical, neuroimaging and clinical studies have extended the role of the cerebellum to the modulation of cognitive and affective processing. Neuroanatomical studies have demonstrated cerebellar connectivity with the supratentorial association areas involved in higher cognitive and affective functioning, while functional neuroimaging and clinical studies have provided evidence of cerebellar involvement in a variety of cognitive and affective tasks. This paper reviews the recently acknowledged role of the cerebellum in linguistic and related cognitive and behavioral-affective functions. In addition, typical cerebellar syndromes such as the cerebellar cognitive affective syndrome (CCAS) and the posterior fossa syndrome (PFS) will be briefly discussed and the current hypotheses dealing with the presumed neurobiological mechanisms underlying the linguistic, cognitive and affective modulatory role of the cerebellum will be reviewed. Copyright © 2012 Elsevier Inc. All rights reserved.
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Human Factors Research in Anesthesia Patient Safety
Weinger, Matthew B.; Slagle, Jason
2002-01-01
Patient safety has become a major public concern. Human factors research in other high-risk fields has demonstrated how rigorous study of factors that affect job performance can lead to improved outcome and reduced errors after evidence-based redesign of tasks or systems. These techniques have increasingly been applied to the anesthesia work environment. This paper describes data obtained recently using task analysis and workload assessment during actual patient care and the use of cognitive task analysis to study clinical decision making. A novel concept of “non-routine events” is introduced and pilot data are presented. The results support the assertion that human factors research can make important contributions to patient safety. Information technologies play a key role in these efforts.
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Human factors research in anesthesia patient safety.
Weinger, M. B.; Slagle, J.
2001-01-01
Patient safety has become a major public concern. Human factors research in other high-risk fields has demonstrated how rigorous study of factors that affect job performance can lead to improved outcome and reduced errors after evidence-based redesign of tasks or systems. These techniques have increasingly been applied to the anesthesia work environment. This paper describes data obtained recently using task analysis and workload assessment during actual patient care and the use of cognitive task analysis to study clinical decision making. A novel concept of "non-routine events" is introduced and pilot data are presented. The results support the assertion that human factors research can make important contributions to patient safety. Information technologies play a key role in these efforts. PMID:11825287
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Varieties of clinical reasoning.
Bolton, Jonathan W
2015-06-01
Clinical reasoning comprises a variety of different modes of inference. The modes that are practiced will be influenced by the sociological characteristics of the clinical settings and the tasks to be performed by the clinician. This article presents C.S. Peirce's typology of modes of inference: deduction, induction and abduction. It describes their differences and their roles as stages in scientific argument. The article applies the typology to reasoning in clinical settings. The article describes their differences, and their roles as stages in scientific argument. It then applies the typology to reasoning in typical clinical settings. Abduction is less commonly taught or discussed than induction and deduction. However, it is a common mode of inference in clinical settings, especially when the clinician must try to make sense of a surprising phenomenon. Whether abduction is followed up with deductive and inductive verification is strongly influenced by situational constraints and the cognitive and psychological stamina of the clinician. Recognizing the inevitability of abduction in clinical practice and its value to discovery is important to an accurate understanding of clinical reasoning. © 2015 John Wiley & Sons, Ltd.
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Muñoz Ladrón de Guevara, Cristina; Fernández-Serrano, María José; Reyes Del Paso, Gustavo A; Duschek, Stefan
2018-01-01
Several investigations suggest the presence of deterioration of executive function in fibromyalgia syndrome (FMS). The study quantified executive functions in patients with FMS. A wide array of functions was assessed, including updating, shifting and inhibition, as well as decision making and mental planning. Moreover, clinical variables were investigated as possible mediators of executive dysfunction, including pain severity, psychiatric comorbidity, medication and body mass index (BMI). Fifty-two FMS patients and 32 healthy controls completed a battery of 14 neuropsychological tests. Clinical interviews were conducted and the McGill Pain Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Fatigue Severity Scale and Oviedo Quality of Sleep Questionnaire were presented. Patients performed poorer than controls on the Letter Number Sequencing, Arithmetic and Similarities subtests of the Wechsler Adult Intelligence Scale, the Spatial Span subtest of the Wechsler Memory Scale, an N-back task, a verbal fluency task, the Ruff Figural Fluency Test, the Inhibition score of the Stroop Test, the Inhibition and Shifting scores of the Five Digits Test, the Key Search Test and the Zoo Map Task. Moreover, patients exhibited less steep learning curves on the Iowa Gambling Task. Among clinical variables, BMI and pain severity explained the largest proportion of performance variance. This study demonstrated impairments in executive functions of updating, shifting inhibition, decision making and planning in FMS. While the mediating role of pain in cognitive impairments in FMS had been previously established, the influence of BMI is a novel finding. Overweight and obesity should be considered by FMS researchers, and in the treatment of the condition.
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2018-01-01
Background Several investigations suggest the presence of deterioration of executive function in fibromyalgia syndrome (FMS). The study quantified executive functions in patients with FMS. A wide array of functions was assessed, including updating, shifting and inhibition, as well as decision making and mental planning. Moreover, clinical variables were investigated as possible mediators of executive dysfunction, including pain severity, psychiatric comorbidity, medication and body mass index (BMI). Methods Fifty-two FMS patients and 32 healthy controls completed a battery of 14 neuropsychological tests. Clinical interviews were conducted and the McGill Pain Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Fatigue Severity Scale and Oviedo Quality of Sleep Questionnaire were presented. Results Patients performed poorer than controls on the Letter Number Sequencing, Arithmetic and Similarities subtests of the Wechsler Adult Intelligence Scale, the Spatial Span subtest of the Wechsler Memory Scale, an N-back task, a verbal fluency task, the Ruff Figural Fluency Test, the Inhibition score of the Stroop Test, the Inhibition and Shifting scores of the Five Digits Test, the Key Search Test and the Zoo Map Task. Moreover, patients exhibited less steep learning curves on the Iowa Gambling Task. Among clinical variables, BMI and pain severity explained the largest proportion of performance variance. Conclusions This study demonstrated impairments in executive functions of updating, shifting inhibition, decision making and planning in FMS. While the mediating role of pain in cognitive impairments in FMS had been previously established, the influence of BMI is a novel finding. Overweight and obesity should be considered by FMS researchers, and in the treatment of the condition. PMID:29694417
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The evolving professional identity of the clinical research nurse: A qualitative exploration.
Kunhunny, Swapna; Salmon, Debra
2017-12-01
To examine the perspectives of CRNs in the UK on their professional role identity, in order to inform the professional practice of Clinical Research Nursing. Clinical research nurses (CRN) make a significant contribution to healthcare research within the UK and internationally. However, lack of clarity about their role, and scope of practice renders their contribution within the profession and in the minds of the wider public invisible. This has implications in terms of promoting the role nurses play not only in terms of recruitment, retention, and care of research participants but also as research leaders of the future. Exploratory qualitative design using thematic analysis conducted within a realist paradigm. Participants viewed the positive aspects of their identity 'as agents of change' who were fundamental to the clinical research process. Resourcefulness and the ability to guide members of the research team were valued as key to job satisfaction. Successful navigation through the complexity of advice, support, management and leadership tasks related to their role in caring for research patients were role affirming and generated a sense of pride. However, lack of recognition, clarity of the role and career development opportunities within an identified structure undermined the CRN identity and optimism about progression in the future. Participants reported feeling invisible to colleagues within the clinical community, isolated and excluded from wider nursing groups. The study describes UK CRN practice, highlighting the positive benefits and challenges associated with the role, including the need to support professional and career development to maximise their research contribution. This study provides nurses, health care and research organisations and academic nursing educators with a broadened understanding of the professional role, identity and context of clinical research nursing practice in the United Kingdom, with recommendations to improve its professional efficiency and recognition. © 2017 John Wiley & Sons Ltd.
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Clinical Reasoning Tasks and Resident Physicians: What Do They Reason About?
McBee, Elexis; Ratcliffe, Temple; Goldszmidt, Mark; Schuwirth, Lambert; Picho, Katherine; Artino, Anthony R; Masel, Jennifer; Durning, Steven J
2016-07-01
A framework of clinical reasoning tasks thought to occur in a clinical encounter was recently developed. It proposes that diagnostic and therapeutic reasoning comprise 24 tasks. The authors of this current study used this framework to investigate what internal medicine residents reason about when they approach straightforward clinical cases. Participants viewed three video-recorded clinical encounters portraying common diagnoses. After each video, participants completed a post encounter form and think-aloud protocol. Two authors analyzed transcripts from the think-aloud protocols using a constant comparative approach. They conducted iterative coding of the utterances, classifying each according to the framework of clinical reasoning tasks. They evaluated the type, number, and sequence of tasks the residents used. Ten residents participated in the study in 2013-2014. Across all three cases, the residents employed 14 clinical reasoning tasks. Nearly all coded tasks were associated with framing the encounter or diagnosis. The order in which residents used specific tasks varied. The average number of tasks used per case was as follows: Case 1, 4.4 (range 1-10); Case 2, 4.6 (range 1-6); and Case 3, 4.7 (range 1-7). The residents used some tasks repeatedly; the average number of task utterances was 11.6, 13.2, and 14.7 for, respectively, Case 1, 2, and 3. Results suggest that the use of clinical reasoning tasks occurs in a varied, not sequential, process. The authors provide suggestions for strengthening the framework to more fully encompass the spectrum of reasoning tasks that occur in residents' clinical encounters.
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Telehealth technology in case/disease management.
Park, Eun-Jun
2006-01-01
Case managers can better coordinate and facilitate chronic illness care by adopting telehealth technology. This article overviews four major categories of telehealth technology based on patients' roles in self-management: surveillance, testing peripherals and messaging, decision support aids, and online support groups related to patients' subordinate, structured, collaborative, and autonomous roles, respectively. These various telehealth technologies should be selected on the basis of patients' care needs and preferences. Moreover, when they are integrated with other clinical information systems, case management practice can be better performed. However, the specific role functions and skill sets needed to be competent in telehealth environments have not yet been clearly identified. Considering role ambiguity and stress among telehealth clinicians, clarifying relevant roles is an urgent task.
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Delegation and beyond: what happens when things go wrong?
Solon, Mark
2013-01-01
Both midwives and maternity support workers can be confused about who is liable if a task is delegated and something goes wrong. With proper understanding of roles and a knowledge of which tasks can and can't be delegated, however, the midwife should be protected, particularly as in practice the NHS body will have vicarious liability in the event of any claim. Clinical negligence training identifies the risks and responsibilities involved--and, leaving aside issues of delegation, training should also instil common sense safeguards against incurring criminal liability, which is independent from any professional or civil sanction.
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Peters, Anne L; Ahmann, Andrew J; Battelino, Tadej; Evert, Alison; Hirsch, Irl B; Murad, M Hassan; Winter, William E; Wolpert, Howard
2016-11-01
To formulate clinical practice guidelines for the use of continuous glucose monitoring and continuous subcutaneous insulin infusion in adults with diabetes. The participants include an Endocrine Society-appointed Task Force of seven experts, a methodologist, and a medical writer. The American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology co-sponsored this guideline. The Task Force developed this evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned one systematic review and used the best available evidence from other published systematic reviews and individual studies. One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, the American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Continuous subcutaneous insulin infusion and continuous glucose monitoring have an important role in the treatment of diabetes. Data from randomized controlled trials are limited on the use of medical devices, but existing studies support the use of diabetes technology for a wide variety of indications. This guideline presents a review of the literature and practice recommendations for appropriate device use.
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The role of working memory in decoding emotions.
Phillips, Louise H; Channon, Shelley; Tunstall, Mary; Hedenstrom, Anna; Lyons, Kathryn
2008-04-01
Decoding facial expressions of emotion is an important aspect of social communication that is often impaired following psychiatric or neurological illness. However, little is known of the cognitive components involved in perceiving emotional expressions. Three dual task studies explored the role of verbal working memory in decoding emotions. Concurrent working memory load substantially interfered with choosing which emotional label described a facial expression (Experiment 1). A key factor in the magnitude of interference was the number of emotion labels from which to choose (Experiment 2). In contrast the ability to decide that two faces represented the same emotion in a discrimination task was relatively unaffected by concurrent working memory load (Experiment 3). Different methods of assessing emotion perception make substantially different demands on working memory. Implications for clinical disorders which affect both working memory and emotion perception are considered. (Copyright) 2008 APA.
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Developing a unified list of physicians' reasoning tasks during clinical encounters.
Goldszmidt, Mark; Minda, John Paul; Bordage, Georges
2013-03-01
The clinical reasoning literature focuses on how physicians reason while making decisions, rather than on what they reason about while performing their clinical tasks. In an attempt to provide a common language for discussing, teaching, and researching clinical reasoning, the authors undertook the task of developing a unified list of physicians' reasoning tasks, or what they reason about, during clinical encounters. The authors compiled an initial list of 20 reasoning tasks based on the literature from four content areas--clinical reasoning, communications, medical errors, and clinical guidelines. In the summer and fall of 2010, they surveyed a purposive sample of 46 international experts in clinical reasoning and communications. From the results of the first survey, the authors refined their list of reasoning tasks, then resurveyed 22 of the original participants. From the results of the second survey, they further refined their list and validated the inclusion of the reasoning tasks. Twenty-four of 46 (52%) and 15 of 22 (65%) participants completed the first- and second-round surveys, respectively. Following the second-round survey, the authors' list included 24 reasoning tasks, and a clinical example corresponding to each, that fell into four broad categories: framing the encounter (3), diagnosis (8), management (11), and self-reflection (2). The development of this unified list represents a first step in offering a vocabulary for discussing, reflecting on, teaching, and studying physicians' reasoning tasks during clinical encounters.
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Wu, Stephen; Miller, Timothy; Masanz, James; Coarr, Matt; Halgrim, Scott; Carrell, David; Clark, Cheryl
2014-01-01
A review of published work in clinical natural language processing (NLP) may suggest that the negation detection task has been “solved.” This work proposes that an optimizable solution does not equal a generalizable solution. We introduce a new machine learning-based Polarity Module for detecting negation in clinical text, and extensively compare its performance across domains. Using four manually annotated corpora of clinical text, we show that negation detection performance suffers when there is no in-domain development (for manual methods) or training data (for machine learning-based methods). Various factors (e.g., annotation guidelines, named entity characteristics, the amount of data, and lexical and syntactic context) play a role in making generalizability difficult, but none completely explains the phenomenon. Furthermore, generalizability remains challenging because it is unclear whether to use a single source for accurate data, combine all sources into a single model, or apply domain adaptation methods. The most reliable means to improve negation detection is to manually annotate in-domain training data (or, perhaps, manually modify rules); this is a strategy for optimizing performance, rather than generalizing it. These results suggest a direction for future work in domain-adaptive and task-adaptive methods for clinical NLP. PMID:25393544
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Sanders, Vicki L; Flanagan, Jennifer
2015-01-01
The purpose of the literature review was to assess the origins of radiology physician extenders and examine the current roles found in the literature of advanced practice physician extenders within medical imaging. Twenty-six articles relating to physician assistants (PAs), nurse practitioners (NPs), radiologist assistants (RAs), and nuclear medicine advanced associates (NMAAs) were reviewed to discern similarities and differences in history, scope of practice, and roles in the medical imaging field. The literature showed PAs and NPs are working mostly in interventional radiology. PAs, NPs, and RAs perform similar tasks in radiology, including history and physicals, evaluation and management, preprocedure work-up, obtaining informed consent, initial observations/reports, and post-procedure follow-up. NPs and PAs perform a variety of procedures but most commonly vascular access, paracentesis, and thoracentesis. RAs perform gastrointestinal, genitourinary, nonvascular invasive fluoroscopy procedures, and vascular access procedures. The review revealed NMAAs are working in an advanced role, but no specific performances of procedures was found in the literature, only suggested tasks and clinical competencies. PAs, NPs, and RAs are currently the three main midlevel providers used in medical imaging. These midlevel providers are being used in a variety of ways to increase the efficiency of the radiologist and provide diagnostic and therapeutic radiologic procedures to patients. NMAAs are being used in medical imaging but little literature is available on current roles in clinical practice. More research is needed to assess the exact procedures and duties being performed by these medical imaging physician extenders.
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Telehealth coordinators in hospital based telehealth services: Who are they and what do they do?
Edirippulige, Sisira; Armfield, Nigel R; Greenup, Phil; Bryett, Andrew
2016-12-01
Many studies have identified the importance of 'telehealth coordinators' for successful telehealth implementation and operation. However, little is known about the telehealth coordinators' functions, the skills and competencies required and the reasons for their influence. This study aimed to examine the key functions of telehealth coordinators in the Queensland public health system, their perceptions about their role, and the level of competencies to support this role. All telehealth coordinators within Queensland Health Telehealth Services were invited to complete a questionnaire. We collected: (i) demographic information; (ii) details of their telehealth work; and (iii) information about knowledge and skills relevant to their telehealth coordinator role. Eighteen of 20 (90%) participants completed and submitted the survey. Telehealth coordinators were responsible for a range of tasks relating to telehealth consultations, technical assistance, administration, research, promotion and marketing. Nearly all telehealth coordinators (n = 17, 94%) were confident in carrying out the tasks of their job. The majority of telehealth coordinators (n = 13, 72%) thought education and training relating to telehealth would help improve their job. The top three topics that telehealth coordinators were keen to learn about were: (i) examples of clinical use of telehealth; (ii) types of technologies used; and (iii) telehealth clinical and business models. Our participants were all hospital-based; as the use of telehealth is growing outside of the traditional hospital settings, the role of telehealth coordinators is likely to change. © The Author(s) 2016.
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Crosswords to computers: a critical review of popular approaches to cognitive enhancement.
Jak, Amy J; Seelye, Adriana M; Jurick, Sarah M
2013-03-01
Cognitive enhancement strategies have gained recent popularity and have the potential to benefit clinical and non-clinical populations. As technology advances and the number of cognitively healthy adults seeking methods of improving or preserving cognitive functioning grows, the role of electronic (e.g., computer and video game based) cognitive training becomes more relevant and warrants greater scientific scrutiny. This paper serves as a critical review of empirical evaluations of publically available electronic cognitive training programs. Many studies have found that electronic training approaches result in significant improvements in trained cognitive tasks. Fewer studies have demonstrated improvements in untrained tasks within the trained cognitive domain, non-trained cognitive domains, or on measures of everyday function. Successful cognitive training programs will elicit effects that generalize to untrained, practical tasks for extended periods of time. Unfortunately, many studies of electronic cognitive training programs are hindered by methodological limitations such as lack of an adequate control group, long-term follow-up and ecologically valid outcome measures. Despite these limitations, evidence suggests that computerized cognitive training has the potential to positively impact one's sense of social connectivity and self-efficacy.
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Sutcliffe, Jane S.; Beaumont, Vahri; Watson, James M.; Chew, Chang Sing; Beconi, Maria; Hutcheson, Daniel M.; Dominguez, Celia; Munoz-Sanjuan, Ignacio
2014-01-01
Cyclic adenosine monophosphate (cAMP) signalling plays an important role in synaptic plasticity and information processing in the hippocampal and basal ganglia systems. The augmentation of cAMP signalling through the selective inhibition of phosphodiesterases represents a viable strategy to treat disorders associated with dysfunction of these circuits. The phosphodiesterase (PDE) type 4 inhibitor rolipram has shown significant pro-cognitive effects in neurological disease models, both in rodents and primates. However, competitive non-isoform selective PDE4 inhibitors have a low therapeutic index which has stalled their clinical development. Here, we demonstrate the pro-cognitive effects of selective negative allosteric modulators (NAMs) of PDE4D, D159687 and D159797 in female Cynomolgous macaques, in the object retrieval detour task. The efficacy displayed by these NAMs in a primate cognitive task which engages the corticostriatal circuitry, together with their suitable pharmacokinetic properties and safety profiles, suggests that clinical development of these allosteric modulators should be considered for the treatment of a variety of brain disorders associated with cognitive decline. PMID:25050979
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The Effects of Respiratory Sinus Arrhythmia on Anger Reactivity and Persistence in Major Depression
Ellis, Alissa J.; Shumake, Jason; Beevers, Christopher G.
2016-01-01
The experience of anger during a depressive episode has recently been identified as a poor prognostic indicator of illness course. Given the clinical implications of anger in major depressive disorder (MDD), understanding the mechanisms involved in anger reactivity and persistence is critical for improved intervention. Biological processes involved in emotion regulation during stress, such as respiratory sinus arrhythmia (RSA), may play a role in maintaining negative moods. Clinically depressed (MDD) (n=49) and non-depressed (non-MDD) (n=50) individuals were challenged with a stressful computer task shown to increase anger, while RSA (high frequency range 0.15–0.4 Hz) was collected. RSA predicted future anger, but was unrelated to current anger. That is, across participants, low baseline RSA predicted anger reactivity during the task, and in depressed individuals, those with low RSA during the task had a greater likelihood of anger persistence during a recovery period. These results suggest that low RSA may be a psychophysiological process involved in anger regulation in depression. Low RSA may contribute to sustained illness course by diminishing the repair of angry moods. PMID:27401801
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New insights into the role of motion and form vision in neurodevelopmental disorders.
Johnston, Richard; Pitchford, Nicola J; Roach, Neil W; Ledgeway, Timothy
2017-12-01
A selective deficit in processing the global (overall) motion, but not form, of spatially extensive objects in the visual scene is frequently associated with several neurodevelopmental disorders, including preterm birth. Existing theories that proposed to explain the origin of this visual impairment are, however, challenged by recent research. In this review, we explore alternative hypotheses for why deficits in the processing of global motion, relative to global form, might arise. We describe recent evidence that has utilised novel tasks of global motion and global form to elucidate the underlying nature of the visual deficit reported in different neurodevelopmental disorders. We also examine the role of IQ and how the sex of an individual can influence performance on these tasks, as these are factors that are associated with performance on global motion tasks, but have not been systematically controlled for in previous studies exploring visual processing in clinical populations. Finally, we suggest that a new theoretical framework is needed for visual processing in neurodevelopmental disorders and present recommendations for future research. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Cox, Nicholas; Brennan, Angela; Dinh, Diem; Brien, Rita; Cowie, Kath; Stub, Dion; Reid, Christopher M; Lefkovits, Jeffrey
2018-04-01
Clinical outcome registries are an increasingly vital component of ensuring quality and safety of patient care. However, Australian hospitals rarely have additional resources or the capacity to fund the additional staff time to complete the task of data collection and entry. At the same time, registry funding models do not support staff for the collection of data at the site but are directed towards the central registry tasks of data reporting, managing and quality monitoring. The sustainability of a registry is contingent on building efficiencies into data management and collection. We describe the methods used in a large Victorian public hospital to develop a sustainable data collection system for the Victorian Cardiac Outcomes Registry (VCOR), using existing staff and resources common to many public hospitals. We describe the features of the registry and the hospital specific strategies that allowed us to do this as part of our routine business of providing good quality cardiac care. All clinical staff involved in patient care were given some data collection task with the entry of these data embedded into the staff's daily workflow. A senior cardiology registrar was empowered to allocate data entry tasks to colleagues when data were found to be incomplete. The task of 30-day follow-up proved the most onerous part of data collection. Cath-lab nursing staff were allocated this role. With hospital accreditation and funding models moving towards performance based quality indicators, collection of accurate and reliable information is crucial. Our experience demonstrates the successful implementation of clinical outcome registry data collection in a financially constrained public hospital environment utilising existing resources. Copyright © 2017. Published by Elsevier B.V.
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Delegation of clinical dietetic tasks in military and civilian hospitals: implications for practice.
Myers, M E; Gregoire, M B; Spears, M C
1991-12-01
The purposes of our research were two-fold: to determine perceptions of the quality of task performance and to identify dietetic personnel currently performing clinical dietetic tasks in military and civilian hospitals. Questionnaires were returned from 309 dietitians and 208 dietetic support personnel at 151 military and civilian hospitals (73% response overall). For tasks completed by support personnel, no task was rated as having optimum quality, 1 was rated as highly acceptable, 6 as acceptable, 19 as somewhat unacceptable, and 4 as unacceptable. Current performance ratings indicated that 1 task was performed solely by dietitians, 21 were completed by dietitians with assistance, 6 were completed jointly by dietitians and support personnel, 2 were completed by support personnel with supervision by dietitians, and no task was completed independently by support personnel. Tasks were grouped into four categories: basic clinical dietetics (11 tasks), intermediate and in-depth clinical dietetics (12 tasks), outpatient nutrition clinic (5 tasks), and nutrition education (community) (4 tasks). Quality scores for the US Air Force (USAF) hospitals were higher for all task categories except intermediate and in-depth clinical dietetic tasks. The quality scores of support personnel were higher than those of dietitians for all task categories. The USAF performance scores indicated significantly more involvement of support personnel. Generally, the performance scores of dietitians increased with experience; the scores of support personnel decreased with experience. Correlations between quality and performance ratings for individual tasks revealed low to moderate relationships. Our results suggest that additional delegation of tasks to dietetic support personnel may be possible without negatively affecting perceptions of the quality of task outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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Grace, Sally A; Rossell, Susan L; Heinrichs, Markus; Kordsachia, Catarina; Labuschagne, Izelle
2018-05-24
Oxytocin (OXT) is a neuropeptide which has a critical role in human social behaviour and cognition. Research investigating the role of OXT on functional brain changes in humans has often used task paradigms that probe socioemotional processes. Preliminary evidence suggests a central role of the amygdala in the social cognitive effects of intranasal OXT (IN-OXT), however, inconsistencies in task-design and analysis methods have led to inconclusive findings regarding a cohesive model of the neural mechanisms underlying OXT's actions. The aim of this meta-analysis was to systematically investigate these findings. A systematic search of PubMed, PsycINFO, and Scopus databases was conducted for fMRI studies which compared IN-OXT to placebo in humans. First, we systematically reviewed functional magnetic resonance imaging (fMRI) studies of IN-OXT, including studies of healthy humans, those with clinical disorders, and studies examining resting-state fMRI (rsfMRI). Second, we employed a coordinate-based meta-analysis for task-based neuroimaging literature using activation likelihood estimation (ALE), whereby, coordinates were extracted from clusters with significant differences in IN-OXT versus placebo in healthy adults. Data were included for 39 fMRI studies that reported a total of 374 distinct foci. The meta-analysis identified task-related IN-OXT increases in activity within a cluster of the left superior temporal gyrus during tasks of emotion processing. These findings are important as they implicate regions beyond the amygdala in the neural effects of IN-OXT. The outcomes from this meta-analysis can guide a priori predictions for future OXT research, and provide an avenue for targeted treatment interventions. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Autoimmune diagnostics: the technology, the strategy and the clinical governance.
Bizzaro, Nicola; Tozzoli, Renato; Villalta, Danilo
2015-02-01
In recent years, there has been a profound change in autoimmune diagnostics. From long, tiring and inaccurate manual methods, the art of diagnostics has turned to modern, rapid and automated technology. New antibody tests have been developed, and almost all autoimmune diseases now have some specific diagnostic markers. The current need to make the most of available economic and human resources has led to the production of diagnostic algorithms and guidelines designated for optimal strategic use of the tests and to increase the diagnostic appropriateness. An important role in this scenario was assumed by the laboratory autoimmunologist, whose task is not only to govern the analytical phase, but also to help clinicians in correctly choosing the most suitable test for each clinical situation and provide consultancy support. In this review, we summarize recent advances in technology, describe the diagnostic strategies and highlight the current role of the laboratory autoimmunologist in the clinical governance of autoimmune diagnostics.
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Clinical judgment research on economic topics: Role of congruence of tasks in clinical practice.
Huttin, Christine C
2017-01-01
This paper discusses what can ensure the performance of judgment studies with an information design that integrates economics of medical systems, in the context of digitalization of healthcare. It is part of a series of 5 methodological papers on statistical procedures and problems to implement judgment research designs and decision models, especially to address cost of care, and ways to measure conversation on cost of care between physicians and patients, with unstructured data such as economic narratives to complement billing and financial information (e.g. cost cognitive cues in conjoint or reversed conjoint designs). The paper discusses how congruence of tasks can increase the reliability of data. It uses some results of two Meta reviews of judgment studies in different fields of applications: psychology, business, medical sciences and education. It compares tests for congruence in judgment studies and efficiency tests in econometric studies.
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Is the Relationship Between ADHD Symptoms and Binge Eating Mediated by Impulsivity?
Steadman, Kylie M; Knouse, Laura E
2016-11-01
Individuals with ADHD may be at risk of developing binge eating disorder (BED). Impulsivity correlates with both BED and ADHD; however, more research is needed to explore whether impulsivity plays an underlying role in the observed relationship between ADHD and BED. Questionnaires were used to assess ADHD and BED symptoms. Multiple questionnaires and a behavioral task were used to assess impulsivity in undiagnosed undergraduate participants (n = 50). Expected correlations were found among ADHD symptoms, BED tendencies, and measures of impulsivity with the exception of impulsivity on the behavioral task and BED symptoms; however, none of the measures of impulsivity were found to be significant mediators between ADHD and BED symptoms. Although impulsivity may play an important role in the interrelationship of ADHD and binge eating, other factors may also be critical in the development of this comorbidity. Investigation of this research question in clinical samples is needed. © The Author(s) 2014.
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Exploring auditory neglect: Anatomo-clinical correlations of auditory extinction.
Tissieres, Isabel; Crottaz-Herbette, Sonia; Clarke, Stephanie
2018-05-23
The key symptoms of auditory neglect include left extinction on tasks of dichotic and/or diotic listening and rightward shift in locating sounds. The anatomical correlates of the latter are relatively well understood, but no systematic studies have examined auditory extinction. Here, we performed a systematic study of anatomo-clinical correlates of extinction by using dichotic and/or diotic listening tasks. In total, 20 patients with right hemispheric damage (RHD) and 19 with left hemispheric damage (LHD) performed dichotic and diotic listening tasks. Either task consists of the simultaneous presentation of word pairs; in the dichotic task, 1 word is presented to each ear, and in the diotic task, each word is lateralized by means of interaural time differences and presented to one side. RHD was associated with exclusively contralesional extinction in dichotic or diotic listening, whereas in selected cases, LHD led to contra- or ipsilesional extinction. Bilateral symmetrical extinction occurred in RHD or LHD, with dichotic or diotic listening. The anatomical correlates of these extinction profiles offer an insight into the organisation of the auditory and attentional systems. First, left extinction in dichotic versus diotic listening involves different parts of the right hemisphere, which explains the double dissociation between these 2 neglect symptoms. Second, contralesional extinction in the dichotic task relies on homologous regions in either hemisphere. Third, ipsilesional extinction in dichotic listening after LHD was associated with lesions of the intrahemispheric white matter, interrupting callosal fibres outside their midsagittal or periventricular trajectory. Fourth, bilateral symmetrical extinction was associated with large parieto-fronto-temporal LHD or smaller parieto-temporal RHD, which suggests that divided attention, supported by the right hemisphere, and auditory streaming, supported by the left, likely play a critical role. Copyright © 2018. Published by Elsevier Masson SAS.
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Silk, Aaron; Lenton, Gavin; Savage, Robbie; Aisbett, Brad
2018-02-01
Search and rescue operations are necessary in locating, assisting and recovering individuals lost or in distress. In Australia, land-based search and rescue roles require a range of physically demanding tasks undertaken in dynamic and challenging environments. The aim of the current research was to identify and characterise the physically demanding tasks inherent to search and rescue operation personnel within Australia. These aims were met through a subjective job task analysis approach. In total, 11 criterion tasks were identified by personnel. These tasks were the most physically demanding, frequently occurring and operationally important tasks to these specialist roles. Muscular strength was the dominant fitness component for 7 of the 11 tasks. In addition to the discrete criterion tasks, an operational scenario was established. With the tasks and operational scenario identified, objective task analysis procedures can be undertaken so that practitioners can implement evidence-based strategies, such as physical selection procedures and task-based physical training programs, commensurate with the physical demands of search and rescue job roles. Practitioner Summary: The identification of physically demanding tasks amongst specialist emergency service roles predicates health and safety strategies which can be incorporated into organisations. Knowledge of physical task parameters allows employers to mitigate injury risk through the implementation of strategies modelled on the precise physical demands of the role.
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Employment, family roles, and mental ill health in young married women.
Woods, N F
1985-01-01
Women are entering the labor force at unprecedented rates, many combining employment with their roles as wives and mothers. The purpose of this study was to determine if the complement of women's roles was associated with negative mental health effects. It was hypothesized that multiple roles would have negative effects on mental health only in the presence of a social context that itself was associated with symptoms of mental ill health. The contextual variables included influence of sex role norms, task-sharing support from the spouse, and support from a confidant. A sample of 140 married women randomly selected from registrants at a family health clinic were interviewed about their roles and mental health. The complement of the women's roles was not associated with mental ill health, nor was there a clear relationship between employment or parenting on mental health. Each of the contextual variables had a moderate influence on symptoms of mental ill health. Women who had traditional sex role norms, little task-sharing support from a spouse, and little support from a confidant had poorer mental health than their counterparts. Thus, in this sample, the context for role performance had a stronger influence on mental health than did the actual roles women performed. In addition, the importance of the social contextual variables was contingent on the woman's complement of roles. For women who were both spouse and parent, confiding support was most important.(ABSTRACT TRUNCATED AT 250 WORDS)
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Learning to listen again: the role of compliance in auditory training for adults with hearing loss.
Chisolm, Theresa Hnath; Saunders, Gabrielle H; Frederick, Melissa T; McArdle, Rachel A; Smith, Sherri L; Wilson, Richard H
2013-12-01
To examine the role of compliance in the outcomes of computer-based auditory training with the Listening and Communication Enhancement (LACE) program in Veterans using hearing aids. The authors examined available LACE training data for 5 tasks (i.e., speech-in-babble, time compression, competing speaker, auditory memory, missing word) from 50 hearing-aid users who participated in a larger, randomized controlled trial designed to examine the efficacy of LACE training. The goals were to determine: (a) whether there were changes in performance over 20 training sessions on trained tasks (i.e., on-task outcomes); and (b) whether compliance, defined as completing all 20 sessions, vs. noncompliance, defined as completing less than 20 sessions, influenced performance on parallel untrained tasks (i.e., off-task outcomes). The majority, 84% of participants, completed 20 sessions, with maximum outcome occurring with at least 10 sessions of training for some tasks and up to 20 sessions of training for others. Comparison of baseline to posttest performance revealed statistically significant improvements for 4 of 7 off-task outcome measures for the compliant group, with at least small (0.2 < d < 0.3) Cohen's d effect sizes for 3 of the 4. There were no statistically significant improvements observed for the noncompliant group. The high level of compliance in the present study may be attributable to use of systematized verbal and written instructions with telephone follow-up. Compliance, as expected, appears important for optimizing the outcomes of auditory training. Methods to improve compliance in clinical populations need to be developed, and compliance data are important to report in future studies of auditory training.
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Legal Issues for the Medical Director
2015-01-01
The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles—nephrology practice and the leadership of a dialysis clinic—may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment. PMID:25492255
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Tortorella, C; Romano, R; Direnzo, V; Taurisano, P; Zoccolella, S; Iaffaldano, P; Fazio, L; Viterbo, R; Popolizio, T; Blasi, G; Bertolino, A; Trojano, M
2013-08-01
Load-related functional magnetic resonance imaging (fMRI) abnormalities of brain activity during performance of attention tasks have been described in definite multiple sclerosis (MS). No data are available in clinically isolated syndrome (CIS) suggestive of MS. The objective of this research is to evaluate in CIS patients the fMRI pattern of brain activation during an attention task and to explore the effect of increasing task load demand on neurofunctional modifications. Twenty-seven untreated CIS patients and 32 age- and sex-matched healthy controls (HCs) underwent fMRI while performing the Variable Attentional Control (VAC) task, a cognitive paradigm requiring increasing levels of attentional control processing. Random-effects models were used for statistical analyses of fMRI data. CIS patients had reduced accuracy and greater reaction time at the VAC task compared with HCs (p=0.007). On blood oxygenation level-dependent (BOLD)-fMRI, CIS patients had greater activity in the right parietal cortex (p=0.0004) compared with HCs. Furthermore, CIS patients had greater activity at the lower (p=0.05) and reduced activity at the greater (p=0.04) level of attentional control demand in the left putamen, compared with HCs. This study demonstrates the failure of attentional control processing in CIS. The load-related fMRI dysfunction of the putamen supports the role of basal ganglia in the failure of attention observed at the earliest stage of MS.
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Physician perceptions of the role and value of basic science knowledge in daily clinical practice.
Fischer, Jennifer A; Muller-Weeks, Susan
2012-01-01
The role of basic science education in a clinical setting remains unclear. Research to understand how academic clinicians perceive and use this part of their education can aid curricular development. To assess physician's attitudes toward the value of science knowledge in their clinical practice. Academic physicians from three medical schools completed a questionnaire about the utility of basic science education in core clinical tasks and in practice-based learning and improvement. A total of 109 clinical faculty returned the survey. Overall, 89% of the respondents indicated that basic science education is valuable to their clinical practice. When asked about the utility of basic science information in relation to direct patient care, greater than 50% of the doctors felt they use this when diagnosing and communicating with patients. This rose to greater than 60% when asked about choosing treatment options for their patients. Individuals also responded that basic science knowledge is valuable when developing evidence-based best practices. Specifically, 89% felt that they draw upon this information when training students/residents and 84% use this information when reading journal articles. This study shows that basic science education is perceived by responding academic physicians to be important to their clinical work.
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The relationship between executive functions and fluid intelligence in Parkinson's disease
Roca, M.; Manes, F.; Chade, A.; Gleichgerrcht, E.; Gershanik, O.; Arévalo, G. G.; Torralva, T.; Duncan, J.
2012-01-01
Background We recently demonstrated that decline in fluid intelligence is a substantial contributor to frontal deficits. For some classical ‘executive’ tasks, such as the Wisconsin Card Sorting Test (WCST) and Verbal Fluency, frontal deficits were entirely explained by fluid intelligence. However, on a second set of frontal tasks, deficits remained even after statistically controlling for this factor. These tasks included tests of theory of mind and multitasking. As frontal dysfunction is the most frequent cognitive deficit observed in early Parkinson's disease (PD), the present study aimed to determine the role of fluid intelligence in such deficits. Method We assessed patients with PD (n=32) and control subjects (n=22) with the aforementioned frontal tests and with a test of fluid intelligence. Group performance was compared and fluid intelligence was introduced as a covariate to determine its role in frontal deficits shown by PD patients. Results In line with our previous results, scores on the WCST and Verbal Fluency were closely linked to fluid intelligence. Significant patient–control differences were eliminated or at least substantially reduced once fluid intelligence was introduced as a covariate. However, for tasks of theory of mind and multitasking, deficits remained even after fluid intelligence was statistically controlled. Conclusions The present results suggest that clinical assessment of neuropsychological deficits in PD should include tests of fluid intelligence, together with one or more specific tasks that allow for the assessment of residual frontal deficits associated with theory of mind and multitasking. PMID:22440401
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Motivation and academic achievement in medical students.
Yousefy, Alireza; Ghassemi, Gholamreza; Firouznia, Samaneh
2012-01-01
Despite their ascribed intellectual ability and achieved academic pursuits, medical students' academic achievement is influenced by motivation. This study is an endeavor to examine the role of motivation in the academic achievement of medical students. In this cross-sectional correlational study, out of the total 422 medical students, from 4th to final year during the academic year 2007-2008, at School of Medicine, Isfahan University of Medical Sciences, 344 participated in completion of the Inventory of School Motivation (ISM), comprising 43 items and measuring eight aspects of motivation. The gold standard for academic achievement was their average academic marks at pre-clinical and clinical levels. Data were computer analyzed by running a couple of descriptive and analytical tests including Pearson Correlation and Student's t-student. Higher motivation scores in areas of competition, effort, social concern, and task were accompanied by higher average marks at pre-clinical as well as clinical levels. However, the latter ones showed greater motivation for social power as compared to the former group. Task and competition motivation for boys was higher than for girls. In view of our observations, students' academic achievement requires coordination and interaction between different aspects of motivation.
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Laboratory review: the role of gait analysis in seniors' mobility and fall prevention.
Bridenbaugh, Stephanie A; Kressig, Reto W
2011-01-01
Walking is a complex motor task generally performed automatically by healthy adults. Yet, by the elderly, walking is often no longer performed automatically. Older adults require more attention for motor control while walking than younger adults. Falls, often with serious consequences, can be the result. Gait impairments are one of the biggest risk factors for falls. Several studies have identified changes in certain gait parameters as independent predictors of fall risk. Such gait changes are often too discrete to be detected by clinical observation alone. At the Basel Mobility Center, we employ the GAITRite electronic walkway system for spatial-temporal gait analysis. Although we have a large range of indications for gait analyses and several areas of clinical research, our focus is on the association between gait and cognition. Gait analysis with walking as a single-task condition alone is often insufficient to reveal underlying gait disorders present during normal, everyday activities. We use a dual-task paradigm, walking while simultaneously performing a second cognitive task, to assess the effects of divided attention on motor performance and gait control. Objective quantification of such clinically relevant gait changes is necessary to determine fall risk. Early detection of gait disorders and fall risk permits early intervention and, in the best-case scenario, fall prevention. We and others have shown that rhythmic movement training such as Jaques-Dalcroze eurhythmics, tai chi and social dancing can improve gait regularity and automaticity, thus increasing gait safety and reducing fall risk. Copyright © 2010 S. Karger AG, Basel.
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Emerging roles of innate lymphoid cells in inflammatory diseases: Clinical implications.
Kortekaas Krohn, I; Shikhagaie, M M; Golebski, K; Bernink, J H; Breynaert, C; Creyns, B; Diamant, Z; Fokkens, W J; Gevaert, P; Hellings, P; Hendriks, R W; Klimek, L; Mjösberg, J; Morita, H; Ogg, G S; O'Mahony, L; Schwarze, J; Seys, S F; Shamji, M H; Bal, S M
2018-04-01
Innate lymphoid cells (ILC) represent a group of lymphocytes that lack specific antigen receptors and are relatively rare as compared to adaptive lymphocytes. ILCs play important roles in allergic and nonallergic inflammatory diseases due to their location at barrier surfaces within the airways, gut, and skin, and they respond to cytokines produced by activated cells in their local environment. Innate lymphoid cells contribute to the immune response by the release of cytokines and other mediators, forming a link between innate and adaptive immunity. In recent years, these cells have been extensively characterized and their role in animal models of disease has been investigated. Data to translate the relevance of ILCs in human pathology, and the potential role of ILCs in diagnosis, as biomarkers and/or as future treatment targets are also emerging. This review, produced by a task force of the Immunology Section of the European Academy of Allergy and Clinical Immunology (EAACI), encompassing clinicians and researchers, highlights the role of ILCs in human allergic and nonallergic diseases in the airways, gastrointestinal tract, and skin, with a focus on new insights into clinical implications, therapeutic options, and future research opportunities. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
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Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review.
Keller, Sara C; Tamma, Pranita D; Cosgrove, Sara E; Miller, Melissa A; Sateia, Heather; Szymczak, Julie; Gurses, Ayse P; Linder, Jeffrey A
2018-01-01
In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. This model describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes. The work system consists of 5 components, tools and technology, organization, person, tasks, and environment, within an external environment. Of 1,288 abstracts initially identified, 42 quantitative studies and 17 qualitative studies met inclusion criteria. Effective interventions focused on tools and technology (eg, clinical decision support and point-of-care testing), the person (eg, clinician education), organization (eg, audit and feedback and academic detailing), tasks (eg, delayed antibiotic prescribing), the environment (eg, commitment posters), and the external environment (media campaigns). Studies have not focused on clinic-wide approaches to AS. A human factors engineering approach suggests that investigating the role of the clinic's processes or physical layout or external pressures' role in antibiotic prescribing may be a promising way to improve ambulatory AS. © Copyright 2018 by the American Board of Family Medicine.
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ERIC Educational Resources Information Center
Munson, Benjamin; Johnson, Julie M.; Edwards, Jan
2012-01-01
Purpose: This study examined whether experienced speech-language pathologists (SLPs) differ from inexperienced people in their perception of phonetic detail in children's speech. Method: Twenty-one experienced SLPs and 21 inexperienced listeners participated in a series of tasks in which they used a visual-analog scale (VAS) to rate children's…
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Farzandipour, Mehrdad; Meidani, Zahra; Riazi, Hossein; Sadeqi Jabali, Monireh
2016-12-01
Considering the integral role of understanding users' requirements in information system success, this research aimed to determine functional requirements of nursing information systems through a national survey. Delphi technique method was applied to conduct this study through three phases: focus group method modified Delphi technique and classic Delphi technique. A cross-sectional study was conducted to evaluate the proposed requirements within 15 general hospitals in Iran. Forty-three of 76 approved requirements were clinical, and 33 were administrative ones. Nurses' mean agreements for clinical requirements were higher than those of administrative requirements; minimum and maximum means of clinical requirements were 3.3 and 3.88, respectively. Minimum and maximum means of administrative requirements were 3.1 and 3.47, respectively. Research findings indicated that those information system requirements that support nurses in doing tasks including direct care, medicine prescription, patient treatment management, and patient safety have been the target of special attention. As nurses' requirements deal directly with patient outcome and patient safety, nursing information systems requirements should not only address automation but also nurses' tasks and work processes based on work analysis.
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Overgeneral autobiographical memory bias in clinical and non-clinical voice hearers.
Jacobsen, Pamela; Peters, Emmanuelle; Ward, Thomas; Garety, Philippa A; Jackson, Mike; Chadwick, Paul
2018-03-14
Hearing voices can be a distressing and disabling experience for some, whilst it is a valued experience for others, so-called 'healthy voice-hearers'. Cognitive models of psychosis highlight the role of memory, appraisal and cognitive biases in determining emotional and behavioural responses to voices. A memory bias potentially associated with distressing voices is the overgeneral memory bias (OGM), namely the tendency to recall a summary of events rather than specific occasions. It may limit access to autobiographical information that could be helpful in re-appraising distressing experiences, including voices. We investigated the possible links between OGM and distressing voices in psychosis by comparing three groups: (1) clinical voice-hearers (N = 39), (2) non-clinical voice-hearers (N = 35) and (3) controls without voices (N = 77) on a standard version of the autobiographical memory test (AMT). Clinical and non-clinical voice-hearers also completed a newly adapted version of the task, designed to assess voices-related memories (vAMT). As hypothesised, the clinical group displayed an OGM bias by retrieving fewer specific autobiographical memories on the AMT compared with both the non-clinical and control groups, who did not differ from each other. The clinical group also showed an OGM bias in recall of voice-related memories on the vAMT, compared with the non-clinical group. Clinical voice-hearers display an OGM bias when compared with non-clinical voice-hearers on both general and voices-specific recall tasks. These findings have implications for the refinement and targeting of psychological interventions for psychosis.
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Impulsivity and the 5-HTTLPR Polymorphism in a Non-Clinical Sample
Lage, Guilherme M.; Malloy-Diniz, Leandro F.; Matos, Lorena O.; Bastos, Marisa A. R.; Abrantes, Suzana S. C.; Corrêa, Humberto
2011-01-01
Background Impulsivity has been associated with serotonergic system functions. However, few researchers have investigated the relationship between a polymorphism in the promoter of the serotonin transporter gene (5-HTTLPR) and the different components of impulsivity in a non-clinical population. The aim of this study was to investigate the relationship between a polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) and the different components of impulsivity in a non-clinical population. Methodology/Principal Findings We administered two neuropsychological tests, the Continuous Performance Task and the Iowa Gambling Task, to 127 healthy participants to measure their levels of motor, attentional and non-planning impulsivity. Then, these participants were grouped by genotype and gender, and their scores on impulsivity measures were compared. There were no significant differences between group scores on attentional, motor and non-planning impulsivity. Conclusions/Significance Our results suggest that 5-HTTLPR genotype is not significantly associated with subsets of impulsive behavior in a non-clinical sample when measured by neuropsychological tests. These findings are discussed in terms of the sensitivity of neuropsychological tests to detect impulsivity in a non-clinical population and the role of gender and race in the relationship between the 5-HTTLPR and impulsivity. PMID:21386887
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Comparison of gesture and conventional interaction techniques for interventional neuroradiology.
Hettig, Julian; Saalfeld, Patrick; Luz, Maria; Becker, Mathias; Skalej, Martin; Hansen, Christian
2017-09-01
Interaction with radiological image data and volume renderings within a sterile environment is a challenging task. Clinically established methods such as joystick control and task delegation can be time-consuming and error-prone and interrupt the workflow. New touchless input modalities may have the potential to overcome these limitations, but their value compared to established methods is unclear. We present a comparative evaluation to analyze the value of two gesture input modalities (Myo Gesture Control Armband and Leap Motion Controller) versus two clinically established methods (task delegation and joystick control). A user study was conducted with ten experienced radiologists by simulating a diagnostic neuroradiological vascular treatment with two frequently used interaction tasks in an experimental operating room. The input modalities were assessed using task completion time, perceived task difficulty, and subjective workload. Overall, the clinically established method of task delegation performed best under the study conditions. In general, gesture control failed to exceed the clinical input approach. However, the Myo Gesture Control Armband showed a potential for simple image selection task. Novel input modalities have the potential to take over single tasks more efficiently than clinically established methods. The results of our user study show the relevance of task characteristics such as task complexity on performance with specific input modalities. Accordingly, future work should consider task characteristics to provide a useful gesture interface for a specific use case instead of an all-in-one solution.
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Autobiographical Memory Task in Assessing Dementia
Dreyfus, Denise Maue; Roe, Catherine M.; Morris, John C.
2009-01-01
Objective To appraise the relationship of a task assessing memory for recent autobiographical events and those of two commonly used brief memory tasks with the results of a clinical assessment for dementia. Design, Setting, and Participants We compared correlations between a task assessing recall of recent autobiographical events and two frequently-used brief clinical memory measures with dementia ratings by clinicians. Participants were enrolled in Washington University Alzheimer’s Disease Research Center studies, were aged 60 years or above, and took part in assessments between May 2002 and August 2005 (N=425). Main Outcome Measures Nonparametric, rank-based Spearman correlations, adjusted for age and education, between the Clinical Dementia Rating Sum of Boxes (CDR-SB) and scores on the autobiographical recall query and two clinical memory tasks taken from the Mini-Mental State Exam and the Short Blessed Test. Results The autobiographical recall task and each of the other brief clinical measures correlated significantly with the CDR-SB (p<.0001). The autobiographical recall task had a significantly higher correlation (p<.0001) with the CDR-SB than the two commonly-used clinical memory measures. Conclusions Clinicians may find autobiographical memories an important indicator of clinical memory function and the autobiographical query a useful tool when assessing for dementia. PMID:20625094
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The effects of respiratory sinus arrhythmia on anger reactivity and persistence in major depression.
Ellis, Alissa J; Shumake, Jason; Beevers, Christopher G
2016-10-01
The experience of anger during a depressive episode has recently been identified as a poor prognostic indicator of illness course. Given the clinical implications of anger in major depressive disorder (MDD), understanding the mechanisms involved in anger reactivity and persistence is critical for improved intervention. Biological processes involved in emotion regulation during stress, such as respiratory sinus arrhythmia (RSA), may play a role in maintaining negative moods. Clinically depressed (MDD; n = 49) and nondepressed (non-MDD; n = 50) individuals were challenged with a stressful computer task shown to increase anger, while RSA (high frequency range 0.15-0.4 Hz) was collected. RSA predicted future anger, but was unrelated to current anger. That is, across participants, low baseline RSA predicted anger reactivity during the task, and in depressed individuals, those with low RSA during the task had a greater likelihood of anger persistence during a recovery period. These results suggest that low RSA may be a psychophysiological process involved in anger regulation in depression. Low RSA may contribute to sustained illness course by diminishing the repair of angry moods. © 2016 Society for Psychophysiological Research.
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The relationship between organizational climate and quality of chronic disease management.
Benzer, Justin K; Young, Gary; Stolzmann, Kelly; Osatuke, Katerine; Meterko, Mark; Caso, Allison; White, Bert; Mohr, David C
2011-06-01
To test the utility of a two-dimensional model of organizational climate for explaining variation in diabetes care between primary care clinics. Secondary data were obtained from 223 primary care clinics in the Department of Veterans Affairs health care system. Organizational climate was defined using the dimensions of task and relational climate. The association between primary care organizational climate and diabetes processes and intermediate outcomes were estimated for 4,539 patients in a cross-sectional study. All data were collected from administrative datasets. The climate data were drawn from the 2007 VA All Employee Survey, and the outcomes data were collected as part of the VA External Peer Review Program. Climate data were aggregated to the facility level of analysis and merged with patient-level data. Relational climate was related to an increased likelihood of diabetes care process adherence, with significant but small effects for adherence to intermediate outcomes. Task climate was generally not shown to be related to adherence. The role of relational climate in predicting the quality of chronic care was supported. Future research should examine the mediators and moderators of relational climate and further investigate task climate. © Health Research and Educational Trust.
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Usability Evaluation of an Unstructured Clinical Document Query Tool for Researchers.
Hultman, Gretchen; McEwan, Reed; Pakhomov, Serguei; Lindemann, Elizabeth; Skube, Steven; Melton, Genevieve B
2018-01-01
Natural Language Processing - Patient Information Extraction for Researchers (NLP-PIER) was developed for clinical researchers for self-service Natural Language Processing (NLP) queries with clinical notes. This study was to conduct a user-centered analysis with clinical researchers to gain insight into NLP-PIER's usability and to gain an understanding of the needs of clinical researchers when using an application for searching clinical notes. Clinical researcher participants (n=11) completed tasks using the system's two existing search interfaces and completed a set of surveys and an exit interview. Quantitative data including time on task, task completion rate, and survey responses were collected. Interviews were analyzed qualitatively. Survey scores, time on task and task completion proportions varied widely. Qualitative analysis indicated that participants found the system to be useful and usable in specific projects. This study identified several usability challenges and our findings will guide the improvement of NLP-PIER 's interfaces.
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Binagwaho, Agnes; Sarriera, Gabriela; Eagan, Arielle
2016-07-09
As Eyal et al put forth in their piece, Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians, task-shifting across sub-Saharan Africa through non-physician clinicians (NPCs) has led to an improvement in access to health services in the context of physician-shortages. Here, we offer a commentary to the piece by Eyal et al, concurring that physician's roles should evolve into specialized medicine and that skills in mentorship, research, management, and leadership may create more holistic physicians clinical services. We believe that learning such non-clinical skills will allow physicians to improve the outcome of their clinical services. However, at the risk of a local, clinical brain drain as physicians shift to explore beyond the clinical sphere, we advocate strongly for increased caution to be exercised by leadership over the encouragement of this evolution. In the context of still-present physician shortages across many developing countries, we advocate to analyze this changing role and to purposefully select each new skill according to the context, giving careful consideration to the timing and degree of its evolution. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Ebert, Kerry Danahy
2014-01-01
Sentence repetition performance is attracting increasing interest as a valuable clinical marker for primary (or specific) language impairment (LI) in both monolingual and bilingual populations. Multiple aspects of memory appear to contribute to sentence repetition performance, but non-verbal memory has not yet been considered. To explore the relationship between a measure of non-verbal auditory working memory (NVWM) and sentence repetition performance in a sample of bilingual children with LI. Forty-seven school-aged Spanish-English bilingual children with LI completed sentence repetition and non-word repetition tasks in both Spanish and English as well as an NVWM task. Hierarchical multiple linear regression was used to predict sentence repetition in each language using age, non-word repetition and NVWM. NVWM predicted unique variance in sentence repetition performance in both languages after accounting for chronological age and language-specific phonological memory, as measured by non-word repetition. Domain-general memory resources play a unique role in sentence repetition performance in children with LI. Non-verbal working memory weaknesses may contribute to the poor performance of children with LI on sentence repetition tasks. © 2014 Royal College of Speech and Language Therapists.
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Ebert, Kerry Danahy
2015-01-01
Background Sentence repetition performance is attracting increasing interest as a valuable clinical marker for Primary (or Specific) Language Impairment (LI) in both monolingual and bilingual populations. Multiple aspects of memory appear to contribute to sentence repetition performance, but nonverbal memory has not yet been considered. Aims The purpose of this study was to explore the relationship between a measure of nonverbal auditory working memory (NVWM) and sentence repetition performance in a sample of bilingual children with LI. Methods & Procedures Forty-seven school-aged Spanish-English bilingual children with LI completed sentence repetition and nonword repetition tasks in both Spanish and English as well as an NVWM task. Hierarchical multiple linear regression was used to predict sentence repetition in each language using age, nonword repetition, and NVWM. Outcomes & Results NVWM predicted unique variance in sentence repetition performance in both languages after accounting for chronological age and language-specific phonological memory, as measured by nonword repetition. Conclusions & Implications Domain-general memory resources play a unique role in sentence repetition performance in children with LI. Nonverbal working memory weaknesses may contribute to the poor performance of children with LI on sentence repetition tasks. PMID:24894308
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Connectivity changes after laser ablation: Resting-state fMRI.
Boerwinkle, Varina L; Vedantam, Aditya; Lam, Sandi; Wilfong, Angus A; Curry, Daniel J
2018-05-01
Resting-state functional magnetic resonance imaging (rsfMRI) is emerging as a useful tool in the multimodal assessment of patients with epilepsy. In pediatric patients who cannot perform task-based fMRI, rsfMRI may present an adjunct and alternative. Although changes in brain activation during task-based fMRI have been described after surgery for epilepsy, there is limited data on the role of postoperative rsfMRI. In this short review, we discuss the role of postoperative rsfMRI after laser ablation of seizure foci. By establishing standardized anesthesia protocols and imaging parameters, we have been able to perform serial rsfMRI at postoperative follow-up. The development of in-house software that can merge rsfMRI images to surgical navigation systems has allowed us to enhance the clinical applications of this technique. Resting-state fMRI after laser ablation has the potential to identify changes in connectivity, localize new seizure foci, and guide antiepileptic therapy. In our experience, rsfMRI complements conventional MR imaging and task-based fMRI for the evaluation of patients with seizure recurrence after laser ablation, and represents a potential noninvasive biomarker for functional connectivity. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
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Building gold standard corpora for medical natural language processing tasks.
Deleger, Louise; Li, Qi; Lingren, Todd; Kaiser, Megan; Molnar, Katalin; Stoutenborough, Laura; Kouril, Michal; Marsolo, Keith; Solti, Imre
2012-01-01
We present the construction of three annotated corpora to serve as gold standards for medical natural language processing (NLP) tasks. Clinical notes from the medical record, clinical trial announcements, and FDA drug labels are annotated. We report high inter-annotator agreements (overall F-measures between 0.8467 and 0.9176) for the annotation of Personal Health Information (PHI) elements for a de-identification task and of medications, diseases/disorders, and signs/symptoms for information extraction (IE) task. The annotated corpora of clinical trials and FDA labels will be publicly released and to facilitate translational NLP tasks that require cross-corpora interoperability (e.g. clinical trial eligibility screening) their annotation schemas are aligned with a large scale, NIH-funded clinical text annotation project.
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Action-semantic and syntactic deficits in subjects at risk for Huntington's disease.
García, Adolfo M; Bocanegra, Yamile; Herrera, Eduar; Pino, Mariana; Muñoz, Edinson; Sedeño, Lucas; Ibáñez, Agustín
2017-03-11
Frontostriatal networks play critical roles in grounding action semantics and syntactic skills. Indeed, their atrophy distinctively disrupts both domains, as observed in patients with Huntington's disease (HD) and Parkinson's disease, even during early disease stages. However, frontostriatal degeneration in these conditions may begin up to 15 years before the onset of clinical symptoms, opening avenues for pre-clinical detection via sensitive tasks. Such a mission is particularly critical in HD, given that patients' children have 50% chances of inheriting the disease. Against this background, we assessed whether deficits in the above-mentioned domains emerge in subjects at risk to develop HD. We administered tasks tapping action semantics, object semantics, and two forms of syntactic processing to 18 patients with HD, 19 asymptomatic first-degree relatives, and sociodemographically matched controls for each group. The patients evinced significant deficits in all tasks, but only those in the two target domains were independent of overall cognitive state. More crucially, relative to controls, the asymptomatic relatives were selectively impaired in action semantics and in the more complex syntactic task, with both patterns emerging irrespective of the subjects' overall cognitive state. Our findings highlight the relevance of these dysfunctions as potential prodromal biomarkers of HD. Moreover, they offer theoretical insights into the differential contributions of frontostriatal hubs to both domains while paving the way for innovations in diagnostic procedures. © 2017 The British Psychological Society.
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How electronic health records can unmask the hidden value of PAs.
Ogunfiditimi, Folusho; Sherry, Scott P; Foote, Monica; Christie, Sarah L; Shock, Lisa P; Cawley, James; Browne, Aaron
2017-06-01
The Fee for Value (FFV) Task Force, a subgroup of the American Academy of PAs' Research and Strategic Initiatives Commission, has examined tools and mechanisms aimed at better clarifying the volume and value of PA work and how that work contributes to improving access to high-quality care. Establishing the value of PAs has been a challenging task for many healthcare providers. Often, PA value has been defined by their clinical productivity, without any clear direction as to what constitutes value versus productivity. The objective of this article is to unmask the value of PAs through the role of electronic health records and highlight PAs' ability to produce services that are value-oriented and quantifiably productive.
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Muhit, A; Zbijewski, W; Stayman, J; Thawait, G; Yorkston, J; Foos, D; Packard, N; Yang, D; Senn, R; Carrino, J; Siewerdsen, J
2012-06-01
To assess the diagnostic performance of a prototype cone-beam CT (CBCT) scanner developed for musculoskeletal extremity imaging. Studies involved controlled observer studies conducted subsequent to rigorous technical assessment as well as patient images from the first clinical trial in imaging the hand and knee. Performance assessment included: 1.) rigorous technical assessment; 2.) controlled observer studies using CBCT images of cadaveric specimens; and 3.) first clinical images. Technical assessment included measurement of spatial resolution (MTF), constrast, and noise (SDNR) versus kVp and dose using standard CT phantoms. Diagnostic performance in comparison to multi- detector CT (MDCT) was assessed in controlled observer studies involving 12 cadaveric hands and knees scanned with and without abnormality (fracture). Observer studies involved five radiologists rating pertinent diagnostics tasks in 9-point preference and 10-point diagnostic satisfaction scales. Finally, the first clinical images from an ongoing pilot study were assessed in terms of diagnostic utility in disease assessment and overall workflow in patient setup. Quantitative assessment demonstrated sub-mm spatial resolution (MTF exceeding 10% out to 15-20 cm-1) and SDNR sufficient for relevant soft-tissue visualization tasks at dose <10 mGy. Observer studies confirmed optimal acquisition techniques and demonstrated superior utility of combined soft-tissue visualization and isotropic spatial resolution in diagnostic tasks. Images from the patient trial demonstrate exquisite contrast and detail and the ability to detect tissue impingement in weight-bearing exams. The prototype CBCT scanner provides isotropic spatial resolution superior to standard-protocol MDCT with soft-tissue visibility sufficient for a broad range of diagnostic tasks in musculoskeletal radiology. Dosimetry and workflow were advantageous in comparison to whole-body MDCT. Multi-mode and weight-bearing capabilities add valuable functionality. An ongoing clinical study further assesses diagnostic utility and defines the role of such technology in the diagnostic arsenal. - Research Grant, Carestream Health - Research Grant, National Institutes of Health 2R01-CA-112163. © 2012 American Association of Physicists in Medicine.
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Higgins, Torrance J.; Janelle, Christopher M.; Naugle, Kelly M.; Knaggs, Jeffrey; Hoover, Brian M.; Marsiske, Michael; Manini, Todd M.
2012-01-01
Classic developmental theory suggests that aging is associated with using compensatory strategies to prolong independence. While compensatory strategies are typically considered positive adaptations, they also signify an early phase in the disablement process — commonly known as pre-clinical disability. To build a better understanding of psychological constructs related to these early signs of disability, we examined the contribution of self-efficacy and state anxiety on using compensatory strategies among pre-clinically disabled older adults. Compensatory strategies were observed during performance of daily activities in 257 pre-clinically disabled older adults (67.6 ± 7.04), and self-efficacy and state anxiety were evaluated prior to performing each task. In univariate models, lower self-efficacy and higher anxiety were associated with more compensation (Spearman correlations: 0.15-0.48, p < 0.05). Multivariate logistic regression indicated that low self-efficacy [Odds Ratio (OR): 1.70; 95% Confidence Interval (CI): 1.40-2.08) and high anxiety (OR: 1.34; 95% CI: 1.10-1.63) were positively associated with using ≥ 6 compensatory strategies – a level signifying substantial compensation. When considered jointly with self-efficacy, the association with anxiety was reversed— higher anxiety demonstrated a lower likelihood of using compensation (OR: 0.70-0.73; 95% CI: 0.50-0.99). The addition of self-efficacy might remove the self-defeating cognitions characterizing anxiety allowing the remaining arousal component to appear beneficial. In conclusion, lower self-efficacy and higher anxiety are associated with using compensation to complete daily tasks among pre-clinically disabled older adults. Such psychological constructs may contribute to the use of compensatory strategies and represent future intervention targets to help reduce early signs of disability. PMID:22770713
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Career development resource: academic career in surgical education.
Sanfey, Hilary; Gantt, Nancy L
2012-07-01
Academic surgeons play an instrumental role in the training of our medical students and surgical residents. Although volunteer faculty often have an important role in the clinical development of surgeons-in-training, the tasks of curricular development, structured didactic sessions, professional advising, research sponsorship, and mentoring at all levels fall to the academic surgeon. Historically, the career advancement path for an academic physician favored grant acquisition and scholarly publication. Broader definitions of scholarship have emerged, along with corresponding modifications in academic award systems that allow advancement in faculty rank based on a surgeon's educational efforts. Copyright © 2012 Elsevier Inc. All rights reserved.
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Stress at School? A Qualitative Study on Illegitimate Tasks during Teacher Training.
Faupel, Stefanie; Otto, Kathleen; Krug, Henning; Kottwitz, Maria U
2016-01-01
What do I expect when stating that "I am going to be a teacher"? Social roles, including professional roles, often become part of people's identity and thus, of the self. As people typically strive for maintaining a positive sense of self, threats to one's role identity are likely to induce stress. In line with these considerations, Semmer et al. recently (e.g., Semmer et al., 2007, 2015) introduced "illegitimate tasks" as a new concept of stressors. Illegitimate tasks, which are defined as unnecessary or unreasonable tasks, threaten the self because they signal a lack of appreciation regarding one's professional role. Teacher training is a phase of role transition in which the occurrence of illegitimate tasks becomes likely. A holistic understanding of these tasks, however, has been missing up to now. Is there already a professional role identity during teacher training that is vulnerable to threats like the illegitimacy of tasks? What are typical illegitimate tasks in the context of teacher training? In order to close this research gap, 39 situations taken from 16 interviews with teaching trainees were analyzed in the present study on the basis of qualitative content analysis. Seminars and standing in to hold lessons for other teachers were identified as most prevalent illegitimate tasks. More specifically, unnecessary tasks could be classified as sub challenging, inefficient and lacking in organization (e.g., writing reports about workshops no one will ever read). Unreasonable tasks appeared overextending, fell outside responsibility, and lacked supervisory support. Training interventions focusing upon task design and supervisory behavior are suggested for improvement.
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Douglas, Heather E; Raban, Magdalena Z; Walter, Scott R; Westbrook, Johanna I
2017-03-01
Multi-tasking is an important skill for clinical work which has received limited research attention. Its impacts on clinical work are poorly understood. In contrast, there is substantial multi-tasking research in cognitive psychology, driver distraction, and human-computer interaction. This review synthesises evidence of the extent and impacts of multi-tasking on efficiency and task performance from health and non-healthcare literature, to compare and contrast approaches, identify implications for clinical work, and to develop an evidence-informed framework for guiding the measurement of multi-tasking in future healthcare studies. The results showed healthcare studies using direct observation have focused on descriptive studies to quantify concurrent multi-tasking and its frequency in different contexts, with limited study of impact. In comparison, non-healthcare studies have applied predominantly experimental and simulation designs, focusing on interleaved and concurrent multi-tasking, and testing theories of the mechanisms by which multi-tasking impacts task efficiency and performance. We propose a framework to guide the measurement of multi-tasking in clinical settings that draws together lessons from these siloed research efforts. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Nowakowski, Matilda E; Tasker, Susan L; Cunningham, Charles E; McHolm, Angela E; Edison, Shannon; Pierre, Jeff St; Boyle, Michael H; Schmidt, Louis A
2011-02-01
Although joint attention processes are known to play an important role in adaptive social behavior in typical development, we know little about these processes in clinical child populations. We compared early school age children with selective mutism (SM; n = 19) versus mixed anxiety (MA; n = 18) and community controls (CC; n = 26) on joint attention measures coded from direct observations with their parent during an unstructured free play task and two structured tasks. As predicted, the SM dyads established significantly fewer episodes of joint attention through parental initiation acts than the MA and CC dyads during the structured tasks. Findings suggest that children with SM may withdraw from their parents during stressful situations, thus missing out on opportunities for learning other coping skills. We discuss the implications of the present findings for understanding the maintenance and treatment of SM.
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Vulnerability to the Irrelevant Sound Effect in Adult ADHD.
Pelletier, Marie-France; Hodgetts, Helen M; Lafleur, Martin F; Vincent, Annick; Tremblay, Sébastien
2016-04-01
An ecologically valid adaptation of the irrelevant sound effect paradigm was employed to examine the relative roles of short-term memory, selective attention, and sustained attention in ADHD. In all, 32 adults with ADHD and 32 control participants completed a serial recall task in silence or while ignoring irrelevant background sound. Serial recall performance in adults with ADHD was reduced relative to controls in both conditions. The degree of interference due to irrelevant sound was greater for adults with ADHD. Furthermore, a positive correlation was observed between task performance under conditions of irrelevant sound and the extent of attentional problems reported by patients on a clinical symptom scale. The results demonstrate that adults with ADHD exhibit impaired short-term memory and a low resistance to distraction; however, their capacity for sustained attention is preserved as the impact of irrelevant sound diminished over the course of the task. © The Author(s) 2013.
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Abu Bakar, A; Mohd Nor, N A; Ab-Murat, N; Jaafar, N
2015-08-01
To assess Malaysian dental therapists' perceptions of their job satisfaction and future roles. A nationwide postal survey involving all Malaysian dental therapists who met the inclusion criteria (n = 1726). The response rate was 76.8%. All respondents were females; mean age 35.4 years (SD = 8.4). Majority were married (85.5%) and more than one-half had a working experience of <10 years (56.1%). Majority worked in community dental service (94.3%) and in urban areas (61.7%). Overall, they were highly satisfied with most aspects of their career. However, they were least satisfied with administrative workload (58.1%), career advancement opportunities (51.9%) and remuneration package; specifically income (45.2%), allowances (45.2%) and non-commensurate between pay and performance (44.0%). Majority perceived their role as very important in routine clinical tasks such as examination and diagnosis, preventive treatment, extraction of deciduous teeth and oral health promotion. However, fewer than one-half consider complex treatment such as placement of preformed crowns on deciduous teeth (37.1%) and extraction of permanent teeth (37.2%) as very important tasks. Majority expressed high career satisfaction with most aspects of their employment but expressed low satisfaction in remuneration, lack of career advancement opportunities and administrative tasks. We conclude that most Malaysian dental therapists have positive perceptions of their current roles but do not favour wider expansion of their roles. These findings imply that there was a need to develop a more attractive career pathway for therapists to ensure sustainability of effective primary oral healthcare delivery system for Malaysia's children. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Jonkman, Lisa M; Markus, C Rob; Franklin, Michael S; van Dalfsen, Jens H
2017-01-01
In adulthood, depressive mood is often comorbid with ADHD, but its role in ADHD-inattentiveness and especially relations with mind wandering remains to be elucidated. This study investigated the effects of laboratory-induced dysphoric mood on task-unrelated mind wandering and its consequences on cognitive task performance in college students with high (n = 46) or low (n = 44) ADHD-Inattention symptomatology and Hyperactivity/Impulsivity symptoms in the normal range. These non-clinical high/low ADHD-Inattention symptom groups underwent negative or positive mood induction after which mind wandering frequency was measured in a sustained attention (SART), and a reading task. Effects of ruminative response style and working memory capacity on mind wandering frequency were also investigated. Significantly higher frequencies of self -reported mind wandering in daily life, in the SART and reading task were reported in the ADHD-Inattention symptom group, with detrimental effects on text comprehension in the reading task. Induced dysphoric mood did specifically enhance the frequency of mind wandering in the ADHD-Inattention symptom group only during the SART, and was related to their higher self-reported intrusive ruminative response styles. Working memory capacity did not differ between high/low attention groups and did not influence any of the reported effects. These combined results suggest that in a non-clinical sample with high ADHD-inattention symptoms, dysphoric mood and a ruminative response style seem to be more important determinants of dysfunctional mind wandering than a failure in working memory capacity/executive control, and perhaps need other ways of remediation, like cognitive behavioral therapy or mindfulness training.
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Reddy, L. Felice; Barch, Deanna M.; Buchanan, Robert W.; Dunayevich, Eduardo; Gold, James M.; Marder, Steven R.; Wynn, Jonathan K.; Young, Jared W.; Green, Michael F.
2015-01-01
Effort-based decision making has strong conceptual links to the motivational disturbances that define a key subdomain of negative symptoms. However, the extent to which effort-based decision-making performance relates to negative symptoms, and other clinical and functionally important variables has yet to be systematically investigated. In 94 clinically stable outpatients with schizophrenia, we examined the external validity of 5 effort-based paradigms, including the Effort Expenditure for Rewards, Balloon Effort, Grip Strength Effort, Deck Choice Effort, and Perceptual Effort tasks. These tasks covered 3 types of effort: physical, cognitive, and perceptual. Correlations between effort related performance and 6 classes of variables were examined, including: (1) negative symptoms, (2) clinically rated motivation and community role functioning, (3) self-reported motivational traits, (4) neurocognition, (5) other psychiatric symptoms and clinical/demographic characteristics, and (6) subjective valuation of monetary rewards. Effort paradigms showed small to medium relationships to clinical ratings of negative symptoms, motivation, and functioning, with the pattern more consistent for some measures than others. They also showed small to medium relations with neurocognitive functioning, but were generally unrelated to other psychiatric symptoms, self-reported traits, antipsychotic medications, side effects, and subjective valuation of money. There were relatively strong interrelationships among the effort measures. In conjunction with findings from a companion psychometric article, all the paradigms warrant further consideration and development, and 2 show the strongest potential for clinical trial use at this juncture. PMID:26209546
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Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer
Waguespack, Steven G.; Bauer, Andrew J.; Angelos, Peter; Benvenga, Salvatore; Cerutti, Janete M.; Dinauer, Catherine A.; Hamilton, Jill; Hay, Ian D.; Luster, Markus; Parisi, Marguerite T.; Rachmiel, Marianna; Thompson, Geoffrey B.; Yamashita, Shunichi
2015-01-01
Background: Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. Methods: A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. Results: These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. Conclusions: In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions. PMID:25900731
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Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer.
Francis, Gary L; Waguespack, Steven G; Bauer, Andrew J; Angelos, Peter; Benvenga, Salvatore; Cerutti, Janete M; Dinauer, Catherine A; Hamilton, Jill; Hay, Ian D; Luster, Markus; Parisi, Marguerite T; Rachmiel, Marianna; Thompson, Geoffrey B; Yamashita, Shunichi
2015-07-01
Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.
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Davies, Charlotte; Malik, Aiysha; Pictet, Arnaud; Blackwell, Simon E; Holmes, Emily A
2012-01-01
Spontaneous negative mental images have been extensively researched due to the crucial role they play in conditions such as post-traumatic stress disorder. However, people can also experience spontaneous positive mental images, and these are little understood. Positive images may play a role in promoting healthy positive mood and may be lacking in conditions such as depression. However, they may also occur in problematic states of elevated mood, such as in bipolar disorder. Can we apply an understanding of spontaneous imagery gained by the study of spontaneous negative images to spontaneous positive images? In an analogue of the trauma film studies, 69 volunteers viewed an explicitly positive (rather than traumatic) film. Participants were randomly allocated post-film either to perform a visuospatial task (the computer game 'Tetris') or to a no-task control condition. Viewing the film enhanced positive mood and immediately post-film increased goal setting on a questionnaire measure. The film was successful in generating involuntary memories of specific scenes over the following week. As predicted, compared with the control condition, participants in the visuospatial task condition reported significantly fewer involuntary memories from the film in a diary over the subsequent week. Furthermore, scores on a recognition memory test at 1 week indicated an impairment in voluntary recall of the film in the visuospatial task condition. Clinical implications regarding the modulation of positive imagery after a positive emotional experience are discussed. Generally, boosting positive imagery may be a useful strategy for the recovery of depressed mood. Copyright © 2012 John Wiley & Sons, Ltd.
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Charlotte, Davies; Malik, Aiysha; Pictet, Arnaud; Blackwell, Simon E; Holmes, Emily A
2012-01-01
Spontaneous negative mental images have been extensively researched due to the crucial role they play in conditions such as post-traumatic stress disorder. However, people can also experience spontaneous positive mental images, and these are little understood. Positive images may play a role in promoting healthy positive mood and may be lacking in conditions such as depression. However, they may also occur in problematic states of elevated mood, such as in bipolar disorder. Can we apply an understanding of spontaneous imagery gained by the study of spontaneous negative images to spontaneous positive images? In an analogue of the trauma film studies, 69 volunteers viewed an explicitly positive (rather than traumatic) film. Participants were randomly allocated post-film either to perform a visuospatial task (the computer game ‘Tetris’) or to a no-task control condition. Viewing the film enhanced positive mood and immediately post-film increased goal setting on a questionnaire measure. The film was successful in generating involuntary memories of specific scenes over the following week. As predicted, compared with the control condition, participants in the visuospatial task condition reported significantly fewer involuntary memories from the film in a diary over the subsequent week. Furthermore, scores on a recognition memory test at 1 week indicated an impairment in voluntary recall of the film in the visuospatial task condition. Clinical implications regarding the modulation of positive imagery after a positive emotional experience are discussed. Generally, boosting positive imagery may be a useful strategy for the recovery of depressed mood. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22570062
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Stress at School? A Qualitative Study on Illegitimate Tasks during Teacher Training
Faupel, Stefanie; Otto, Kathleen; Krug, Henning; Kottwitz, Maria U.
2016-01-01
What do I expect when stating that “I am going to be a teacher”? Social roles, including professional roles, often become part of people's identity and thus, of the self. As people typically strive for maintaining a positive sense of self, threats to one's role identity are likely to induce stress. In line with these considerations, Semmer et al. recently (e.g., Semmer et al., 2007, 2015) introduced “illegitimate tasks” as a new concept of stressors. Illegitimate tasks, which are defined as unnecessary or unreasonable tasks, threaten the self because they signal a lack of appreciation regarding one's professional role. Teacher training is a phase of role transition in which the occurrence of illegitimate tasks becomes likely. A holistic understanding of these tasks, however, has been missing up to now. Is there already a professional role identity during teacher training that is vulnerable to threats like the illegitimacy of tasks? What are typical illegitimate tasks in the context of teacher training? In order to close this research gap, 39 situations taken from 16 interviews with teaching trainees were analyzed in the present study on the basis of qualitative content analysis. Seminars and standing in to hold lessons for other teachers were identified as most prevalent illegitimate tasks. More specifically, unnecessary tasks could be classified as sub challenging, inefficient and lacking in organization (e.g., writing reports about workshops no one will ever read). Unreasonable tasks appeared overextending, fell outside responsibility, and lacked supervisory support. Training interventions focusing upon task design and supervisory behavior are suggested for improvement. PMID:27683572
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van Amerongen, G; Siebenga, P; de Kam, M L; Hay, J L; Groeneveld, G J
2018-04-10
A battery of evoked pain tasks (PainCart) was developed to investigate the pharmacodynamic properties of novel analgesics in early-phase clinical research. As part of its clinical validation, compounds with different pharmacological mechanisms of actions are investigated. The aim was to investigate the analgesic effects of classic and nonclassic analgesics compared to a sedating negative control in a randomized placebo-controlled crossover study in 24 healthy volunteers using the PainCart. The PainCart consisted of pain tasks eliciting electrical, pressure, heat, cold and inflammatory pain. Subjective scales for cognitive functioning and psychotomimetic effects were included. Subjects were administered each of the following oral treatments: paracetamol (1000 mg), Δ9-THC (10 mg), promethazine (50 mg) or matching placebo. Pharmacodynamic measurements were performed at baseline and repeated up to 10 h postdose. Paracetamol did not show a significant reduction in pain sensation or subjective cognitive functioning compared to placebo. Promethazine induced a statistically significant reduction in PTT for cold pressor and pressure stimulation. Furthermore, reduced subjective alertness was observed. Δ9-THC showed a statistically significant decrease in PTT for electrical and pressure stimulation. Δ9-THC also demonstrated subjective effects, including changes in alertness and calmness, as well as feeling high and psychotomimetic effects. This study found a decreased pain tolerance due to Δ9-THC and promethazine, or lack thereof, using an evoked pain task battery. Pain thresholds following paracetamol administration remained unchanged, which may be due to insufficient statistical power. We showed that pain thresholds determined using this pain test battery are not driven by sedation. The multimodal battery of evoked pain tasks utilized in this study may play an important role in early-phase clinical drug development. This battery of pain tasks is not sensitive to the effects of sedation alone, and thus suitable to investigate the analgesic potential of novel analgesic compounds. © 2018 European Pain Federation - EFIC®.
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Cingi, C; Gevaert, P; Mösges, R; Rondon, C; Hox, V; Rudenko, M; Muluk, N B; Scadding, G; Manole, F; Hupin, C; Fokkens, W J; Akdis, C; Bachert, C; Demoly, P; Mullol, J; Muraro, A; Papadopoulos, N; Pawankar, R; Rombaux, P; Toskala, E; Kalogjera, L; Prokopakis, E; Hellings, P W; Bousquet, J
2017-01-01
This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is to highlight the role of multimorbidities in the definition, classification, mechanisms, recommendations for diagnosis and treatment of AR, and to define the needs in this neglected area by a literature review. AR is a systemic allergic disease and is generally associated with numerous multi-morbid disorders, including asthma, eczema, food allergies, eosinophilic oesophagitis (EoE), conjunctivitis, chronic middle ear effusions, rhinosinusitis, adenoid hypertrophy, olfaction disorders, obstructive sleep apnea, disordered sleep and consequent behavioural and educational effects. This report provides up-to-date usable information to: (1) improve the knowledge and skills of allergists, so as to ultimately improve the overall quality of patient care; (2) to increase interest in this area; and (3) to present a unique contribution to the field of upper inflammatory disease.
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Measuring treatment effects on dual-task performance: a framework for research and clinical practice
Plummer, Prudence; Eskes, Gail
2015-01-01
The relevance of dual-task walking to everyday ambulation is widely acknowledged, and numerous studies have demonstrated that dual-task interference can significantly impact recovery of functional walking in people with neurological disorders. The magnitude and direction of dual-task interference is influenced by the interaction between the two tasks, including how individuals spontaneously prioritize their attention. Therefore, to accurately interpret and characterize dual-task interference and identify changes over time, it is imperative to evaluate single and dual-task performance in both tasks, as well as the tasks relative to each other. Yet, reciprocal dual-task effects (DTE) are frequently ignored. The purpose of this perspective paper is to present a framework for measuring treatment effects on dual-task interference, specifically taking into account the interactions between the two tasks and how this can provide information on whether overall dual-task capacity has improved or a different attentional strategy has been adopted. In discussing the clinical implications of using this framework, we provide specific examples of using this method and provide some explicit recommendations for research and clinical practice. PMID:25972801
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Health care management of sickness certification tasks: results from two surveys to physicians
2013-01-01
Background Health care in general and physicians in particular, play an important role in patients’ sickness certification processes. However, a lack of management within health care regarding how sickness certification is carried out has been identified in Sweden. A variety of interventions to increase the quality of sickness certification were introduced by the government and County Councils. Some of these measures were specifically aimed at strengthening health care management of sickness certification; e.g. policy making and management support. The aim was to describe to what extent physicians in different medical specialties had access to a joint policy regarding sickness certification in their clinical settings and experienced management support in carrying out sickness certification. Method A descriptive study, based on data from two cross-sectional questionnaires sent to all physicians in the Stockholm County regarding their sickness certification practice. Criteria for inclusion in this study were working in a clinical setting, being a board-certified specialist, <65 years of age, and having sickness certification consultations at least a few times a year. These criteria were met by 2497 physicians in 2004 and 2204 physicians in 2008. Proportions were calculated regarding access to policy and management support, stratified according to medical specialty. Results The proportions of physicians working in clinical settings with a well-established policy regarding sickness certification were generally low both in 2004 and 2008, but varied greatly between different types of medical specialties (from 6.1% to 46.9%). Also, reports of access to substantial management support regarding sickness certification varied greatly between medical specialties (from 10.5% to 48.8%). More than one third of the physicians reported having no such management support. Conclusions Most physicians did not work in a clinical setting with a well-established policy on sickness certification tasks, nor did they experience substantial support from their manager. The results indicate a need of strengthening health care management of sickness certification tasks in order to better support physicians in these tasks. PMID:23701711
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Language mapping with verbs and sentences in awake surgery: a review.
Rofes, Adrià; Miceli, Gabriele
2014-06-01
Intraoperative language mapping in awake surgery is typically conducted by asking the patient to produce automatic speech and to name objects. These tasks might not map language with sufficient accuracy, as some linguistic processes can only be triggered by tasks that use verbs and sentences. Verb and sentence processing tasks are currently used during surgery, albeit sparsely. Medline, PubMed, and Web of Science records were searched to retrieve studies focused on language mapping with verbs/sentences in awake surgery. We review the tasks reported in the published literature, spell out the language processes assessed by each task, list the cortical and subcortical regions whose stimulation inhibited language processing, and consider the types of errors elicited by stimulation in each region. We argue that using verb tasks allows a more thorough evaluation of language functions. We also argue that verb tasks are preferable to object naming tasks in the case of frontal lesions, as lesion and neuroimaging data demonstrate that these regions play a critical role in verb and sentence processing. We discuss the clinical value of these tasks and the current limitations of the procedure, and provide some guidelines for their development. Future research should aim toward a differentiated approach to language mapping - one that includes the administration of standardized and customizable tests and the use of longitudinal neurocognitive follow-up studies. Further work will allow researchers and clinicians to understand brain and language correlates and to improve the current surgical practice.
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Malassis, Raphaëlle; Del Cul, Antoine; Collins, Thérèse
2015-01-01
Predicting the sensory consequences of saccadic eye movements likely plays a crucial role in planning sequences of saccades and in maintaining visual stability despite saccade-caused retinal displacements. Deficits in predictive activity, such as that afforded by a corollary discharge signal, have been reported in patients with schizophrenia, and may lead to the emergence of positive symptoms, in particular delusions of control and auditory hallucinations. We examined whether a measure of delusional thinking in the general, non-clinical population correlated with measures of predictive activity in two oculomotor tasks. The double-step task measured predictive activity in motor control, and the in-flight displacement task measured predictive activity in trans-saccadic visual perception. Forty-one healthy adults performed both tasks and completed a questionnaire to assess delusional thinking. The quantitative measure of predictive activity we obtained correlated with the tendency towards delusional ideation, but only for the motor task, and not the perceptual task: Individuals with higher levels of delusional thinking showed less self-movement information use in the motor task. Variation of the degree of self-generated movement knowledge as a function of the prevalence of delusional ideation in the normal population strongly supports the idea that corollary discharge deficits measured in schizophrenic patients in previous researches are not due to neuroleptic medication. We also propose that this difference in results between the perceptual and the motor tasks may point to a dissociation between corollary discharge for perception and corollary discharge for action.
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Malassis, Raphaëlle; Del Cul, Antoine; Collins, Thérèse
2015-01-01
Predicting the sensory consequences of saccadic eye movements likely plays a crucial role in planning sequences of saccades and in maintaining visual stability despite saccade-caused retinal displacements. Deficits in predictive activity, such as that afforded by a corollary discharge signal, have been reported in patients with schizophrenia, and may lead to the emergence of positive symptoms, in particular delusions of control and auditory hallucinations. We examined whether a measure of delusional thinking in the general, non-clinical population correlated with measures of predictive activity in two oculomotor tasks. The double-step task measured predictive activity in motor control, and the in-flight displacement task measured predictive activity in trans-saccadic visual perception. Forty-one healthy adults performed both tasks and completed a questionnaire to assess delusional thinking. The quantitative measure of predictive activity we obtained correlated with the tendency towards delusional ideation, but only for the motor task, and not the perceptual task: Individuals with higher levels of delusional thinking showed less self-movement information use in the motor task. Variation of the degree of self-generated movement knowledge as a function of the prevalence of delusional ideation in the normal population strongly supports the idea that corollary discharge deficits measured in schizophrenic patients in previous researches are not due to neuroleptic medication. We also propose that this difference in results between the perceptual and the motor tasks may point to a dissociation between corollary discharge for perception and corollary discharge for action. PMID:26305115
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Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret
2012-05-31
Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination.
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Johnson, Matthew W; Herrmann, Evan S; Sweeney, Mary M; LeComte, Robert S; Johnson, Patrick S
2017-02-01
Although cocaine use has been linked to sexual HIV risk behavior for decades, the direct effects of cocaine on sexual desire and sexual decision-making are unexamined. Research suggests delay discounting (devaluation of future outcomes) and probability discounting (devaluation of uncertain outcomes) play roles in condom use decisions. This study examined the effect of cocaine administration on sexual desire, hypothetical condom use, and discounting tasks. This double-blind, within-subjects study compared the effects of 0, 125, and 250 mg/70 kg oral cocaine HCl in 12 cocaine users. Measures included sexual desire and other subjective ratings, the Sexual Delay Discounting Task, the Sexual Probability Discounting Task, and monetary delay and probability discounting tasks. Cocaine caused dose-related increases in sexual desire and prototypical stimulant abuse-liability ratings. Relative to placebo, cocaine did not significantly alter condom use likelihood when condoms were immediately available or when sex was associated with 100% certainty of sexually transmitted infection (STI). In contrast, cocaine dose-dependently strengthened the effect of delay (sexual delay discounting) and STI uncertainty (sexual probability discounting) in decreasing condom use likelihood. Cocaine caused no significant change in monetary delay and probability discounting. This is the first study showing that cocaine administration increases sexual desire. Detrimental effects of cocaine on sexual risk were only observed when safer sex required delay, or STI risk was uncertain (representative of many real-world scenarios), suggesting a critical role of discounting processes. Lack of monetary effects highlights the importance of studying clinically relevant outcomes when examining drug effects on behavioral processes.
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Role of right posterior parietal cortex in maintaining attention to spatial locations over time
Coulthard, Elizabeth J.; Husain, Masud
2009-01-01
Recent models of human posterior parietal cortex (PPC) have variously emphasized its role in spatial perception, visuomotor control or directing attention. However, neuroimaging and lesion studies also suggest that the right PPC might play a special role in maintaining an alert state. Previously, assessments of right-hemisphere patients with hemispatial neglect have revealed significant overall deficits on vigilance tasks, but to date there has been no demonstration of a deterioration of performance over time—a vigilance decrement—considered by some to be a key index of a deficit in maintaining attention. Moreover, sustained attention deficits in neglect have not specifically been related to PPC lesions, and it remains unclear whether they interact with spatial impairments in this syndrome. Here we examined the ability of right-hemisphere patients with neglect to maintain attention, comparing them to stroke controls and healthy individuals. We found evidence of an overall deficit in sustaining attention associated with PPC lesions, even for a simple detection task with stimuli presented centrally. In a second experiment, we demonstrated a vigilance decrement in neglect patients specifically only when they were required to maintain attention to spatial locations, but not verbal material. Lesioned voxels in the right PPC spanning a region between the intraparietal sulcus and inferior parietal lobe were significantly associated with this deficit. Finally, we compared performance on a task that required attention to be maintained either to visual patterns or spatial locations, matched for task difficulty. Again, we found a vigilance decrement but only when attention had to be maintained on spatial information. We conclude that sustaining attention to spatial locations is a critical function of the human right PPC which needs to be incorporated into models of normal parietal function as well as those of the clinical syndrome of hemispatial neglect. PMID:19158107
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The American Organization of Nurse Executives System CNE task force: a work in progress.
Rudisill, Pamela T; Thompson, Pamela A
2012-01-01
Health care is a complex industry, consequently requiring a diverse group of health care executives leading initiatives for efficiency and effectiveness in patient care delivery. Value-based purchasing and pay for performance are at the top of the list for indicators of success, and many hospitals are merging into health care systems. The role of the system chief nurse executive is an evolving role to lead health care systems in clinical, operational, patient safety, and patient satisfaction processes and outcomes. The American Organization of Nurse Executives, being the voice for nursing leadership, convened a group of system chief nurse executives to address the role, function, and competencies needed for this significant and emerging role in health care. This article describes the role statement and system chief nurse executive competencies needed for success in the role. In addition, the next steps for addressing the needs of this group will be outlined in this article.
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Holistic rubric vs. analytic rubric for measuring clinical performance levels in medical students.
Yune, So Jung; Lee, Sang Yeoup; Im, Sun Ju; Kam, Bee Sung; Baek, Sun Yong
2018-06-05
Task-specific checklists, holistic rubrics, and analytic rubrics are often used for performance assessments. We examined what factors evaluators consider important in holistic scoring of clinical performance assessment, and compared the usefulness of applying holistic and analytic rubrics respectively, and analytic rubrics in addition to task-specific checklists based on traditional standards. We compared the usefulness of a holistic rubric versus an analytic rubric in effectively measuring the clinical skill performances of 126 third-year medical students who participated in a clinical performance assessment conducted by Pusan National University School of Medicine. We conducted a questionnaire survey of 37 evaluators who used all three evaluation methods-holistic rubric, analytic rubric, and task-specific checklist-for each student. The relationship between the scores on the three evaluation methods was analyzed using Pearson's correlation. Inter-rater agreement was analyzed by Kappa index. The effect of holistic and analytic rubric scores on the task-specific checklist score was analyzed using multiple regression analysis. Evaluators perceived accuracy and proficiency to be major factors in objective structured clinical examinations evaluation, and history taking and physical examination to be major factors in clinical performance examinations evaluation. Holistic rubric scores were highly related to the scores of the task-specific checklist and analytic rubric. Relatively low agreement was found in clinical performance examinations compared to objective structured clinical examinations. Meanwhile, the holistic and analytic rubric scores explained 59.1% of the task-specific checklist score in objective structured clinical examinations and 51.6% in clinical performance examinations. The results show the usefulness of holistic and analytic rubrics in clinical performance assessment, which can be used in conjunction with task-specific checklists for more efficient evaluation.
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Shrestha, Priyanka; Abbott, Katherine M
2018-02-01
The current study explored the contribution of non-clinical professionals, such as housekeepers and maintenance mechanics, in promoting person-centered care (PCC) for older adults residing in assisted living. Semi-structured face-to-face interviews with staff (n = 8), concierge (n = 2), maintenance mechanics (n = 2), housekeepers (n = 3), and an administrative assistant (n = 1) from an assisted living organization were conducted. Interviews were audiorecorded, transcribed, and reviewed for accuracy. The comments from the staff were coded based on prior PCC themes (i.e., promoting decision making, meaningful living, pleasurable living, and personhood). Results show that non-clinical staff play an important role in facilitating PCC in their everyday tasks with residents. A new sub-theme was added regarding how non-clinical staff help residents in assisted living navigate the organization. Findings suggest that all tasks, no matter how routine, can be performed in a person-centered manner, contributing to the quality of life of older adults in assisted living. The authors recommend including all staff who have direct contact with residents in person-centered education and training efforts as they support the PCC goals of an organization. [Journal of Gerontological Nursing, 44(2), 9-13.]. Copyright 2018, SLACK Incorporated.
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Sustained Attention in Children with Primary Language Impairment: A Meta-Analysis
Ebert, Kerry Danahy; Kohnert, Kathryn
2014-01-01
Purpose This study provides a meta-analysis of the difference between children with primary or specific language impairment (LI) and their typically developing peers on tasks of sustained attention. The meta-analysis seeks to determine if children with LI demonstrate subclinical deficits in sustained attention and, if so, under what conditions. Methods Articles that reported empirical data from the performance of children with LI, in comparison to typically developing peers, on a task assessing sustained attention were considered for inclusion. Twenty-eight effect sizes were included in the meta-analysis. Two moderator analyses addressed the effects of stimulus modality and ADHD exclusion. In addition, reaction time outcomes and the effects of task variables were summarized qualitatively. Results The meta-analysis supports the existence of sustained attention deficits in children with LI in both auditory and visual modalities, as demonstrated by reduced accuracy compared to typically developing peers. Larger effect sizes are found in tasks that use auditory and linguistic stimuli than in studies that use visual stimuli. Conclusions Future research should consider the role that sustained attention weaknesses play in LI, as well as the implications for clinical and research assessment tasks. Methodological recommendations are summarized. PMID:21646419
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Sustained attention in children with primary language impairment: a meta-analysis.
Ebert, Kerry Danahy; Kohnert, Kathryn
2011-10-01
This study provides a meta-analysis of the difference between children with primary or specific language impairment (LI) and their typically developing peers on tasks of sustained attention. The meta-analysis seeks to determine whether children with LI demonstrate subclinical deficits in sustained attention and, if so, under what conditions. Articles that reported empirical data from the performance of children with LI, in comparison to typically developing peers, on a task assessing sustained attention were considered for inclusion. Twenty-eight effect sizes were included in the meta-analysis. Two moderator analyses addressed the effects of stimulus modality and attention-deficit/hypereactivity disorder exclusion. In addition, reaction time outcomes and the effects of task variables were summarized qualitatively. The meta-analysis supports the existence of sustained attention deficits in children with LI in both auditory and visual modalities, as demonstrated by reduced accuracy compared with typically developing peers. Larger effect sizes are found in tasks that use auditory-linguistic stimuli than in studies that use visual stimuli. Future research should consider the role that sustained attention weaknesses play in LI as well as the implications for clinical and research assessment tasks. Methodological recommendations are summarized.
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The Impact of Selective Dopamine D2, D3 and D4 Ligands on the Rat Gambling Task.
Di Ciano, Patricia; Pushparaj, Abhiram; Kim, Aaron; Hatch, Jessica; Masood, Talal; Ramzi, Abby; Khaled, Maram A T M; Boileau, Isabelle; Winstanley, Catherine A; Le Foll, Bernard
2015-01-01
Gambling is an addictive disorder with serious societal and personal costs. To-date, there are no approved pharmacological treatments for gambling disorder. Evidence suggests a role for dopamine in gambling disorder and thus may provide a therapeutic target. The present study therefore aimed to investigate the effects of selective antagonists and agonists of D2, D3 and D4 receptors in a rodent analogue of the Iowa gambling task used clinically. In this rat gambling task (rGT), animals are trained to associate different response holes with different magnitudes and probabilities of food pellet rewards and punishing time-out periods. As in the Iowa gambling task, the optimal strategy is to avoid the tempting high-risk high-reward options, and instead favor those linked to smaller per-trial rewards but also lower punishments, thereby maximizing the amount of reward earned over time. Administration of those selective ligands did not affect decision making under the rGT. Only the D4 drug had modest effects on latency measures suggesting that D4 may contribute in some ways to decision making under this task.
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The relationship between social roles and self-management behavior in women living with HIV/AIDS.
Webel, Allison R; Higgins, Patricia A
2012-01-01
The social roles that women perform can be complicated and may affect their health. While there is some evidence describing traditional social roles of women, there is little evidence exploring the impact of those roles on how a woman manages a chronic condition. The purpose of this paper is to identify and examine the main social roles of 48 HIV infected women, and to explore how these roles relate to their self-management of HIV/AIDS. Forty-eight HIV infected, adult women were recruited from HIV clinics and AIDS service organizations in Northeast Ohio. All participants participated in one of 12 digitially recorded focus groups. All data were analyzed using qualitative description methodology. The participants were predominantly middle-aged (mean = 42 years), African American (69%), and single (58%). Analysis revealed six social roles that these women experience and which affect their self-management. These social roles are: Mother/Grandmother, Believer, Advocate, Stigmatized Patient, Pet Owner, and Employee. These roles had both a positive and negative effect on a woman's self-management of her HIV disease and varied by age and time living with HIV. Women living with HIV/AIDS struggle to manage the many daily tasks required to live well with this disease. The social context in which this self-management happens is important, and the various social roles that women perform can facilitate or hinder them from completing these tasks. Healthcare and social service providers should learn about these roles in their individual patients, particularly how these roles can be developed to increase HIV/AIDS self-management. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
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Tolsgaard, Martin G; Kulasegaram, Kulamakan M; Ringsted, Charlotte V
2016-01-01
This study is designed to provide an overview of why, how, when and for whom collaborative learning of clinical skills may work in health professions education. Collaborative learning of clinical skills may influence learning positively according to the non-medical literature. Training efficiency may therefore be improved if the outcomes of collaborative learning of clinical skills are superior or equivalent to those attained through individual learning. According to a social interaction perspective, collaborative learning of clinical skills mediates its effects through social interaction, motivation, accountability and positive interdependence between learners. Motor skills learning theory suggests that positive effects rely on observational learning and action imitation, and negative effects may include decreased hands-on experience. Finally, a cognitive perspective suggests that learning is dependent on cognitive co-construction, shared knowledge and reduced cognitive load. The literature on the collaborative learning of clinical skills in health science education is reviewed to support or contradict the hypotheses provided by the theories outlined above. Collaborative learning of clinical skills leads to improvements in self-efficacy, confidence and performance when task processing is observable or communicable. However, the effects of collaborative learning of clinical skills may decrease over time as benefits in terms of shared cognition, scaffolding and cognitive co-construction are outweighed by reductions in hands-on experience and time on task. Collaborative learning of clinical skills has demonstrated promising results in the simulated setting. However, further research into how collaborative learning of clinical skills may work in clinical settings, as well as into the role of social dynamics between learners, is required. © 2015 John Wiley & Sons Ltd.
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ERIC Educational Resources Information Center
Monetta, Laura; Ouellet-Plamondon, Clairelaine; Joanette, Yves
2006-01-01
Lately, many studies have suggested that communication impairments in brain-damaged individuals might be explained--at least in part--in terms of cognitive resource allocation. Reproducing a clinical pattern in normal subjects by using a dual-task treatment might be a way of evaluating the role of cognitive resources in the right hemisphere's…
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Cooper, Simon; O'Carroll, Judith; Jenkin, Annie; Badger, Beryl
2007-01-01
Objective To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods A 12‐month (2005–2006) mixed methods clinical case study was carried out in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multi‐professional emergency care practitioners (ECPs), interviews with 45 ECPs and stakeholders, and an audit of 611 patients Results Using a generic qualitative approach, observational records and interviews showed that ECPs' numerous links with other professions were influenced by three major themes as follows. (i) The ECP role: for example, “restricted transport codes” of communication, focus on reducing admissions, frustrations about patient tasking and conflicting views about leadership and team work. (ii) Education and training: drivers for multi‐professional clinically focussed graduate level education, requirements for skill development in minor injury units (MIUs) and general practice, and the need for clinical supervision/mentorship. (iii) Cultural perspectives: a “crew room” blue collar view of inter‐professional working versus emerging professional white collar views, power and communication conflicts, and a lack of understanding of the ECPs' role. The quantitative findings are reported elsewhere. Conclusions The final model of collaborative practice suggests that ECPs are having an impact on patient care, but that improvements can be made. We recommend the appointment of ECP clinical leads, degree level clinically focussed multi‐professional education, communication skills training, clinical supervision and multi‐professional ECP appointments. PMID:17711937
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Inoue, Daisuke; Yoshimoto, Koji; Uemura, Munenori; Yoshida, Masaki; Ohuchida, Kenoki; Kenmotsu, Hajime; Tomikawa, Morimasa; Sasaki, Tomio; Hashizume, Makoto
2013-11-01
The purpose of this research was to investigate the usefulness of three-dimensional (3D) endoscopy compared with two-dimensional (2D) endoscopy in neuroendoscopic surgeries in a comparative study and to test the clinical applications. Forty-three examinees were divided into three groups according to their endoscopic experience: novice, beginner, or expert. Examinees performed three separate tasks using 3D and 2D endoscopy. A recently developed 3D high-definition (HD) neuroendoscope, 4.7 mm in diameter (Shinko Optical Co., Ltd., Tokyo, Japan) was used. In one of the three tasks, we developed a full-sized skull model of acrylic-based plastic using a 3D printer and a patient's thin slice computed tomography data, and evaluated the execution time and total path length of the tip of the pointer using an optical tracking system. Sixteen patients underwent endoscopic transnasal transsphenoidal pituitary surgery using both 3D and 2D endoscopy. Horizontal motion was evaluated using task 1, and anteroposterior motion was evaluated with task 3. Execution time and total path length in task 3 using the 3D system in both novice and beginner groups were significantly shorter than with the 2D system (p < 0.05), although no significant difference between 2D and 3D systems in task 1 was seen. In both the novice and beginner groups, the 3D system was better for depth perception than horizontal motion. No difference was seen in the expert group in this regard. The 3D HD endoscope was used for the pituitary surgery and was found very useful to identify the spatial relationship of carotid arteries and bony structures. The use of a 3D neuroendoscope improved depth perception and task performance. Our results suggest that 3D endoscopes could shorten the learning curve of young neurosurgeons and play an important role in both general surgery and neurosurgery. Georg Thieme Verlag KG Stuttgart · New York.
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2011-01-01
Background Practicing arm and gait movements with robotic assistance after neurologic injury can help patients improve their movement ability, but patients sometimes reduce their effort during training in response to the assistance. Reduced effort has been hypothesized to diminish clinical outcomes of robotic training. To better understand patient slacking, we studied the role of visual distraction and auditory feedback in modulating patient effort during a common robot-assisted tracking task. Methods Fourteen participants with chronic left hemiparesis from stroke, five control participants with chronic right hemiparesis and fourteen non-impaired healthy control participants, tracked a visual target with their arms while receiving adaptive assistance from a robotic arm exoskeleton. We compared four practice conditions: the baseline tracking task alone; tracking while also performing a visual distracter task; tracking with the visual distracter and sound feedback; and tracking with sound feedback. For the distracter task, symbols were randomly displayed in the corners of the computer screen, and the participants were instructed to click a mouse button when a target symbol appeared. The sound feedback consisted of a repeating beep, with the frequency of repetition made to increase with increasing tracking error. Results Participants with stroke halved their effort and doubled their tracking error when performing the visual distracter task with their left hemiparetic arm. With sound feedback, however, these participants increased their effort and decreased their tracking error close to their baseline levels, while also performing the distracter task successfully. These effects were significantly smaller for the participants who used their non-paretic arm and for the participants without stroke. Conclusions Visual distraction decreased participants effort during a standard robot-assisted movement training task. This effect was greater for the hemiparetic arm, suggesting that the increased demands associated with controlling an affected arm make the motor system more prone to slack when distracted. Providing an alternate sensory channel for feedback, i.e., auditory feedback of tracking error, enabled the participants to simultaneously perform the tracking task and distracter task effectively. Thus, incorporating real-time auditory feedback of performance errors might improve clinical outcomes of robotic therapy systems. PMID:21513561
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Platiša, Ljiljana; Brantegem, Leen Van; Kumcu, Asli; Ducatelle, Richard; Philips, Wilfried
2017-01-01
Abstract. Despite the current rapid advance in technologies for whole slide imaging, there is still no scientific consensus on the recommended methodology for image quality assessment of digital pathology slides. For medical images in general, it has been recommended to assess image quality in terms of doctors’ success rates in performing a specific clinical task while using the images (clinical image quality, cIQ). However, digital pathology is a new modality, and already identifying the appropriate task is difficult. In an alternative common approach, humans are asked to do a simpler task such as rating overall image quality (perceived image quality, pIQ), but that involves the risk of nonclinically relevant findings due to an unknown relationship between the pIQ and cIQ. In this study, we explored three different experimental protocols: (1) conducting a clinical task (detecting inclusion bodies), (2) rating image similarity and preference, and (3) rating the overall image quality. Additionally, within protocol 1, overall quality ratings were also collected (task-aware pIQ). The experiments were done by diagnostic veterinary pathologists in the context of evaluating the quality of hematoxylin and eosin-stained digital pathology slides of animal tissue samples under several common image alterations: additive noise, blurring, change in gamma, change in color saturation, and JPG compression. While the size of our experiments was small and prevents drawing strong conclusions, the results suggest the need to define a clinical task. Importantly, the pIQ data collected under protocols 2 and 3 did not always rank the image alterations the same as their cIQ from protocol 1, warning against using conventional pIQ to predict cIQ. At the same time, there was a correlation between the cIQ and task-aware pIQ ratings from protocol 1, suggesting that the clinical experiment context (set by specifying the clinical task) may affect human visual attention and bring focus to their criteria of image quality. Further research is needed to assess whether and for which purposes (e.g., preclinical testing) task-aware pIQ ratings could substitute cIQ for a given clinical task. PMID:28653011
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Platiša, Ljiljana; Brantegem, Leen Van; Kumcu, Asli; Ducatelle, Richard; Philips, Wilfried
2017-04-01
Despite the current rapid advance in technologies for whole slide imaging, there is still no scientific consensus on the recommended methodology for image quality assessment of digital pathology slides. For medical images in general, it has been recommended to assess image quality in terms of doctors' success rates in performing a specific clinical task while using the images (clinical image quality, cIQ). However, digital pathology is a new modality, and already identifying the appropriate task is difficult. In an alternative common approach, humans are asked to do a simpler task such as rating overall image quality (perceived image quality, pIQ), but that involves the risk of nonclinically relevant findings due to an unknown relationship between the pIQ and cIQ. In this study, we explored three different experimental protocols: (1) conducting a clinical task (detecting inclusion bodies), (2) rating image similarity and preference, and (3) rating the overall image quality. Additionally, within protocol 1, overall quality ratings were also collected (task-aware pIQ). The experiments were done by diagnostic veterinary pathologists in the context of evaluating the quality of hematoxylin and eosin-stained digital pathology slides of animal tissue samples under several common image alterations: additive noise, blurring, change in gamma, change in color saturation, and JPG compression. While the size of our experiments was small and prevents drawing strong conclusions, the results suggest the need to define a clinical task. Importantly, the pIQ data collected under protocols 2 and 3 did not always rank the image alterations the same as their cIQ from protocol 1, warning against using conventional pIQ to predict cIQ. At the same time, there was a correlation between the cIQ and task-aware pIQ ratings from protocol 1, suggesting that the clinical experiment context (set by specifying the clinical task) may affect human visual attention and bring focus to their criteria of image quality. Further research is needed to assess whether and for which purposes (e.g., preclinical testing) task-aware pIQ ratings could substitute cIQ for a given clinical task.
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Usability assessment of an electronic health record in a comprehensive dental clinic.
Suebnukarn, Siriwan; Rittipakorn, Pawornwan; Thongyoi, Budsara; Boonpitak, Kwanwong; Wongsapai, Mansuang; Pakdeesan, Panu
2013-12-01
In this paper we present the development and usability of an electronic health record (EHR) system in a comprehensive dental clinic.The graphic user interface of the system was designed to consider the concept of cognitive ergonomics.The cognitive task analysis was used to evaluate the user interface of the EHR by identifying all sub-tasks and classifying them into mental or physical operators, and to predict task execution time required to perform the given task. We randomly selected 30 cases that had oral examinations for routine clinical care in a comprehensive dental clinic. The results were based on the analysis of 4 prototypical tasks performed by ten EHR users. The results showed that on average a user needed to go through 27 steps to complete all tasks for one case. To perform all 4 tasks of 30 cases, they spent about 91 min (independent of system response time) for data entry, of which 51.8 min were spent on more effortful mental operators. In conclusion, the user interface can be improved by reducing the percentage of mental effort required for the tasks.
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Affective Biases in Humans and Animals.
Robinson, E S J; Roiser, J P
Depression is one of the most common but poorly understood psychiatric conditions. Although drug treatments and psychological therapies are effective in some patients, many do not achieve full remission and some patients receive no apparent benefit. Developing new improved treatments requires a better understanding of the aetiology of symptoms and evaluation of novel therapeutic targets in pre-clinical studies. Recent developments in our understanding of the basic cognitive processes that may contribute to the development of depression and its treatment offer new opportunities for both clinical and pre-clinical research. This chapter discusses the clinical evidence supporting a cognitive neuropsychological model of depression and antidepressant efficacy, and how this information may be usefully translated to pre-clinical investigation. Studies using neuropsychological tests in depressed patients and at risk populations have revealed basic negative emotional biases and disrupted reward and punishment processing, which may also impact on non-affective cognition. These affective biases are sensitive to antidepressant treatments with early onset effects observed, suggesting an important role in recovery. This clinical work into affective biases has also facilitated back-translation to animals and the development of assays to study affective biases in rodents. These animal studies suggest that, similar to humans, rodents in putative negative affective states exhibit negative affective biases on decision-making and memory tasks. Antidepressant treatments also induce positive biases in these rodent tasks, supporting the translational validity of this approach. Although still in the early stages of development and validation, affective biases in depression have the potential to offer new insights into the clinical condition, as well as facilitating the development of more translational approaches for pre-clinical studies.
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The role of stereopsis (three-dimensional vision) in dentistry: review of the current literature.
Syrimi, M; Ali, N
2015-05-22
Clinical dental work is placing increasing demands on a clinician's vision as new techniques that require fine detail become more common. High hand-eye coordination requires good visual acuity as well as other psychological and neurological qualities such as stereopsis. Stereopsis (three-dimensional vision) is the highest form of depth perception obtained by visual disparity of images formed in the retinas of two eyes. It is believed to confer functional benefits on everyday tasks such as hand-eye coordination. Although its role in depth perception has long been established, little is known regarding the importance of stereopsis in dentistry. This article reviews the role of stereopsis in everyday life and the available literature on the importance of stereopsis in dentistry.
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Dual tasking and stuttering: from the laboratory to the clinic.
Metten, Christine; Bosshardt, Hans-Georg; Jones, Mark; Eisenhuth, John; Block, Susan; Carey, Brenda; O'Brian, Sue; Packman, Ann; Onslow, Mark; Menzies, Ross
2011-01-01
The aim of the three studies in this article was to develop a way to include dual tasking in speech restructuring treatment for persons who stutter (PWS). It is thought that this may help clients maintain the benefits of treatment in the real world, where attentional resources are frequently diverted away from controlling fluency by the demands of other tasks. In Part 1, 17 PWS performed a story-telling task and a computer semantic task simultaneously. Part 2 reports the incorporation of the Part 1 protocol into a handy device for use in a clinical setting (the Dual Task and Stuttering Device, DAS-D). Part 3 is a proof of concept study in which three PWS reported on their experiences of using the device during treatment. In Part 1, stuttering frequency and errors on the computer task both increased under dual task conditions, indicating that the protocol would be appropriate for use in a clinical setting. All three participants in Part 3 reported positively on their experiences using the DAS-D. Dual tasking during treatment using the DAS-D appears to be a viable clinical procedure. Further research is required to establish effectiveness.
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Nagendra, Arundati; Twery, Benjamin L; Neblett, Enrique W; Mustafic, Hasan; Jones, Tevin S; Gatewood, D'Angelo; Penn, David L
2018-01-01
The Social Cognition Psychometric Evaluation (SCOPE) study consists of a battery of eight tasks selected to measure social-cognitive deficits in individuals with schizophrenia. The battery is currently in a multisite validation process. While the SCOPE study collects basic demographic data, more nuanced race-related factors might artificially inflate cross-cultural differences in social cognition. As an initial step, we investigated whether race, independent of mental illness status, affects performance on the SCOPE battery. Thus, we examined the effects of perceived discrimination and experimenter race on the performance of 51 non-clinical African American men on the SCOPE battery. Results revealed that these factors impacted social cognitive task performance. Specifically, participants performed better on a skills-based task factor in the presence of Black experimenters, and frequency of perceived racism predicted increased perception of hostility in negative interpersonal situations with accidental causes. Thus, race-related factors are important to identify and explore in the measurement of social cognition in African Americans. Copyright © 2017 Elsevier B.V. All rights reserved.
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Cardillo, Ramona; Garcia, Ricardo Basso; Mammarella, Irene C; Cornoldi, Cesare
2017-03-15
The present study aims to find empirical evidence of deficits in linguistic pragmatic skills and theory of mind (ToM) in children with dyslexia with associated language difficulties or nonverbal learning disabilities (NLD), when compared with a group of typically developing (TD) children matched for age and gender. Our results indicate that children with dyslexia perform less well than TD children in most of the tasks measuring pragmatics of language, and in one of the tasks measuring ToM. In contrast, children with NLD generally performed better than the dyslexia group, and performed significantly worse than the TD children only in a metaphors task based on visual stimuli. A discriminant function analysis confirmed the crucial role of the metaphors subtest and the verbal ToM task in distinguishing between the groups. We concluded that, contrary to a generally-held assumption, children with dyslexia and associated language difficulties may be weaker than children with NLD in linguistic pragmatics and ToM, especially when language is crucially involved. The educational and clinical implications of these findings are discussed.
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Heuristics in Managing Complex Clinical Decision Tasks in Experts’ Decision Making
Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme
2016-01-01
Background Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. Objective The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. Method After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. Results We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Conclusion Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Application Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design. PMID:27275019
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Heuristics in Managing Complex Clinical Decision Tasks in Experts' Decision Making.
Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme
2014-09-01
Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design.
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The role of memory representation in the vigilance decrement.
Caggiano, Daniel M; Parasuraman, Raja
2004-10-01
Working memory load is critically important for the overall level of performance on vigilance tasks. However, its role in a key aspect of vigilance-sensitivity decrement over time-is unclear. We used a dual-task procedure in which either a spatial or a nonspatial working memory task was performed simultaneously with a spatial vigilance task for 20 min. Sensitivity in the vigilance task declined over time when the concurrent task involved spatial working memory. In contrast, there was no sensitivity decrement with a nonspatial working memory task. The results provide the first evidence of a specific role for working memory representation in vigilance decrement. The findings are also consistent with a multiple resource theory in which separate resources for memory representation and cognitive control operations are differentially susceptible to depletion over time, depending on the demands of the task at hand.
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Morain, Philippe; Lestage, Pierre; De Nanteuil, Guillaume; Jochemsen, Roeline; Robin, Jean-Loïc; Guez, David; Boyer, Pierre-Alain
2002-01-01
Any treatment that could positively modulate central neuropeptides levels would provide a promising therapeutic approach to the treatment of cognitive deficits associated with aging and/or neurodegenerative diseases. Therefore, based on the activity in rodents, S 17092 (2S,3aS,7aS)-1][(R,R)-2-phenylcyclopropyl]carbonyl]-2-[(thiazolidin-3-yl)carbonyl]octahydro-1H-indole) has been selected as a potent inhibitor of cerebral prolyl-endopeptidase (PEP). By retarding the degradation of neuroactive peptides, S 17092 was successfully used in a variety of memory tasks. These tasks explored short-term, long-term, reference and working memory in aged mice, as well as in rodents and monkeys with chemically induced amnesia or spontaneous memory deficits. S 17092 has also been safely administered to humans, and showed a clear peripheral expression of its mechanism of action through its inhibitory effect upon PEP activity in plasma. S 17092 exhibited central effects, as evidenced by EEG recording in healthy volunteers, and could improve a delayed verbal memory task. Collectively, the preclinical and clinical effects of S 17092 have suggested a promising role for this compound as an agent for the treatment of cognitive disorders associated with cerebral aging.
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Differences in neuropsychological performance between subtypes of obsessive-compulsive disorder.
Nedeljkovic, Maja; Kyrios, Michael; Moulding, Richard; Doron, Guy; Wainwright, Kylie; Pantelis, Chris; Purcell, Rosemary; Maruff, Paul
2009-03-01
Neuropsychological studies have suggested that frontal-striatal dysfunction plays a role in obsessive-compulsive disorder (OCD), although findings have been inconsistent, possibly due to heterogeneity within the disorder and methodological issues. The purpose of the present study was therefore to compare the neuropsychological performance of different subtypes of OCD and matched non-clinical controls (NCs) on the Cambridge Automated Neuropsychological Test Battery (CANTAB). Fifty-nine OCD patients and 59 non-clinical controls completed selected tests from CANTAB examining executive function, visual memory and attentional-set shifting. Depression, anxiety and OCD symptoms were also assessed. From 59 OCD patients, four subtypes were identified: (i) washers; (ii) checkers; (iii) obsessionals; and (iv) mixed symptom profile. Comparisons between washers, checkers, obsessionals and NCs indicated few differences, although checkers were generally found to exhibit poorer performance on spatial working memory, while obsessionals performed poorly on the spatial recognition task. Both checkers and the mixed subgroups showed slowed initial movement on the Stockings of Cambridge planning task and poorer pattern recognition relative to NCs. Overall the results suggested greater impairments in performance on neuropsychological tasks in checkers relative to other subtypes, although the observed effects were small and the conclusions limited by the small subtype samples. Future research will need to account for factors that influence neuropsychological performance in OCD subtypes.
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The Relationship between Organizational Climate and Quality of Chronic Disease Management
Benzer, Justin K; Young, Gary; Stolzmann, Kelly; Osatuke, Katerine; Meterko, Mark; Caso, Allison; White, Bert; Mohr, David C
2011-01-01
Objective To test the utility of a two-dimensional model of organizational climate for explaining variation in diabetes care between primary care clinics. Data Sources/Study Setting Secondary data were obtained from 223 primary care clinics in the Department of Veterans Affairs health care system. Study Design Organizational climate was defined using the dimensions of task and relational climate. The association between primary care organizational climate and diabetes processes and intermediate outcomes were estimated for 4,539 patients in a cross-sectional study. Data Collection/Extraction Methods All data were collected from administrative datasets. The climate data were drawn from the 2007 VA All Employee Survey, and the outcomes data were collected as part of the VA External Peer Review Program. Climate data were aggregated to the facility level of analysis and merged with patient-level data. Principal Findings Relational climate was related to an increased likelihood of diabetes care process adherence, with significant but small effects for adherence to intermediate outcomes. Task climate was generally not shown to be related to adherence. Conclusions The role of relational climate in predicting the quality of chronic care was supported. Future research should examine the mediators and moderators of relational climate and further investigate task climate. PMID:21210799
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Neuropsychological predictors of clinical outcome in opiate addiction.
Passetti, F; Clark, L; Mehta, M A; Joyce, E; King, M
2008-04-01
A growing literature supports a role for neurocognitive deficits such as impaired decision-making in the development and maintenance of addictive behaviour. On the basis of these findings, it has been suggested that measures of neurocognitive functioning may be applied to the task of predicting clinical outcome in drug addiction. This in turn may have relevance for differentiating treatment based on individual patient needs. To explore this hypothesis we obtained neurocognitive measures of planning, impulsivity and decision-making from 37 opiate dependent individuals within 6 weeks of starting a community drug treatment programme and we followed them up 3 months into the programme. Performance on two tests of decision-making, but not on tests of planning, motor inhibition, reflection impulsivity or delay discounting, was found to predict abstinence from illicit drugs at 3 months with high specificity and moderate sensitivity. In particular, two thirds of the participants performing normally on the Cambridge Gamble Task and the Iowa Gambling Task, but none of those impaired on both, were abstinent from illicit drugs at follow up. Other neuropsychological, psychiatric or psychosocial factors measured in this sample did not explain this finding. The results are discussed in terms of the brain circuitry involved and the potential implications for the planning of treatment services for opiate dependence.
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Effect of retinal defocus on basketball free throw shooting performance.
Bulson, Ryan C; Ciuffreda, Kenneth J; Hayes, John; Ludlam, Diana P
2015-07-01
Vision plays a critical role in athletic performance; however, previous studies have demonstrated that a variety of simulated athletic sensorimotor tasks can be surprisingly resilient to retinal defocus (blurred vision). The purpose of the present study was to extend this work to determine the effect of retinal defocus on overall basketball free throw performance, as well as for the factors gender, refractive error and experience. Forty-four young adult participants of both genders were recruited. They had a range of refractive errors and basketball experience. Each performed 20 standard basketball free throws under five lens defocus conditions in a randomised manner: plano, +1.50 D, +3.00 D, +4.50 D and +10.00 D. Overall, free throw performance was significantly reduced under the +10.00 D lens defocus condition only. Previous experience, but neither refractive error nor gender, yielded a statistically significant difference in performance. Consistent with previous studies of complex sensorimotor tasks, basketball free throw performance was resilient to low and moderate levels of retinal defocus. Thus, for a relatively non-dynamic motor task at a fixed far distance, such as the basketball free throw, precise visual clarity was not critical. Other factors such as motor memory may be important. However, in the dynamic athletic competitive environment it is likely that visual clarity plays a more critical role in one's performance level, at least for specific task demands. © 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.
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Patella Fracture in US Servicemember in an Austere Location.
Schermerhorn, Sophia M; Auchincloss, Paul J; Kraft, Kyle; Nelson, Kenneth J; Pamplin, Jeremy C
Review the management of a patient with acute patella fracture supported by telemedical consultation. Clinical Context: Regionally Aligned Forces (RAF) supporting US Army Africa/Southern European Task Force (USARAF/ SETAF) in Africa Command area of responsibility. Care was provided by a Role I facility on the compound. Organic Expertise: Three 68W combat medics; one Special Operations Combat Medic (SOCM). Closest Medical Support: Organic battalion physician assistant (PA) located in the United States; USARAF PA located in a European country; French Role II located in nearby West African country; telemedical consults via e-mail, phone, or videoteleconsultation. Earliest Evacuation: Estimated at 12 to 24 hours with appropriate clearances. 2018.
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Methods to Succeed in Effective Knowledge Translation in Clinical Practice.
Kitson, Alison L; Harvey, Gillian
2016-05-01
To explore the evidence around facilitation as an intervention for the successful implementation of new knowledge into clinical practice. The revised version of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, called the integrated or i-PARIHS framework, is used as the explanatory framework. This framework posits that evidence is a multidimensional construct embedded within innovation and operationalized by clinicians (individuals and within teams), working across multiple layers of context. Facilitation is the active ingredient that promotes successful implementation. An emerging body of evidence supports facilitation as a mechanism to getting new knowledge into clinical practice. Facilitation roles are divided into beginner, experienced, and expert facilitators. Facilitators can be internal or external to the organization they work in, and their skills and attributes complement other knowledge translation (KT) roles. Complex KT projects require facilitators who are experienced in implementation methods. Facilitation is positioned as the active ingredient to effectively introduce new knowledge into a clinical setting. Levels of facilitation experience are assessed in relation to the complexity of the KT task. Three core facilitation roles are identified, and structured interventions are established taking into account the nature and novelty of the evidence, the receptiveness of the clinicians, and the context or setting where the new evidence is to be introduced. Roles such as novice, experienced, and expert facilitators have important and complementary parts to play in enabling the successful translation of evidence into everyday practice in order to provide effective care for patients. © 2016 Sigma Theta Tau International.
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Hawkins, Amy L; Haskett, Mary E
2014-01-01
Abused children's internal working models (IWM) of relationships are known to relate to their socioemotional adjustment, but mechanisms through which negative representations increase vulnerability to maladjustment have not been explored. We sought to expand the understanding of individual differences in IWM of abused children and investigate the mediating role of self-regulation in links between IWM and adjustment. Cluster analysis was used to subgroup 74 physically abused children based on their IWM. Internal working models were identified by children's representations, as measured by a narrative story stem task. Self-regulation was assessed by teacher report and a behavioral task, and adjustment was measured by teacher report. Cluster analyses indicated two subgroups of abused children with distinct patterns of IWMs. Cluster membership predicted internalizing and externalizing problems. Associations between cluster membership and adjustment were mediated by children's regulation, as measured by teacher reports of many aspects of regulation. There was no support for mediation when regulation was measured by a behavioral task that tapped more narrow facets of regulation. Abused children exhibit clinically relevant individual differences in their IWMs; these models are linked to adjustment in the school setting, possibly through children's self-regulation. © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.
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McDonald, Cody L; Fuhs, Amy K; Kartin, Deborah
2018-05-01
This study aimed to better understand current clinical practice of rehabilitation professionals in Lima, Peru, and to explore the existence of and potential for interprofessional collaboration. A secondary purpose was to assess rehabilitation professionals' agreement with evidence-based stroke rehabilitation statements and confidence performing stroke rehabilitation tasks prior to and following an interprofessional stroke rehabilitation training. Current clinical practice for rehabilitation professionals in Peru differs from high-income counties like the United States, as physical therapists work with dysphagia and feeding, prosthetist orthotists serve a strictly technical role, and nurses have a limited role in rehabilitation. Additionally, while opportunity for future interprofessional collaboration within stroke rehabilitation exists, it appears to be discouraged by current health system policies. Pre- and post-training surveys were conducted with a convenience sample of 107 rehabilitation professionals in Peru. Survey response options included endorsement of professionals for rehabilitation tasks and a Likert scale of agreement and confidence. Training participants largely agreed with evidence-based stroke rehabilitation statements. Differences in opinion remained regarding the prevalence of dysphagia and optimal frequency of therapy post-stroke. Substantially increased agreement post-training was seen in favour of early initiation of stroke rehabilitation and ankle foot orthosis use. Participants were generally confident performing traditional profession-specific interventions and educating patients and families. Substantial increases were seen in respondents' confidence to safely and independently conduct bed to chair transfers and determine physiological stability. Identification of key differences in rehabilitation professionals' clinical practice in Peru is a first step toward strengthening the development of sustainable rehabilitation systems and interprofessional collaboration.
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Frontal lobe neurology and the creative mind
de Souza, Leonardo C.; Guimarães, Henrique C.; Teixeira, Antônio L.; Caramelli, Paulo; Levy, Richard; Dubois, Bruno; Volle, Emmanuelle
2014-01-01
Concepts from cognitive neuroscience strongly suggest that the prefrontal cortex (PFC) plays a crucial role in the cognitive functions necessary for creative thinking. Functional imaging studies have repeatedly demonstrated the involvement of PFC in creativity tasks. Patient studies have demonstrated that frontal damage due to focal lesions or neurodegenerative diseases are associated with impairments in various creativity tasks. However, against all odds, a series of clinical observations has reported the facilitation of artistic production in patients with neurodegenerative diseases affecting PFC, such as frontotemporal dementia (FTD). An exacerbation of creativity in frontal diseases would challenge neuroimaging findings in controls and patients, as well as the theoretical role of prefrontal functions in creativity processes. To explore this paradox, we reported the history of a FTD patient who exhibited the emergence of visual artistic productions during the course of the disease. The patient produced a large amount of drawings, which have been evaluated by a group of professional artists who were blind to the diagnosis. We also reviewed the published clinical cases reporting a change in the artistic abilities in patients with neurological diseases. We attempted to reconcile these clinical observations to previous experimental findings by addressing several questions raised by our review. For instance, to what extent can the cognitive, conative, and affective changes following frontal damage explain changes in artistic abilities? Does artistic exacerbation truly reflect increased creative capacities? These considerations could help to clarify the place of creativity—as it has been defined and explored by cognitive neuroscience—in artistic creation and may provide leads for future lesion studies. PMID:25101029
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Frontal lobe neurology and the creative mind.
de Souza, Leonardo C; Guimarães, Henrique C; Teixeira, Antônio L; Caramelli, Paulo; Levy, Richard; Dubois, Bruno; Volle, Emmanuelle
2014-01-01
Concepts from cognitive neuroscience strongly suggest that the prefrontal cortex (PFC) plays a crucial role in the cognitive functions necessary for creative thinking. Functional imaging studies have repeatedly demonstrated the involvement of PFC in creativity tasks. Patient studies have demonstrated that frontal damage due to focal lesions or neurodegenerative diseases are associated with impairments in various creativity tasks. However, against all odds, a series of clinical observations has reported the facilitation of artistic production in patients with neurodegenerative diseases affecting PFC, such as frontotemporal dementia (FTD). An exacerbation of creativity in frontal diseases would challenge neuroimaging findings in controls and patients, as well as the theoretical role of prefrontal functions in creativity processes. To explore this paradox, we reported the history of a FTD patient who exhibited the emergence of visual artistic productions during the course of the disease. The patient produced a large amount of drawings, which have been evaluated by a group of professional artists who were blind to the diagnosis. We also reviewed the published clinical cases reporting a change in the artistic abilities in patients with neurological diseases. We attempted to reconcile these clinical observations to previous experimental findings by addressing several questions raised by our review. For instance, to what extent can the cognitive, conative, and affective changes following frontal damage explain changes in artistic abilities? Does artistic exacerbation truly reflect increased creative capacities? These considerations could help to clarify the place of creativity-as it has been defined and explored by cognitive neuroscience-in artistic creation and may provide leads for future lesion studies.
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Ketchum, S M
1991-01-01
The high-pressure work environment of the clinical laboratory presents significant challenges for managers. Often thrust into supervisory roles without formal management training, laboratory managers must find ways to delegate tasks, mediate conflict, minimize office politics, and build effective teams out of employees who may be quite diverse in their experience levels, motivation levels, and cultural backgrounds. This article explores the concept of situational leadership, which was developed by Ken Blanchard and Paul Hersey, and its applicability within the clinical laboratory. This practical paradigm involves matching one of four distinct management styles to the four development levels of employees. Each leadership style is explained, along with guidelines for giving performance feedback to employees, so that managers can evaluate their own supervisory styles. Finally, step-by-step recommendations for coping with the four management roles of delegator, referee, influencer, and team builder are presented.
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Challenges of being a scholarly clinician as perceived by stroke rehabilitation professionals.
Fillion, Barbara; Rochette, Annie; Girard, Anik
2014-01-01
Stroke rehabilitation clinicians are responsible for offering quality services through evidence-based practices. How is this role fulfilled on a daily basis? (1) To explore the perceptions, experiences, and attitudes of rehabilitation professionals regarding their scholar role; (2) To identify factors that facilitate or hinder this role in their practices. Qualitative design of a phenomenological orientation. Face-to-face interviews conducted with professionals with at least 1 year experience in stroke rehabilitation using a pre-tested interview guide. Transcripts were coded using QDA-Miner software. Mean age of the participants was 40.7 years ± 11.2. Participants were mostly women (n = 9/11). The role of scholar emerged as not having great value. Main themes (5) emerging from the analysis are emphasis on tacit knowledge; experience and clinical intuition leading to self-confidence and comfort in clinical practice; dissatisfaction with the lack of knowledge sharing among clinicians; importance of diversifying clinical tasks; and the underdevelopment of reflective practice. Four factors identified as influencing the role of scholar: motivation, critical incident as a main trigger of reflective practice, interns facilitating reflective practice, and lack of time. From these results emerged questions about measures to encourage the scholar role and facilitate reflective practice in stroke rehabilitation. Implications for Rehabilitation Reflective practice has to be encouraged in professional rehabilitation of stroke. Managers' involvement is crucial to promote and support the role of scholar among professionals in stroke rehabilitation. The updated knowledge and networking from reading scientific paper, participation in trainings and conferences should be systematically disseminated.
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Task Modification and Knowledge Utilization by Korean Prospective Mathematics Teachers
ERIC Educational Resources Information Center
Lee, Kyeong-Hwa; Lee, Eun-Jung; Park, Min-Sun
2016-01-01
It has been asserted that mathematical tasks play a critical role in the teaching and learning of mathematics. Modification of tasks included in intended curriculum materials, such as textbooks, can be an effective activity for prospective teachers to understand the role of mathematical tasks in the teaching and learning of mathematics; designing…
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Clinical Research After Catastrophic Disasters: Lessons Learned From Hurricane Katrina
Flory, Kate; Kloos, Bret; Hankin, Benjamin L.; Cheely, Catherine A.
2008-01-01
When catastrophic disasters such as Hurricane Katrina strike, psychologists and other mental health professionals often wonder how to use resources and fill needed roles. We argue that conducting clinical research in response to disasters is 1 important way that these professionals can contribute. However, we recognize that designing and implementing a clinical research study can be a daunting task, particularly in the context of the personal and system-wide chaos that follows most disasters. Thus, we offer a detailed description of our own experiences with conducting clinical research as part of our response to Hurricane Katrina. We describe our study design, recruitment and data collection efforts, and summarize and synthesize the lessons we have learned from this endeavor. Our hope is that others who may wish to conduct disaster-related research will learn from our mistakes and successes. PMID:19177173
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Naci, Huseyin; Ioannidis, John P A
2015-01-01
Promising evidence from clinical studies of drug effects does not always translate to improvements in patient outcomes. In this review, we discuss why early evidence is often ill suited to the task of predicting the clinical utility of drugs. The current gap between initially described drug effects and their subsequent clinical utility results from deficits in the design, conduct, analysis, reporting, and synthesis of clinical studies-often creating conditions that generate favorable, but ultimately incorrect, conclusions regarding drug effects. There are potential solutions that could improve the relevance of clinical evidence in predicting the real-world effectiveness of drugs. What is needed is a new emphasis on clinical utility, with nonconflicted entities playing a greater role in the generation, synthesis, and interpretation of clinical evidence. Clinical studies should adopt strong design features, reflect clinical practice, and evaluate outcomes and comparisons that are meaningful to patients. Transformative changes to the research agenda may generate more meaningful and accurate evidence on drug effects to guide clinical decision making.
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Knowledge of Previous Tasks: Task Similarity Influences Bias in Task Duration Predictions
Thomas, Kevin E.; König, Cornelius J.
2018-01-01
Bias in predictions of task duration has been attributed to misremembering previous task duration and using previous task duration as a basis for predictions. This research sought to further examine how previous task information affects prediction bias by manipulating task similarity and assessing the role of previous task duration feedback. Task similarity was examined through participants performing two tasks 1 week apart that were the same or different. Duration feedback was provided to all participants (Experiment 1), its recall was manipulated (Experiment 2), and its provision was manipulated (Experiment 3). In all experiments, task similarity influenced bias on the second task, with predictions being less biased when the first task was the same task. However, duration feedback did not influence bias. The findings highlight the pivotal role of knowledge about previous tasks in task duration prediction and are discussed in relation to the theoretical accounts of task duration prediction bias. PMID:29881362
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Dodich, Alessandra; Cerami, Chiara; Cappa, Stefano F; Marcone, Alessandra; Golzi, Valeria; Zamboni, Michele; Giusti, Maria Cristina; Iannaccone, Sandro
2018-01-01
Current diagnostic criteria for behavioral variant of frontotemporal dementia (bvFTD) and typical Alzheimer's disease (AD) include a differential pattern of neuropsychological impairments (episodic memory deficit in typical AD and dysexecutive syndrome in bvFTD). There is, however, large evidence of a frequent overlap in neuropsychological features, making the differential diagnosis extremely difficult. In this retrospective study, we evaluated the diagnostic value of different cognitive and neurobehavioral markers in bvFTD and AD patient groups. We included 95 dementia patients with a clinical and biomarker evidence of bvFTD (n = 48) or typical AD (n = 47) pathology. A clinical 2-year follow-up confirmed clinical classification. Performances at basic cognitive tasks (memory, executive functions, visuo-spatial, language) as well as social cognition skills and neurobehavioral profiles have been recorded. A stepwise logistic regression model compared the neuropsychological profiles between groups and assessed the accuracy of cognitive and neurobehavioral markers in discriminating bvFTD from AD. Statistical comparison between patient groups proved social cognition and episodic memory impairments as main cognitive signatures of bvFTD and AD neuropsychological profiles, respectively. Only half of bvFTD patients showed attentive/executive deficits, questioning their role as cognitive marker of bvFTD. Notably, the large majority of bvFTD sample (i.e., 70%) poorly performed at delayed recall tasks. Logistic regression analysis identified social cognition performances, Frontal Behavioral Inventory and Mini-Mental State Examination scores as the best combination in distinguishing bvFTD from AD. Social cognition tasks and socio-behavioral questionnaires are recommended in clinical settings to improve the accuracy of early diagnosis of bvFTD.
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Cleary, Timothy J; Durning, Steven J; Artino, Anthony R
2016-11-01
Helping medical educators obtain and use assessment data to assist medical students, residents, and physicians in reducing diagnostic errors and other forms of ineffective clinical practice is of critical importance. Self-Regulated Learning-Microanalytic Assessment and Training is an assessment-to-intervention framework designed to address this need by generating data about trainees' strategic processes (e.g., focusing on clinical task procedures), regulatory processes (e.g., planning how to do a task), and motivational processes (e.g., increasing confidence for performing a task) as they perform clinical activities. In this article, the authors review several studies that have used an innovative assessment approach, called self-regulated learning (SRL) microanalysis, to generate data about how trainees regulate their thinking and actions during clinical reasoning tasks. Across the studies, initial findings revealed that medical students often do not exhibit strategic thinking and action during clinical reasoning practice tasks even though some regulatory processes (e.g., planning) are predictive of important medical education outcomes. Further, trainees' motivation beliefs, strategic thinking, and self-evaluative judgments tend to shift rapidly during clinical skills practice and may also vary across different parts of a patient encounter. Collectively, these findings underscore the value of dynamically assessing trainees' SRL as they complete clinical tasks. The findings also set the stage for exploring how medical educators can best use SRL microanalytic assessment data to guide remedial practices and the provision of feedback to trainees. Implications and future research directions for connecting assessments to intervention in medical education are discussed.
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The Chinese in Canada: a study in ethnic change with emphasis on gender roles.
Kim, Chankon; Laroche, Michel; Tomiuk, Marc A
2004-02-01
The authors investigated the impact of ethnic change experienced by Chinese Canadian couples on gender-role attitude, household task-role expectations and performance. The authors presented acculturation and Chinese ethnic identification as the two discriminant facets of ethnic change. Results indicated a nonsignificant role of acculturation in bringing about modifications of the gender-role attitudes of husbands and of their household task-role expectations. In contrast, the acculturation of Chinese Canadian wives proved to be a significant factor in promoting more modern (less traditional) gender-role attitudes, which in turn led to role expectations that they should contribute less to the performance of the tasks that traditionally fall in the female domain whereas their husbands should contribute more. Subsequent results also revealed that the acculturation of wives was directly linked to the role expectation that they should assume a greater share of responsibility in taking care of the traditionally husband-responsible tasks whereas their husbands should contribute a smaller share. Moreover, Chinese ethnic identification emerged as a significant determinant of husbands' gender-role attitudes and influenced their role expectation that husbands should contribute more to the performance of the tasks that traditionally fall in the male domain whereas their wives should contribute less.
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Markus, C. Rob.; Franklin, Michael S.; van Dalfsen, Jens H.
2017-01-01
Objective In adulthood, depressive mood is often comorbid with ADHD, but its role in ADHD-inattentiveness and especially relations with mind wandering remains to be elucidated. This study investigated the effects of laboratory-induced dysphoric mood on task-unrelated mind wandering and its consequences on cognitive task performance in college students with high (n = 46) or low (n = 44) ADHD-Inattention symptomatology and Hyperactivity/Impulsivity symptoms in the normal range. Methods These non-clinical high/low ADHD-Inattention symptom groups underwent negative or positive mood induction after which mind wandering frequency was measured in a sustained attention (SART), and a reading task. Effects of ruminative response style and working memory capacity on mind wandering frequency were also investigated. Results Significantly higher frequencies of self -reported mind wandering in daily life, in the SART and reading task were reported in the ADHD-Inattention symptom group, with detrimental effects on text comprehension in the reading task. Induced dysphoric mood did specifically enhance the frequency of mind wandering in the ADHD-Inattention symptom group only during the SART, and was related to their higher self-reported intrusive ruminative response styles. Working memory capacity did not differ between high/low attention groups and did not influence any of the reported effects. Conclusions These combined results suggest that in a non-clinical sample with high ADHD-inattention symptoms, dysphoric mood and a ruminative response style seem to be more important determinants of dysfunctional mind wandering than a failure in working memory capacity/executive control, and perhaps need other ways of remediation, like cognitive behavioral therapy or mindfulness training. PMID:28742115
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Firn, Janice; DeVries, Keli; Morano, Dawnielle; Spano-English, Toni
2017-07-01
During inhospital cardiopulmonary resuscitation attempts, a designated family support person (FSP) may provide guidance and support to family members. Research on nurses and chaplains in this role has been published. Social workers also regularly fulfill this service, however, little is known about how they perceive and enact this role. To explore their experiences, qualitative interviews (n = 10) were conducted with FSP social workers. Critical realist thematic analysis identified five themes: walking in cold, promoting family presence, responding to the whole spectrum of grief, going beyond the family support role, and repercussions of bearing witness. Social workers perform a variety of tasks to promote family presence during resuscitation attempts and provide psychosocial support over the continuum of care. The FSP role impacts social workers emotionally and professionally. Implications for hospital policy, staffing, and clinical practice are discussed.
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The role of memory representation in the vigilance decrement
CAGGIANO, DANIEL M.; PARASURAMAN, RAJA
2005-01-01
Working memory load is critically important for the overall level of performance on vigilance tasks. However, its role in a key aspect of vigilance—sensitivity decrement over time—is unclear. We used a dual-task procedure in which either a spatial or a nonspatial working memory task was performed simultaneously with a spatial vigilance task for 20 min. Sensitivity in the vigilance task declined over time when the concurrent task involved spatial working memory. In contrast, there was no sensitivity decrement with a nonspatial working memory task. The results provide the first evidence of a specific role for working memory representation in vigilance decrement. The findings are also consistent with a multiple resource theory in which separate resources for memory representation and cognitive control operations are differentially susceptible to depletion over time, depending on the demands of the task at hand. PMID:15732706
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Challenges and leadership strategies for managers of nurse practitioners.
Reay, Trish; Golden-Biddle, Karen; Germann, Kathy
2003-11-01
The aim of this paper is to report on the findings from our research into the recent introduction of nurse practitioners in Alberta, Canada. Through an organizational research perspective, we identify the critical role of health care managers in developing a sustainable nurse practitioner role. Previous literature has focused on nurse practitioners themselves as the key factor in their integration into the health care system. Although they are qualified and organizationally well placed, managers of nurse practitioners have been overlooked as a critical part of implementation strategies. We interviewed 25 nurse practitioners and seven of their managers. Through our data analysis we identified three major challenges for managers: (1) clarifying the reallocation of tasks; (2) managing altered working relationships within the team; (3) continuing to manage the team in an evolving situation. Associated with these challenges, we propose leadership strategies that managers may find useful as they work through the consequences of introducing the nurse practitioner role. These strategies are: * encourage all team members to sort out 'who does what'; * ensure that task reallocation preserves job motivating properties; * give consideration to how tasks have been allocated when issues identified as 'personal conflict' arise; * pay attention to all perspectives of the working relationships within the team; * facilitate positive relationships between team members; * lead from a 'balcony' perspective; * work with the team to develop goals that are not over focused on the nurse practitioner; * regularly share with other managers the experiences and lessons learned in introducing nurse practitioners. For managers to be most effective, they need to address three challenges that are of a managerial, not clinical, nature. By implementing specific leadership strategies, managers of nurse practitioners can facilitate the introduction of the new role and improve its sustainability in health organizations.
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The function of the left anterior temporal pole: evidence from acute stroke and infarct volume
Tsapkini, Kyrana; Frangakis, Constantine E.
2011-01-01
The role of the anterior temporal lobes in cognition and language has been much debated in the literature over the last few years. Most prevailing theories argue for an important role of the anterior temporal lobe as a semantic hub or a place for the representation of unique entities such as proper names of peoples and places. Lately, a few studies have investigated the role of the most anterior part of the left anterior temporal lobe, the left temporal pole in particular, and argued that the left anterior temporal pole is the area responsible for mapping meaning on to sound through evidence from tasks such as object naming. However, another recent study indicates that bilateral anterior temporal damage is required to cause a clinically significant semantic impairment. In the present study, we tested these hypotheses by evaluating patients with acute stroke before reorganization of structure–function relationships. We compared a group of 20 patients with acute stroke with anterior temporal pole damage to a group of 28 without anterior temporal pole damage matched for infarct volume. We calculated the average percent error in auditory comprehension and naming tasks as a function of infarct volume using a non-parametric regression method. We found that infarct volume was the only predictive variable in the production of semantic errors in both auditory comprehension and object naming tasks. This finding favours the hypothesis that left unilateral anterior temporal pole lesions, even acutely, are unlikely to cause significant deficits in mapping meaning to sound by themselves, although they contribute to networks underlying both naming and comprehension of objects. Therefore, the anterior temporal lobe may be a semantic hub for object meaning, but its role must be represented bilaterally and perhaps redundantly. PMID:21685458
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MacAulay, Rebecca K; Wagner, Mark T; Szeles, Dana; Milano, Nicholas J
2017-07-01
Longitudinal research indicates that cognitive load dual-task gait assessment is predictive of cognitive decline and thus might provide a sensitive measure to screen for mild cognitive impairment (MCI). However, research among older adults being clinically evaluated for cognitive concerns, a defining feature of MCI, is lacking. The present study investigated the effect of performing a cognitive task on normal walking speed in patients presenting to a memory clinic with cognitive complaints. Sixty-one patients with a mean age of 68 years underwent comprehensive neuropsychological testing, clinical interview, and gait speed (simple- and dual-task conditions) assessments. Thirty-four of the 61 patients met criteria for MCI. Repeated measure analyses of covariance revealed that greater age and MCI both significantly associated with slower gait speed, ps<.05. Follow-up analysis indicated that the MCI group had significantly slower dual-task gait speed but did not differ in simple-gait speed. Multivariate linear regression across groups found that executive attention performance accounted for 27.4% of the variance in dual-task gait speed beyond relevant demographic and health risk factors. The present study increases the external validity of dual-task gait assessment of MCI. Differences in dual-task gait speed appears to be largely attributable to executive attention processes. These findings have clinical implications as they demonstrate expected patterns of gait-brain behavior relationships in response to a cognitive dual task within a clinically representative population. Cognitive load dual-task gait assessment may provide a cost efficient and sensitive measure to detect older adults at high risk of a dementia disorder. (JINS, 2017, 23, 493-501).
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Pai, Umesh Y.; Reddy, Vikram Simha; Hosi, Rushad Nariman
2014-01-01
Complete denture fabrication in clinically compromised situations such as flabby ridges is a challenging task for the clinician. Accurate impressioning of these tissues plays a major role in ensuring a well-fitting prosthesis. In this paper, the authors have proposed a newer technique of impression making of the flabby tissues using a combination of readily available newer and older materials to ensure an accurate and easy impression of these tissues. PMID:24872897
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2013-09-01
right time. The CCS will use this to create task oriented, role based gestalt views of the patient that the ICU clinical team can understand and rely on...these artifacts, such as diagrams, organize crucial information to assist cognitive work, from perception to decision making and outcome assessment...In: D. Silverman, ed. Qualitative research: Theory , method and practice. London: Sage: 161-82. Nemeth, C., O’Connor, M., Klock, P.A., and Cook
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Healthcare and the Roles of the Medical Profession in the Big Data Era*1
YAMAMOTO, Yuji
2016-01-01
The accumulation of large amounts of healthcare information is in progress, and society is about to enter the Health Big Data era by linking such data. Medical professionals’ daily tasks in clinical practice have become more complicated due to information overload, accelerated technological development, and the expansion of conceptual frameworks for medical care. Further, their responsibilities are more challenging and their workload is consistently increasing. As medical professionals enter the Health Big Data era, we need to reevaluate the fundamental significance and role of medicine and investigate ways to utilize this available information and technology. For example, a data analysis on diabetes patients has already shed light on the status of accessibility to physicians and the treatment response rate. In time, large amounts of health data will help find solutions including new effective treatment that could not be discovered by conventional means. Despite the vastness of accumulated data and analyses, their interpretation is necessarily conducted by attending physicians who communicate these findings to patients face to face; this task cannot be replaced by technology. As medical professionals, we must take the initiative to evaluate the framework of medicine in the Health Big Data era, study the ideal approach for clinical practitioners within this framework, and spread awareness to the public about our framework and approach while implementing them. PMID:28299246
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Howell, Ashley N; Weeks, Justin W
2017-01-01
Psychosocial factors, such as gender role norms, may impact how social anxiety disorder (SAD) is experienced and expressed in different social contexts for women. However to date, these factors have not been examined via experimental methodology. This was a cross-sectional, quasi-experimental controlled study. The current study included 48 highly socially anxious (HSA) women (70.9% meeting criteria for SAD) and examined the relationships among psychosocial factors (i.e. gender role self-discrepancies and self-perceived physical attractiveness), self-perceived social performance, and state anxiety, across two in vivo social tasks (i.e. conversation and opinion speech). On average, participants reported belief that they ought to be less feminine for the speech task and more masculine for both the conversation and speech tasks. Also, for the conversation task, only lower self-rated attractiveness predicted poorer self-perceived performance and greater post-task state anxiety, above gender role self-discrepancies and confederate gender. For the speech task, only greater self-discrepancy in prototypical masculine traits predicted poorer performance ratings, and it was related to greater state anxiety in anticipation of the task. For HSA women, psychosocial factors may play different roles in social anxiety across social contexts.
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Horan, William P; Reddy, L Felice; Barch, Deanna M; Buchanan, Robert W; Dunayevich, Eduardo; Gold, James M; Marder, Steven R; Wynn, Jonathan K; Young, Jared W; Green, Michael F
2015-09-01
Effort-based decision making has strong conceptual links to the motivational disturbances that define a key subdomain of negative symptoms. However, the extent to which effort-based decision-making performance relates to negative symptoms, and other clinical and functionally important variables has yet to be systematically investigated. In 94 clinically stable outpatients with schizophrenia, we examined the external validity of 5 effort-based paradigms, including the Effort Expenditure for Rewards, Balloon Effort, Grip Strength Effort, Deck Choice Effort, and Perceptual Effort tasks. These tasks covered 3 types of effort: physical, cognitive, and perceptual. Correlations between effort related performance and 6 classes of variables were examined, including: (1) negative symptoms, (2) clinically rated motivation and community role functioning, (3) self-reported motivational traits, (4) neurocognition, (5) other psychiatric symptoms and clinical/demographic characteristics, and (6) subjective valuation of monetary rewards. Effort paradigms showed small to medium relationships to clinical ratings of negative symptoms, motivation, and functioning, with the pattern more consistent for some measures than others. They also showed small to medium relations with neurocognitive functioning, but were generally unrelated to other psychiatric symptoms, self-reported traits, antipsychotic medications, side effects, and subjective valuation of money. There were relatively strong interrelationships among the effort measures. In conjunction with findings from a companion psychometric article, all the paradigms warrant further consideration and development, and 2 show the strongest potential for clinical trial use at this juncture. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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Perception Measurement in Clinical Trials of Schizophrenia: Promising Paradigms From CNTRICS
Green, Michael F.; Butler, Pamela D.; Chen, Yue; Geyer, Mark A.; Silverstein, Steven; Wynn, Jonathan K.; Yoon, Jong H.; Zemon, Vance
2009-01-01
The third meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) focused on selecting promising measures for each of the cognitive constructs selected in the first CNTRICS meeting. In the domain of perception, the 2 constructs of interest were gain control and visual integration. CNTRICS received 5 task nominations for gain control and three task nominations for visual integration. The breakout group for perception evaluated the degree to which each of these tasks met prespecified criteria. For gain control, the breakout group for perception believed that 2 of the tasks (prepulse inhibition of startle and mismatch negativity) were already mature and in the process of being incorporated into multisite clinical trials. However, the breakout group recommended that steady-state visual-evoked potentials be combined with contrast sensitivity to magnocellular vs parvocellular biased stimuli and that this combined task and the contrast-contrast effect task be recommended for translation for use in clinical trial contexts in schizophrenia research. For visual integration, the breakout group recommended the Contour Integration and Coherent Motion tasks for translation for use in clinical trials. This manuscript describes the ways in which each of these tasks met the criteria used by the breakout group to evaluate and recommend tasks for further development. PMID:19023123
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ERIC Educational Resources Information Center
Bull, Rebecca; Phillips, Louise H.; Conway, Claire A.
2008-01-01
Conflicting evidence has arisen from correlational studies regarding the role of executive control functions in Theory of Mind. The current study used dual-task manipulations of executive functions (inhibition, updating and switching) to investigate the role of these control functions in mental state and non-mental state tasks. The "Eyes"…
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Gonzalo, Jed D; Dekhtyar, Michael; Hawkins, Richard E; Wolpaw, Daniel R
2017-09-01
As health systems evolve, the education community is seeking to reimagine student roles that combine learning with meaningful contributions to patient care. The authors sought to identify potential stakeholders regarding the value of student work, and roles and tasks students could perform to add value to the health system, including key barriers and associated strategies to promote value-added roles in undergraduate medical education. In 2016, 32 U.S. medical schools in the American Medical Association's (AMA's) Accelerating Change in Education Consortium met for a two-day national meeting to explore value-added medical education; 121 educators, systems leaders, clinical mentors, AMA staff leadership and advisory board members, and medical students were included. A thematic qualitative analysis of workshop discussions and written responses was performed, which extracted key themes. In current clinical roles, students can enhance value by performing detailed patient histories to identify social determinants of health and care barriers, providing evidence-based medicine contributions at the point-of-care, and undertaking health system research projects. Novel value-added roles include students serving as patient navigators/health coaches, care transition facilitators, population health managers, and quality improvement team extenders. Six priority areas for advancing value-added roles are student engagement, skills, and assessments; balance of service versus learning; resources, logistics, and supervision; productivity/billing pressures; current health systems design and culture; and faculty factors. These findings provide a starting point for collaborative work to positively impact clinical care and medical education through the enhanced integration of value-added medical student roles into care delivery systems.
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Training the intern: The value of a pre-intern year in preparing students for practice.
Dare, Anna; Fancourt, Nicholas; Robinson, Elizabeth; Wilkinson, Tim; Bagg, Warwick
2009-08-01
To evaluate the clinical and professional development that occurs during a New Zealand trainee intern year in preparation for the first house officer role. A quantitative questionnaire was distributed to all trainee interns (year 6) and year 5 medical students in New Zealand at the end of the 2007 academic year. This survey assessed self-reported competency and performance across clinical, professional and role development domains. Response rate was 65% (457/702). Compared to year 5 students, trainee interns reported significantly greater competence and performance levels across all three domains. The greatest improvement occurred in the independent performance of procedural skills (trainee interns: 77%, year 5: 35%, p < 0.001) and clinical tasks (trainee interns: 94%, year 5: 56%, p < 0.001) and in the level of clinical responsibility taken (p < 0.001). At the end of the trainee intern year, 92% of students felt prepared to be a junior doctor, versus only 53% at the end of their 5th year (p < 0.0001). The trainee intern year is important in preparing graduates for the intern role. The year affords increased responsibility and practical experience, whilst retaining an educational focus, facilitating the move from competence towards performance. Preparedness for practice was substantially higher following the New Zealand trainee intern year than has been reported with other pre-intern placements.
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Greenslade, Kathryn J; Coggins, Truman E
2014-01-01
Identifying what a communication partner is looking at (referential intention) and why (social intention) is essential to successful social communication, and may be challenging for children with social communication deficits. This study explores a clinical task that assesses these intention-reading abilities within an authentic context. To gather evidence of the task's reliability and validity, and to discuss its clinical utility. The intention-reading task was administered to twenty 4-7-year-olds with typical development (TD) and ten with autism spectrum disorder (ASD). Task items were embedded in an authentic activity, and they targeted the child's ability to identify the examiner's referential and social intentions, which were communicated through joint attention behaviours. Reliability and construct validity evidence were addressed using established psychometric methods. Reliability and validity evidence supported the use of task scores for identifying children whose intention-reading warranted concern. Evidence supported the reliability of task administration and coding, and item-level codes were highly consistent with overall task performance. Supporting task validity, group differences aligned with predictions, with children with ASD exhibiting poorer and more variable task scores than children with TD. Also, as predicted, task scores correlated significantly with verbal mental age and ratings of parental concerns regarding social communication abilities. The evidence provides preliminary support for the reliability and validity of the clinical task's scores in assessing young children's real-time intention-reading abilities, which are essential for successful interactions in school and beyond. © 2014 Royal College of Speech and Language Therapists.
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Controversy and consensus on a clinical pharmacist in primary care in the Netherlands.
Hazen, Ankie C M; Wal, Aletta W van der; Sloeserwij, Vivianne M; Zwart, Dorien L M; Gier, Johan J de; Wit, Niek J de; Leendertse, Anne J; Bouvy, Marcel L; Bont, Antoinette A de
2016-10-01
Background Controversy about the introduction of a non-dispensing pharmacist in primary care practice hampers implementation. Objective The aim of this study is to systematically map the debate on this new role for pharmacists amongst all stakeholders to uncover and understand the controversy and consensus. Primary health care in the Netherlands. Method Q methodology. 163 participants rank-ordered statements on issues concerning the integration of a non-dispensing pharmacist in primary care practice. Stakeholder perspectives on the role of the non-dispensing pharmacist and pharmaceutical care in primary care. Results This study identified the consensus on various features of the non-dispensing pharmacist role as well as the financial, organisational and collaborative aspects of integrating a non-dispensing pharmacist in primary care practice. Q factor analysis revealed four perspectives: "the independent community pharmacist", "the independent clinical pharmacist", "the dependent clinical pharmacist" and "the medication therapy management specialist". These four perspectives show controversies to do with the level of professional independency of the non-dispensing pharmacist and the level of innovation of task performance. Conclusion Despite the fact that introducing new professional roles in healthcare can lead to controversy, the results of this Q study show the potential of a non-dispensing pharmacist as a pharmaceutical care provider and the willingness for interprofessional collaboration. The results from the POINT intervention study in the Netherlands will be an important next step in resolving current controversies.
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Consideration of species differences in developing novel molecules as cognition enhancers.
Young, Jared W; Jentsch, J David; Bussey, Timothy J; Wallace, Tanya L; Hutcheson, Daniel M
2013-11-01
The NIH-funded CNTRICS initiative has coordinated efforts to promote the vertical translation of novel procognitive molecules from testing in mice, rats and non-human primates, to clinical efficacy in patients with schizophrenia. CNTRICS highlighted improving construct validation of tasks across species to increase the likelihood that the translation of a candidate molecule to humans will be successful. Other aspects of cross-species behaviors remain important however. This review describes cognitive tasks utilized across species, providing examples of differences and similarities of innate behavior between species, as well as convergent construct and predictive validity. Tests of attention, olfactory discrimination, reversal learning, and paired associate learning are discussed. Moreover, information on the practical implication of species differences in drug development research is also provided. The issues covered here will aid in task development and utilization across species as well as reinforcing the positive role preclinical research can have in developing procognitive treatments for psychiatric disorders. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Induced sadness increases persistence in a simulated slot machine task among recreational gamblers.
Devos, Gaëtan; Clark, Luke; Maurage, Pierre; Billieux, Joël
2018-05-01
Gambling may constitute a strategy for coping with depressive mood, but a direct influence of depressive mood on gambling behaviors has never been tested via realistic experimental designs in gamblers. The current study tested whether experimentally induced sadness increases persistence on a simulated slot machine task using real monetary reinforcement in recreational gamblers. Sixty participants were randomly assigned to an experimental (sadness induction) or control (no emotional induction) condition, and then performed a slot machine task consisting of a mandatory phase followed by a persistence phase. Potential confounding variables (problem gambling symptoms, impulsivity traits, gambling cognitions) were measured to ensure that the experimental and control groups were comparable. The study showed that participants in the sadness condition displayed greater gambling persistence than control participants (p = .011). These data support the causal role of negative affect in decisions to gamble and persistence, which bears important theoretical and clinical implications. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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ERIC Educational Resources Information Center
Ketch, Karen M.; Brodeur, Darlene A.; McGee, Robin
2009-01-01
This study investigated the effects of response rate and attention focusing on performance of ADHD, clinical-control (CRNA) and non-clinical control children in response inhibition tasks. All children completed the "Go-NoGo" task, a computer-based task of attention and impulsivity. Focused attention on this task was manipulated using a priming…
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Agmon, Maayan; Armon, Galit; Denesh, Shani; Doumas, Mihalis
2018-01-02
Falls are a major problem for older adults. Many falls occur when a person's attention is divided between two tasks, such as a dual task (DT) involving walking. Most recently, the role of personality in walking performance was addressed; however, its association with DT performance remains to be determined. This cross-sectional study of 73 older, community-dwelling adults explores the association between personality and DT walking and the role of gender in this relationship. Personality was evaluated using the five-factor model. Single-task (ST) and DT assessment of walking-cognitive DT performance comprised a 1-min walking task and an arithmetic task performed separately (ST) and concurrently (DT). Dual-task costs (DTCs), reflecting the proportional difference between ST and DT performance, were also calculated. Gender plays a role in the relationship between personality and DT. Extraversion was negatively associated with DTC-motor for men (ΔR 2 = 0.06, p < 0.05). Conscientiousness was positively associated with DTC-cognition for women (ΔR 2 = 0.08, p < 0.01). These findings may lead to effective personality-based early detection and intervention for fall prevention.
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Sugarman, Michael A.; Woodard, John L.; Nielson, Kristy A.; Seidenberg, Michael; Smith, J. Carson; Durgerian, Sally; Rao, Stephen M.
2011-01-01
Extensive research efforts have been directed toward strategies for predicting risk of developing Alzheimer’s disease (AD) prior to the appearance of observable symptoms. Existing approaches for early detection of AD vary in terms of their efficacy, invasiveness, and ease of implementation. Several non-invasive magnetic resonance imaging strategies have been developed for predicting decline in cognitively healthy older adults. This review will survey a number of studies, beginning with the development of a famous name discrimination task used to identify neural regions that participate in semantic memory retrieval and to test predictions of several key theories of the role of the hippocampus in memory. This task has revealed medial temporal and neocortical contributions to recent and remote memory retrieval, and it has been used to demonstrate compensatory neural recruitment in older adults, apolipoprotein E ε4 carriers, and amnestic mild cognitive impairment patients. Recently, we have also found that the famous name discrimination task provides predictive value for forecasting episodic memory decline among asymptomatic older adults. Other studies investigating the predictive value of semantic memory tasks will also be presented. We suggest several advantages associated with the use of semantic processing tasks, particularly those based on person identification, in comparison to episodic memory tasks to study AD risk. Future directions for research and potential clinical uses of semantic memory paradigms are also discussed. PMID:21996618
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Item Dependency in an Objective Structured Clinical Examination
ERIC Educational Resources Information Center
Iramaneerat, Cherdsak; Myford, Carol M.; Yudkowsky, Rachel
2006-01-01
An Objective Structured Clinical Examination (OSCE) is an assessment approach employed in medical education, in which residents rotate through multiple stations of standardized clinical tasks to evaluate their clinical competence. Because items used to evaluate residents' performance in each OSCE station are linked to the same task and are rated…
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The Role of L2 Learner Goal Differences in Task-Generated Oral Production
ERIC Educational Resources Information Center
Ben Maad, Mohamed Ridha
2016-01-01
In light of the growing interest in the cognitive approach to task in second language (L2) research, comparatively little has been done to examine such effect over time and the role of individual differences (IDs). The present study was designed to verify some longitudinal evidence for the role of tasks in L2 production and whether IDs, in the…
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Curry, Susan J; Whitlock, Evelyn P
2015-09-01
The importance of behavioral counseling as a clinical preventive service derives from the social and economic burden of preventable disease in the U.S., the central role behavioral risk factors play as leading causes of premature morbidity and mortality, and the promise of the healthcare visit as a teachable moment for behavioral counseling support. In November 2013, the U.S. Preventive Services Task Force convened an expert forum on behavioral counseling interventions. The forum brought together NIH, CDC, and Agency for Healthcare Research and Quality leaders, leading behavioral counseling researchers, and members of the U.S. Preventive Services Task Force to discuss issues related to optimizing evidence-based behavioral counseling recommendations. This paper provides an overview of the methods used by the Task Force to develop counseling recommendations. Special focus is on the development and evaluation of evidence from systematic reviews. Assessment of the net benefit of a behavioral counseling intervention, based on the evidence review, determines the recommendation statement and accompanying letter grade. A recent Task Force recommendation on screening and behavioral counseling interventions in primary care to reduce alcohol misuse provides a brief example. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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Mancuso, Francesco; Horan, William P.; Kern, Robert S.; Green, Michael F.
2010-01-01
Social cognitive impairments are common, detectable across a wide range of tasks, and appear to play a key role in explaining poor outcome in schizophrenia and related psychotic disorders. However, little is known about the underlying factor structure of social cognition in people with psychotic disorders due to a lack of exploratory factor analyses using a relatively comprehensive social cognitive assessment battery. In a sample of 85 outpatients with psychosis, we examined the factor structure and clinical/functional correlates of eight indexes derived from five social cognition tasks that span the domains of emotional processing, social perception, attributional style, and Theory of Mind. Exploratory factor analysis revealed three factors with relatively low inter-correlations that explained a total of 54% of the variance: (1) Hostile attributional style, (2) Lower-level social cue detection, and (3) Higher-level inferential and regulatory processes. None of the factors showed significant correlations with negative symptoms. Factor 1 significantly correlated with clinical symptoms (positive, depression-anxiety, agitation) but not functional outcome, whereas Factors 2 and 3 significantly correlated with functional outcome (functional capacity and real-world social and work functioning) but not clinical symptoms. Furthermore, Factor 2 accounted for unique incremental variance in functional capacity, above and beyond non-social neurocognition (measured with MATRICS Consensus Cognitive Battery) and negative symptoms. Results suggest that multiple separable dimensions of social cognition can be identified in psychosis, and these factors show distinct patterns of correlation with clinical features and functional outcome. PMID:21112743
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Drooling in Parkinson's Disease: Evidence of a Role for Divided Attention.
Reynolds, Hannah; Miller, Nick; Walker, Richard
2018-05-21
Drooling is a frequently reported symptom in Parkinson's Disease (PD) with significant psychosocial impact and negative health consequences including silent aspiration of saliva with the associated risk of respiratory infections. It is suggested that in PD drooling is associated with inefficient oropharyngeal swallowing which reduces the effective clearance of saliva rather than hyper-salivation. This is compounded by unintended mouth opening and flexed posture increasing anterior loss of saliva. It is reported to occur most frequently during cognitively distracting concurrent tasks suggesting an impact from divided attention in a dual-task situation. However, this supposition has not been systematically examined. This study assessed whether frequency of saliva swallows reduced, and drooling severity and frequency increased, when people with PD engaged in a cognitively distracting task. 18 patients with idiopathic PD reporting daytime drooling on the Unified Parkinson's Disease Rating Scale (UPDRS) were recruited. They completed the Radboud Oral Motor Inventory for PD saliva questionnaire and the Montreal Cognitive Assessment. UPDRS drooling score, disease stage, duration, gender, and age were recorded. Swallow frequency and drooling severity and frequency were measured at rest and during a distracting computer-based language task. There was no significant difference between drooling severity at rest and during distraction (Wilcoxon signed rank test z = - 1.724, p = 0.085). There was a significant difference between at rest and distraction conditions for both drooling frequency (Wilcoxon signed rank test z = - 2.041, p = 0.041) and swallow frequency (Wilcoxon signed rank test z = - 3.054, p = 0.002). Participants swallowed less frequently and drooled more often during the distraction task. The frequency of saliva swallows and drooling are affected by divided attention in a dual-task paradigm. Further studies are needed to explore the exact role of attention in saliva management and the clinical applications in assessment and treatment.
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Takamura, T; Hanakawa, T
2017-07-01
Although functional magnetic resonance imaging (fMRI) has long been used to assess task-related brain activity in neuropsychiatric disorders, it has not yet become a widely available clinical tool. Resting-state fMRI (rs-fMRI) has been the subject of recent attention in the fields of basic and clinical neuroimaging research. This method enables investigation of the functional organization of the brain and alterations of resting-state networks (RSNs) in patients with neuropsychiatric disorders. Rs-fMRI does not require participants to perform a demanding task, in contrast to task fMRI, which often requires participants to follow complex instructions. Rs-fMRI has a number of advantages over task fMRI for application with neuropsychiatric patients, for example, although applications of task fMR to participants for healthy are easy. However, it is difficult to apply these applications to patients with psychiatric and neurological disorders, because they may have difficulty in performing demanding cognitive task. Here, we review the basic methodology and analysis techniques relevant to clinical studies, and the clinical applications of the technique for examining neuropsychiatric disorders, focusing on mood disorders (major depressive disorder and bipolar disorder) and dementia (Alzheimer's disease and mild cognitive impairment).
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Preparing clinical laboratory science students with teaching skills.
Isabel, Jeanne M
2010-01-01
Training clinical laboratory science (CLS) students in techniques of preparation and delivery of an instructional unit is an important component of all CLS education programs and required by the national accrediting agency. Participants of this study included students admitted to the CLS program at Northern Illinois University and enrolled in the teaching course offered once a year between the years of 1997 and 2009. Courses on the topic of "teaching" may be regarded by CLS students as unnecessary. However, entry level practitioners are being recruited to serve as clinical instructors soon after entering the workforce. Evaluation of the data collected indicates that students are better prepared to complete tasks related to instruction of a topic after having an opportunity to study and practice skills of teaching. Mentoring CLS students toward the career role of clinical instructor or professor is important to maintaining the workforce.
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Holmberg, Leif
2007-11-01
A health-care organization simultaneously belongs to two different institutional value patterns: a professional and an administrative value pattern. At the administrative level, medical problem-solving processes are generally perceived as the efficient application of familiar chains of activities to well-defined problems; and a low task uncertainty is therefore assumed at the work-floor level. This assumption is further reinforced through clinical pathways and other administrative guidelines. However, studies have shown that in clinical practice such administrative guidelines are often considered inadequate and difficult to implement mainly because physicians generally perceive task uncertainty to be high and that the guidelines do not cover the scope of encountered deviations. The current administrative level guidelines impose uniform structural features that meet the requirement for low task uncertainty. Within these structural constraints, physicians must organize medical problem-solving processes to meet any task uncertainty that may be encountered. Medical problem-solving processes with low task uncertainty need to be organized independently of processes with high task uncertainty. Each process must be evaluated according to different performance standards and needs to have autonomous administrative guideline models. Although clinical pathways seem appropriate when there is low task uncertainty, other kinds of guidelines are required when the task uncertainty is high.
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A profession under threat? An exploratory case study of changes in Norwegian public health nursing.
Clancy, Anne
2007-06-01
The first courses for public health nurses in Norway were held in the 1920s-1930s. In 1957, the Act regulating public health nursing was passed. Norwegian public health nurses have a primary role in promoting health and preventing illnesses. Their role has changed with a changing society. This article shows some of the challenges the nurses have faced. It focuses on collaboration, tasks, leadership and authority/status. The study's intentions are exploratory. It looks into how the nurses experience their changing role. A single case with an embedded design is the method chosen; the case is 'Changes in the role of the Norwegian public health nurse during the period 1984-2005'. Document analysis and interviews are sources of evidence. The findings show that public health nurses' visibility seems to be an important issue. There are some divergences between relevant literature on the nurses' professional status and the views of the nurses in the study. Several other public health professionals have lost tasks and formal positions of authority. The nurses interviewed still feel that they are a respected and trusted profession despite being less visible. A recent study among parents who frequent local clinics confirms their important role. Can the nurses' lack of visibility have undesired outcomes? A profession that is unassuming, not visible and that fights silent battles may have problems being heard when it tries to promote issues concerning family health. Further studies are indicated.
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Homer, Sophie R; Deeprose, Catherine; Andrade, Jackie
2016-03-01
This study sought to reconcile two lines of research. Previous studies have identified a prevalent and causal role of negative imagery in social phobia and public speaking anxiety; others have demonstrated that lateral eye movements during visualisation of imagery reduce its vividness, most likely by loading the visuospatial sketchpad of working memory. It was hypothesised that using eye movements to reduce the intensity of negative imagery associated with public speaking may reduce anxiety resulting from imagining a public speaking scenario compared to an auditory control task. Forty undergraduate students scoring high in anxiety on the Personal Report of Confidence as a Speaker scale took part. A semi-structured interview established an image that represented the participant's public speaking anxiety, which was then visualised during an eye movement task or a matched auditory task. Reactions to imagining a hypothetical but realistic public speaking scenario were measured. As hypothesised, representative imagery was established and reduced in vividness more effectively by the eye movement task than the auditory task. The public speaking scenario was then visualised less vividly and generated less anxiety when imagined after performing the eye movement task than after the auditory task. Self-report measures and a hypothetical scenario rather than actual public speaking were used. Replication is required in larger as well as clinical samples. Visuospatial working memory tasks may preferentially reduce anxiety associated with personal images of feared events, and thus provide cognitive resistance which reduces emotional reactions to imagined, and potentially real-life future stressful experiences. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Kiyuna, Asanori; Kise, Norimoto; Hiratsuka, Munehisa; Kondo, Shunsuke; Uehara, Takayuki; Maeda, Hiroyuki; Ganaha, Akira; Suzuki, Mikio
2017-05-01
Spasmodic dysphonia (SD) is considered a focal dystonia. However, the detailed pathophysiology of SD remains unclear, despite the detection of abnormal activity in several brain regions. The aim of this study was to clarify the pathophysiological background of SD. This is a case-control study. Both task-related brain activity measured by functional magnetic resonance imaging by reading the five-digit numbers and resting-state functional connectivity (FC) measured by 150 T2-weighted echo planar images acquired without any task were investigated in 12 patients with adductor SD and in 16 healthy controls. The patients with SD showed significantly higher task-related brain activation in the left middle temporal gyrus, left thalamus, bilateral primary motor area, bilateral premotor area, bilateral cerebellum, bilateral somatosensory area, right insula, and right putamen compared with the controls. Region of interest voxel FC analysis revealed many FC changes within the cerebellum-basal ganglia-thalamus-cortex loop in the patients with SD. Of the significant connectivity changes between the patients with SD and the controls, the FC between the left thalamus and the left caudate nucleus was significantly correlated with clinical parameters in SD. The higher task-related brain activity in the insula and cerebellum was consistent with previous neuroimaging studies, suggesting that these areas are one of the unique characteristics of phonation-induced brain activity in SD. Based on FC analysis and their significant correlations with clinical parameters, the basal ganglia network plays an important role in the pathogenesis of SD. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
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Nursing Work in Long-Term Care: An Integrative Review.
Montayre, Jed; Montayre, Jasmine
2017-11-01
Evidence suggests that delivery of good nursing care in long-term care (LTC) facilities is reflected in nurses' descriptions of the factors and structures that affect their work. Understanding the contemporary nature of nursing work in aged care will influence policies for improving current work structures in this practice setting. The current review aims to present a contemporary perspective of RNs' work in LTC facilities. A comprehensive search and purposeful selection of the literature was conducted using CINAHL, PubMed, Medline, Scopus, and Google Scholar databases. Nine studies were eligible for review. Common themes revealed that nursing work in aged care settings is characterized by RNs providing indirect care tasks-primarily care coordination, engaging in non-nursing activities, and having an expanded and overlapping role. As care providers, aged care RNs do not always provide direct care as part of their nursing work. The scope of RN work beyond its clinical nature or performance of non-nursing tasks adds complexity in clarifying RN work roles in aged care. [Journal of Gerontological Nursing, 43(11), 41-49.]. Copyright 2017, SLACK Incorporated.
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The UK clinical research network--has it been a success for dermatology clinical trials?
Thomas, Kim S; Koller, Karin; Foster, Katharine; Perdue, Jo; Charlesworth, Lisa; Chalmers, Joanne R
2011-06-16
Following the successful introduction of five topic-specific research networks in the UK, the Comprehensive Local Research Network (CLRN) was established in 2008 in order to provide a blanket level of support across the whole country regardless of the clinical discipline. The role of the CLRN was to facilitate recruitment into clinical trials, and to encourage greater engagement in research throughout the National Health Service (NHS). This report evaluates the impact of clinical research networks in supporting clinical trials in the UK, with particular reference to our experiences from two non-commercial dermatology trials. It covers our experience of engaging with the CLRN (and other research networks) using two non-commercial dermatology trials as case studies. We present the circumstances that led to our approach to the research networks for support, and the impact that this support had on the delivery of these trials. In both cases, recruitment was boosted considerably following the provision of additional support, although other factors such as the availability of experienced personnel, and the role of advertising and media coverage in promoting the trials were also important in translating this additional resource into increased recruitment. Recruitment into clinical trials is a complex task that can be influenced by many factors. A world-class clinical research infrastructure is now in place in England (with similar support available in Scotland and Wales), and it is the responsibility of the research community to ensure that this unique resource is used effectively and responsibly.
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A neurocomputational account of cognitive deficits in Parkinson’s disease
Hélie, Sébastien; Paul, Erick J.; Ashby, F. Gregory
2014-01-01
Parkinson’s disease (PD) is caused by the accelerated death of dopamine (DA) producing neurons. Numerous studies documenting cognitive deficits of PD patients have revealed impairments in a variety of tasks related to memory, learning, visuospatial skills, and attention. While there have been several studies documenting cognitive deficits of PD patients, very few computational models have been proposed. In this article, we use the COVIS model of category learning to simulate DA depletion and show that the model suffers from cognitive symptoms similar to those of human participants affected by PD. Specifically, DA depletion in COVIS produced deficits in rule-based categorization, non-linear information-integration categorization, probabilistic classification, rule maintenance, and rule switching. These were observed by simulating results from younger controls, older controls, PD patients, and severe PD patients in five well-known tasks. Differential performance among the different age groups and clinical populations was modeled simply by changing the amount of DA available in the model. This suggests that COVIS may not only be an adequate model of the simulated tasks and phenomena but also more generally of the role of DA in these tasks and phenomena. PMID:22683450
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NASA Astrophysics Data System (ADS)
Wendell, Kristen Bethke; Lee, Hee-Sun
2010-12-01
Materials science, which entails the practices of selecting, testing, and characterizing materials, is an important discipline within the study of matter. This paper examines how third grade students' materials science performance changes over the course of instruction based on an engineering design challenge. We conducted a case study of nine students who participated in engineering design-based science instruction with the goal of constructing a stable, quiet, thermally comfortable model house. The learning outcome of materials science practices was assessed by clinical interviews conducted before and after the instruction, and the learning process was assessed by students' workbooks completed during the instruction. The interviews included two materials selection tasks for designing a sturdy stepstool and an insulated pet habitat. Results indicate that: (1) students significantly improved on both materials selection tasks, (2) their gains were significantly positively associated with the degree of completion of their workbooks, and (3) students who were highly engaged with the workbook's reflective record-keeping tasks showed the greatest improvement on the interviews. These findings suggest the important role workbooks can play in facilitating elementary students' learning of science through authentic activity such as engineering design.
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Dimensions of clinical nurse specialist work in the UK.
Leary, Alison; Crouch, Heather; Lezard, Anthony; Rawcliffe, Chris; Boden, Louise; Richardson, Alison
To model the work of clinical nurse specialists (CNSs) in the UK. This article examines data mined as part of a national project. The Pandora database was initially collected on a Microsoft Office Access database and subsequently, a Structured Query Language database in several iterations from June 2006 to September 2008. Pandora recorded CNS activity as a series of events with eight dimensions to each event. Data from this were mined to examine the complexity of CNS work. This study represents the work of 463 CNSs over 2,778 days in England, Scotland and Wales. Clinical work, including physical assessment, referral, symptom control and 'rescue' work, accounted for a large part of the CNS's role. Administration was the second highest workload, with about half of these administrative tasks identified as being suitable for secretarial staff to undertake. Research, education and consultation accounted for less time. A significant proportion of the nurses' clinical work is undertaken by telephone. CNSs in this study spent much of their time doing complex clinical work. Payment by Results (Department of Health 2006) should recognise the work undertaken by CNSs, particularly that done on the telephone. Complex clinical work by CNSs takes place in many different contexts using a wide range of interventions. The role of the CNS is complex and diverse, making comparisons of it difficult. More research needs to be done in relation to quality, safety and efficiency.
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'Let other people do it…': the role of emergency department nurses in health promotion.
Shoqirat, Noordeen
2014-01-01
To explore emergency department nurses' roles in health promotion and contributing factors involved. In many healthcare systems, emergency departments are increasingly urged to play a crucial role in health promotion. Although much has been written about health promotion and nurses in acute care settings, less has focused on emergency departments. A qualitative design was used. In-depth semi-structured interviews were used with a convenient sample of 15 nurses in a Jordanian emergency department. Data were analysed using nvivo 9 (QSR International, Doncaster, Victoria, Australia). The analysis identified two themes. The first focused on nurses' roles in health promotion, comprising two categories: having no roles and 'let other people do it'. The second theme focused on the context and constraints of health promotion comprising fear of violence, the nature of healthcare service and patients' beliefs. The majority of nurses in emergency departments do not associate health promotion with their practice, hold some negative attitudes and devote more time to clinical tasks than health promotion, which is seen as a second priority. The ideology of medicalised tasks has penetrated deeply into the core principles of health promotion, and thus, nurses' roles and potential in this area are questioned. Decision-makers and nurses within the hospital are urged to address the constraints identified in this study and debate them further. Failure to do so may lead to emergency nursing not being optimally achieved, with the absence of sustained and concerted health promotion work matching patients' cultural needs and sensitivities. © 2013 John Wiley & Sons Ltd.
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Napier, Patti; Norris, Pauline; Braund, Rhiannon
2018-04-01
Internationally there is an increasing focus on the clinical and cognitive services that pharmacists can provide. Lack of time has been identified as a barrier to pharmacists increasing their clinical activities. Within the pharmacy workplace there are many tasks that can only be performed by a pharmacist. The final accuracy check of a dispensed prescription is currently the sole responsibility of pharmacists in New Zealand. This takes up a significant amount of time during a pharmacist's work day. The introduction of a checking technician role has been suggested to allow pharmacists more time to do more patient focused work. To investigate the amount of time pharmacy staff spend on specific activities and to establish whether the introduction of a checking technician into twelve pilot sites increased the amount of time that the pharmacists could spend on patient focused activities. This study utilised a self-reported work sampling technique in twelve pilot sites, selected from both the hospital and community settings. Work sampling using an electronic device was conducted at two time-points (before the implementation of a Pharmacy Accuracy Checking Technician (PACT) role and when the PACT was in place). Data was collected at 10 min intervals for the period of five days, a working week. Tasks were grouped into patient focused, dispensing and personal activities. The introduction of the PACT into the pilot sites saw a mean increase of 19% in pharmacists' patient focused activities and a mean 20% decrease in dispensing activities. The introduction of a checking technician role into New Zealand pharmacies demonstrated the potential to provide pharmacists with more time to spend on patient focused activities. Copyright © 2017 Elsevier Inc. All rights reserved.
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Joly, Florence; Giffard, Bénédicte; Rigal, Olivier; De Ruiter, Michiel B; Small, Brent J; Dubois, Martine; LeFel, Johan; Schagen, Sanne B; Ahles, Tim A; Wefel, Jeffrey S; Vardy, Janette L; Pancré, Véronique; Lange, Marie; Castel, Hélène
2015-12-01
Although cognitive impairments have been identified in patients with non-central nervous system cancer, especially breast cancer, the respective roles of cancer and therapies, and the mechanisms involved in cognitive dysfunction remain unclear. To report a state-of-the-art update from the International Cognitive and Cancer Task Force conference held in 2012. A report of the meeting and recent new perspectives are presented. Recent clinical data support that non-central nervous system cancer per se may be involved in cognitive dysfunctions associated with inflammation parameters. The role of chemotherapy on cognitive decline was confirmed in colorectal and testicular cancers. Whereas the impact of hormone therapy remains debatable, some studies support a negative impact of targeted therapies on cognition. Regarding interventions, preliminary results of cognitive rehabilitation showed encouraging results. The methodology of future longitudinal studies has to be optimized by a priori end points, the use of validated test batteries, and the inclusion of control groups. Comorbidities and aging are important factors to be taken into account in future studies. Preclinical studies in animal models highlighted the role of cancer itself on cognition and support the possible benefits of prevention/care during chemotherapy. Progress in neuroimaging will help specify neural processes affected by treatments. Clinical data and animal models confirmed that chemotherapy induces direct cognitive deficit. The benefits of cognitive rehabilitation are still to be confirmed. Studies evaluating the mechanisms underlying cognitive impairments using advanced neuroimaging techniques integrating the evaluation of genetic factors are ongoing. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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A Novel Method for Assessing Task Complexity in Outpatient Clinical-Performance Measures.
Hysong, Sylvia J; Amspoker, Amber B; Petersen, Laura A
2016-04-01
Clinical-performance measurement has helped improve the quality of health-care; yet success in attaining high levels of quality across multiple domains simultaneously still varies considerably. Although many sources of variability in care quality have been studied, the difficulty required to complete the clinical work itself has received little attention. We present a task-based methodology for evaluating the difficulty of clinical-performance measures (CPMs) by assessing the complexity of their component requisite tasks. Using Functional Job Analysis (FJA), subject-matter experts (SMEs) generated task lists for 17 CPMs; task lists were rated on ten dimensions of complexity, and then aggregated into difficulty composites. Eleven outpatient work SMEs; 133 VA Medical Centers nationwide. Clinical Performance: 17 outpatient CPMs (2000-2008) at 133 VA Medical Centers nationwide. Measure Difficulty: for each CPM, the number of component requisite tasks and the average rating across ten FJA complexity scales for the set of tasks comprising the measure. Measures varied considerably in the number of component tasks (M = 10.56, SD = 6.25, min = 5, max = 25). Measures of chronic care following acute myocardial infarction exhibited significantly higher measure difficulty ratings compared to diabetes or screening measures, but not to immunization measures ([Formula: see text] = 0.45, -0.04, -0.05, and -0.06 respectively; F (3, 186) = 3.57, p = 0.015). Measure difficulty ratings were not significantly correlated with the number of component tasks (r = -0.30, p = 0.23). Evaluating the difficulty of achieving recommended CPM performance levels requires more than simply counting the tasks involved; using FJA to assess the complexity of CPMs' component tasks presents an alternate means of assessing the difficulty of primary-care CPMs and accounting for performance variation among measures and performers. This in turn could be used in designing performance reward programs, or to match workflow to clinician time and effort.
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The role of nontechnical skills in simulated trauma resuscitation.
Briggs, Alexandra; Raja, Ali S; Joyce, Maurice F; Yule, Steven J; Jiang, Wei; Lipsitz, Stuart R; Havens, Joaquim M
2015-01-01
Trauma team training provides instruction on crisis management through debriefing and discussion of teamwork and leadership skills during simulated trauma scenarios. The effects of team leader's nontechnical skills (NTSs) on technical performance have not been thoroughly studied. We hypothesized that team's and team leader's NTSs correlate with technical performance of clinical tasks. Retrospective cohort study. Brigham and Women's Hospital, STRATUS Center for Surgical Simulation A total of 20 teams composed of surgical residents, emergency medicine residents, emergency department nurses, and emergency services assistants underwent 2 separate, high-fidelity, simulated trauma scenarios. Each trauma scenario was recorded on video for analysis and divided into 4 consecutive sections. For each section, 2 raters used the Non-Technical Skills for Surgeons framework to assess NTSs of the team. To evaluate the entire team's NTS, 2 additional raters used the Modified Non-Technical Skills Scale for Trauma system. Clinical performance measures including adherence to guidelines and time to perform critical tasks were measured independently. NTSs performance by both teams and team leaders in all NTS categories decreased from the beginning to the end of the scenario (all p < 0.05). There was significant correlation between team's and team leader's cognitive skills and critical task performance, with correlation coefficients between 0.351 and 0.478 (p < 0.05). The NTS performance of the team leader highly correlated with that of the entire team, with correlation coefficients between 0.602 and 0.785 (p < 0.001). The NTSs of trauma teams and team leaders deteriorate as clinical scenarios progress, and the performance of team leaders and teams is highly correlated. Cognitive NTS scores correlate with critical task performance. Increased attention to NTSs during trauma team training may lead to sustained performance throughout trauma scenarios. Decision making and situation awareness skills are critical for both team leaders and teams and should be specifically addressed to improve performance. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
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Jastremski, M; Jastremski, C; Shepherd, M; Friedman, V; Porembka, D; Smith, R; Gonzales, E; Swedlow, D; Belzberg, H; Crass, R
1995-10-01
To test a model for the assessment of critical care technology on closed loop infusion control, a technology that is in its early stages of development and testing on human subjects. A computer-assisted search of the English language literature and reviews of the gathered data by experts in the field of closed loop infusion control systems. Studies relating to closed loop infusion control that addressed one or more of the questions contained in our technology assessment template were analyzed. Study design was not a factor in article selection. However, the lack of well-designed clinical outcome studies was an important factor in determining our conclusions. A focus person summarized the data from the selected studies that related to each of the assessment questions. The preliminary data summary developed by the focus person was further analyzed and refined by the task force. Experts in closed loop systems were then added to the group to review the summary provided by the task force. These experts' comments were considered by the task force and this final consensus report was developed. Closed loop system control is a technological concept that may be applicable to several aspects of critical care practice. This is a technology in the early stages of evolution and much more research and data are needed before its introduction into usual clinical practice. Furthermore, each specific application and each device for each application (e.g., nitroprusside infusion, ventilator adjustment), although based on the same technological concept, are sufficiently different in terms of hardware and computer algorithms to require independent validation studies. Closed loop infusion systems may have a role in critical care practice. However, for most applications, further development is required to move this technology from the innovation phase to the point where it can be evaluated so that its role in critical car practice can be defined. Each application of closed loop infusion systems must be independently validated by appropriately designed research studies. Users should be provided with the clinical parameters driving each closed loop system so that they can ensure that it agrees with their opinion of acceptable medical practice. Clinical researchers and leaders in industry should collaborate to perform the scientifically valid, outcome-based research that is necessary to evaluate the effect of this new technology. The original model we developed for technology assessment required the addition of several more questions to produce a complete analysis of an emerging technology. An emerging technology should be systematically assessed (using a model such as the model developed by the Society of Critical Care Medicine), before its introduction into clinical practice in order to provide a focus for human outcome validation trials and to minimize the possibility of widespread use of an unproven technology.
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Özdem, Ceylan; Brass, Marcel; Van der Cruyssen, Laurens; Van Overwalle, Frank
2017-04-01
Neuroimaging research has demonstrated that the temporo-parietal junction (TPJ) is activated when unexpected stimuli appear in spatial reorientation tasks as well as during thinking about the beliefs of other people triggered by verbal scenarios. While the role of potential common component processes subserved by the TPJ has been extensively studied to explain this common activation, the potential confounding role of input modality (spatial vs. verbal) has been largely ignored. To investigate the role of input modality apart from task processes, we developed a novel spatial false belief task based on moving shapes. We explored the overlap in TPJ activation across this novel task and traditional tasks of spatial reorientation (Posner) and verbal belief (False Belief vs. Photo stories). The results show substantial overlap across the same spatial input modality (both reorientation and false belief) as well as across the common task process (verbal and spatial belief), but no triple overlap. This suggests the potential for an overarching function of the TPJ, with some degree of specialization in different subregions due to modality, function and connectivity. The results are discussed with respect to recent theoretical models of the TPJ.
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Ansari, Shabnam; Rashidian, Arash
2012-01-01
Objectives We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks. Methods We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as ‘necessary’ tasks. Result Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks’ weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors. Discussion Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings help decision makers in identifying the necessary tasks for guideline development, provide an updated comparative list of guideline development handbooks, and provide a checklist to assess the comprehensiveness of guideline development processes. PMID:23189167
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Gottlieb, Klaus; Hussain, Fez
2015-02-19
Independent central reading or off-site reading of imaging endpoints is increasingly used in clinical trials. Clinician-reported outcomes, such as endoscopic disease activity scores, have been shown to be subject to bias and random error. Central reading attempts to limit bias and improve accuracy of the assessment, two factors that are critical to trial success. Whether one central reader is sufficient and how to best integrate the input of more than one central reader into one output measure, is currently not known.In this concept paper we develop the theoretical foundations of a reading algorithm that can achieve both objectives without jeopardizing operational efficiency We examine the role of expert versus competent reader, frame scoring of imaging as a classification task, and propose a voting algorithm (VISA: Voting for Image Scoring and Assessment) as the most appropriate solution which could also be used to operationally define imaging gold standards. We propose two image readers plus an optional third reader in cases of disagreement (2 + 1) for ordinary scoring tasks. We argue that it is critical in trials with endoscopically determined endpoints to include the score determined by the site reader, at least in endoscopy clinical trials. Juries with more than 3 readers could define a reference standard that would allow a transition from measuring reader agreement to measuring reader accuracy. We support VISA by applying concepts from engineering (triple-modular redundancy) and voting theory (Condorcet's jury theorem) and illustrate our points with examples from inflammatory bowel disease trials, specifically, the endoscopy component of the Mayo Clinic Score of ulcerative colitis disease activity. Detailed flow-diagrams (pseudo-code) are provided that can inform program design.The VISA "2 + 1" reading algorithm, based on voting, can translate individual reader scores into a final score in a fashion that is both mathematically sound (by avoiding averaging of ordinal data) and in a manner that is consistent with the scoring task at hand (based on decisions about the presence or absence of features, a subjective classification task). While the VISA 2 + 1 algorithm is currently being used in clinical trials, empirical data of its performance have not yet been reported.
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Altered resting state functional connectivity of anterior insula in young smokers.
Bi, Yanzhi; Yuan, Kai; Guan, Yanyan; Cheng, Jiadong; Zhang, Yajuan; Li, Yangding; Yu, Dahua; Qin, Wei; Tian, Jie
2017-02-01
The insula has been implicated in cognitive control and craving, all of which are critical to the clinical manifestations of nicotine dependence. However, little evidence exists about the abnormalities in resting state functional connectivity (RSFC) of the insula in young smokers, which might improve our understanding of the neural mechanisms of nicotine dependence. Due to the structural and functional heterogeneity of the insula, the RSFC patterns of both left and right anterior (AI) and posterior insula (PI) were investigated in young smokers and non-smokers. Meanwhile, the relationship was assessed between the neuroimaging findings and clinical information (pack-years, FTND, and craving) as well as cognitive control deficits measured by Stroop task performance. Compared with non-smokers, young smokers showed reduced RSFC between right AI and anterior cingulate cortex (ACC), ventromedial prefrontal cortex (VMPFC), amygdala, left dorsolateral prefrontal cortex, and dorsal striatum. Additionally, left AI showed reduced RSFC with ACC. Both left and right PI network differences were not observed between two groups. Moreover, in young smokers, FTND and incongruent errors in the Stroop task were negatively correlated with the RSFC between AI and ACC. Craving scores showed a significantly negative relationship with the RSFC strength between right AI and left VMPFC. These results provide a more thorough network-level understanding the role of insula in cigarette smoking. The findings provide new insights into the roles of AI-ACC circuit in cognitive control deficits and right AI-VMPFC circuit relevant to the craving of nicotine dependence for young smokers.
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The Role of Reading Strategies in Integrated L2 Writing Tasks
ERIC Educational Resources Information Center
Plakans, Lia
2009-01-01
Integrated second-language writing tasks elicit writing performances that involve other abilities such as reading or listening. Thus, understanding the role of these other abilities is necessary for interpreting performance on such tasks. This study used an inductive analysis of think-aloud protocol data and interviews to uncover the reading…
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Improving Dual-Task Control With a Posture-Second Strategy in Early-Stage Parkinson Disease.
Huang, Cheng-Ya; Chen, Yu-An; Hwang, Ing-Shiou; Wu, Ruey-Meei
2018-03-31
To examine the task prioritization effects on postural-suprapostural dual-task performance in patients with early-stage Parkinson disease (PD) without clinically observed postural symptoms. Cross-sectional study. Participants performed a force-matching task while standing on a mobile platform, and were instructed to focus their attention on either the postural task (posture-first strategy) or the force-matching task (posture-second strategy). University research laboratory. Individuals (N=16) with early-stage PD who had no clinically observed postural symptoms. Not applicable. Dual-task change (DTC; percent change between single-task and dual-task performance) of posture error, posture approximate entropy (ApEn), force error, and reaction time (RT). Positive DTC values indicate higher postural error, posture ApEn, force error, and force RT during dual-task conditions compared with single-task conditions. Compared with the posture-first strategy, the posture-second strategy was associated with smaller DTC of posture error and force error, and greater DTC of posture ApEn. In contrast, greater DTC of force RT was observed under the posture-second strategy. Contrary to typical recommendations, our results suggest that the posture-second strategy may be an effective dual-task strategy in patients with early-stage PD who have no clinically observed postural symptoms in order to reduce the negative effect of dual tasking on performance and facilitate postural automaticity. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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de Pierrefeu, Inès; Corbière, Marc; Pachoud, Bernard
Objectives Some programs have been developed in France for helping people with a psychiatric disability to get competitive employment, especially prevocational programs such as transitional social firms. However, these programs have not been studied until now. Studies on supported employment programs (evidence-based practices) conducted in other countries demonstrated that variation of work outcomes is due, among other factors, to employment specialists' competencies. These results highlight the need for describing more specifically the work of the two professionals, employment counselors and supervisors, working in transitional social firms in order to better understand their role, tasks and competencies. Therefore, the objective of this study aims at describing the roles, tasks and competencies of these two professionals working in transitional social firms, to better understand how they support people with psychiatric disability for eventually obtaining competitive employment.Methods A qualitative method was used to describe roles, tasks and competencies of employment counselors and supervisors working in the transitional social firms of the Messidor's association (7 regions). In sum, 24 individual interviews with employment counselors and supervisors of these social firms as well as 7 focus groups with the two types of professionals, were conducted.Results This study allowed to define the work of the two professionals (role and tasks) and a list of 110 competencies for employment counselors as well as 155 competencies for supervisors working in these transitional social firms, emerged from qualitative analyses. This "double support" has been defined as a complementary approach helping workers to change their own perceptions, becoming more confident in their work abilities, and thus helping them to gain competitive employment. On the one hand, the employment counselor supports each worker in developing strategies and actions to reach competitive employment, and put in place "job development skills" to coordinate his role with key stakeholders (e.g. psychiatrist, employers) involved in the work integration of people with severe mental disorders. On the other hand, the supervisor is following each worker all day long, training and helping them to overcome potential difficulties regarding the work to do, and building confidence and self-esteem in the workers under their supervision, which are all key elements to gain competitive employment.Conclusion Clinical implications are suggested regarding the recruitment of professionals working in transitional social firms, and thus improving work outcomes for people with a severe mental illness.
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Delegation to nurses in general practice
Bowling, Ann
1981-01-01
A random sample of general practitioners and their nursing staff was interviewed to examine the extent to which the doctors delegated medical tasks to the nurses and to analyse attitudes towards delegation. A significant minority of both doctors and nurses were reluctant to have minor clinical tasks delegated and a majority did not think that nurses should carry out delegated diagnostic procedures. Doctors and nurses who had completed their training since 1960 were more likely to favour delegation than those who had completed their training before 1960. This suggests that delegation may become more common. However, the finding that there is considerable opposition to delegation and that this opposition is often based on feelings of professional threat suggests that many doctors may not be ready to experiment with ways of expanding the nurse's role in general practice. PMID:7328527
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Passier, Leanne; McPhail, Steven
2011-01-25
Physiotherapy and occupational therapy are two professions at high risk of work related musculoskeletal disorders (WRMD). This investigation aimed to identify risk factors for WRMD as perceived by the health professionals working in these roles (Aim 1), as well as current and future strategies they perceive will allow them to continue to work in physically demanding clinical roles (Aim 2). A two phase exploratory investigation was undertaken. The first phase included a survey administered via a web based platform with qualitative open response items. The second phase involved four focus group sessions which explored topics obtained from the survey. Thematic analysis of qualitative data from the survey and focus groups was undertaken. Overall 112 (34.3%) of invited health professionals completed the survey; 66 (58.9%) were physiotherapists and 46 (41.1%) were occupational therapists. Twenty-four health professionals participated in one of four focus groups. The risk factors most frequently perceived by health professionals included: work postures and movements, lifting or carrying, patient related factors and repetitive tasks. The six primary themes for strategies to allow therapists to continue to work in physically demanding clinical roles included: organisational strategies, workload or work allocation, work practices, work environment and equipment, physical condition and capacity, and education and training. Risk factors as well as current and potential strategies for reducing WRMD amongst these health professionals working in clinically demanding roles have been identified and discussed. Further investigation regarding the relative effectiveness of these strategies is warranted.
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Payne, J L; Baumgartner, R G
1996-01-01
THE CNS ROLE has been actualized in a variety of ways. Flexibility-inherent in the role-and the revolution in health care consciousness tend to place the CNS at risk for criticism regarding value to the organization. At Vanderbilt University Medical Center, a CNS task force evaluated the current reality of CNS practice and recommended role changes to include the financial analysis of patient care. After incorporating a financial perspective into our present practice, we have embarked on an interesting journey of post-Master's degree study, that of the tertiary care nurse practitioner. This practice option could elevated the clinical and financial aspects of providing cost-effective health care to a more autonomous role form; however, the transition has been challenging. Since 1990, the American Nurses Association has recommended that nursing school curricula change to meet the needs of the health care environment and provide increased career flexibility through creating one advanced degree incorporating both CNS and NP functions. Swiftly moving past differences and toward similarities will bridge the gap for advanced practice nurses in the future.
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Lessons learned from a pharmacy practice model change at an academic medical center.
Knoer, Scott J; Pastor, John D; Phelps, Pamela K
2010-11-01
The development and implementation of a new pharmacy practice model at an academic medical center are described. Before the model change, decentralized pharmacists responsible for order entry and verification and clinical specialists were both present on the care units. Staff pharmacists were responsible for medication distribution and sterile product preparation. The decentralized pharmacists handling orders were not able to use their clinical training, the practice model was inefficient, and few clinical services were available during evenings and weekends. A task force representing all pharmacy department roles developed a process and guiding principles for the model change, collected data, and decided on a model. Teams consisting of decentralized pharmacists, decentralized pharmacy technicians, and team leaders now work together to meet patients' pharmacy needs and further departmental safety, quality, and cost-saving goals. Decentralized service hours have been expanded through operational efficiencies, including use of automation (e.g., computerized provider order entry, wireless computers on wheels used during rounds with physician teams). Nine clinical specialist positions were replaced by five team leader positions and four pharmacists functioning in decentralized roles. Additional staff pharmacist positions were shifted into decentralized roles, and the hospital was divided into areas served by teams including five to eight pharmacists. Technicians are directly responsible for medication distribution. No individual's job was eliminated. The new practice model allowed better alignment of staff with departmental goals, expanded pharmacy hours and services, more efficient medication distribution, improved employee engagement, and a staff succession plan.
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Ait Khelifa-Gallois, N; Puget, S; Longaud, A; Laroussinie, F; Soria, C; Sainte-Rose, C; Dellatolas, G
2015-04-01
It has been suggested that the cerebellum is involved in reading acquisition and in particular in the progression from automatic grapheme-phoneme conversion to the internalization of speech required for silent reading. This idea is in line with clinical and neuroimaging data showing a cerebellar role in subvocal rehearsal for printed verbalizable material and with computational "internal models" of the cerebellum suggesting its role in inner speech (i.e. covert speech without mouthing the words). However, studies examining a possible cerebellar role in the suppression of articulatory movements during silent reading acquisition in children are lacking. Here, we report clinical evidence that the cerebellum plays a part in this transition. Reading performances were compared between a group of 17 paediatric patients treated for benign cerebellar tumours and a group of controls matched for age, gender, and parental socio-educational level. The patients scored significantly lower on all reading, but the most striking difference concerned silent reading, perfectly acquired by almost all controls, contrasting with 41 % of the patients who were unable to read any item silently. Silent reading was correlated with the Working Memory Index. The present findings converge with previous reports on an implication of the cerebellum in inner speech and in the automatization of reading. This cerebellar implication is probably not specific to reading, as it also seems to affect non-reading tasks such as counting.
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[Influence of Nurses' Self-leadership on Individual and Team Members' Work Role Performance].
Kim, Se Young; Kim, Eun Kyung; Kim, Byungsoo; Lee, Eunpyo
2016-06-01
The purpose of this study was to examine correlations between nurses' self-leadership and individual work role performance and correlations between self-leadership in nursing units and team members' work role performance. Participants were 202 conveniently selected general nurses from 5 general hospitals in Korea. The study was carried out on 35 nursing units. Data were collected during February 2015 with self-report questionnaires. For factors affecting individual work role performance, self-expectation, self-goal setting, constructive thought, clinical career in the present nursing unit and marital status accounted for 44.0% of proficiency, while self-expectation, self-goal setting, constructive thought, and marital status accounted for 42.3% of adaptivity. Self-expectation, self-goal setting, constructive thought, self-reward, clinical career in the present nursing unit and position accounted for 26.4% of proactivity. In terms of team members' work role performance, self-reward and self-expectation in nursing units explained 29.0% of team members' proficiency. Self-reward and self-expectation in nursing units explained 31.6% of team members' adaptivity, and self-reward in nursing units explained 16.8% of team members' proactivity. The results confirm that nurses' self-leadership affects not only individual self-leadership but also team members' work role performance. Accordingly, to improve nurses' work role performance in nursing units of nursing organizations, improvement in nursing environment based on self-leadership education is necessary and nurses' tasks rearranged so they can appreciate work-autonomy and challenges of work.
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Sugarman, Michael A; Woodard, John L; Nielson, Kristy A; Seidenberg, Michael; Smith, J Carson; Durgerian, Sally; Rao, Stephen M
2012-03-01
Extensive research efforts have been directed toward strategies for predicting risk of developing Alzheimer's disease (AD) prior to the appearance of observable symptoms. Existing approaches for early detection of AD vary in terms of their efficacy, invasiveness, and ease of implementation. Several non-invasive magnetic resonance imaging strategies have been developed for predicting decline in cognitively healthy older adults. This review will survey a number of studies, beginning with the development of a famous name discrimination task used to identify neural regions that participate in semantic memory retrieval and to test predictions of several key theories of the role of the hippocampus in memory. This task has revealed medial temporal and neocortical contributions to recent and remote memory retrieval, and it has been used to demonstrate compensatory neural recruitment in older adults, apolipoprotein E ε4 carriers, and amnestic mild cognitive impairment patients. Recently, we have also found that the famous name discrimination task provides predictive value for forecasting episodic memory decline among asymptomatic older adults. Other studies investigating the predictive value of semantic memory tasks will also be presented. We suggest several advantages associated with the use of semantic processing tasks, particularly those based on person identification, in comparison to episodic memory tasks to study AD risk. Future directions for research and potential clinical uses of semantic memory paradigms are also discussed. This article is part of a Special Issue entitled: Imaging Brain Aging and Neurodegenerative disease. Copyright © 2011 Elsevier B.V. All rights reserved.
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Gorlick, Marissa A; Worthy, Darrell A; Knopik, Valerie S; McGeary, John E; Beevers, Christopher G; Maddox, W Todd
2015-03-01
Humans with seven or more repeats in exon III of the DRD4 gene (long DRD4 carriers) sometimes demonstrate impaired attention, as seen in attention-deficit hyperactivity disorder, and at other times demonstrate heightened attention, as seen in addictive behavior. Although the clinical effects of DRD4 are the focus of much work, this gene may not necessarily serve as a "risk" gene for attentional deficits, but as a plasticity gene where attention is heightened for priority items in the environment and impaired for minor items. Here we examine the role of DRD4 in two tasks that benefit from selective attention to high-priority information. We examine a category learning task where performance is supported by focusing on features and updating verbal rules. Here, selective attention to the most salient features is associated with good performance. In addition, we examine the Operation Span (OSPAN) task, a working memory capacity task that relies on selective attention to update and maintain items in memory while also performing a secondary task. Long DRD4 carriers show superior performance relative to short DRD4 homozygotes (six or less tandem repeats) in both the category learning and OSPAN tasks. These results suggest that DRD4 may serve as a "plasticity" gene where individuals with the long allele show heightened selective attention to high-priority items in the environment, which can be beneficial in the appropriate context.
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The influence of schizotypal traits on attention under high perceptual load.
Stotesbury, Hanne; Gaigg, Sebastian B; Kirhan, Saim; Haenschel, Corinna
2018-03-01
Schizophrenia Spectrum Disorders (SSD) are known to be characterised by abnormalities in attentional processes, but there are inconsistencies in the literature that remain unresolved. This article considers whether perceptual resource limitations play a role in moderating attentional abnormalities in SSD. According to perceptual load theory, perceptual resource limitations can lead to attenuated or superior performance on dual-task paradigms depending on whether participants are required to process, or attempt to ignore, secondary stimuli. If SSD is associated with perceptual resource limitations, and if it represents the extreme end of an otherwise normally distributed neuropsychological phenotype, schizotypal traits in the general population should lead to disproportionate performance costs on dual-task paradigms as a function of the perceptual task demands. To test this prediction, schizotypal traits were quantified via the Schizotypal Personality Questionnaire (SPQ) in 74 healthy volunteers, who also completed a dual-task signal detection paradigm that required participants to detect central and peripheral stimuli across conditions that varied in the overall number of stimuli presented. The results confirmed decreasing performance as the perceptual load of the task increased. More importantly, significant correlations between SPQ scores and task performance confirmed that increased schizotypal traits, particularly in the cognitive-perceptual domain, are associated with greater performance decrements under increasing perceptual load. These results confirm that attentional difficulties associated with SSD extend sub-clinically into the general population and suggest that cognitive-perceptual schizotypal traits may represent a risk factor for difficulties in the regulation of attention under increasing perceptual load.
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Gorlick, Marissa A.; Worthy, Darrell A.; Knopik, Valerie S.; McGeary, John E.; Beevers, Christopher G.; Maddox, W. Todd
2014-01-01
Humans with 7 or more repeats in exon III of the DRD4 gene (long DRD4 carriers) sometimes demonstrate impaired attention, as seen in ADHD, and at other times demonstrate heightened attention, as seen in addictive behavior. Though the clinical effects of DRD4 are the focus of much work, this gene may not necessarily serve as a ‘risk’ gene for attentional deficits, but as a plasticity gene where attention is heightened for priority items in the environment and impaired for minor items. Here we examine the role of DRD4 in two tasks that benefit from selective attention to high-priority information. We examine a category learning task where performance is supported by focusing on features and updating verbal rules. Here selective attention to the most salient features is associated with good performance. In addition, we examine the Operation Span Task (OSPAN), a working memory capacity task that relies on selective attention to update and maintain items in memory while also performing a secondary task. Long DRD4 carriers show superior performance relative to short DRD4 homozygotes (six or less tandem repeats) in both the category learning and OSPAN tasks. These results suggest that DRD4 may serve as a ‘plasticity’ gene where individuals with the long allele show heightened selective attention to high-priority items in the environment, which can be beneficial in the appropriate context. PMID:25244120
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Guell, Xavier; Gabrieli, John D E; Schmahmann, Jeremy D
2018-05-15
Delineation of functional topography is critical to the evolving understanding of the cerebellum's role in a wide range of nervous system functions. We used data from the Human Connectome Project (n = 787) to analyze cerebellar fMRI task activation (motor, working memory, language, social and emotion processing) and resting-state functional connectivity calculated from cerebral cortical seeds corresponding to the peak Cohen's d of each task contrast. The combination of exceptional statistical power, activation from both motor and multiple non-motor tasks in the same participants, and convergent resting-state networks in the same participants revealed novel aspects of the functional topography of the human cerebellum. Consistent with prior studies there were two distinct representations of motor activation. Newly revealed were three distinct representations each for working memory, language, social, and emotional task processing that were largely separate for these four cognitive and affective domains. In most cases, the task-based activations and the corresponding resting-network correlations were congruent in identifying the two motor representations and the three non-motor representations that were unique to working memory, language, social cognition, and emotion. The definitive localization and characterization of distinct triple representations for cognition and emotion task processing in the cerebellum opens up new basic science questions as to why there are triple representations (what different functions are enabled by the different representations?) and new clinical questions (what are the differing consequences of lesions to the different representations?). Copyright © 2018 Elsevier Inc. All rights reserved.
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Cummings, J; Fox, N; Vellas, B; Aisen, P; Shan, G
2018-01-01
Disease-modifying therapies are urgently needed for the treatment of Alzheimer's disease (AD). The European Union/United States (EU/US) Task Force represents a broad range of stakeholders including biopharma industry personnel, academicians, and regulatory authorities. The EU/US Task Force represents a community of knowledgeable individuals who can inform views of evidence supporting disease modification and the development of disease-modifying therapies (DMTs). We queried their attitudes toward clinical trial design and biomarkers in support of DMTs. A survey of members of the EU/US Alzheimer's Disease Task Force was conducted. Ninety-three members (87%) responded. The details were analyzed to understand what clinical trial design and biomarker data support disease modification. Task Force members favored the parallel group design compared to delayed start or staggered withdrawal clinical trial designs to support disease modification. Amyloid biomarkers were regarded as providing mild support for disease modification while tau biomarkers were regarded as providing moderate support. Combinations of biomarkers, particularly combinations of tau and neurodegeneration, were regarded as providing moderate to marked support for disease modification and combinations of all three classes of biomarkers were regarded by a majority as providing marked support for disease modification. Task Force members considered that evidence derived from clinical trials and biomarkers supports clinical meaningfulness of an intervention, and when combined with a single clinical trial outcome, nearly all regarded the clinical trial design or biomarker evidence as supportive of disease modification. A minority considered biomarker evidence by itself as indicative of disease modification in prevention trials. Levels of evidence (A,B,C) were constructed based on these observations. The survey indicates the view of knowledgeable stakeholders regarding evidence derived from clinical trial design and biomarkers in support of disease modification. Results of this survey can assist in designing clinical trials of DMTs.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Smith, Benjamin D.; Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX; Arthur, Douglas W.
2009-07-15
Purpose: To present guidance for patients and physicians regarding the use of accelerated partial-breast irradiation (APBI), based on current published evidence complemented by expert opinion. Methods and Materials: A systematic search of the National Library of Medicine's PubMed database yielded 645 candidate original research articles potentially applicable to APBI. Of these, 4 randomized trials and 38 prospective single-arm studies were identified. A Task Force composed of all authors synthesized the published evidence and, through a series of meetings, reached consensus regarding the recommendations contained herein. Results: The Task Force proposed three patient groups: (1) a 'suitable' group, for whom APBImore » outside of a clinical trial is acceptable, (2) a 'cautionary' group, for whom caution and concern should be applied when considering APBI outside of a clinical trial, and (3) an 'unsuitable' group, for whom APBI outside of a clinical trial is not generally considered warranted. Patients who choose treatment with APBI should be informed that whole-breast irradiation (WBI) is an established treatment with a much longer track record that has documented long-term effectiveness and safety. Conclusion: Accelerated partial-breast irradiation is a new technology that may ultimately demonstrate long-term effectiveness and safety comparable to that of WBI for selected patients with early breast cancer. This consensus statement is intended to provide guidance regarding the use of APBI outside of a clinical trial and to serve as a framework to promote additional clinical investigations into the optimal role of APBI in the treatment of breast cancer.« less
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Implementation of Task-Tracking Software for Clinical IT Management.
Purohit, Anne-Maria; Brutscheck, Clemens; Prokosch, Hans-Ulrich; Ganslandt, Thomas; Schneider, Martin
2017-01-01
Often in clinical IT departments, many different methods and IT systems are used for task-tracking and project organization. Based on managers' personal preferences and knowledge about project management methods, tools differ from team to team and even from employee to employee. This causes communication problems, especially when tasks need to be done in cooperation with different teams. Monitoring tasks and resources becomes impossible: there are no defined deliverables, which prevents reliable deadlines. Because of these problems, we implemented task-tracking software which is now in use across all seven teams at the University Hospital Erlangen. Over a period of seven months, a working group defined types of tasks (project, routine task, etc.), workflows, and views to monitor the tasks of the 7 divisions, 20 teams and 340 different IT services. The software has been in use since December 2016.
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Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity.
Islam, R; Weir, C; Del Fiol, G
2016-01-01
Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The measurement model was adapted and modified for the healthcare domain. Three clinical infectious disease teams were observed, audio-recorded and transcribed. Each team included an infectious diseases expert, one infectious diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding processes and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen's kappa. The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.
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Functional topography of the cerebellum for motor and cognitive tasks: an fMRI study
Stoodley, Catherine J.; Valera, Eve M.; Schmahmann, Jeremy D.
2011-01-01
Anatomical, clinical and imaging findings suggest that the cerebellum is engaged in cognitive and affective functions as well as motor control. Evidence from converging modalities also indicates that there is a functional topography in the human cerebellum for overt control of movement vs. higher functions, such that the cerebellum can be divided into zones depending on connectivity with sensorimotor vs. multimodal association cortices. Using functional MRI, we show that regions active during overt movement differ from those involved in higher-level language, spatial processing and working memory tasks. Nine healthy participants each completed five tasks in order to determine the relative activation patterns for the different paradigms. Right-handed finger-tapping activated right cerebellar lobules IV-V and VIII, consistent with descriptions of the cerebellar homunculi. Verb generation engaged right cerebellar lobules VI-Crus I and a second cluster in lobules VIIB-VIIIA. Mental rotation activation peaks were localized to medial left cerebellar lobule VII (Crus II). A 2-back working memory task activated bilateral regions of lobules VI-VII. Viewing arousing vs. neutral images did not reliably activate the cerebellum or cerebral limbic areas in this study. The cerebellar functional topography identified in this study reflects the involvement of different cerebro-cerebellar circuits depending on the demands of the task being performed: overt movement activated sensorimotor cortices along with contralateral cerebellar lobules IV-VI and VIII, whereas more cognitively demanding tasks engaged prefrontal and parietal cortices along with cerebellar lobules VI and VII. These findings provide further support for a cerebellar role in both motor and cognitive tasks, and better establish the existence of functional subregions in the cerebellum. Future studies are needed to determine the exact contribution of the cerebellum – and different cerebro-cerebellar circuits – to task performance. PMID:21907811
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Frontal Lobe Involvement in a Task of Time-Based Prospective Memory
ERIC Educational Resources Information Center
McFarland, Craig P.; Glisky, Elizabeth L.
2009-01-01
Time-based prospective memory (PM) has been found to be negatively affected by aging, possibly as a result of declining frontal lobe (FL) function. Despite a clear retrospective component to PM tasks, the medial temporal lobes (MTL) are thought to play only a secondary role in successful task completion. The present study investigated the role of…
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ERIC Educational Resources Information Center
Kim, YouJin; Taguchi, Naoko
2016-01-01
Previous task complexity studies have suggested that learners produce more negotiation of meaning opportunities during complex tasks than simple tasks (Robinson, 2011). The present study builds on the existing task complexity literature by examining the impact of task complexity and pragmatic situational demands on the number of learning…
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Parvan, Kobra; Shahbazi, Shahla; Ebrahimi, Hossein; Valizadeh, Susan; Rahmani, Azad; Jabbarzadeh Tabrizi, Faranak; Esmaili, Fariba
2018-01-01
Introduction: Despite being aware of the importance of nurses’ role in providing clinical training to nursing students, studies show that sufficient research has not yet been conducted on the experience of clinical nurses who are engaged in training nursing students outside their normal working hours. The present study aim to describe the experience of these nurses who are training outside their routine working hours. Methods: This study was conducted using descriptive-phenomenology method. Twelve nurses was participated in this research. Data were collected using purposive sampling method and face to face interviews based on nurses’ real life experience of students’ learning in clinical settings through answering open-ended questions. Spiegel burg analysis method was used to analyze the data. Results: The result of data analysis was the derivation of four themes and eight sub-themes. Themes included "nurses as teaching sources", "changes in the balance of doing routine tasks", "professional enthusiasm", and "nurses as students' professional socialization source of inspiration". Sub-themes included "efficient education", "poor education", "support", "interference in the role," "self-efficacy development", "inner satisfaction", "positive imaging" and "being a model". Conclusion: It is necessary that academic centers plan for teaching nurses working on a contractual basis in the field of the evaluation method and various methods of teaching. The findings also suggested the development of individual self-efficacy in clinical nurses who train students. PMID:29637056
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Ranzini, Mariagrazia; Carbè, Katia; Gevers, Wim
2017-05-01
Number interval bisection consists of estimating the mid-number within a pair (1-9=>5). Healthy adults and right-brain damage patients can show biased performance in this task, underestimating and overestimating the mid-number, respectively. The role of visuospatial attention during this task, and its interplay with other cognitive abilities (e.g., working memory) is still object of debate. In this study we explored the relation between visuospatial attention and individual differences in working memory and executive functions during number interval bisection. To manipulate the deployment of visuospatial attention, healthy participants tracked a dot moving to the left or moving to the right while bisecting numerical intervals. We also collected information concerning verbal and visuospatial short-term memory span, and concerning verbal and visuospatial fluency scores. Beside replicating what is typically observed in this task (e.g., underestimation bias), a correlation was observed between verbal short-term memory and bisection bias, and an interesting relation between performance in the number interval bisection, verbal short-term memory, and visuospatial attention. Specifically, performance of those participants with low verbal span was affected by the direction of the moving dot, underestimating at a larger extent when the dot moved leftward than rightward. Finally, it was also observed that participants' verbal fluency ability contributed in the generation of biases in the numerical task. The finding of the involvement of abilities belonging to the verbal domain contributes to unveil the multi-componential nature of number interval bisection. Considering the debate on the nature of number interval bisection and its use in the clinical assessment of deficits following brain damage, this finding may be interesting also from a clinical perspective. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Popolo, Raffaele; Dimaggio, Giancarlo; Luther, Lauren; Vinci, Giancarlo; Salvatore, Giampaolo; Lysaker, Paul H
2016-03-01
Poor insight in schizophrenia is a risk factor for both poor outcomes and treatment adherence. Accordingly, interest in identifying causes of poor insight has increased. This study explored whether theory of mind (ToM) impairments are linked to poor clinical and cognitive insight independent of psychopathology. Participants with schizophrenia (n = 37) and control subjects (n = 40) completed assessments of ToM with the Hinting Task and the Brüne Picture Sequencing Task, clinical insight and psychopathology with the Positive and Negative Syndrome Scale, and cognitive insight with the Beck Cognitive Insight Scale. Results indicated that the schizophrenia group had greater impairments in ToM relative to control subjects. In the schizophrenia group, the Hinting Task performance was related to both cognitive and clinical insight, with only the relationship with cognitive insight persisting after controlling for psychopathology. Picture Sequencing Task performance was related to cognitive insight only. Future research directions and clinical implications are discussed.
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Mirror Therapy and Task-Oriented Training for People With a Paretic Upper Extremity.
Bondoc, Salvador; Booth, Julie; Budde, Grace; Caruso, Katelyn; DeSousa, Michelle; Earl, Brittany; Hammerton, Kaitlynn; Humphreys, Jill
This study investigates the effect of mirror therapy and task-oriented training on the paretic upper extremity function and occupational performance of people with stroke. This study used a repeated-measures, case-series design in which 4 participants completed a 4-wk intervention consisting of mirror therapy and task-specific training. The intervention was conducted 2×/wk in the clinic and 4×/wk at home. All participants displayed clinically meaningful improvements in self-identified goals at the end of the intervention and at follow-up. Three participants showed clinically meaningful changes in motor function. Although only 1 participant improved in his reported amount of use, all participants showed clinically meaningful improvements in perceived movement quality at varying points of assessment. Mirror therapy, when used as priming for task-oriented training, can produce clinical improvements in upper extremity function and occupational performance in people with hemiparesis. Copyright © 2018 by the American Occupational Therapy Association, Inc.
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Broster, Lucas S; Jenkins, Shonna L; Holmes, Sarah D; Edwards, Matthew G; Jicha, Gregory A; Jiang, Yang
2018-05-07
Forms of implicit memory, including repetition effects, are preserved relative to explicit memory in clinical Alzheimer's disease. Consequently, cognitive interventions for persons with Alzheimer's disease have been developed that leverage this fact. However, despite the clinical robustness of behavioral repetition effects, altered neural mechanisms of repetition effects are studied as biomarkers of both clinical Alzheimer's disease and pre-morbid Alzheimer's changes in the brain. We hypothesized that the clinical preservation of behavioral repetition effects results in part from concurrent operation of discrete memory systems. We developed two experiments that included probes of emotional repetition effects differing in that one included an embedded working memory task. We found that neural repetition effects manifested in patients with amnestic mild cognitive impairment, the earliest form of clinical Alzheimer's disease, during emotional working memory tasks, but they did not manifest during the task that lacked the embedded working memory manipulation. Specifically, the working memory task evoked neural repetition effects in the P600 time-window, but the same neural mechanism was only minimally implicated in the task without a working memory component. We also found that group differences in behavioral repetition effects were smaller in the experiment with a working memory task. We suggest that cross-domain cognitive challenge can expose "defunct" neural capabilities of individuals with amnestic mild cognitive impairment. Copyright © 2018. Published by Elsevier Ltd.
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Davies, James
2017-04-01
This paper examines how Task Force votes were central to the development of Diagnostic and Statistical Manual of Mental Disorders (DSM-III and DSM-III-R). Data were obtained through a literature review, investigation of DSM archival material housed at the American Psychiatric Association (APA), and interviews with key Task Force members of DSM-III and DSM-III-R. Such data indicate that Task Force votes played a central role in the making of DSM-III, from establishing diagnostic criteria and diagnostic definitions to settling questions about the inclusion or removal of diagnostic categories. The paper concludes that while the APA represented DSM-III, and the return to descriptive psychiatry it inaugurated, as a triumph of empirically based decision-making, the evidence presented here fails to support that view. Since the DSM is a cumulative project, and as DSM-III lives on through subsequent editions, this paper calls for a more socio-historically informed understanding of DSM's construction to be deployed in how the DSM is taught and implemented in training and clinical settings.
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Dual-task testing to predict falls in community-dwelling older adults: a systematic review.
Muir-Hunter, S W; Wittwer, J E
2016-03-01
Cognitive impairment increases fall risk in older adults. Dual-task testing is an accepted way to assess the interaction between cognition and mobility; however, there is a lack of evidence-based recommendations for dual-task testing to evaluate fall risk in clinical practice. To evaluate the association between dual-task testing protocols and future fall risk, and to identify the specific dual-task test protocols associated with elevated risk. MEDLINE, Pubmed and EMBASE electronic databases were searched from January 1988 to September 2013. Two independent raters identified prospective cohort studies (duration of at least 1 year) of dual-task assessment in community-dwelling participants aged ≥60 years, with 'falls' as the primary outcome. Methodological quality was scored independently by two raters using a published checklist of criteria for evaluating threats to the validity of observational studies. Deterioration in gait during dual-task testing compared with single-task performance was associated with increased fall risk. Shortcomings within the literature significantly limit knowledge translation of dual-task gait protocols into clinical practice. There is a paucity of prospective studies on the association of dual-task gait assessment with fall risk. Changes in gait under dual-task testing are associated with future fall risk, and this association is stronger than that for single-task conditions. Limitations in the available literature preclude development of detailed recommendations for dual-task gait testing procedures in clinical practice to identify and stratify fall risk in older adults. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
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A design space of visualization tasks.
Schulz, Hans-Jörg; Nocke, Thomas; Heitzler, Magnus; Schumann, Heidrun
2013-12-01
Knowledge about visualization tasks plays an important role in choosing or building suitable visual representations to pursue them. Yet, tasks are a multi-faceted concept and it is thus not surprising that the many existing task taxonomies and models all describe different aspects of tasks, depending on what these task descriptions aim to capture. This results in a clear need to bring these different aspects together under the common hood of a general design space of visualization tasks, which we propose in this paper. Our design space consists of five design dimensions that characterize the main aspects of tasks and that have so far been distributed across different task descriptions. We exemplify its concrete use by applying our design space in the domain of climate impact research. To this end, we propose interfaces to our design space for different user roles (developers, authors, and end users) that allow users of different levels of expertise to work with it.
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Will, Johanna L; Eckart, Moritz T; Rosenow, Felix; Bauer, Sebastian; Oertel, Wolfgang H; Schwarting, Rainer K W; Norwood, Braxton A
2013-06-15
The human serial reaction time task (SRTT) has widely been used to study the neural basis of implicit learning. It is well documented, in both human and animal studies, that striatal dopaminergic processes play a major role in this task. However, findings on the role of the hippocampus - which is mainly associated with declarative memory - in implicit learning and performance are less univocal. We used a SRTT to evaluate implicit learning and performance in rats with perforant pathway stimulation-induced hippocampal neuron loss; a clinically-relevant animal model of mesial temporal lobe epilepsy (MTLS-HS). As has been previously reported for the Sprague-Dawley strain, 8h of continuous stimulation in male Wistar rats reliably induced widespread neuron loss in areas CA3 and CA1 with a characteristic sparing of CA2 and the granule cells. Histological analysis revealed that hippocampal volume was reduced by an average of 44%. Despite this severe hippocampal injury, rats showed superior performance in our instrumental SRTT, namely shorter reaction times, and without a loss in accuracy, especially during the second half of our 16-days testing period. These results demonstrate that a hippocampal lesion can improve performance in a rat SRTT, which is probably due to enhanced instrumental performance. In line with our previous findings based on ibotenic-acid induced hippocampal lesion, these data support the hypothesis that loss or impairment of hippocampal function can enhance specific task performance, especially when it is dependent on procedural (striatum-dependent) mechanisms with minimal spatial requirements. As the animal model used here exhibits the defining characteristics of MTLE-HS, these findings may have implications for the study and management of patients with MTLE. Copyright © 2013 Elsevier B.V. All rights reserved.
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2017-10-01
casualty care using descriptive statistical analysis and modeling techniques. Aim 2: Identify the ideal provider training and competency assessment... Methodologies , Course Type, Course Availability, Assessment Criteria, Requirements, Funding, Alignment with Clinical Practice Guidelines (CPGs...Aim 1: Descriptive study of all available information for combat casualties in Afghanistan. Specific Tasks: 1) who – patients treated; clinician mix
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2015-07-01
MSc, MRCSEd; David N. Naumann, MB BChir, MRCS; Paul Guyver, MBBS, FRCS; Jonathan Bishop, PhD; Simon Davies, BN(Hons), DipIMC RCSEd, RGN; Jonathan...Smith, I. M. Naumann, D. N. Guyver, P. Bishop, J . Davies, S. Lundy, J . B. Bowley, D. M. 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER...McLeod J , et al. The role of trauma scoring in developing trauma clinical governance in the De- fence Medical Services. Philos Trans R Soc Lond B
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The hospital tech laboratory: quality innovation in a new era of value-conscious care.
Keteyian, Courtland K; Nallamothu, Brahmajee K; Ryan, Andrew M
2017-08-01
For decades, the healthcare industry has been incentivized to develop new diagnostic technologies, but this limitless progress fueled rapidly growing expenditures. With an emphasis on value, the future will favor information synthesis and processing over pure data generation, and hospitals will play a critical role in developing these systems. A Michigan Medicine, IBM, and AirStrip partnership created a robust streaming analytics platform tasked with creating predictive algorithms for critical care with the potential to support clinical decisions and deliver significant value.
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The future of laboratory medicine - a 2014 perspective.
Kricka, Larry J; Polsky, Tracey G; Park, Jason Y; Fortina, Paolo
2015-01-01
Predicting the future is a difficult task. Not surprisingly, there are many examples and assumptions that have proved to be wrong. This review surveys the many predictions, beginning in 1887, about the future of laboratory medicine and its sub-specialties such as clinical chemistry and molecular pathology. It provides a commentary on the accuracy of the predictions and offers opinions on emerging technologies, economic factors and social developments that may play a role in shaping the future of laboratory medicine. Copyright © 2014 Elsevier B.V. All rights reserved.
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The role of man in flight experiment payload missions. Volume 1: Results
NASA Technical Reports Server (NTRS)
Malone, T. B.
1973-01-01
It is pointed out that a controversy exists concerning the required role of man, and his attendant skills and levels of skills, for Sortie Lab operations. As a result, a study was conducted to generate a taxonomy of candidate crew roles which would: (1) be applicable across all experiments, and (2) be usable for Sortie scientists and engineers in determination of level of skill as well as type of skill. Nine basic roles were identified in the study, and the tasks associated with each were developed from a functional description of a generalized in-flight experiment. The functional analysis comprised the baseline for establishment of crew roles, with roles being defined as combinations of tasks, associated skills, and knowledges. A role classification scheme was developed in which the functions and tasks identified were allocated to each of the nine role types. This classification scheme is presented together with the significant results of the study.
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Morrissey, Ann-Marie; Gill-Thwaites, Helen; Wilson, Barbara; Leonard, Rachel; McLellan, Lindsay; Pundole, Amy; Shiel, Agnes
2017-08-01
As the prevalence and incidence of disorders of consciousness (DoC) increase, researchers and clinicians are tasked with developing best practice assessment techniques. Neurobehavioural assessment remains the most clinically available method of measuring consciousness. Neuroimaging and other physiological measurements are demonstrating promise in supporting this assessment but many of these techniques require further research and are not widely available in sub-acute and long-term care settings. No study to date has explored in-depth complementary use of multiple neurobehavioural assessments in aiding beside assessment of consciousness. This paper describes and proposes complementary use of two commonly used standardised neurobehavioural assessments. The Sensory Modality Assessment and Rehabilitation Technique (SMART) and the Wessex Head Injury Matrix (WHIM) both have specific aims and play an important role in behavioural assessment across the care continuum. This paper proposes that when used together appropriately these two assessments promote best practice and strengthen behavioural assessment of consciousness by providing increased opportunities to capture awareness. Further research into use of more than one neurobehavioural tool is highlighted as an important area of inquiry for this heterogeneous population not only in clinical practice but also in research.
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Roberts, Chris; Shadbolt, Narelle; Clark, Tyler; Simpson, Phillip
2014-09-20
Little is known about the technical adequacy of portfolios in reporting multiple complex academic and performance-based assessments. We explored, first, the influencing factors on the precision of scoring within a programmatic assessment of student learning outcomes within an integrated clinical placement. Second, the degree to which validity evidence supported interpretation of student scores. Within generalisability theory, we estimated the contribution that each wanted factor (i.e. student capability) and unwanted factors (e.g. the impact of assessors) made to the variation in portfolio task scores. Relative and absolute standard errors of measurement provided a confidence interval around a pre-determined pass/fail standard for all six tasks. Validity evidence was sought through demonstrating the internal consistency of the portfolio and exploring the relationship of student scores with clinical experience. The mean portfolio mark for 257 students, across 372 raters, based on six tasks, was 75.56 (SD, 6.68). For a single student on one assessment task, 11% of the variance in scores was due to true differences in student capability. The most significant interaction was context specificity (49%), the tendency for one student to engage with one task and not engage with another task. Rater subjectivity was 29%. An absolute standard error of measurement of 4.74%, gave a 95% CI of +/- 9.30%, and a 68% CI of +/- 4.74% around a pass/fail score of 57%. Construct validity was supported by demonstration of an assessment framework, the internal consistency of the portfolio tasks, and higher scores for students who did the clinical placement later in the academic year. A portfolio designed as a programmatic assessment of an integrated clinical placement has sufficient evidence of validity to support a specific interpretation of student scores around passing a clinical placement. It has modest precision in assessing students' achievement of a competency standard. There were identifiable areas for reducing measurement error and providing more certainty around decision-making. Reducing the measurement error would require engaging with the student body on the value of the tasks, more focussed academic and clinical supervisor training, and revisiting the rubric of the assessment in the light of feedback.
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A social-technological epistemology of clinical decision-making as mediated by imaging.
van Baalen, Sophie; Carusi, Annamaria; Sabroe, Ian; Kiely, David G
2017-10-01
In recent years there has been growing attention to the epistemology of clinical decision-making, but most studies have taken the individual physicians as the central object of analysis. In this paper we argue that knowing in current medical practice has an inherently social character and that imaging plays a mediating role in these practices. We have analyzed clinical decision-making within a medical expert team involved in diagnosis and treatment of patients with pulmonary hypertension (PH), a rare disease requiring multidisciplinary team involvement in diagnosis and management. Within our field study, we conducted observations, interviews, video tasks, and a panel discussion. Decision-making in the PH clinic involves combining evidence from heterogeneous sources into a cohesive framing of a patient, in which interpretations of the different sources can be made consistent with each other. Because pieces of evidence are generated by people with different expertise and interpretation and adjustments take place in interaction between different experts, we argue that this process is socially distributed. Multidisciplinary team meetings are an important place where information is shared, discussed, interpreted, and adjusted, allowing for a collective way of seeing and a shared language to be developed. We demonstrate this with an example of image processing in the PH service, an instance in which knowledge is distributed over multiple people who play a crucial role in generating an evaluation of right heart function. Finally, we argue that images fulfill a mediating role in distributed knowing in 3 ways: first, as enablers or tools in acquiring information; second, as communication facilitators; and third, as pervasively framing the epistemic domain. With this study of clinical decision-making in diagnosis and treatment of PH, we have shown that clinical decision-making is highly social and mediated by technologies. The epistemology of clinical decision-making needs to take social and technological mediation into account. © 2016 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.
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ERIC Educational Resources Information Center
Graf, Edith Aurora
2014-01-01
In "How Task Features Impact Evidence from Assessments Embedded in Simulations and Games," Almond, Kim, Velasquez, and Shute have prepared a thought-provoking piece contrasting the roles of task model variables in a traditional assessment of mathematics word problems to their roles in "Newton's Playground," a game designed…
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ERIC Educational Resources Information Center
Sherman, Milan
2011-01-01
This study investigates the role of digital cognitive technologies in supporting students' mathematical thinking while engaging with instructional tasks. Specifically, the study sought to better understand how the use of technology is related to the cognitive demand of tasks. Data were collected in four secondary mathematics classrooms via…
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ERIC Educational Resources Information Center
Kurnaz, Ahmet
2018-01-01
In this study whether the expectancy belief has a mediating role in the correlation between cost value perception and task value perception of gifted students towards mathematics was examined. It is predicted that the correlation between cost value and task value perceptions of gifted students towards mathematics can change according to their…
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ERIC Educational Resources Information Center
Carretti, Barbara; Borella, Erika; Cornoldi, Cesare; De Beni, Rossana
2009-01-01
It is well established that working memory is related to reading comprehension ability. However, its role in explaining specific reading comprehension difficulties is still under debate: the issue mainly concerns whether the contribution of working memory is dependent on task modality (verbal tasks being more predictive than visuo-spatial tasks)…
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Understanding the role of mind wandering in stress-related working memory impairments.
Banks, Jonathan B; Boals, Adriel
2017-08-01
Mind wandering has been identified as a possible cause for stress-related working memory (WM) task impairments following laboratory stressors. The current study attempted to induce mind wandering regarding negative, positive, or neutral events using an expressive writing task and examined the impact on WM task performance. We examined the role of mind wandering in understanding the impact of life stress on WM. Additionally, we explored the role of thought suppression on the relationship between mind wandering and WM. One hundred and fifty participants completed WM measures before (Time 1) and after (Time 2) the writing manipulation. The writing manipulation did not alter mind wandering or WM task performance. Time 1 WM predicted mind wandering during the Time 2 WM task, which subsequently predicted poorer Time 2 WM task performance. The impact of daily life stress on WM was mediated by mind wandering. Trait levels of thought suppression moderated the impact of mind wandering on WM. Specifically, higher levels of suppression resulted in stronger negative impact of mind wandering on WM task performance. Findings are discussed in terms of the impact of mind wandering on WM task performance.
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Task-technology fit of video telehealth for nurses in an outpatient clinic setting.
Cady, Rhonda G; Finkelstein, Stanley M
2014-07-01
Incorporating telehealth into outpatient care delivery supports management of consumer health between clinic visits. Task-technology fit is a framework for understanding how technology helps and/or hinders a person during work processes. Evaluating the task-technology fit of video telehealth for personnel working in a pediatric outpatient clinic and providing care between clinic visits ensures the information provided matches the information needed to support work processes. The workflow of advanced practice registered nurse (APRN) care coordination provided via telephone and video telehealth was described and measured using a mixed-methods workflow analysis protocol that incorporated cognitive ethnography and time-motion study. Qualitative and quantitative results were merged and analyzed within the task-technology fit framework to determine the workflow fit of video telehealth for APRN care coordination. Incorporating video telehealth into APRN care coordination workflow provided visual information unavailable during telephone interactions. Despite additional tasks and interactions needed to obtain the visual information, APRN workflow efficiency, as measured by time, was not significantly changed. Analyzed within the task-technology fit framework, the increased visual information afforded by video telehealth supported the assessment and diagnostic information needs of the APRN. Telehealth must provide the right information to the right clinician at the right time. Evaluating task-technology fit using a mixed-methods protocol ensured rigorous analysis of fit within work processes and identified workflows that benefit most from the technology.
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What physicians reason about during admission case review.
Juma, Salina; Goldszmidt, Mark
2017-08-01
Research suggests that physicians perform multiple reasoning tasks beyond diagnosis during patient review. However, these remain largely theoretical. The purpose of this study was to explore reasoning tasks in clinical practice during patient admission review. The authors used a constant comparative approach-an iterative and inductive process of coding and recoding-to analyze transcripts from 38 audio-recorded case reviews between junior trainees and their senior residents or attendings. Using a previous list of reasoning tasks, analysis focused on what tasks were performed, when they occurred, and how they related to the other tasks. All 24 tasks were observed in at least one review with a mean of 17.9 (Min = 15, Max = 22) distinct tasks per review. Two new tasks-assess illness severity and patient decision-making capacity-were identified, thus 26 tasks were examined. Three overarching tasks were identified-assess priorities, determine and refine the most likely diagnosis and establish and refine management plans-that occurred throughout all stages of the case review starting from patient identification and continuing through to assessment and plan. A fourth possible overarching task-reflection-was also identified but only observed in four instances across three cases. The other 22 tasks appeared to be context dependent serving to support, expand, and refine one or more overarching tasks. Tasks were non-sequential and the same supporting task could serve more than one overarching task. The authors conclude that these findings provide insight into the 'what' and 'when' of physician reasoning during case review that can be used to support professional development, clinical training and patient care. In particular, they draw attention to the iterative way in which each task is addressed during a case review and how this finding may challenge conventional ways of teaching and assessing clinical communication and reasoning. They also suggest that further research is needed to explore how physicians decide why a supporting task is required in a particular context.
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The Role of Subjective Task Value in Service-Learning Engagement among Chinese College Students.
Li, Yulan; Guo, Fangfang; Yao, Meilin; Wang, Cong; Yan, Wenfan
2016-01-01
Most service-learning studies in higher education focused on its effects on students' development. The dynamic processes and mechanisms of students' development during service-learning, however, have not been explored thoroughly. Student engagement in service-learning may affect service-learning outcomes and be affected by subjective task value at the same time. The present study aimed to explore the effect of subjective task value on Chinese college student engagement during service-learning. Fifty-four Chinese college students participated in a 9-weeks service-learning program of interacting with children with special needs. Students' engagement and subjective task value were assessed via self-report questionnaires and 433 weekly reflective journals. The results indicated that the cognitive, emotional and behavioral engagement of Chinese college students demonstrated different developmental trends during service-learning process. Subjective task value played an essential role in student engagement in service-learning activities. However, the role of subjective task value varied with different stages. Finally, the implications for implementing service-learning in Chinese education were discussed.
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[Microbiological diagnosis of human immunodeficiency virus infection].
Álvarez Estévez, Marta; Reina González, Gabriel; Aguilera Guirao, Antonio; Rodríguez Martín, Carmen; García García, Federico
2015-10-01
This document attempts to update the main tasks and roles of the Clinical Microbiology laboratory in HIV diagnosis and monitoring. The document is divided into three parts. The first deals with HIV diagnosis and how serological testing has changed in the last few years, aiming to improve diagnosis and to minimize missed opportunities for diagnosis. Technological improvements for HIV Viral Load are shown in the second part of the document, which also includes a detailed description of the clinical significance of low-level and very low-level viremia. Finally, the third part of the document deals with resistance to antiretroviral drugs, incorporating clinical indications for integrase and tropism testing, as well as the latest knowledge on minority variants. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
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Huang, Xianwei; Naghdy, Fazel; Naghdy, Golshah; Du, Haiping
2017-07-01
Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive rehabilitation training in restoring motor skills after a stroke. This study focuses on the rehabilitation of fine hand motion skills due to their vital role in performing delicate activities of daily living (ADL) tasks. The proposed rehabilitation system combines an adaptive assist-as-needed (AAN) control algorithm and a Virtual Reality (VR) based rehabilitation gaming system (RGS). The developed system is described and its effectiveness is validated through clinical trials on a group of eight subacute stroke patients for a period of six weeks. The impact of the training is verified through standard clinical evaluation methods and measuring key kinematic parameters. A comparison of the pre- and post-training results indicates that the method proposed in this study can improve fine hand motion rehabilitation training effectiveness.
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Validity of a verbal incidental learning measure from the WAIS-IV in older adults.
Hammers, Dustin B; Kucera, Amanda M; Card, Stephanie J; Tolle, Kathryn A; Atkinson, Taylor J; Duff, Kevin; Spencer, Robert J
2018-01-01
Incidental memory may reflect a form of learning in everyday life, although it is not consistently evaluated during standard neuropsychological evaluations. Further validation of a recently created measure of verbal Incidental Learning (IL) from the Wechsler Adult Intelligence Scale-IV is necessary to understand the utility of such a measure in clinical settings. Sixty-eight adults aged 50 to 89 were recruited from a Cognitive Disorders Clinic while receiving a standard neuropsychological assessment, along with two additional measures of IL. IL-Total Score was significantly correlated with immediate and delayed memory trials from standard neuropsychological tests (rs = .43 to .73, ps < .001, ds = 0.94-2.14), with worse IL performance being associated with lower memory abilities. Participants with probable Alzheimer's disease performed worse on the IL-Total Score than participants with Mild Cognitive Impairment, t(39.997) = 5.46, p < .001, d = 1.13. Given the strong relationships between this IL task and traditional memory measures in our sample, and the discrimination of IL-Total Score performance among diagnostic groups despite its short administration time, this IL task may play a role as a measure of memory in brief cognitive evaluations.
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Speaking to the yet unknowing world: Hamlet, Horatio and the problem of imperfect witness.
Phillips, Christine
2010-12-01
Every day doctors bear witness to others about the experiences, needs and feelings of their patients, drawing on what they have learnt from clinical consultations. This paper considers the medical task of bearing honourable and truthful witness through an examination of the role and actions of Horatio in Hamlet. Horatio is simultaneously located among the background machinery of the play, separate from the lives of the protagonists, and in the foreground, where his authoritative witness is repeatedly called upon by the play's characters. Horatio is invited to watch an unfolding disaster, his warnings are not heard, and at its conclusion he stands apart from the drama to give its account. The tensions between engagement and observation, and between partial and impartial accounting echo those faced by doctors in everyday clinical practice. The act of bearing witness, Shakespeare suggests, even for those who are tasked with being objective, is necessarily imperfect, and not dispassionate. Those people, including doctors, who are expected to construct authoritative accounts of the motives and actions of others may find in Hamlet a small lesson on the need to approach their summary narratives about others more humbly, aware of the narrowness and partiality of their perspective.
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Nonspeech Oral Movements and Oral Motor Disorders: A Narrative Review.
Kent, Ray D
2015-11-01
Speech and other oral functions such as swallowing have been compared and contrasted with oral behaviors variously labeled quasispeech, paraspeech, speechlike, and nonspeech, all of which overlap to some degree in neural control, muscles deployed, and movements performed. Efforts to understand the relationships among these behaviors are hindered by the lack of explicit and widely accepted definitions. This review article offers definitions and taxonomies for nonspeech oral movements and for diverse speaking tasks, both overt and covert. Review of the literature included searches of Medline, Google Scholar, HighWire Press, and various online sources. Search terms pertained to speech, quasispeech, paraspeech, speechlike, and nonspeech oral movements. Searches also were carried out for associated terms in oral biology, craniofacial physiology, and motor control. Nonspeech movements have a broad spectrum of clinical applications, including developmental speech and language disorders, motor speech disorders, feeding and swallowing difficulties, obstructive sleep apnea syndrome, trismus, and tardive stereotypies. The role and benefit of nonspeech oral movements are controversial in many oral motor disorders. It is argued that the clinical value of these movements can be elucidated through careful definitions and task descriptions such as those proposed in this review article.
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Nonspeech Oral Movements and Oral Motor Disorders: A Narrative Review
2015-01-01
Purpose Speech and other oral functions such as swallowing have been compared and contrasted with oral behaviors variously labeled quasispeech, paraspeech, speechlike, and nonspeech, all of which overlap to some degree in neural control, muscles deployed, and movements performed. Efforts to understand the relationships among these behaviors are hindered by the lack of explicit and widely accepted definitions. This review article offers definitions and taxonomies for nonspeech oral movements and for diverse speaking tasks, both overt and covert. Method Review of the literature included searches of Medline, Google Scholar, HighWire Press, and various online sources. Search terms pertained to speech, quasispeech, paraspeech, speechlike, and nonspeech oral movements. Searches also were carried out for associated terms in oral biology, craniofacial physiology, and motor control. Results and Conclusions Nonspeech movements have a broad spectrum of clinical applications, including developmental speech and language disorders, motor speech disorders, feeding and swallowing difficulties, obstructive sleep apnea syndrome, trismus, and tardive stereotypies. The role and benefit of nonspeech oral movements are controversial in many oral motor disorders. It is argued that the clinical value of these movements can be elucidated through careful definitions and task descriptions such as those proposed in this review article. PMID:26126128
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Editorial Comments, 1974-1986: The Case For and Against the Use of Computer-Assisted Decision Making
Weaver, Robert R.
1987-01-01
Journal editorials are an important medium for communicating information about medical innovations. Evaluative statements contained in editorials pertain to the innovation's technical merits, as well as its probable economic, social and political, and ethical consequences. This information will either promote or impede the subsequent diffusion of innovations. This paper analyzes the evaluative information contained in thirty editorials that pertain to the topic of computer-assisted decision making (CDM). Most editorials agree that CDM technology is effective and economical in performing routine clinical tasks; controversy surrounds the use of more sophisticated CDM systems for complex problem solving. A few editorials argue that the innovation should play an integral role in transforming the established health care system. Most, however, maintain that it can or should be accommodated within the existing health care framework. Finally, while few editorials discuss the ethical ramifications of CDM technology, those that do suggest that it will contribute to more humane health care. The editorial analysis suggests that CDM technology aimed at routine clinical task will experience rapid diffusion. In contrast, the diffusion of more sophisticated CDM systems will, in the foreseeable future, likely be sporadic at best.
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Primary care physicians' use of an electronic medical record system: a cognitive task analysis.
Shachak, Aviv; Hadas-Dayagi, Michal; Ziv, Amitai; Reis, Shmuel
2009-03-01
To describe physicians' patterns of using an Electronic Medical Record (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient-doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular. Cognitive task analysis using semi-structured interviews and field observations. Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel. The comprehensiveness, organization, and readability of data in the EMR system reduced physicians' need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient's chart. EMR use interfered with patient-doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians' communication skills also helped. There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians' offices and by enhancing physicians' computer and communication skills.
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Primary Care Physicians’ Use of an Electronic Medical Record System: A Cognitive Task Analysis
Hadas-Dayagi, Michal; Ziv, Amitai; Reis, Shmuel
2009-01-01
OBJECTIVE To describe physicians’ patterns of using an Electronic Medical Record (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient–doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular. DESIGN Cognitive task analysis using semi-structured interviews and field observations. PARTICIPANTS Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel. RESULTS The comprehensiveness, organization, and readability of data in the EMR system reduced physicians’ need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient’s chart. EMR use interfered with patient–doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians’ communication skills also helped. CONCLUSIONS There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians’ offices and by enhancing physicians’ computer and communication skills. PMID:19130148
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ERIC Educational Resources Information Center
Provencher, Veronique; Demers, Louise; Gelinas, Isabelle
2012-01-01
Meal preparation assessments conducted in clinical environments (such as rehabilitation settings) might not reflect frail patients' performance at home. In addition, factors that may explain differences in performance between settings remain unknown. The aim of this study was to compare home and clinic performance on meal preparation tasks in…
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USDA-ARS?s Scientific Manuscript database
The International Osteoporosis Foundation (IOF) and the International Society for Clinical Densitometry (ISCD) appointed a joint Task Force to develop resource documents in order to make recommendations on how to improve FRAX and better inform clinicians who use FRAX. The Task Force met in November...
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The Roles of Social Stress and Decision-Making in Non-Suicidal Self-Injury
Schatten, Heather T.; Armey, Michael F.; Andover, Margaret S.
2015-01-01
Research suggests that individuals with a history of non-suicidal self-injury (NSSI) do not have difficulty generating alternatives to social problems but choose more negative solutions, suggesting a deficit in decision-making. However, studies report no significant differences in risky decision-making on a performance-based task among individuals with and without NSSI histories. A limitation of these studies is that decision-making was only assessed at baseline. As individuals with a history of NSSI typically self-injure when experiencing negative emotions, decision-making ability may become impaired specifically in the presence of these emotions. The aim of the current study was to investigate decision-making ability among individuals with and without NSSI histories both at baseline and following a distressing social exclusion task. We compared individuals with (n = 48) and without (n = 72) NSSI histories on the Iowa Gambling Task, a behavioral measure of risky decision-making, before and after exclusion or inclusion on the Cyberball task. Results indicated no significant group differences in performance regardless of condition. When participants were grouped by racial/ethnic minority status, results indicated that non-Hispanic White individuals with a history of NSSI exhibited deterioration in risky decision-making ability following social exclusion. Potential explanations for these findings and clinical implications are discussed. PMID:26260569
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Toward a Cognitive Task Analysis for Biomedical Query Mediation
Hruby, Gregory W.; Cimino, James J.; Patel, Vimla; Weng, Chunhua
2014-01-01
In many institutions, data analysts use a Biomedical Query Mediation (BQM) process to facilitate data access for medical researchers. However, understanding of the BQM process is limited in the literature. To bridge this gap, we performed the initial steps of a cognitive task analysis using 31 BQM instances conducted between one analyst and 22 researchers in one academic department. We identified five top-level tasks, i.e., clarify research statement, explain clinical process, identify related data elements, locate EHR data element, and end BQM with either a database query or unmet, infeasible information needs, and 10 sub-tasks. We evaluated the BQM task model with seven data analysts from different clinical research institutions. Evaluators found all the tasks completely or semi-valid. This study contributes initial knowledge towards the development of a generalizable cognitive task representation for BQM. PMID:25954589
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Toward a cognitive task analysis for biomedical query mediation.
Hruby, Gregory W; Cimino, James J; Patel, Vimla; Weng, Chunhua
2014-01-01
In many institutions, data analysts use a Biomedical Query Mediation (BQM) process to facilitate data access for medical researchers. However, understanding of the BQM process is limited in the literature. To bridge this gap, we performed the initial steps of a cognitive task analysis using 31 BQM instances conducted between one analyst and 22 researchers in one academic department. We identified five top-level tasks, i.e., clarify research statement, explain clinical process, identify related data elements, locate EHR data element, and end BQM with either a database query or unmet, infeasible information needs, and 10 sub-tasks. We evaluated the BQM task model with seven data analysts from different clinical research institutions. Evaluators found all the tasks completely or semi-valid. This study contributes initial knowledge towards the development of a generalizable cognitive task representation for BQM.
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Marshall, Gad A; Aghjayan, Sarah L; Dekhtyar, Maria; Locascio, Joseph J; Jethwani, Kamal; Amariglio, Rebecca E; Johnson, Keith A; Sperling, Reisa A; Rentz, Dorene M
2017-01-01
Impairment in activities of daily living is a major burden to both patients and caregivers. Mild impairment in instrumental activities of daily living is often seen at the stage of mild cognitive impairment. The field of Alzheimer's disease is moving toward earlier diagnosis and intervention and more sensitive and ecologically valid assessments of instrumental or complex activities of daily living are needed. The Harvard Automated Phone Task, a novel performance-based activities of daily living instrument, has the potential to fill this gap. To further validate the Harvard Automated Phone Task by assessing its longitudinal relationship to global cognition and specific cognitive domains in clinically normal elderly and individuals with mild cognitive impairment. In a longitudinal study, the Harvard Automated Phone Task was associated with cognitive measures using mixed effects models. The Harvard Automated Phone Task's ability to discriminate across diagnostic groups at baseline was also assessed. Academic clinical research center. Two hundred and seven participants (45 young normal, 141 clinically normal elderly, and 21 mild cognitive impairment) were recruited from the community and the memory disorders clinics at Brigham and Women's Hospital and Massachusetts General Hospital. Participants performed the three tasks of the Harvard Automated Phone Task, which consist of navigating an interactive voice response system to refill a prescription (APT-Script), select a new primary care physician (APT-PCP), and make a bank account transfer and payment (APT-Bank). The 3 tasks were scored based on time, errors, repetitions, and correct completion of the task. The primary outcome measure used for each of the tasks was total time adjusted for correct completion. The Harvard Automated Phone Task discriminated well between young normal, clinically normal elderly, and mild cognitive impairment participants (APT-Script: p<0.001; APT-PCP: p<0.001; APT-Bank: p=0.04). Worse baseline Harvard Automated Phone Task performance or worsening Harvard Automated Phone Task performance over time tracked with overall worse performance or worsening performance over time in global cognition, processing speed, executive function, and episodic memory. Prior cross-sectional and current longitudinal analyses have demonstrated the utility of the Harvard Automated Phone Task, a new performance-based activities of daily living instrument, in the assessment of early changes in complex activities of daily living in non-demented elderly at risk for Alzheimer's disease. Future studies will focus on cross-validation with other sensitive activities of daily living tests and Alzheimer's disease biomarkers.
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A specific role for serotonin in overcoming effort cost.
Meyniel, Florent; Goodwin, Guy M; Deakin, Jf William; Klinge, Corinna; MacFadyen, Christine; Milligan, Holly; Mullings, Emma; Pessiglione, Mathias; Gaillard, Raphaël
2016-11-08
Serotonin is implicated in many aspects of behavioral regulation. Theoretical attempts to unify the multiple roles assigned to serotonin proposed that it regulates the impact of costs, such as delay or punishment, on action selection. Here, we show that serotonin also regulates other types of action costs such as effort. We compared behavioral performance in 58 healthy humans treated during 8 weeks with either placebo or the selective serotonin reuptake inhibitor escitalopram. The task involved trading handgrip force production against monetary benefits. Participants in the escitalopram group produced more effort and thereby achieved a higher payoff. Crucially, our computational analysis showed that this effect was underpinned by a specific reduction of effort cost, and not by any change in the weight of monetary incentives. This specific computational effect sheds new light on the physiological role of serotonin in behavioral regulation and on the clinical effect of drugs for depression. ISRCTN75872983.
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Professional development needs of nurse managers.
Miltner, Rebecca S; Jukkala, Angela; Dawson, Martha A; Patrician, Patricia A
2015-06-01
Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within today's complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role. Copyright 2015, SLACK Incorporated.
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Redesigning Journal Clubs to Staying Current with the Literature.
Dickerson, Roland N; Wood, G Christopher; Swanson, Joseph M; Brown, Rex O
2017-11-06
Staying current with the literature is of paramount importance to the pharmacist engaged in an evidence-based clinical practice. Given the expanding roles and responsibilities of today's pharmacists combined with exponential growth in new medical and health sciences literature, staying current has become an extremely daunting task. Traditional journal clubs have focused upon their role as a training vehicle for teaching critical reading skills to residents. However, schools of pharmacy are now required to provide instruction in biostatistics, research design, and interpretation. We present a paradigm shift in the traditional journal club model whereby a collection of periodicals is screened and a short synopsis of the pertinent articles is provided. The associated tasks for screening and presenting of the primary literature are shared among a group of clinicians and trainees with similar practice interests resulting in a more reasonable workload for the individual. This journal club method was effective in identifying a significant majority of articles judged to be pertinent by independent groups of clinicians in the same practice arenas. Details regarding the shared core practice and knowledge base elements, journal club format, identification of journals, and evaluation of the success of the journal club technique are provided.
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Cohen-Mimran, Ravit; Adwan-Mansour, Jasmeen; Sapir, Shimon
2013-06-01
To examine the role of morphology in verbal working memory. Forty nine children, all native speakers of Arabic from the same region and of the same dialect, performed a Listening Word Span Task, whereby they had to recall Arabic uninflected words (i.e., base words), inflected words with regular (possessive) morphology, or inflected words with irregular (broken plural) morphology. Each of these words was at the end of a sentence (henceforth, target word). The participant's task was to listen to a series of sentences and then recall the target words. Recall of inflected words was significantly poorer than uninflected words, and recall of words with regular morphology was significantly poorer than recall of words with irregular morphology. These findings, albeit preliminary, suggest a role of morphology in verbal working memory. They also suggest that, at least in Arabic, regular morphological forms are decomposed into their component elements and hence impose an extra load on the central executive and episodic buffer components of working memory. Furthermore, in concert with findings from other studies, they suggest that the effect of morphology on working memory is probably language-specific. The clinical implications of the present findings are addressed.
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Barrios, Chelsey S; Bufferd, Sara J; Klein, Daniel N; Dougherty, Lea R
2017-10-01
Little is known about the role of stress reactivity in the emergence of psychopathology across early childhood. In this longitudinal study, we tested the hypothesis that child cortisol reactivity at age 3 moderates associations between early parenting and children's internalizing and externalizing symptoms from age 3 to age 6. One hundred and sixty children were assessed at age 3, and 135 children were reassessed at age 6. At age 3, we exposed children to stress-inducing laboratory tasks, during which we obtained four salivary cortisol samples, and parental hostility was assessed using an observational parent-child interaction task. At ages 3 and 6, child psychiatric symptoms were assessed using a clinical interview with parents. The results indicated that the combination of high child cortisol reactivity and high observed parental hostility at age 3 was associated with greater concurrent externalizing symptoms at age 3 and predicted increases in internalizing and externalizing symptoms from age 3 to age 6. Findings highlight that increased stress reactivity, within the context of hostile parenting, plays a role in the emergence of psychopathology from preschool to school entry.
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Barrios, Chelsey S.; Bufferd, Sara J.; Klein, Daniel N.; Dougherty, Lea R.
2017-01-01
Little is known about the role of stress reactivity in the emergence of psychopathology across early childhood. In this longitudinal study, we tested the hypothesis that child cortisol reactivity at age three moderates associations between early parenting and children’s internalizing and externalizing symptoms from age three to age six. 160 children were assessed at age three and 135 children were reassessed at age six. At age three, we exposed children to stress-inducing laboratory tasks, during which we obtained four salivary cortisol samples, and parental hostility was assessed using an observational parent-child interaction task. At ages three and six, child psychiatric symptoms were assessed using a clinical interview with parents. Results indicated that the combination of high child cortisol reactivity and high observed parental hostility at age three was associated with greater concurrent externalizing symptoms at age three and predicted increases in internalizing and externalizing symptoms from age three to age six. Findings highlight that increased stress reactivity, within the context of hostile parenting, plays a role in the emergence of psychopathology from preschool to school entry. PMID:28290253
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Redesigning Journal Clubs to Staying Current with the Literature
Dickerson, Roland N.; Wood, G. Christopher; Swanson, Joseph M.; Brown, Rex O.
2017-01-01
Staying current with the literature is of paramount importance to the pharmacist engaged in an evidence-based clinical practice. Given the expanding roles and responsibilities of today’s pharmacists combined with exponential growth in new medical and health sciences literature, staying current has become an extremely daunting task. Traditional journal clubs have focused upon their role as a training vehicle for teaching critical reading skills to residents. However, schools of pharmacy are now required to provide instruction in biostatistics, research design, and interpretation. We present a paradigm shift in the traditional journal club model whereby a collection of periodicals is screened and a short synopsis of the pertinent articles is provided. The associated tasks for screening and presenting of the primary literature are shared among a group of clinicians and trainees with similar practice interests resulting in a more reasonable workload for the individual. This journal club method was effective in identifying a significant majority of articles judged to be pertinent by independent groups of clinicians in the same practice arenas. Details regarding the shared core practice and knowledge base elements, journal club format, identification of journals, and evaluation of the success of the journal club technique are provided. PMID:29113107
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Olivar-Parra, José-Sixto; De-La-Iglesia-Gutiérrez, Myriam; Forns, Maria
2011-12-01
The present study reports the effects of referential communication training in individuals formally diagnosed with autism spectrum disorder (ASD). Participants were 20 children with ASD (M age = 14.3 yr., SD = 4.2; 6 girls, 14 boys) in the role of speakers and 20 control children, who acted as listeners. They were all enrolled in mainstream compulsory education. Inclusion/exclusion criteria were defined according to the clinical diagnosis of ASD, the presence or absence of additional or associated disability, previous training in referential communication, and any drug treatment. Speakers were randomly assigned to one of two groups (trained vs untrained). Linguistic age, cognitive level and autistic symptoms were analyzed, respectively, with the Peabody Picture Vocabulary Test (PPVT), the Wechsler Intelligence Scale (WISC-R or WAIS-III), and the Autistic Behavior Checklist (ABC). Communicative abilities were analyzed through two indexes related to message complexity and self-regulation. The trained group was trained in referential communication tasks (task analysis, role taking, and task evaluation), while the untrained group took part in a communicative game but without any specific communicative training. The results showed that the complexity of emitted messages had improved statistically significantly in the trained group as an effect of training. Ecological referential communication is shown to be an appropriate paradigm for studying the communicative process and its products and could be used to develop and implement a training program focused on those skills in which individuals with ASD are most deficient.
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Facial Emotion Recognition in Bipolar Disorder and Healthy Aging.
Altamura, Mario; Padalino, Flavia A; Stella, Eleonora; Balzotti, Angela; Bellomo, Antonello; Palumbo, Rocco; Di Domenico, Alberto; Mammarella, Nicola; Fairfield, Beth
2016-03-01
Emotional face recognition is impaired in bipolar disorder, but it is not clear whether this is specific for the illness. Here, we investigated how aging and bipolar disorder influence dynamic emotional face recognition. Twenty older adults, 16 bipolar patients, and 20 control subjects performed a dynamic affective facial recognition task and a subsequent rating task. Participants pressed a key as soon as they were able to discriminate whether the neutral face was assuming a happy or angry facial expression and then rated the intensity of each facial expression. Results showed that older adults recognized happy expressions faster, whereas bipolar patients recognized angry expressions faster. Furthermore, both groups rated emotional faces more intensely than did the control subjects. This study is one of the first to compare how aging and clinical conditions influence emotional facial recognition and underlines the need to consider the role of specific and common factors in emotional face recognition.
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The mental health treatment team as a work group: team dynamics and the role of the leader.
Yank, G R; Barber, J W; Hargrove, D S; Whitt, P D
1992-08-01
Although treatment teams have been examined often in the mental health literature, this literature seldom addresses the crucial property of "teamness"--the key set of intangible phenomena that allow a team to function synergistically as more than the sum of its parts, and with a sense of team identity. In this paper, the concept of the work group is used to develop a framework for understanding the factors contributing to effective team functioning and identity, an their implications for the tasks of team leadership and sociotherapy: "the art of maintaining a social system in which the treatment of an individual patient can best occur" (Edelson 1970). Leadership activities that promote team cohesiveness and boundary maintenance are discussed, and suggestions are provided for ways in which the subjective experiences and emotional reactions of the leader and team members can be used to promote improved task performance and clinical care.
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Superwoman in the third world.
Clift, E; Goldberg, M
1987-01-01
Women play crucial roles in both production and reproduction, but development planners have focused on women as childbearers and homemakers rather than as individuals with their own needs and problems. Women are vehicles to achieve a project's ends. As a result, many ambitious development programs have failed. Women's health, necessary for their participation in programs, and traditional women's tasks have been neglected. Planners frequently disregard the demands and inflexibility of women's existing responsibilities. Most rural women work 10 to 12 hours per week and can not set aside family survival tasks to participate in classes, clinic visits or demonstrations. The 1st step in designing successful programs is to recognize the realities of poor women's lives, and to focus on the women themselves, their basic needs, health and responsibilities. Women must participate in planning their own development. Women's voices must be heard for programs that depend on their participation to succeed.
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Lichtner, Valentina; Cornford, Tony; Klecun, Ela
2013-01-01
Successful health information technology (HIT) implementations need to be informed on the context of use and on users' attitudes. To this end, we developed the CLinical Computer Systems Survey (CLICS) instrument. CLICS reflects a socio-technical view of HIT adoption, and is designed to encompass all members of the clinical team. We used the survey in a large English hospital as part of its internal evaluation of the implementation of an electronic patient record system (EPR). The survey revealed extent and type of use of the EPR; how it related to and integrated with other existing systems; and people's views on its use, usability and emergent safety issues. Significantly, participants really appreciated 'being asked'. They also reminded us of the wider range of administrative roles engaged with EPR. This observation reveals pertinent questions as to our understanding of the boundaries between administrative tasks and clinical medicine - what we propose as the field of 'administrative medicine'.
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The use of mechanistic evidence in drug approval.
Aronson, Jeffrey K; La Caze, Adam; Kelly, Michael P; Parkkinen, Veli-Pekka; Williamson, Jon
2018-06-11
The role of mechanistic evidence tends to be under-appreciated in current evidence-based medicine (EBM), which focusses on clinical studies, tending to restrict attention to randomized controlled studies (RCTs) when they are available. The EBM+ programme seeks to redress this imbalance, by suggesting methods for evaluating mechanistic studies alongside clinical studies. Drug approval is a problematic case for the view that mechanistic evidence should be taken into account, because RCTs are almost always available. Nevertheless, we argue that mechanistic evidence is central to all the key tasks in the drug approval process: in drug discovery and development; assessing pharmaceutical quality; devising dosage regimens; assessing efficacy, harms, external validity, and cost-effectiveness; evaluating adherence; and extending product licences. We recommend that, when preparing for meetings in which any aspect of drug approval is to be discussed, mechanistic evidence should be systematically analysed and presented to the committee members alongside analyses of clinical studies. © 2018 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.
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ERIC Educational Resources Information Center
Weyers, Lori; Langerman, Philip
In 1989-90, the General Education Task Force of the Wisconsin Technical College System (WTCS) was convened to determine the role of the general education curriculum in the attainment of skills that enhance the likelihood of success among technical college graduates in their careers, homes and communities. The Task Force consisted of at least one…
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I can do that: the impact of implicit theories on leadership role model effectiveness.
Hoyt, Crystal L; Burnette, Jeni L; Innella, Audrey N
2012-02-01
This research investigates the role of implicit theories in influencing the effectiveness of successful role models in the leadership domain. Across two studies, the authors test the prediction that incremental theorists ("leaders are made") compared to entity theorists ("leaders are born") will respond more positively to being presented with a role model before undertaking a leadership task. In Study 1, measuring people's naturally occurring implicit theories of leadership, the authors showed that after being primed with a role model, incremental theorists reported greater leadership confidence and less anxious-depressed affect than entity theorists following the leadership task. In Study 2, the authors demonstrated the causal role of implicit theories by manipulating participants' theory of leadership ability. They replicated the findings from Study 1 and demonstrated that identification with the role model mediated the relationship between implicit theories and both confidence and affect. In addition, incremental theorists outperformed entity theorists on the leadership task.
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Morey, Candice Coker; Cowan, Nelson; Morey, Richard D; Rouder, Jeffery N
2011-02-01
Prominent roles for general attention resources are posited in many models of working memory, but the manner in which these can be allocated differs between models or is not sufficiently specified. We varied the payoffs for correct responses in two temporally-overlapping recognition tasks, a visual array comparison task and a tone sequence comparison task. In the critical conditions, an increase in reward for one task corresponded to a decrease in reward for the concurrent task, but memory load remained constant. Our results show patterns of interference consistent with a trade-off between the tasks, suggesting that a shared resource can be flexibly divided, rather than only fully allotted to either of the tasks. Our findings support a role for a domain-general resource in models of working memory, and furthermore suggest that this resource is flexibly divisible.
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Consciousness, Functional Networks and Delirium Screening.
Eeles, Eamonn; Burianova, Hana; Pandy, Shaun; Pinsker, Donna
2017-01-01
Consciousness, the medium of sentient thought, requires integrity of functional networks and their connectivity. In health, they function as a co-operative but mutually exclusive paradigm of introspection versus external awareness subserved via the Default Mode Network and Task Positive State, respectively. Higher thinking in the conscious state is then segregated according to need. There is research evidence to suggest that functional networks may be impacted in disorders of consciousness and conceptual support for a mechanistic role in delirium. This potentially central aspect of delirium manifestation is relatively unexplored. This article describes the role of disrupted functional networks in delirium. How this relates to current understanding of delirium neurobiology and the ramifications for clinical diagnosis is discussed. A review of the role of functional networks, particularly DMN and TPN, has been undertaken with respect to health and delirium. An exploration of how symptoms of delirium may be related to functional network aberrancy has been undertaken. Implications for research and clinical practice in delirium have been presented. In delirium, a disturbance of consciousness, the DMN is pathologically co-activated and functional cortical connectivity is compromised. The clinical correlate is of an experiential singularity where internal and external drivers become indistinguishable, reality and delusion merge and the notion of self is effaced. Our group propose that functional network disruption in conjunction with cortical disconnectivity is central to the mechanism of delirium. Clinical tools may exploit the neurobiology of delirium to improve its diagnosis and an example of such a simple screening instrument (SQeeC) is provided. Functional networks are critically disrupted in delirium and may be central to clinical features. A better understanding of the neurobiology of delirium will generate research opportunities with potential for therapeutic gains in detection, diagnosis, and management. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.
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Development of job standards for clinical nutrition therapy for dyslipidemia patients.
Kang, Min-Jae; Seo, Jung-Sook; Kim, Eun-Mi; Park, Mi-Sun; Woo, Mi-Hye; Ju, Dal-Lae; Wie, Gyung-Ah; Lee, Song-Mi; Cha, Jin-A; Sohn, Cheong-Min
2015-04-01
Dyslipidemia has significantly contributed to the increase of death and morbidity rates related to cardiovascular diseases. Clinical nutrition service provided by dietitians has been reported to have a positive effect on relief of medical symptoms or reducing the further medical costs. However, there is a lack of researches to identify key competencies and job standard for clinical dietitians to care patients with dyslipidemia. Therefore, the purpose of this study was to analyze the job components of clinical dietitian and develop the standard for professional practice to provide effective nutrition management for dyslipidemia patients. The current status of clinical nutrition therapy for dyslipidemia patients in hospitals with 300 or more beds was studied. After duty tasks and task elements of nutrition care process for dyslipidemia clinical dietitians were developed by developing a curriculum (DACUM) analysis method. The developed job standards were pretested in order to evaluate job performance, difficulty, and job standards. As a result, the job standard included four jobs, 18 tasks, and 53 task elements, and specific job description includes 73 basic services and 26 recommended services. When clinical dietitians managing dyslipidemia patients performed their practice according to this job standard for 30 patients the job performance rate was 68.3%. Therefore, the job standards of clinical dietitians for clinical nutrition service for dyslipidemia patients proposed in this study can be effectively used by hospitals.
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Articulating nursing in an interprofessional world.
Sommerfeldt, Susan C
2013-11-01
It is essential that nurses in practice clearly articulate their role in interprofessional clinical settings. Assumptions, stereotypes, power differentials and miscommunication can complicate the interaction of healthcare professionals when clarity does not exist about nurses' knowledge, skills and roles. Conflicting views among nurse scholars as to the nature of nursing knowledge and its relationship to practice complicate the task of nurses in explaining their performance and role to others in interprofessional environments. Interprofessionality is potentially misunderstood by nurse leaders, practitioners and educators, isolating nurses in an increasingly inter-disciplinary healthcare system. The theorization of contemporary nursing is explored through the views and perspectives of current nurse scholars. The ability to explain nursing knowledge, skills and roles to others in interprofessional interactions is a nursing competency, as well as an interprofessional one. Nurses, nurse leaders and nurse educators are challenged to engage in interprofessionalism so as to have an influence in the evolution of healthcare education and practice environments. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Voon, V; Baek, K; Enander, J; Worbe, Y; Morris, L S; Harrison, N A; Robbins, T W; Rück, C; Daw, N
2015-11-03
Our decisions are based on parallel and competing systems of goal-directed and habitual learning, systems which can be impaired in pathological behaviours. Here we focus on the influence of motivation and compare reward and loss outcomes in subjects with obsessive-compulsive disorder (OCD) on model-based goal-directed and model-free habitual behaviours using the two-step task. We further investigate the relationship with acquisition learning using a one-step probabilistic learning task. Forty-eight OCD subjects and 96 healthy volunteers were tested on a reward and 30 OCD subjects and 53 healthy volunteers on the loss version of the two-step task. Thirty-six OCD subjects and 72 healthy volunteers were also tested on a one-step reversal task. OCD subjects compared with healthy volunteers were less goal oriented (model-based) and more habitual (model-free) to reward outcomes with a shift towards greater model-based and lower habitual choices to loss outcomes. OCD subjects also had enhanced acquisition learning to loss outcomes on the one-step task, which correlated with goal-directed learning in the two-step task. OCD subjects had greater stay behaviours or perseveration in the one-step task irrespective of outcome. Compulsion severity was correlated with habitual learning in the reward condition. Obsession severity was correlated with greater switching after loss outcomes. In healthy volunteers, we further show that greater reward magnitudes are associated with a shift towards greater goal-directed learning further emphasizing the role of outcome salience. Our results highlight an important influence of motivation on learning processes in OCD and suggest that distinct clinical strategies based on valence may be warranted.
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Commentary: deconstructing gender difference.
Carnes, Molly
2010-04-01
In Japan, as in the United States, a growing proportion of physicians are women. Hence, the different social roles that men and women occupy and the gendered norms for behavior are increasingly relevant in ensuring that male and female physicians have equal opportunity to participate and advance in all aspects of medicine. Elsewhere in this issue, Nomura and colleagues report on a large survey of primary care residents in Japan. They found that on average women's self-rated confidence on many clinical tasks was lower than men's. This is not surprising given similar gender differences in self-assessed competence in other research and the socialization of women in virtually all cultures to be modest. The actual differences in average scores were small suggesting considerable overlap in the distributions of responses from male and female residents. In addition, research from other countries finds no association between physicians' self-reported confidence in clinical tasks and objective measures of competence on which female physicians rate at or above the level of their male counterparts. Congruent with different social roles for men and women, Nomura and colleagues also found gender differences in the average responses about work-family priorities and aspirations toward leadership, but some women indicated a desire for research careers and some men were "life-oriented." The author of this commentary argues that to draw conclusions about all male or all female physicians from average differences of a large group of residents may reinforce gender stereotypes that continue to impede each individual female physician's career advancement and each individual male physician's struggle for work-life balance.
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Barbato, Mariapaola; Liu, Lu; Cadenhead, Kristin S; Cannon, Tyrone D; Cornblatt, Barbara A; McGlashan, Thomas H; Perkins, Diana O; Seidman, Larry J; Tsuang, Ming T; Walker, Elaine F; Woods, Scott W; Bearden, Carrie E; Mathalon, Daniel H; Heinssen, Robert; Addington, Jean
2015-09-01
Social cognition, the mental operations that underlie social interactions, is a major construct to investigate in schizophrenia. Impairments in social cognition are present before the onset of psychosis, and even in unaffected first-degree relatives, suggesting that social cognition may be a trait marker of the illness. In a large cohort of individuals at clinical high risk for psychosis (CHR) and healthy controls, three domains of social cognition (theory of mind, facial emotion recognition and social perception) were assessed to clarify which domains are impaired in this population. Six-hundred and seventy-five CHR individuals and 264 controls, who were part of the multi-site North American Prodromal Longitudinal Study, completed The Awareness of Social Inference Test , the Penn Emotion Recognition task , the Penn Emotion Differentiation task , and the Relationship Across Domains , measures of theory of mind, facial emotion recognition, and social perception, respectively. Social cognition was not related to positive and negative symptom severity, but was associated with age and IQ. CHR individuals demonstrated poorer performance on all measures of social cognition. However, after controlling for age and IQ, the group differences remained significant for measures of theory of mind and social perception, but not for facial emotion recognition. Theory of mind and social perception are impaired in individuals at CHR for psychosis. Age and IQ seem to play an important role in the arising of deficits in facial affect recognition. Future studies should examine the stability of social cognition deficits over time and their role, if any, in the development of psychosis.
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Wearn, Andy; Bhoopatkar, Harsh
2006-10-01
Early clinical skills teaching often requires students to learn through examining one another. This model should acknowledge ethical, practical and individual issues, disclosure and identification of abnormalities. Consent to peer physical examination (PPE) is usually expected rather than discussed and sought. We sought to evaluate a formal written consent process for PPE and to explore students' views of this approach. A survey tool was designed and distributed to all years 2 and 3 students in the Auckland University medical programme (2004). Results were analysed using univariate statistics and thematic analysis. The response rate was 57% (146/258). Most students had read the participant information sheet prior to signing, with 78% giving consent. They had not felt coerced and the in-course experience matched the 'promise'. Comments included: PPE gave insights into the 'patient's world', encouraged peer learning and raised some professional issues. More than 95% of students took the examination role at least once (less likely if female, P = 0.002). Some European, Maori and Pacific students never took the role; all Asian students did at least once. Students preferred PPE in groups consisting of 'friends'. The task influenced group composition by sex (P < 0.0001) but not ethnicity. Students accept and support a formal consent process. PPE participation rates are similar to predictions. The experience must match the promises made. Formal preparation alone might have produced similar student outcomes. Female students are more selective about tasks undertaken. The influence of ethnicity and the effect on future behaviour and attitudes needs further exploration.
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COMT genotype, gambling activity, and cognition.
Grant, Jon E; Leppink, Eric W; Redden, Sarah A; Odlaug, Brian L; Chamberlain, Samuel R
2015-09-01
Neuropsychological studies of adults with problem gambling indicate impairments across multiple cognitive domains. Catechol-O-methyltransferase (COMT) plays a unique role in the regulation of dopamine in the prefrontal cortex, and has been implicated in the cognitive dysfunction evident in problem gambling. This study examined adults with varying levels of gambling behavior to determine whether COMT genotype was associated with differences in gambling symptoms and cognitive functioning. 260 non-treatment-seeking adults aged 18-29 years with varying degrees of gambling behavior provided saliva samples for genotyping COMT val158met (rs4680). All subjects underwent clinical evaluations and neurocognitive assessment of decision-making, working memory, and impulsivity. The Val/Val COMT genotype was associated with the largest percentage of subjects with gambling disorder (31.8%), a rate significantly different from the Val/Met (13.2%) group (p = 0.001). The Val/Val COMT group was also associated with significantly more gambling disorder diagnostic criteria being met, greater frequency of gambling behavior, and significantly worse cognitive performance on the Cambridge Gamble Task (risk adjustment and delay aversion) and the Spatial Working Memory task (total errors). This study adds to the growing literature on the role of COMT in impulsive behaviors by showing that the Val/Val genotype was associated with specific clinical and cognitive elements among young adults who gamble, in the absence of differences on demographic measures and other cognitive domains. Future work should consider using genotyping to explore whether certain polymorphisms predict subsequent development of impulsive behaviors including gambling disorder, and treatment outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Using task analysis in healthcare design to improve clinical efficiency.
Lu, Jun; Hignett, Sue
2009-01-01
To review the functionality of the proposed soiled workroom design for efficient and safe clinical activities. As part of a hospital refurbishment program, the planning team of a United Kingdom National Health Service hospital requested a review of a proposed standardized room design. A 7-day observational study was conducted in five clinical departments at three hospitals. Link analysis was used to record and analyze the movements among components, i.e., nursing staff, equipment/devices, and furniture. Fifty-four observations were recorded for 18 clinical tasks. The most frequent tasks were the disposal of urine and used urine bottles, and returning used commode chairs. Minor recommendations were made to improve the proposed design, and major revisions were suggested to address functionality problems. It was found that the proposed design did not offer the optimal layout for efficient and safe clinical activities. Link analysis was found to be effective for plotting the movements of the staff and accounting for the complexity of tasks. This ergonomic method, in combination with observational field studies, provided a simple and effective way to determine functional space requirements for clinical activities and should be used in all healthcare building design projects.
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Promoting Task-Based Pragmatics Instruction in EFL Classroom Contexts: The Role of Task Complexity
ERIC Educational Resources Information Center
Kim, Youjin; Taguchi, Naoko
2015-01-01
Robinson's (2001) Cognition Hypothesis claims that more complex tasks promote interaction and language development. This study examined the effect of task complexity in the learning of request-making expressions. Task complexity was operationalized as [+/- reasoning] following Robinson's framework. The study employed a pretest-posttest research…
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Agmon, Maayan; Belza, Basia; Nguyen, Huong Q; Logsdon, Rebecca G; Kelly, Valerie E
2014-01-01
Injury due to falls is a major problem among older adults. Decrements in dual-task postural control performance (simultaneously performing two tasks, at least one of which requires postural control) have been associated with an increased risk of falling. Evidence-based interventions that can be used in clinical or community settings to improve dual-task postural control may help to reduce this risk. THE AIMS OF THIS SYSTEMATIC REVIEW ARE: 1) to identify clinical or community-based interventions that improved dual-task postural control among older adults; and 2) to identify the key elements of those interventions. Studies were obtained from a search conducted through October 2013 of the following electronic databases: PubMed, CINAHL, PsycINFO, and Web of Science. Randomized and nonrandomized controlled studies examining the effects of interventions aimed at improving dual-task postural control among community-dwelling older adults were selected. All studies were evaluated based on methodological quality. Intervention characteristics including study purpose, study design, and sample size were identified, and effects of dual-task interventions on various postural control and cognitive outcomes were noted. Twenty-two studies fulfilled the selection criteria and were summarized in this review to identify characteristics of successful interventions. The ability to synthesize data was limited by the heterogeneity in participant characteristics, study designs, and outcome measures. Dual-task postural control can be modified by specific training. There was little evidence that single-task training transferred to dual-task postural control performance. Further investigation of dual-task training using standardized outcome measurements is needed.
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NASA's Role in Aeronautics: A Workshop. Volume III - Transport Aircraft.
ERIC Educational Resources Information Center
National Academy of Sciences - National Research Council, Washington, DC. Assembly of Engineering.
The central task of a 1980 workshop on the role of the National Aeronautics and Space Administration (NASA) in aeronautics was to examine the relationship of NASA's research capabilities to the state of U.S. aviation and to make recommendations about NASA's future role in aeronautics. The specific task of the Panel on Transport Aircraft was to…
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Physician's perceived roles, as well as barriers, towards caring for women sex assault survivors
Amin, Priyanka; Buranosky, Raquel; Chang, Judy C.
2016-01-01
Background Sexual assault (SA) affects about 40% of women in the US and has many mental and physical health sequelae. Physicians often do not address SA with patients although SA survivors describe a desire to talk to physicians to obtain additional help. Little information exists on how providers perceive their roles regarding caring for women SA survivors and what barriers they face in providing this care. Methods We performed a qualitative study using semi-structured one-on-one interviews with sixteen faculty physicians from five specialties: obstetrics and gynecology (four), internal medicine (four), family medicine (one), emergency medicine (three), and psychiatry (four). Interviews were conducted between July 2011 and July 2012, transcribed verbatim, and coded using a constant comparative approach. Once a final coding scheme was applied to all transcripts, we identified patterns and themes related to perceived roles and barriers to caring for SA survivors. Results Physicians described two main categories of roles: clinical tasks (e.g. testing and treating for sexually transmitted infections, managing associated mental health sequelae) and interpersonal roles (e.g. providing support, acting as patient advocate). Physician barriers fell into three main categories: (1) internal barriers (e.g. discomfort with the topic of SA); (2) physician-patient communication; and (3) system obstacles (e.g. competing priorities for time). Conclusions Although physicians describe key roles in caring for SA survivors, several barriers hinder their ability to fulfill these roles. Training interventions are needed to reduce the barriers that would ultimately improve clinical care for SA survivors. PMID:27863981
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Social Cognition Psychometric Evaluation: Results of the Initial Psychometric Study
Pinkham, Amy E.; Penn, David L.; Green, Michael F.; Harvey, Philip D.
2016-01-01
Measurement of social cognition in treatment trials remains problematic due to poor and limited psychometric data for many tasks. As part of the Social Cognition Psychometric Evaluation (SCOPE) study, the psychometric properties of 8 tasks were assessed. One hundred and seventy-nine stable outpatients with schizophrenia and 104 healthy controls completed the battery at baseline and a 2–4-week retest period at 2 sites. Tasks included the Ambiguous Intentions Hostility Questionnaire (AIHQ), Bell Lysaker Emotion Recognition Task (BLERT), Penn Emotion Recognition Task (ER-40), Relationships Across Domains (RAD), Reading the Mind in the Eyes Task (Eyes), The Awareness of Social Inferences Test (TASIT), Hinting Task, and Trustworthiness Task. Tasks were evaluated on: (i) test-retest reliability, (ii) utility as a repeated measure, (iii) relationship to functional outcome, (iv) practicality and tolerability, (v) sensitivity to group differences, and (vi) internal consistency. The BLERT and Hinting task showed the strongest psychometric properties across all evaluation criteria and are recommended for use in clinical trials. The ER-40, Eyes Task, and TASIT showed somewhat weaker psychometric properties and require further study. The AIHQ, RAD, and Trustworthiness Task showed poorer psychometric properties that suggest caution for their use in clinical trials. PMID:25943125
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Sanders, M R; Woolley, M L
2005-01-01
The present study examined the relationship between maternal self-efficacy, dysfunctional discipline practices and child conduct problems. Specifically, three levels of self-efficacy, global, domain and task-specific self-efficacy, were assessed in mothers of 2- to 8-year-old children with conduct problems (clinic group, n=45) and non-clinic mothers from the community (non-clinic group, n=79). Measures of global, domain and task-specific self-efficacy were completed by mothers. Clinic mothers reported significantly lower self-efficacy than non-clinic mothers for all but one of the parenting tasks assessed. Both groups of mothers reported lowest self-efficacy for similar parenting tasks. In the sample as a whole self-efficacy measures were significant predictors of maternal discipline style after controlling for other parent, child and risk factors. Of the self-efficacy variables behavioural self-efficacy was the best predictor of mothers discipline style. The findings support the importance of developing parenting strategies that enable parents to generalize their parenting skills to a diverse range of diverse parenting contexts both in the home and in the community.
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Research on a dynamic workflow access control model
NASA Astrophysics Data System (ADS)
Liu, Yiliang; Deng, Jinxia
2007-12-01
In recent years, the access control technology has been researched widely in workflow system, two typical technologies of that are RBAC (Role-Based Access Control) and TBAC (Task-Based Access Control) model, which has been successfully used in the role authorizing and assigning in a certain extent. However, during the process of complicating a system's structure, these two types of technology can not be used in minimizing privileges and separating duties, and they are inapplicable when users have a request of frequently changing on the workflow's process. In order to avoid having these weakness during the applying, a variable flow dynamic role_task_view (briefly as DRTVBAC) of fine-grained access control model is constructed on the basis existed model. During the process of this model applying, an algorithm is constructed to solve users' requirements of application and security needs on fine-grained principle of privileges minimum and principle of dynamic separation of duties. The DRTVBAC model is implemented in the actual system, the figure shows that the task associated with the dynamic management of role and the role assignment is more flexible on authority and recovery, it can be met the principle of least privilege on the role implement of a specific task permission activated; separated the authority from the process of the duties completing in the workflow; prevented sensitive information discovering from concise and dynamic view interface; satisfied with the requirement of the variable task-flow frequently.
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A social‐technological epistemology of clinical decision‐making as mediated by imaging
Carusi, Annamaria; Sabroe, Ian; Kiely, David G.
2016-01-01
Abstract In recent years there has been growing attention to the epistemology of clinical decision‐making, but most studies have taken the individual physicians as the central object of analysis. In this paper we argue that knowing in current medical practice has an inherently social character and that imaging plays a mediating role in these practices. We have analyzed clinical decision‐making within a medical expert team involved in diagnosis and treatment of patients with pulmonary hypertension (PH), a rare disease requiring multidisciplinary team involvement in diagnosis and management. Within our field study, we conducted observations, interviews, video tasks, and a panel discussion. Decision‐making in the PH clinic involves combining evidence from heterogeneous sources into a cohesive framing of a patient, in which interpretations of the different sources can be made consistent with each other. Because pieces of evidence are generated by people with different expertise and interpretation and adjustments take place in interaction between different experts, we argue that this process is socially distributed. Multidisciplinary team meetings are an important place where information is shared, discussed, interpreted, and adjusted, allowing for a collective way of seeing and a shared language to be developed. We demonstrate this with an example of image processing in the PH service, an instance in which knowledge is distributed over multiple people who play a crucial role in generating an evaluation of right heart function. Finally, we argue that images fulfill a mediating role in distributed knowing in 3 ways: first, as enablers or tools in acquiring information; second, as communication facilitators; and third, as pervasively framing the epistemic domain. With this study of clinical decision‐making in diagnosis and treatment of PH, we have shown that clinical decision‐making is highly social and mediated by technologies. The epistemology of clinical decision‐making needs to take social and technological mediation into account. PMID:27696641
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Marshall, Gad A.; Aghjayan, Sarah L.; Dekhtyar, Maria; Locascio, Joseph J.; Jethwani, Kamal; Amariglio, Rebecca E.; Johnson, Keith A.; Sperling, Reisa A.; Rentz, Dorene M.
2017-01-01
Background Impairment in activities of daily living is a major burden to both patients and caregivers. Mild impairment in instrumental activities of daily living is often seen at the stage of mild cognitive impairment. The field of Alzheimer’s disease is moving toward earlier diagnosis and intervention and more sensitive and ecologically valid assessments of instrumental or complex activities of daily living are needed. The Harvard Automated Phone Task, a novel performance-based activities of daily living instrument, has the potential to fill this gap. Objective To further validate the Harvard Automated Phone Task by assessing its longitudinal relationship to global cognition and specific cognitive domains in clinically normal elderly and individuals with mild cognitive impairment. Design In a longitudinal study, the Harvard Automated Phone Task was associated with cognitive measures using mixed effects models. The Harvard Automated Phone Task’s ability to discriminate across diagnostic groups at baseline was also assessed. Setting Academic clinical research center. Participants Two hundred and seven participants (45 young normal, 141 clinically normal elderly, and 21 mild cognitive impairment) were recruited from the community and the memory disorders clinics at Brigham and Women’s Hospital and Massachusetts General Hospital. Measurements Participants performed the three tasks of the Harvard Automated Phone Task, which consist of navigating an interactive voice response system to refill a prescription (APT-Script), select a new primary care physician (APT-PCP), and make a bank account transfer and payment (APT-Bank). The 3 tasks were scored based on time, errors, repetitions, and correct completion of the task. The primary outcome measure used for each of the tasks was total time adjusted for correct completion. Results The Harvard Automated Phone Task discriminated well between young normal, clinically normal elderly, and mild cognitive impairment participants (APT-Script: p<0.001; APT-PCP: p<0.001; APT-Bank: p=0.04). Worse baseline Harvard Automated Phone Task performance or worsening Harvard Automated Phone Task performance over time tracked with overall worse performance or worsening performance over time in global cognition, processing speed, executive function, and episodic memory. Conclusions Prior cross-sectional and current longitudinal analyses have demonstrated the utility of the Harvard Automated Phone Task, a new performance-based activities of daily living instrument, in the assessment of early changes in complex activities of daily living in non-demented elderly at risk for Alzheimer’s disease. Future studies will focus on cross-validation with other sensitive activities of daily living tests and Alzheimer’s disease biomarkers. PMID:29124043
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Foley, J I; Drummie, J
2012-06-01
To assess the effect of an introductory Clinical Skills Program on the development of two tasks aimed at teaching a Class II cavity preparation technique. A prospective, observational study. Twenty three first year students (F: 19; M: 4) were asked to complete two cavities on a Frasaco(®) tooth 46 using a FG 565 pear-shaped diamond bur. Task One: A groove was cut from the central fissure area to within 1mm of the marginal ridge which was 5mm in length, 2mm in width and 2mm in depth. Task Two: As for Task One and in addition, a slot was cut vertically downward at the marginal ridge to create a box 2mm in length, 2mm in width and 3mm in depth. Both tasks were undertaken at the start of an introductory Clinical Skills course and two months later after further skills practice. Cavity dimensions were measured using a digital caliper with a depth gauge. Data were analysed using a two-sample t-test (MINITAB(®) 15.1). Regarding Task One, a statistically-significant improvement in groove width was noted (p=0.001). Concerning Task Two, both the groove width and the box width improved and both were statistically significant p=0.023 and p=0.049, respectively). A Clinical Skills Program would appear to result in an improvement in cavity preparation, particularly in relation to cavity width.
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Palese, Alvisa; Basso, Felix; Del Negro, Elena; Achil, Illarj; Ferraresi, Annamaria; Morandini, Marzia; Moreale, Renzo; Mansutti, Irene
2017-05-01
Some nursing programmes offer night shifts for students while others do not, mainly due to the lack of evidence regarding their effectiveness on clinical learning. The principal aims of the study were to describe nursing students' perceptions and to explore conditions influencing effectiveness on learning processes during night shifts. An explanatory mixed-method study design composed of a cross-sectional study (primary method, first phase) followed by a descriptive phenomenological study design (secondary method, second phase) in 2015. Two bachelor of nursing degree programmes located in Northern Italy, three years in length and requiring night shifts for students starting in the second semester of the 1st year, were involved. First phase: all nursing students ending their last clinical placement of the academic year attended were eligible; 352 out the 370 participated. Second phase: a purposeful sample of nine students among those included in the first phase and who attended the highest amount of night shifts were interviewed. First phase: a questionnaire composed of closed and open-ended questions was adopted; data was analyzed through descriptive statistical methods. Second phase: an open-ended face-to-face audio-recorded interview was adopted and data was analyzed through content analysis. Findings from the quantitative phase, showed that students who attended night shifts reported satisfaction (44.7%) less frequently than those who attended only day shifts (55.9%). They also reported boredom (23.5%) significantly more often compared to day shift students (p=0001). Understanding of the nursing role and learning competence was significantly inferior among night shift students as compared to day shift students, while the perception of wasting time was significantly higher among night shift students compared to their counterparts. Night shift students performed nursing rounds (288; 98.2%), non-nursing tasks (247; 84.3%) and/or less often managed clinical problems (insomnia 37; 12.6% and disorientation/confusion 32; 10.9%). Findings from the qualitative phase showed night shifts are experienced by students as a "time potentially capable of generating clinical learning": learning is maximized when students play an active role, encounter patients' clinical problems and develop relationships with patients, caregivers and staff. Night shifts remains ambiguous from the students' perspective and their introduction in nursing education should be approached with care, considering the learning aims expected by students in their clinical placements and the education of clinical mentors education who should be capable of effectively involving students in the process of night care by avoiding non-nursing tasks. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Comparative costs and activity from a sample of UK clinical trials units.
Hind, Daniel; Reeves, Barnaby C; Bathers, Sarah; Bray, Christopher; Corkhill, Andrea; Hayward, Christopher; Harper, Lynda; Napp, Vicky; Norrie, John; Speed, Chris; Tremain, Liz; Keat, Nicola; Bradburn, Mike
2017-05-02
The costs of medical research are a concern. Clinical Trials Units (CTUs) need to better understand variations in the costs of their activities. Representatives of ten CTUs and two grant-awarding bodies pooled their experiences in discussions over 1.5 years. Five of the CTUs provided estimates of, and written justification for, costs associated with CTU activities required to implement an identical protocol. The protocol described a 5.5-year, nonpharmacological randomized controlled trial (RCT) conducted at 20 centres. Direct and indirect costs, the number of full time equivalents (FTEs) and the FTEs attracting overheads were compared and qualitative methods (unstructured interviews and thematic analysis) were used to interpret the results. Four members of the group (funding-body representatives or award panel members) reviewed the justification statements for transparency and information content. Separately, 163 activities common to trials were assigned to roles used by nine CTUs; the consistency of role delineation was assessed by Cohen's κ. Median full economic cost of CTU activities was £769,637 (range: £661,112 to £1,383,323). Indirect costs varied considerably, accounting for between 15% and 59% (median 35%) of the full economic cost of the grant. Excluding one CTU, which used external statisticians, the total number of FTEs ranged from 2.0 to 3.0; total FTEs attracting overheads ranged from 0.3 to 2.0. Variation in directly incurred staff costs depended on whether CTUs: supported particular roles from core funding rather than grants; opted not to cost certain activities into the grant; assigned clerical or data management tasks to research or administrative staff; employed extensive on-site monitoring strategies (also the main source of variation in non-staff costs). Funders preferred written justifications of costs that described both FTEs and indicative tasks for funded roles, with itemised non-staff costs. Consistency in role delineation was fair (κ = 0.21-0.40) for statisticians/data managers and poor for other roles (κ < 0.20). Some variation in costs is due to factors outside the control of CTUs such as access to core funding and levels of indirect costs levied by host institutions. Research is needed on strategies to control costs appropriately, especially the implementation of risk-based monitoring strategies.
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Flindall, Ian; Leff, Daniel Richard; Goodship, Jonathan; Sugden, Colin; Darzi, Ara
2016-04-01
To evaluate the impact of modafinil on "free" and "cued" recall of clinical information in fatigued but nonsleep-deprived clinicians. Despite attempts to minimize sleep deprivation through redesign of the roster of residents and staff surgeons, evidence suggests that fatigue remains prevalent. The wake-promoting agent modafinil improves cognition in the sleep-deprived fatigued state and may improve information recall in fatigued nonsleep-deprived clinicians. Twenty-four medical undergraduates participated in a double-blind, parallel, randomized controlled trial (modafinil-200 mg:placebo). Medication was allocated 2 hours before a 90-minute fatigue-inducing, continuous performance task (dual 2-back task). A case history memorization task was then performed. Clinical information recall was assessed as "free"(no cognitive aids) and "cued"(using aid memoirs). Open and closed cues represent information of increasing specificity to aid the recall of clinical information. Fatigue was measured objectively using the psychomotor vigilance task at induction, before and after the dual 2-back task. Modafinil decreased false starts and lapses (modafinil = 0.50, placebo = 9.83, P < .05) and improved psychomotor vigilance task performance (Decreased Performance, modafinil = 0.006, placebo = 0.098, P < .05). Modafinil improved free information recall (modafinil = 137.8, placebo = 106.0, P < .01). There was no significant difference between groups in the amount of information recalled with open (modafinil = 62.3, placebo = 52.8, P = .1) and closed cues (modafinil = 80.1, placebo = 75.9, P = .3). Modafinil attenuated fatigue and improved free recall of clinical information without improving cue-based recall under the design of our experimental conditions. Memory cues to aid retrieval of clinical information are convenient interventions that could decrease fatigue-related error without adverse effects of the neuropharmacology. Copyright © 2016 Elsevier Inc. All rights reserved.
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Applicability Evaluation of Job Standards for Diabetes Nutritional Management by Clinical Dietitian.
Baek, Young Jin; Oh, Na Gyeong; Sohn, Cheong-Min; Woo, Mi-Hye; Lee, Seung Min; Ju, Dal Lae; Seo, Jung-Sook
2017-04-01
This study was conducted to evaluate applicability of job standards for diabetes nutrition management by hospital clinical dietitians. In order to promote the clinical nutrition services, it is necessary to present job standards of clinical dietitian and to actively apply these standardized tasks to the medical institution sites. The job standard of clinical dietitians for diabetic nutrition management was distributed to hospitals over 300 beds. Questionnaire was collected from 96 clinical dietitians of 40 tertiary hospitals, 47 general hospitals, and 9 hospitals. Based on each 5-point scale, the importance of overall duty was 4.4 ± 0.5, performance was 3.6 ± 0.8, and difficulty was 3.1 ± 0.7. 'Nutrition intervention' was 4.5 ± 0.5 for task importance, 'nutrition assessment' was 4.0 ± 0.7 for performance, and 'nutrition diagnosis' was 3.4 ± 0.9 for difficulty. These 3 items were high in each category. Based on the grid diagram, the tasks of both high importance and high performance were 'checking basic information,' 'checking medical history and therapy plan,' 'decision of nutritional needs,' 'supply of foods and nutrients,' and 'education of nutrition and self-management.' The tasks with high importance but low performance were 'derivation of nutrition diagnosis,' 'planning of nutrition intervention,' 'monitoring of nutrition intervention process.' The tasks of both high importance and high difficulty were 'derivation of nutrition diagnosis,' 'planning of nutrition intervention,' 'supply of foods and nutrients,' 'education of nutrition and self-management,' and 'monitoring of nutrition intervention process.' The tasks of both high performance and high difficulty were 'documentation of nutrition assessment,' 'supply of foods and nutrients,' and 'education of nutrition and self-management.'
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O'Connor, Nick; Paton, Michael
2008-04-01
A framework developed to promote the understanding and application of clinical governance principles in an area mental health service is described. The framework is operationalized through systems, processes, roles and responsibilities. The development of an explicit and operationalizable framework for clinical governance arose from the authors' experiences in leading and managing mental health services. There is a particular emphasis on improvement of quality of care and patient safety. The framework is informed by recent developments in thinking about clinical governance, including key documents from Australia and the United Kingdom. The operational nature of the framework allows for key components of clinical governance to be described explicitly, communicated effectively, and continually tested and improved. Further consideration and assessment of the value of differing approaches to this task are required. For example, a general, illustrative approach to raise clinician awareness can be contrasted with prescriptive and specified approaches which progressively encompass the many functions and processes of a mental health service. Mental health clinicians and managers can be guided by a framework that will ensure safe, high quality and continually improving processes of care.
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McCloskey, Eugene V; Binkley, Neil
2011-01-01
The World Health Organization fracture risk assessment tool, FRAX(®), is an advance in clinical care that can assist in clinical decision-making. However, with increasing clinical utilization, numerous questions have arisen regarding how to best estimate fracture risk in an individual patient. Recognizing the need to assist clinicians in optimal use of FRAX(®), the International Osteoporosis Foundation (IOF) in conjunction with the International Society for Clinical Densitometry (ISCD) assembled an international panel of experts that ultimately developed joint Official Positions of the ISCD and IOF advising clinicians regarding FRAX(®) usage. As part of the process, the charge of the FRAX(®) Clinical Task Force was to review and synthesize data surrounding a number of recognized clinical risk factors including rheumatoid arthritis, smoking, alcohol, prior fracture, falls, bone turnover markers and glucocorticoid use. This synthesis was presented to the expert panel and constitutes the data on which the subsequent Official Positions are predicated. A summary of the Clinical Task Force composition and charge is presented here. Copyright © 2011. Published by Elsevier Inc.
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A functional neuroimaging study of the clinical reasoning of medical students.
Chang, Hyung-Joo; Kang, June; Ham, Byung-Joo; Lee, Young-Mee
2016-12-01
As clinical reasoning is a fundamental competence of physicians for good clinical practices, medical academics have endeavored to teach reasoning skills to undergraduate students. However, our current understanding of student-level clinical reasoning is limited, mainly because of the lack of evaluation tools for this internal cognitive process. This functional magnetic resonance imaging (fMRI) study aimed to examine the clinical reasoning processes of medical students in response to problem-solving questions. We recruited 24 2nd-year medical students who had completed their preclinical curriculum. They answered 40 clinical vignette-based multiple-choice questions during fMRI scanning. We compared the imaging data for 20 problem-solving questions (reasoning task) and 20 recall questions (recall task). Compared to the recall task, the reasoning task resulted in significantly greater activation in nine brain regions, including the dorsolateral prefrontal cortex and inferior parietal cortex, which are known to be associated with executive function and deductive reasoning. During the recall task, significant activation was observed in the brain regions that are related to memory and emotions, including the amygdala and ventromedial prefrontal cortex. Our results support that medical students mainly solve clinical questions with deductive reasoning involving prior knowledge structures and executive functions. The problem-solving questions induced the students to utilize higher cognitive functions compared with the recall questions. Interestingly, the results suggested that the students experienced some emotional distress while they were solving the recall questions. In addition, these results suggest that fMRI is a promising research tool for investigating students' cognitive processes.
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Application development environment for advanced digital workstations
NASA Astrophysics Data System (ADS)
Valentino, Daniel J.; Harreld, Michael R.; Liu, Brent J.; Brown, Matthew S.; Huang, Lu J.
1998-06-01
One remaining barrier to the clinical acceptance of electronic imaging and information systems is the difficulty in providing intuitive access to the information needed for a specific clinical task (such as reaching a diagnosis or tracking clinical progress). The purpose of this research was to create a development environment that enables the design and implementation of advanced digital imaging workstations. We used formal data and process modeling to identify the diagnostic and quantitative data that radiologists use and the tasks that they typically perform to make clinical decisions. We studied a diverse range of radiology applications, including diagnostic neuroradiology in an academic medical center, pediatric radiology in a children's hospital, screening mammography in a breast cancer center, and thoracic radiology consultation for an oncology clinic. We used object- oriented analysis to develop software toolkits that enable a programmer to rapidly implement applications that closely match clinical tasks. The toolkits support browsing patient information, integrating patient images and reports, manipulating images, and making quantitative measurements on images. Collectively, we refer to these toolkits as the UCLA Digital ViewBox toolkit (ViewBox/Tk). We used the ViewBox/Tk to rapidly prototype and develop a number of diverse medical imaging applications. Our task-based toolkit approach enabled rapid and iterative prototyping of workstations that matched clinical tasks. The toolkit functionality and performance provided a 'hands-on' feeling for manipulating images, and for accessing textual information and reports. The toolkits directly support a new concept for protocol based-reading of diagnostic studies. The design supports the implementation of network-based application services (e.g., prefetching, workflow management, and post-processing) that will facilitate the development of future clinical applications.
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Hotton, Matthew; Derakshan, Nazanin; Fox, Elaine
2018-01-01
The process of worry has been associated with reductions in working memory capacity and availability of resources necessary for efficient attentional control. This, in turn, can lead to escalating worry. Recent investigations into working memory training have shown improvements in attentional control and cognitive performance in high trait-anxious individuals and individuals with sub-clinical depression. The current randomised controlled trial investigated the effects of 15 days of adaptive n-back working memory training, or an active control task, on working memory capacity, attentional control and worry in a sample of high worriers. Pre-training, post-training and one-month follow-up measures of working memory capacity were assessed using a Change Detection task, while a Flanker task was used to assess attentional control. A breathing focus task was used as a behavioural measure of worry in addition to a number of self-report assessments of worry and anxiety. Overall there was no difference between the active training and the active control condition with both groups demonstrating similar improvements in working memory capacity and worry, post-training and at follow-up. However, training-related improvements on the n-back task were associated with gains in working memory capacity and reductions in worry symptoms in the active training condition. These results highlight the need for further research investigating the role of individual differences in working memory training. Copyright © 2017. Published by Elsevier Ltd.
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Choi, Jimmy; Choi, Kee-Hong; Reddy, Felice; Fiszdon, Joanna M.
2014-01-01
Despite the important role of motivation in rehabilitation and functional outcomes in schizophrenia, to date, there has been little emphasis on how motivation is assessed. This is important, since different measures may tap potentially discrete motivational constructs, which in turn may have very different associations to important outcomes. In the current study, we used baseline data from 71 schizophrenia spectrum outpatients enrolled in a rehabilitation program to examine the relationship between task-specific motivation, as measured by the Intrinsic Motivation Inventory (IMI), and a more general state of volition/initiation, as measured by the three item Quality of Life (QLS) motivation index. We also examined the relationship of these motivation measures to demographic, clinical and functional variables relevant to rehabilitation outcomes. The two motivation measures were not correlated, and participants with low general state motivation exhibited a full range of task-specific motivation. Only the QLS motivation index correlated with variables relevant to rehabilitation outcomes. The lack of associations between QLS motivation index and IMI subscales suggests that constructs tapped by these measures may be divergent in schizophrenia, and specifically that task-specific intrinsic motivation is not contingent on a general state of motivation. That is, even in individuals with a general low motivational state (i.e. amotivation), interventions aimed at increasing task-specific motivation may still be effective. Moreover, the pattern of interrelationships between the QLS motivation index and variables relevant to psychosocial rehabilitation supports its use in treatment outcome studies. PMID:24529609
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Towards the unification of inference structures in medical diagnostic tasks.
Mira, J; Rives, J; Delgado, A E; Martínez, R
1998-01-01
The central purpose of artificial intelligence applied to medicine is to develop models for diagnosis and therapy planning at the knowledge level, in the Newell sense, and software environments to facilitate the reduction of these models to the symbol level. The usual methodology (KADS, Common-KADS, GAMES, HELIOS, Protégé, etc) has been to develop libraries of generic tasks and reusable problem-solving methods with explicit ontologies. The principal problem which clinicians have with these methodological developments concerns the diversity and complexity of new terms whose meaning is not sufficiently clear, precise, unambiguous and consensual for them to be accessible in the daily clinical environment. As a contribution to the solution of this problem, we develop in this article the conjecture that one inference structure is enough to describe the set of analysis tasks associated with medical diagnoses. To this end, we first propose a modification of the systematic diagnostic inference scheme to obtain an analysis generic task and then compare it with the monitoring and the heuristic classification task inference schemes using as comparison criteria the compatibility of domain roles (data structures), the similarity in the inferences, and the commonality in the set of assumptions which underlie the functionally equivalent models. The equivalences proposed are illustrated with several examples. Note that though our ongoing work aims to simplify the methodology and to increase the precision of the terms used, the proposal presented here should be viewed more in the nature of a conjecture.
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Mallorquí-Bagué, Nuria; Fagundo, Ana B.; Jimenez-Murcia, Susana; de la Torre, Rafael; Baños, Rosa M.; Botella, Cristina; Casanueva, Felipe F.; Crujeiras, Ana B.; Fernández-García, Jose C.; Fernández-Real, Jose M.; Frühbeck, Gema; Granero, Roser; Rodríguez, Amaia; Tolosa-Sola, Iris; Ortega, Francisco J.; Tinahones, Francisco J.; Alvarez-Moya, Eva; Ochoa, Cristian; Menchón, Jose M.
2016-01-01
Introduction Addictions are associated with decision making impairments. The present study explores decision making in Substance use disorder (SUD), Gambling disorder (GD) and Obesity (OB) when assessed by Iowa Gambling Task (IGT) and compares them with healthy controls (HC). Methods For the aims of this study, 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) were assessed according to DSM criteria, completed a sociodemographic interview and conducted the IGT. Results SUD, GD and OB present impaired decision making when compared to the HC in the overall task and task learning, however no differences are found for the overall performance in the IGT among the clinical groups. Results also reveal some specific learning across the task patterns within the clinical groups: OB maintains negative scores until the third set where learning starts but with a less extend to HC, SUD presents an early learning followed by a progressive although slow improvement and GD presents more random choices with no learning. Conclusions Decision making impairments are present in the studied clinical samples and they display individual differences in the task learning. Results can help understanding the underlying mechanisms of OB and addiction behaviors as well as improve current clinical treatments. PMID:27690367
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Waites, Anthony B; Mannfolk, Peter; Shaw, Marnie E; Olsrud, Johan; Jackson, Graeme D
2007-02-01
Clinical functional magnetic resonance imaging (fMRI) occasionally fails to detect significant activation, often due to variability in task performance. The present study seeks to test whether a more flexible statistical analysis can better detect activation, by accounting for variance associated with variable compliance to the task over time. Experimental results and simulated data both confirm that even at 80% compliance to the task, such a flexible model outperforms standard statistical analysis when assessed using the extent of activation (experimental data), goodness of fit (experimental data), and area under the operator characteristic curve (simulated data). Furthermore, retrospective examination of 14 clinical fMRI examinations reveals that in patients where the standard statistical approach yields activation, there is a measurable gain in model performance in adopting the flexible statistical model, with little or no penalty in lost sensitivity. This indicates that a flexible model should be considered, particularly for clinical patients who may have difficulty complying fully with the study task.
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How age affects memory task performance in clinically normal hearing persons.
Vercammen, Charlotte; Goossens, Tine; Wouters, Jan; van Wieringen, Astrid
2017-05-01
The main objective of this study is to investigate memory task performance in different age groups, irrespective of hearing status. Data are collected on a short-term memory task (WAIS-III Digit Span forward) and two working memory tasks (WAIS-III Digit Span backward and the Reading Span Test). The tasks are administered to young (20-30 years, n = 56), middle-aged (50-60 years, n = 47), and older participants (70-80 years, n = 16) with normal hearing thresholds. All participants have passed a cognitive screening task (Montreal Cognitive Assessment (MoCA)). Young participants perform significantly better than middle-aged participants, while middle-aged and older participants perform similarly on the three memory tasks. Our data show that older clinically normal hearing persons perform equally well on the memory tasks as middle-aged persons. However, even under optimal conditions of preserved sensory processing, changes in memory performance occur. Based on our data, these changes set in before middle age.
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The role of working memory in spatial S-R correspondence effects.
Wühr, Peter; Biebl, Rupert
2011-04-01
This study investigates the impact of working memory (WM) load on response conflicts arising from spatial (non) correspondence between irrelevant stimulus location and response location (Simon effect). The dominant view attributes the Simon effect to automatic processes of location-based response priming. The automaticity view predicts insensitivity of the Simon effect to manipulations of processing load. Four experiments investigated the role of spatial and verbal WM in horizontal and vertical Simon tasks by using a dual-task approach. Participants maintained different amounts of spatial or verbal information in WM while performing a horizontal or vertical Simon task. Results showed that high load generally decreased, and sometimes eliminated, the Simon effect. It is interesting to note that spatial load had a larger impact than verbal load on the horizontal Simon effect, whereas verbal load had a larger impact than spatial load on the vertical Simon effect. The results highlight the role of WM as the perception-action interface in choice-response tasks. Moreover, the results suggest spatial coding of horizontal stimulus-response (S-R) tasks, and verbal coding of vertical S-R tasks.
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Kurtz, Tanja; Mogle, Jacqueline; Sliwinski, Martin J.; Hofer, Scott M.
2013-01-01
Background The role of processing speed and working memory was investigated in terms of individual differences in task-specific paired associates learning in a sample of older adults. Task-specific learning, as distinct from content-oriented item-specific learning, refers to gains in performance due to repeated practice on a learning task in which the to-be-learned material changes over trials. Methods Learning trajectories were modeled within an intensive repeated-measures design based on participants obtained from an opt-in internet-based sampling service (Mage = 65.3, SD = 4.81). Participants completed an eight-item paired associates task daily over a seven-day period. Results Results indicated that a three-parameter hyperbolic model (i.e., initial level, learning rate, and asymptotic performance) best described learning trajectory. After controlling for age-related effects, both higher working memory and higher processing speed had a positive effect on all three learning parameters. Conclusion These results emphasize the role of cognitive abilities for individual differences in task-specific learning of older adults. PMID:24151913
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The Role of Subjective Task Value in Service-Learning Engagement among Chinese College Students
Li, Yulan; Guo, Fangfang; Yao, Meilin; Wang, Cong; Yan, Wenfan
2016-01-01
Most service-learning studies in higher education focused on its effects on students’ development. The dynamic processes and mechanisms of students’ development during service-learning, however, have not been explored thoroughly. Student engagement in service-learning may affect service-learning outcomes and be affected by subjective task value at the same time. The present study aimed to explore the effect of subjective task value on Chinese college student engagement during service-learning. Fifty-four Chinese college students participated in a 9-weeks service-learning program of interacting with children with special needs. Students’ engagement and subjective task value were assessed via self-report questionnaires and 433 weekly reflective journals. The results indicated that the cognitive, emotional and behavioral engagement of Chinese college students demonstrated different developmental trends during service-learning process. Subjective task value played an essential role in student engagement in service-learning activities. However, the role of subjective task value varied with different stages. Finally, the implications for implementing service-learning in Chinese education were discussed. PMID:27445919
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Ariza, Ferran; Kalra, Dipak; Potts, Henry Ww
2015-11-20
Clinical information systems in the National Health Service do not need to conform to any explicit usability requirements. Poor usability can increase the mental workload experienced by clinicians and cause fatigue, increase error rates and impact the overall patient safety. Mental workload can be used as a measure of usability. To assess the subjective cognitive workload experienced by general practitioners (GPs) with their systems. To raise awareness of the importance of usability in system design among users, designers, developers and policymakers. We used a modified version of the NASA Task Load Index, adapted for web. We developed a set of common clinical scenarios and computer tasks on an online survey. We emailed the study link to 199 clinical commissioning groups and 1,646 GP practices in England. Sixty-seven responders completed the survey. The respondents had spent an average of 17 years in general practice, had experience of using a mean of 1.5 GP computer systems and had used their current system for a mean time of 6.7 years. The mental workload score was not different among systems. There were significant differences among the task scores, but these differences were not specific to particular systems. The overall score and task scores were related to the length of experience with their present system. Four tasks imposed a higher mental workload on GPs: 'repeat prescribing', 'find episode', 'drug management' and 'overview records'. Further usability studies on GP systems should focus on these tasks. Users, policymakers, designers and developers should remain aware of the importance of usability in system design.What does this study add?• Current GP systems in England do not need to conform to explicit usability requirements. Poor usability can increase the mental workload of clinicians and lead to errors.• Some clinical computer tasks incur more cognitive workload than others and should be considered carefully during the design of a system.• GPs did not report overall very high levels of subjective cognitive workload when undertaking common clinical tasks with their systems.• Further usability studies on GP systems should focus on the tasks incurring higher cognitive workload.• Users, policymakers, and designers and developers should remain aware of the importance of usability in system design.
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The role of emergency physicians in the institutionalization of emergency medicine.
van Schothorst, Jannine; van den Brand, Crispijn L; Gaakeer, Menno I; Wallenburg, Iris
2017-08-01
Emergency medicine is a fast-growing medical profession. Nevertheless, the clinical activities emergency physicians (EPs) carry out and the responsibilities they have differ considerably between hospitals. This article addresses the question how the role of EPs is shaped and institutionalized in the everyday context of acute care in hospitals. A cross-case ethnographic study was conducted, comprising observations, document analysis, and in-depth interviews in three emergency departments in the Netherlands. Drawing on the theoretical concept of institutional work, we show that managers, already established medical specialties, and EPs all conduct institutional work to enhance private interests, which both restricts and enlarges EPs' work domain. These actions are strategic and intentional, as well as unintentional and part of EPs' everyday work in acute care delivery. It is in this very process that tasks and responsibilities are redistributed and the role of the EP is shaped. In contemporary literature it is often argued that the role and status of EPs should be enhanced by strengthening regulation and improving training programs. This article shows that attention should also be paid to the more subtle everyday processes of role development.
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The Role of Task Repetition in Learning Word-Stress Patterns through Auditory Priming Tasks
ERIC Educational Resources Information Center
Jung, YeonJoo; Kim, YouJin; Murphy, John
2017-01-01
This study focused on an instructional component often neglected when teaching the pronunciation of English as either a second, foreign, or international language--namely, the suprasegmental feature of lexical stress. Extending previous research on collaborative priming tasks and task repetition, the study investigated the impact of task and…
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van Duijn, Tina; Buszard, Tim; Hoskens, Merel C J; Masters, Rich S W
2017-01-01
This study explored the relationship between working memory (WM) capacity, corticocortical communication (EEG coherence), and propensity for conscious control of movement during the performance of a complex far-aiming task. We were specifically interested in the role of these variables in predicting motor performance by novices. Forty-eight participants completed (a) an assessment of WM capacity (an adapted Rotation Span task), (b) a questionnaire that assessed the propensity to consciously control movement (the Movement Specific Reinvestment Scale), and (c) a hockey push-pass task. The hockey push-pass task was performed in a single task (movement only) condition and a combined task (movement plus decision) condition. Electroencephalography (EEG) was used to examine brain activity during the single task. WM capacity best predicted single task performance. WM capacity in combination with T8-Fz coherence (between the visuospatial and motor regions of the brain) best predicted combined task performance. We discuss the implied roles of visuospatial information processing capacity, neural coactivation, and propensity for conscious processing during performance of complex motor tasks. © 2017 Elsevier B.V. All rights reserved.
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Decentration Revisited: A Two-Factor Model for Role-Taking Development in Young Children.
ERIC Educational Resources Information Center
O'Connor, Margaret
This study investigates spatial and conceptual role-taking at the preschool level to determine the components of and relationship between these two forms of role-taking. A total of 80 children between 3 and 5 years of age were tested individually on four spatial tasks and five conceptual tasks and rated on the levels of egocentrism employed.…
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Corcoran, Rhiannon; Bentall, Richard P; Rowse, Georgina; Moore, Rosanne; Cummins, Sinead; Blackwood, Nigel; Howard, Robert; Shryane, Nick M
2011-11-01
INTRODUCTION. This study used Item-Response Theory (IRT) to model the psychometric properties of a false belief picture sequencing task. Consistent with the mental time travel hypothesis of paranoia, we anticipated that performance on this deductive theory of mind (ToM) task would not be associated with the presence of persecutory delusions but would be related to other clinical, cognitive, and demographic factors. METHOD. A large (N=237) and diverse clinical and nonclinical sample differing in levels of depression and paranoid ideation performed 2 ToM tasks: the false belief sequencing task and a ToM stories task that was used to assess the validity of the false belief sequencing task as a measure of ToM. RESULTS. A unidimensional IRT model was found to fit the data well. Latent ToM ability as measured by the false belief sequencing task was negatively related with age and positively with IQ. In contrast to the ToM stories measure, there was no association between clinical diagnosis or symptoms and false belief picture sequencing after controlling for age and IQ. CONCLUSIONS. In line with mental time travel hypothesis of paranoia (Corcoran, 2010 ), performance on this deductive nonverbal ToM task is not related to the presence of paranoid symptoms. This measure is best suited for assessing ToM functioning where participants' performance falls just short of the average latent ToM ability. Furthermore, it is sensitive to the effects of increasing age and decreasing IQ.
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Science Teacher Leaders: Exploring Practices and Potential
NASA Astrophysics Data System (ADS)
Stinson, John Kevin
It has become standard practice for teachers to step into the role of "teacher leaders" and perform a variety of curriculum, instruction and assessment tasks for schools and school districts. The literature regarding these Ohio K-12 teacher leaders, who may perform these tasks in addition to or in lieu of regular teaching assignments, rarely includes a disciplinary focus. In this exploratory, descriptive study the results of a web-based survey containing both closed and open-ended items were used in an inquiry into teacher leaders working with the discipline of science. Data from Ohio teachers responding to the survey were used first to create a standard profile for science teacher leaders. Descriptive statistics and correlations were then performed on quantitative survey data to explore science teacher leader tasks and factors that influence task performance. Analysis of data included descriptions of sense of purpose for their role held by these science teacher leaders. Results indicate that science teacher leaders appear to embrace their role as advocates for science and have great potential for implementing science education reform as well as other science-related school initiatives. Aligning performance, administrative oversight, impact on student achievement and teacher training concerning tasks science teacher leaders are expected to perform would enhance this potential. However, science teacher leaders face challenges to realizing that potential due to ambiguity of their leadership role, the breadth of tasks they tend to perform and lack of alignment between task and outcomes.
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An fMRI Study of Risky Decision Making: The Role of Mental Preparation and Conflict.
Sohrabi, Ahmad; Smith, Andra M; West, Robert L; Cameron, Ian
2015-10-01
The current study aimed to elucidate the role of preparatory cognitive control in decision making and its neural correlates using functional Magnetic Resonance Imaging (fMRI). To this effect, by employing a series of new cognitive tasks, we assessed the role of preparatory cognitive control in monetary (risky) decision making. The participants had to decide between a risky and a safe gamble based on their chance of winning (high or low). In the 2-phase gambling task (similar to Cambridge gambling task), the chance and the gamble were presented at the same time (i.e. in a single phase), but in a new 3-phase gambling task, the chance is presented before the gamble. The tasks ended with a feedback phase. In the 3-phase task, holding the chance in memory to guide their decision enabled the participants to have more control on their risk taking behaviors as shown by activation in a network of brain areas involved in the control and conflict, including dorsal Anterior Cingulate Cortex (dACC), indexed by faster reaction times and better performance in the gambling task, and the temporal lobe, which has a role in holding contextual information. Holding information in memory to guide decision presumably enables the participants to have more control on their risk taking behaviors. The conflict and uncertainty resulting from this risky decision was indexed by the activation of dACC, known to be activated in conflict and cognitive control.
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Breaking a habit: a further role of the phonological loop in action control.
Saeki, Erina; Baddeley, Alan D; Hitch, Graham J; Saito, Satoru
2013-10-01
Recent research has suggested that keeping track of a task goal in rapid task switching may depend on the phonological loop component of working memory. In this study, we investigated whether the phonological loop plays a similar role when a single switch extending over several trials is required after many trials on which one has performed a competing task. Participants were shown pairs of digits varying in numerical and physical size, and they were required to decide which digit was numerically or physically larger. An experimental cycle consisted of four blocks of 24 trials. In Experiment 1, participants in the task change groups performed the numerical-size judgment task during the first three blocks, and then changed to the physical-size judgment task in the fourth. Participants in the continuation groups performed only the physical-size judgment task throughout all four blocks. We found negative effects of articulatory suppression on the fourth block, but only in the task change groups. Experiment 2 was a replication, with the modification that both groups received identical instructions and practice. Experiment 3 was a further replication using numerical-size judgment as the target task. The results showed a pattern similar to that from Experiment 1, with negative effects of articulatory suppression found only in the task change group. The congruity of numerical and physical size had a reliable effect on performance in all three experiments, but unlike the task change, it did not reliably interact with articulatory suppression. The results suggest that in addition to its well-established role in rapid task switching, the phonological loop also contributes to active goal maintenance in longer-term action control.
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Providing travel health care--the nurses' role: an international comparison.
Bauer, Irmgard; Hall, Sheila; Sato, Nahoko
2013-01-01
In many countries, the responsibility for travel health lies with medical practitioners who delegate certain tasks to nursing staff. Elsewhere, nurses have taken a leading role and work independently in private or hospital-based clinics, occupational health departments and general practices. The purpose of this study was to examine the roles and challenges faced by nurses providing travel health care in Australia, Japan and the UK, and to compare educational and professional needs. Nurses involved in travel health care were invited to complete an online questionnaire with multiple choice, open-ended, and Likert Scale questions. SurveyMonkey's statistical facilities analysed quantitative data; thematic content analysis was applied to qualitative responses. Differences and similarities between the three countries were conveyed by 474 participants focusing on current positions, work arrangements, and educational and practical concerns. Clinical practice issues, including vaccination and medication regulations, were highlighted with the differences between countries explained by the respective history of travel health care development and the involvement within their nursing profession. The call for more educational opportunities, including more support from employers, and a refinement of the role as travel health nurse appears to be international. Nurses require support networks within the field, and the development of a specialist "travel health nurse" would give a stronger voice to their concerns and needs for specific education and training in travel health care. Copyright © 2013 Elsevier Ltd. All rights reserved.
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2004-01-01
Background Evaluation is a challenging but necessary part of the development cycle of clinical information systems like the electronic medical records (EMR) system. It is believed that such evaluations should include multiple perspectives, be comparative and employ both qualitative and quantitative methods. Self-administered questionnaires are frequently used as a quantitative evaluation method in medical informatics, but very few validated questionnaires address clinical use of EMR systems. Methods We have developed a task-oriented questionnaire for evaluating EMR systems from the clinician's perspective. The key feature of the questionnaire is a list of 24 general clinical tasks. It is applicable to physicians of most specialties and covers essential parts of their information-oriented work. The task list appears in two separate sections, about EMR use and task performance using the EMR, respectively. By combining these sections, the evaluator may estimate the potential impact of the EMR system on health care delivery. The results may also be compared across time, site or vendor. This paper describes the development, performance and validation of the questionnaire. Its performance is shown in two demonstration studies (n = 219 and 80). Its content is validated in an interview study (n = 10), and its reliability is investigated in a test-retest study (n = 37) and a scaling study (n = 31). Results In the interviews, the physicians found the general clinical tasks in the questionnaire relevant and comprehensible. The tasks were interpreted concordant to their definitions. However, the physicians found questions about tasks not explicitly or only partially supported by the EMR systems difficult to answer. The two demonstration studies provided unambiguous results and low percentages of missing responses. In addition, criterion validity was demonstrated for a majority of task-oriented questions. Their test-retest reliability was generally high, and the non-standard scale was found symmetric and ordinal. Conclusion This questionnaire is relevant for clinical work and EMR systems, provides reliable and interpretable results, and may be used as part of any evaluation effort involving the clinician's perspective of an EMR system. PMID:15018620
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Laerum, Hallvard; Faxvaag, Arild
2004-02-09
Evaluation is a challenging but necessary part of the development cycle of clinical information systems like the electronic medical records (EMR) system. It is believed that such evaluations should include multiple perspectives, be comparative and employ both qualitative and quantitative methods. Self-administered questionnaires are frequently used as a quantitative evaluation method in medical informatics, but very few validated questionnaires address clinical use of EMR systems. We have developed a task-oriented questionnaire for evaluating EMR systems from the clinician's perspective. The key feature of the questionnaire is a list of 24 general clinical tasks. It is applicable to physicians of most specialties and covers essential parts of their information-oriented work. The task list appears in two separate sections, about EMR use and task performance using the EMR, respectively. By combining these sections, the evaluator may estimate the potential impact of the EMR system on health care delivery. The results may also be compared across time, site or vendor. This paper describes the development, performance and validation of the questionnaire. Its performance is shown in two demonstration studies (n = 219 and 80). Its content is validated in an interview study (n = 10), and its reliability is investigated in a test-retest study (n = 37) and a scaling study (n = 31). In the interviews, the physicians found the general clinical tasks in the questionnaire relevant and comprehensible. The tasks were interpreted concordant to their definitions. However, the physicians found questions about tasks not explicitly or only partially supported by the EMR systems difficult to answer. The two demonstration studies provided unambiguous results and low percentages of missing responses. In addition, criterion validity was demonstrated for a majority of task-oriented questions. Their test-retest reliability was generally high, and the non-standard scale was found symmetric and ordinal. This questionnaire is relevant for clinical work and EMR systems, provides reliable and interpretable results, and may be used as part of any evaluation effort involving the clinician's perspective of an EMR system.
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Lord, Susan E; Rochester, Lynn; Weatherall, Mark; McPherson, Kathryn M; McNaughton, Harry K
2006-07-01
To assess the effect of environment and a secondary task on gait parameters in community ambulant stroke survivors and to assess the contribution of clinical symptoms to gait performance. A 2x3 randomized factorial design with 2 main factors: task (no task, motor task, cognitive task) and environment (clinic, suburban street, shopping mall). Subjects were assessed in 1 of 3 settings: 2 in the community (a suburban street and shopping mall) and 1 clinical environment. Twenty-seven people with stroke (mean age, 61+/-11.6y; mean time since stroke onset, 45.8+/-34.2mo), living at home, were recruited from community stroke groups and from a local rehabilitation unit. Selection criteria included the following: ability to give informed consent, unilateral first ever or recurrent stroke at least 6 months previously, walking independently in the community, a gait speed between 24 and 50 m/min, Mini-Mental State Examination score of 24 or higher, and no severe comorbidity. Not applicable. Gait speed (in m/min), cadence, and step length were assessed by using an accelerometer with adjustable thresholds. Clinical measures hypothesized to influence gait parameters in community environments were also assessed including fatigue, anxiety and depression, and attentional deficit. Twenty-seven people with a mean baseline gait speed of 42.2+/-5.9 m/min were randomly allocated to 1 of 9 conditions in which the setting and distraction were manipulated. Analysis of variance showed a significant main effect for environment (P = .046) but not for task (P = .37). The interaction between task and environment was not significant (P = .73). Adjusting for baseline gait speed, people walked on average 8.8m/min faster in the clinic (95% confidence interval, 0.3-17.3m/min) than in the mall. Scores for fatigue, anxiety and depression, and attentional deficit were higher than normative values but did not influence gait performance. This study suggests that people with chronic stroke cope well with the challenges of varied environments and can maintain their gait speed while performing a secondary task. Despite moderate levels of gait impairment, gait automaticity may be restored over time to a functional level.
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Palmer, Clare E; Langbehn, Douglas; Tabrizi, Sarah J; Papoutsi, Marina
2017-01-01
Cognitive impairment is common amongst many neurodegenerative movement disorders such as Huntington's disease (HD) and Parkinson's disease (PD) across multiple domains. There are many tasks available to assess different aspects of this dysfunction, however, it is imperative that these show high test-retest reliability if they are to be used to track disease progression or response to treatment in patient populations. Moreover, in order to ensure effects of practice across testing sessions are not misconstrued as clinical improvement in clinical trials, tasks which are particularly vulnerable to practice effects need to be highlighted. In this study we evaluated test-retest reliability in mean performance across three testing sessions of four tasks that are commonly used to measure cognitive dysfunction associated with striatal impairment: a combined Simon Stop-Signal Task; a modified emotion recognition task; a circle tracing task; and the trail making task. Practice effects were seen between sessions 1 and 2 across all tasks for the majority of dependent variables, particularly reaction time variables; some, but not all, diminished in the third session. Good test-retest reliability across all sessions was seen for the emotion recognition, circle tracing, and trail making test. The Simon interference effect and stop-signal reaction time (SSRT) from the combined-Simon-Stop-Signal task showed moderate test-retest reliability, however, the combined SSRT interference effect showed poor test-retest reliability. Our results emphasize the need to use control groups when tracking clinical progression or use pre-baseline training on tasks susceptible to practice effects.
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Social Cognition Psychometric Evaluation: Results of the Final Validation Study.
Pinkham, Amy E; Harvey, Philip D; Penn, David L
2018-06-06
Social cognition is increasingly recognized as an important treatment target in schizophrenia; however, the dearth of well-validated measures that are suitable for use in clinical trials remains a significant limitation. The Social Cognition Psychometric Evaluation (SCOPE) study addresses this need by systematically evaluating the psychometric properties of promising measures. In this final phase of SCOPE, eight new or modified tasks were evaluated. Stable outpatients with schizophrenia (n = 218) and healthy controls (n = 154) completed the battery at baseline and 2-4 weeks later across three sites. Tasks included the Bell Lysaker Emotion Recognition Task (BLERT), Penn Emotion Recognition Task (ER-40), Reading the Mind in the Eyes Task (Eyes), The Awareness of Social Inferences Test (TASIT), Hinting Task, Mini Profile of Nonverbal Sensitivity (MiniPONS), Social Attribution Task-Multiple Choice (SAT-MC), and Intentionality Bias Task (IBT). BLERT and ER-40 modifications included response time and confidence ratings. The Eyes task was modified to include definitions of terms and TASIT to include response time. Hinting was scored with more stringent criteria. MiniPONS, SAT-MC, and IBT were new to this phase. Tasks were evaluated on (1) test-retest reliability, (2) utility as a repeated measure, (3) relationship to functional outcome, (4) practicality and tolerability, (5) sensitivity to group differences, and (6) internal consistency. Hinting, BLERT, and ER-40 showed the strongest psychometric properties and are recommended for use in clinical trials. Eyes, TASIT, and IBT showed somewhat weaker psychometric properties and require further study. MiniPONS and SAT-MC showed poorer psychometric properties that suggest caution for their use in clinical trials.
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Buccafusco, Jerry J; Terry, Alvin V; Webster, Scott J; Martin, Daniel; Hohnadel, Elizabeth J; Bouchard, Kristy A; Warner, Samantha E
2008-08-01
The scopolamine-reversal model is enjoying a resurgence of interest in clinical studies as a reversible pharmacological model for Alzheimer's disease (AD). The cognitive impairment associated with scopolamine is similar to that in AD. The scopolamine model is not simply a cholinergic model, as it can be reversed by drugs that are noncholinergic cognition-enhancing agents. The objective of the study was to determine relevance of computer-assisted operant-conditioning tasks in the scopolamine-reversal model in rats and monkeys. Rats were evaluated for their acquisition of a spatial reference memory task in the Morris water maze. A separate cohort was proficient in performance of an automated delayed stimulus discrimination task (DSDT). Rhesus monkeys were proficient in the performance of an automated delayed matching-to-sample task (DMTS). The AD drug donepezil was evaluated for its ability to reverse the decrements in accuracy induced by scopolamine administration in all three tasks. In the DSDT and DMTS tasks, the effects of donepezil were delay (retention interval)-dependent, affecting primarily short delay trials. Donepezil produced significant but partial reversals of the scopolamine-induced impairment in task accuracies after 2 mg/kg in the water maze, after 1 mg/kg in the DSDT, and after 50 microg/kg in the DMTS task. The two operant-conditioning tasks (DSDT and DMTS) provided data most in keeping with those reported in clinical studies with these drugs. The model applied to nonhuman primates provides an excellent transitional model for new cognition-enhancing drugs before clinical trials.
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Crane, Monique Frances; Brouwers, Sue; Wiggins, Mark William; Loveday, Thomas; Forrest, Kirsty; Tan, Suyin Giselle Marianne; Cyna, Allan Michael
2018-04-01
This research examined whether negative and positive arousal emotions modify the relationship between experience level and cue utilization among anesthetists. The capacity of a practitioner to form precise associations between clusters of features (e.g., symptoms) and events (e.g., diagnosis) and then act on them is known as cue utilization. A common assumption is that practice experience allows opportunities for cue acquisition and cue utilization. However, this relationship is often not borne out in research findings. This study investigates the role of emotional state in this relationship. An online tool (EXPERTise 2.0) was used to assess practitioner cue utilization for tasks relevant to anesthesia. The experience of positive and negative arousal emotions in the previous three days was measured, and emotion clusters were generated. Experience was measured as the composite of practice years and hours of practice experience. The moderating role of emotion on the relationship between experience and cue utilization was examined. Data on 125 anesthetists (36% female) were included in the analysis. The predicted interaction between arousal emotions and the experience level emerged. In particular, post hoc analyses revealed that anxiety-related emotions facilitated the likelihood of high cue utilization in less experienced practitioners. The findings suggest a role for emotions in cue use and suggest a functional role for normal range anxiety emotions in a simulated work-relevant task. This research illustrates the importance of understanding the potentially functional effects common negative arousal emotions may have on clinical performance, particularly for those with less experience.
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IVHS Countermeasures for Rear-End Collisions, Task 1 Vol. III: 1991 NASS CDS Case Analysis
DOT National Transportation Integrated Search
1994-02-15
This report is from the NHTSA sponsored program, "IVHS Countermeasures for Rear-End Collisions". The Task 1 Interim Report consists of six volumes. This Volume, Volume III, 1991 NASS CDS Clinical Case Analysis presents the results of a clinical case ...
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A usability evaluation of four commercial dental computer-based patient record systems
Thyvalikakath, Thankam P.; Monaco, Valerie; Thambuganipalle, Hima Bindu; Schleyer, Titus
2008-01-01
Background The usability of dental computer-based patient record (CPR) systems has not been studied, despite early evidence that poor usability is a problem for dental CPR system users at multiple levels. Methods The authors conducted formal usability tests of four dental CPR systems by using a purposive sample of four groups of five novice users. The authors measured task outcomes (correctly completed, incorrectly completed and incomplete) in each CPR system while the participants performed nine clinical documentation tasks, as well as the number of usability problems identified in each CPR system and their potential relationship to task outcomes. The authors reviewed the software application design aspects responsible for these usability problems. Results The range for correctly completed tasks was 16 to 64 percent, for incorrectly completed tasks 18 to 38 percent and for incomplete tasks 9 to 47 percent. The authors identified 286 usability problems. The main types were three unsuccessful attempts, negative affect and task incorrectly completed. They also identified six problematic interface and interaction designs that led to usability problems. Conclusion The four dental CPR systems studied have significant usability problems for novice users, resulting in a steep learning curve and potentially reduced system adoption. Clinical Implications The significant number of data entry errors raises concerns about the quality of documentation in clinical practice. PMID:19047669
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The effect of video game "warm-up" on performance of laparoscopic surgery tasks.
Rosser, James C; Gentile, Douglas A; Hanigan, Kevin; Danner, Omar K
2012-01-01
Performing laparoscopic procedures requires special training and has been documented as a significant source of surgical errors. "Warming up" before performing a task has been shown to enhance performance. This study investigates whether surgeons benefit from "warming up" using select video games immediately before performing laparoscopic partial tasks and clinical tasks. This study included 303 surgeons (249 men and 54 women). Participants were split into a control (n=180) and an experimental group (n=123). The experimental group played 3 previously validated video games for 6 minutes before task sessions. The Cobra Rope partial task and suturing exercises were performed immediately after the warm-up sessions. Surgeons who played video games prior to the Cobra Rope drill were significantly faster on their first attempt and across all 10 trials. The experimental and control groups were significantly different in their total suturing scores (t=2.28, df=288, P<.05). The overall Top Gun score showed that the experimental group performed marginally better overall. This study demonstrates that subjects completing "warming-up" sessions with select video games prior to performing laparoscopic partial and clinical tasks (intracorporeal suturing) were faster and had fewer errors than participants not engaging in "warm-up." More study is needed to determine whether this translates into superior procedural execution in the clinical setting.
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ROLE CONFUSION AND SELF ASSESSMENT IN INTERPROFESSIONAL TRAUMA TEAMS
Steinemann, Susan; Kurosawa, Gene; Wei, Alexander; Ho, Nina; Lim, Eunjung; Suares, Gregory; Bhatt, Ajay; Berg, Benjamin
2015-01-01
Background Trauma care requires coordinating an interprofessional team, with formative feedback on teamwork skills. We hypothesized nurses and surgeons have different perceptions regarding roles during resuscitation; that nurses’ teamwork self-assessment differs from experts’, and that video debriefing might improve accuracy of self-assessment. Methods Trauma nurses and surgeons were surveyed regarding resuscitation responsibilities. Subsequently, nurses joined interprofessional teams in simulated trauma resuscitations. Following each resuscitation, nurses and teamwork experts independently scored teamwork (T-NOTECHS). After video debriefing, nurses repeated T-NOTECHS self-assessment. Results Nurses and surgeons assumed significantly more responsibility by their own profession for 71% of resuscitation tasks. Nurses’ overall T-NOTECHS ratings were slightly higher than experts’. This was evident in all T-NOTECHS subdomains except “leadership,” but despite statistical significance the difference was small and clinically irrelevant. Video debriefing did not improve the accuracy of self-assessment. Conclusions Nurses and physicians demonstrated discordant perceptions of responsibilities. Nurses’ self-assessment of teamwork was statistically, but not clinically significantly, higher than experts’ in all domains except physician leadership. PMID:26801092
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Topical Review: Translating Translational Research in Behavioral Science.
Hommel, Kevin A; Modi, Avani C; Piazza-Waggoner, Carrie; Myers, James D
2015-01-01
To present a model of translational research for behavioral science that communicates the role of behavioral research at each phase of translation. A task force identified gaps in knowledge regarding behavioral translational research processes and made recommendations regarding advancement of knowledge. A comprehensive model of translational behavioral research was developed. This model represents T1, T2, and T3 research activities, as well as Phase 1, 2, 3, and 4 clinical trials. Clinical illustrations of translational processes are also offered as support for the model. Behavioral science has struggled with defining a translational research model that effectively articulates each stage of translation and complements biomedical research. Our model defines key activities at each phase of translation from basic discovery to dissemination/implementation. This should be a starting point for communicating the role of behavioral science in translational research and a catalyst for better integration of biomedical and behavioral research. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Agmon, Maayan; Belza, Basia; Nguyen, Huong Q; Logsdon, Rebecca G; Kelly, Valerie E
2014-01-01
Background Injury due to falls is a major problem among older adults. Decrements in dual-task postural control performance (simultaneously performing two tasks, at least one of which requires postural control) have been associated with an increased risk of falling. Evidence-based interventions that can be used in clinical or community settings to improve dual-task postural control may help to reduce this risk. Purpose The aims of this systematic review are: 1) to identify clinical or community-based interventions that improved dual-task postural control among older adults; and 2) to identify the key elements of those interventions. Data sources Studies were obtained from a search conducted through October 2013 of the following electronic databases: PubMed, CINAHL, PsycINFO, and Web of Science. Study selection Randomized and nonrandomized controlled studies examining the effects of interventions aimed at improving dual-task postural control among community-dwelling older adults were selected. Data extraction All studies were evaluated based on methodological quality. Intervention characteristics including study purpose, study design, and sample size were identified, and effects of dual-task interventions on various postural control and cognitive outcomes were noted. Data synthesis Twenty-two studies fulfilled the selection criteria and were summarized in this review to identify characteristics of successful interventions. Limitations The ability to synthesize data was limited by the heterogeneity in participant characteristics, study designs, and outcome measures. Conclusion Dual-task postural control can be modified by specific training. There was little evidence that single-task training transferred to dual-task postural control performance. Further investigation of dual-task training using standardized outcome measurements is needed. PMID:24741296
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Wilson, Sarah J; Baxendale, Sallie; Barr, William; Hamed, Sherifa; Langfitt, John; Samson, Séverine; Watanabe, Masako; Baker, Gus A; Helmstaedter, Christoph; Hermann, Bruce P; Smith, Mary-Lou
2015-05-01
The International League Against Epilepsy (ILAE) Diagnostic Methods Commission charged the Neuropsychology Task Force with the job of developing a set of recommendations to address the following questions: (1) What is the role of a neuropsychological assessment? (2) Who should do a neuropsychological assessment? (3) When should people with epilepsy be referred for a neuropsychological assessment? and (4) What should be expected from a neuropsychological assessment? The recommendations have been broadly written for health care clinicians in established epilepsy settings as well as those setting up new services. They are based on a detailed survey of neuropsychological assessment practices across international epilepsy centers, and formal ranking of specific recommendations for advancing clinical epilepsy care generated by specialist epilepsy neuropsychologists from around the world. They also incorporate the latest research findings to establish minimum standards for training and practice, reflecting the many roles of neuropsychological assessment in the routine care of children and adults with epilepsy. The recommendations endorse routine screening of cognition, mood, and behavior in new-onset epilepsy, and describe the range of situations when more detailed, formal neuropsychological assessment is indicated. They identify a core set of cognitive and psychological domains that should be assessed to provide an objective account of an individual's cognitive, emotional, and psychosocial functioning, including factors likely contributing to deficits identified on qualitative and quantitative examination. The recommendations also endorse routine provision of feedback to patients, families, and clinicians about the implications of the assessment results, including specific clinical recommendations of what can be done to improve a patient's cognitive or psychosocial functioning and alleviate the distress of any difficulties identified. By canvassing the breadth and depth of scope of neuropsychological assessment, this report demonstrates the pivotal role played by this noninvasive and minimally resource intensive investigation in the care of people with epilepsy. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.
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Clinical quality needs complex adaptive systems and machine learning.
Marsland, Stephen; Buchan, Iain
2004-01-01
The vast increase in clinical data has the potential to bring about large improvements in clinical quality and other aspects of healthcare delivery. However, such benefits do not come without cost. The analysis of such large datasets, particularly where the data may have to be merged from several sources and may be noisy and incomplete, is a challenging task. Furthermore, the introduction of clinical changes is a cyclical task, meaning that the processes under examination operate in an environment that is not static. We suggest that traditional methods of analysis are unsuitable for the task, and identify complexity theory and machine learning as areas that have the potential to facilitate the examination of clinical quality. By its nature the field of complex adaptive systems deals with environments that change because of the interactions that have occurred in the past. We draw parallels between health informatics and bioinformatics, which has already started to successfully use machine learning methods.
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Beads task vs. box task: The specificity of the jumping to conclusions bias.
Balzan, Ryan P; Ephraums, Rachel; Delfabbro, Paul; Andreou, Christina
2017-09-01
Previous research involving the probabilistic reasoning 'beads task' has consistently demonstrated a jumping-to-conclusions (JTC) bias, where individuals with delusions make decisions based on limited evidence. However, recent studies have suggested that miscomprehension may be confounding the beads task. The current study aimed to test the conventional beads task against a conceptually simpler probabilistic reasoning "box task" METHODS: One hundred non-clinical participants completed both the beads task and the box task, and the Peters et al. Delusions Inventory (PDI) to assess for delusion-proneness. The number of 'draws to decision' was assessed for both tasks. Additionally, the total amount of on-screen evidence was manipulated for the box task, and two new box task measures were assessed (i.e., 'proportion of evidence requested' and 'deviation from optimal solution'). Despite being conceptually similar, the two tasks did not correlate, and participants requested significantly less information on the beads task relative to the box task. High-delusion-prone participants did not demonstrate hastier decisions on either task; in fact, for box task, this group was observed to be significantly more conservative than low-delusion-prone group. Neither task was incentivized; results need replication with a clinical sample. Participants, and particularly those identified as high-delusion-prone, displayed a more conservative style of responding on the novel box task, relative to the beads task. The two tasks, whilst conceptually similar, appear to be tapping different cognitive processes. The implications of these results are discussed in relation to the JTC bias and the theoretical mechanisms thought to underlie it. Copyright © 2016 Elsevier Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Kanas, Nick; Ritsher, Jennifer
2005-05-01
In isolated and confined environments, two important leadership roles have been identified: the task/instrumental role (which focuses on work goals and operational needs), and the supportive/expressive role (which focuses on morale goals and emotional needs). On the International Space Station, the mission commander should be familiar with both of these aspects of leadership. In previous research involving a 135-day Mir space station simulation in Moscow and a series of on-orbit Mir space station missions during the Shuttle/Mir program, both these leadership roles were studied. In new analyses of the Shuttle/Mir data, we found that for crewmembers, the supportive role of the commander (but not the task role) related positively with crew cohesion. For mission control personnel on the ground, both the task and supportive roles of their leader were related positively to mission control cohesion. The implications of these findings are discussed in terms of leadership on board the International Space Station.
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Kanas, Nick; Ritsher, Jennifer
2005-01-01
In isolated and confined environments, two important leadership roles have been identified: the task/instrumental role (which focuses on work goals and operational needs), and the supportive/expressive role (which focuses on morale goals and emotional needs). On the International Space Station, the mission commander should be familiar with both of these aspects of leadership. In previous research involving a 135-day Mir space station simulation in Moscow and a series of on-orbit Mir space station missions during the Shuttle/Mir program, both these leadership roles were studied. In new analyses of the Shuttle/Mir data, we found that for crewmembers, the supportive role of the commander (but not the task role) related positively with crew cohesion. For mission control personnel on the ground, both the task and supportive roles of their leader were related positively to mission control cohesion. The implications of these findings are discussed in terms of leadership on board the International Space Station. c2005 Elsevier Ltd. All rights reserved.
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Issues in transferring preclinical skill learning to the clinical context.
Chambers, D W
1987-05-01
The relationship between student performance in preclinical technique laboratory courses and in clinic is not straightforward. While American dental education in the preclinical courses is effective in teaching mastery of fundamentals to most students and identifying those who should not proceed to patient care, the prediction from technique laboratory performance of who will do well in clinic is weak. Factors accounting for this poor correlation include differences in the mix of skills required in the two contexts, failure to teach for transfer of skills to new settings, and laboratory education practices that create clinically dysfunctional habits. As a means of understanding the transfer issue, a distinction is made among task as given by the instructor, task as interpreted by the student, and task as negotiated in the interpersonal context of dental education.
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Morphological clues to the appropriate recognition of hereditary renal neoplasms.
Moch, Holger; Ohashi, Riuko; Gandhi, Jatin S; Amin, Mahul B
2018-05-01
An important emerging role of the surgical pathologist besides the traditional tasks of establishment of the diagnosis and documentation of prognostic and predictive factors, is to recognize the possibility of a hereditary condition in cases where the histology is suggestive for a familial cancer syndrome. In recent years, the knowledge regarding all of the above roles, including the role of recognition of familial cancer, has particularly expanded in renal neoplasms with the close scrutiny to morphology, molecular correlates and clinical features of the different sub-types of renal cell carcinoma. Awareness of these clinically distinctive sub-types and their associated histologic clues will prompt the pathologist for further immunohistochemical or molecular work up, to look for clinical information to support the suspected diagnosis of familial cancer, to alert managing physician/s to look for stigmata of history of familial cancer, which will permit triaging patients and their families for appropriate genetic counseling. This review provides a comprehensive review of the known sub-types of renal cell carcinoma that have a predilection to occur in the setting of hereditary disease; examples include renal cancers occurring in the background of von Hippel Lindau disease, hereditary leiomyomatosis and renal cell carcinoma syndrome, tuberous sclerosis, Birt Hogg Dube syndrome and succinate dehydrogenase deficiency. Herein we focus on diagnostic clues for renal tumors occurring in a non-pediatric setting that should prompt their correct recognition and reiterate the importance of the correct diagnosis. Copyright © 2018 Elsevier Inc. All rights reserved.
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Closing Achievement Gaps: Roles and Tasks of Elementary School Counselors
ERIC Educational Resources Information Center
Trusty, Jerry; Mellin, Elizabeth A.; Herbert, James T.
2008-01-01
Achievement gaps among racial-ethnic and socioeconomic status groups are an enduring, pervasive, and multifaceted phenomenon. Therefore, efforts aimed at understanding and addressing these gaps must be developmentally and environmentally broad, involving numerous school counselor roles and tasks, including leadership, advocacy, collaboration, and…
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A Framework to Describe, Analyze and Generate Interactive Motor Behaviors
Jarrassé, Nathanaël; Charalambous, Themistoklis; Burdet, Etienne
2012-01-01
While motor interaction between a robot and a human, or between humans, has important implications for society as well as promising applications, little research has been devoted to its investigation. In particular, it is important to understand the different ways two agents can interact and generate suitable interactive behaviors. Towards this end, this paper introduces a framework for the description and implementation of interactive behaviors of two agents performing a joint motor task. A taxonomy of interactive behaviors is introduced, which can classify tasks and cost functions that represent the way each agent interacts. The role of an agent interacting during a motor task can be directly explained from the cost function this agent is minimizing and the task constraints. The novel framework is used to interpret and classify previous works on human-robot motor interaction. Its implementation power is demonstrated by simulating representative interactions of two humans. It also enables us to interpret and explain the role distribution and switching between roles when performing joint motor tasks. PMID:23226231
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A framework to describe, analyze and generate interactive motor behaviors.
Jarrassé, Nathanaël; Charalambous, Themistoklis; Burdet, Etienne
2012-01-01
While motor interaction between a robot and a human, or between humans, has important implications for society as well as promising applications, little research has been devoted to its investigation. In particular, it is important to understand the different ways two agents can interact and generate suitable interactive behaviors. Towards this end, this paper introduces a framework for the description and implementation of interactive behaviors of two agents performing a joint motor task. A taxonomy of interactive behaviors is introduced, which can classify tasks and cost functions that represent the way each agent interacts. The role of an agent interacting during a motor task can be directly explained from the cost function this agent is minimizing and the task constraints. The novel framework is used to interpret and classify previous works on human-robot motor interaction. Its implementation power is demonstrated by simulating representative interactions of two humans. It also enables us to interpret and explain the role distribution and switching between roles when performing joint motor tasks.
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Cordonnier, Aline; Barnier, Amanda J; Sutton, John
2016-01-01
Research on future thinking has emphasized how episodic details from memories are combined to create future thoughts, but has not yet examined the role of semantic scripts. In this study, participants recalled how they planned a past camping trip in Australia (past planning task) and imagined how they would plan a future camping trip (future planning task), set either in a familiar (Australia) or an unfamiliar (Antarctica) context. Transcripts were segmented into information units that were coded according to semantic category (e.g., where, when, transport, material, actions). Results revealed a strong interaction between tasks and their presentation order. Starting with the past planning task constrained the future planning task when the context was familiar. Participants generated no new information when the future camping trip was set in Australia and completed second (after the past planning task). Conversely, starting with the future planning task facilitated the past planning task. Participants recalled more information units of their past plan when the past planning task was completed second (after the future planning task). These results shed new light on the role of scripts in past and future thinking and on how past and future thinking processes interact.
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Blitz, Julia; De Villiers, Marietjie; Van Schalkwyk, Susan
2018-05-01
Medical faculties have the responsibility to graduate competent health professionals and a consequent obligation to assure the quality and effectiveness of their students' clinical teaching. Many institutions are responding to rural workforce needs by extending clinical training from the traditional academic teaching hospital to include rural and remote sites distributed away from the central training institution. It is incumbent upon medical schools to consider how this might impact on the faculty development of these clinicians as teachers. The research reported here sought to develop an understanding of how clinicians working at distant resource-constrained and new training sites view their early experiences of having been delegated the task of clinical teaching. This was with a view to informing the development of initiatives that could strengthen their role as teachers. Qualitative research using an interpretive approach was used to reach an understanding of the views and subjective experiences of clinicians taking on the role of clinical teaching. Participants were emerging clinical teachers at distant peri-urban, rural and remote sites in South Africa. They were deemed to be emerging by virtue of either having recently taken on the role of clinical teacher, or working at sites newly used for clinical teaching. In-depth interviews were conducted with all nine clinicians meeting these criteria. The interviews were coded inductively looking for underlying meanings, which were then grouped into categories. The findings clustered into three inter-related themes: relationships, responsibilities and resources. The clinicians take pleasure in developing learning relationships that enable students to have a good experience by participating actively in the clinical environment, value what students bring from the medical school in terms of clinical advances and different perspectives, and in the contribution that they feel they are making to creating a more appropriately trained future healthcare workforce. However, they yearn for a closer relationship with the medical school, which they think could acknowledge the contributions they make, while also offering opportunities for them to become more effective clinical teachers. They also feel that they have a role to play in both curriculum re-alignment and student evaluation. These clinicians felt that the medical school has a responsibility to let them know if they are doing 'the right thing' as clinical teachers. Interestingly, these participants see trusted clinical colleagues and mentors as a resource when needing advice or mentorship concerning clinical teaching. This study adds to an understanding around designing faculty development initiatives that meet the needs of clinicians at distant sites that take on the role of clinical teaching. There remains the need to impart particular strategies to support the learning of particular kinds of knowledge that is commonly dealt with in faculty development. However, there may be an additional need for faculty developers to embrace what is known about rural doctor social learning systems by overtly designing for incorporation of the foundational three Rs: relationships, responsibilities and resources.
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ERIC Educational Resources Information Center
Szucs, Susan C.; And Others
This curriculum guide provides competencies and tasks for the position of clinical laboratory helper; it serves as both a career exploration experience and/or entry-level employment training. A list of 25 validated competencies and tasks covers careers from entry level to those that must be mastered to earn an associate degree in clinical…
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The Task Is Not Enough: Processing Approaches to Task-Based Performance
ERIC Educational Resources Information Center
Skehan, Peter; Xiaoyue, Bei; Qian, Li; Wang, Zhan
2012-01-01
This article reports on three research studies, all of which concern second language task performance. The first focuses on planning, and compares on-line and strategic planning as well as task repetition. The second study examines the role of familiarity on task performance, and compares this with conventional strategic planning. The third study…
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ERIC Educational Resources Information Center
Feldman, Matthew
2010-01-01
This study compares the professional roles of school counselors and school social workers in terms of the frequency of performing various practice tasks, feelings of preparedness to perform various practice tasks, discrepancies between frequency of task performance and feelings of preparedness to perform said tasks, and factors that may affect…
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ERIC Educational Resources Information Center
Technomics, Inc., McLean, VA.
This publication is Attachment 4 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties for clinical physician assistants. (BT)
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ERIC Educational Resources Information Center
National Institutes of Health (DHEW), Bethesda, MD. High Blood Pressure Information Center.
This curriculum guide on high blood pressure (hypertension) for nursing educators has five sections: (1) Introduction and Objectives provides information regarding the establishment and objectives of the National Task Force on the Role of Nursing in High Blood Pressure Control and briefly discusses nursing's role in hypertension control; (2) Goals…
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Amotivation in Schizophrenia: Integrated Assessment With Behavioral, Clinical, and Imaging Measures
Wolf, Daniel H.; Satterthwaite, Theodore D.; Kantrowitz, Jacob J.; Katchmar, Natalie; Vandekar, Lillie; Elliott, Mark A.; Ruparel, Kosha
2014-01-01
Motivational deficits play a central role in disability caused by schizophrenia and constitute a major unmet therapeutic need. Negative symptoms have previously been linked to hypofunction in ventral striatum (VS), a core component of brain motivation circuitry. However, it remains unclear to what extent this relationship holds for specific negative symptoms such as amotivation, and this question has not been addressed with integrated behavioral, clinical, and imaging measures. Here, 41 individuals with schizophrenia and 37 controls performed a brief, computerized progressive ratio task (PRT) that quantifies effort exerted in pursuit of monetary reward. Clinical amotivation was assessed using the recently validated Clinical Assessment Interview for Negative Symptoms (CAINS). VS function was probed during functional magnetic resonance imaging using a monetary guessing paradigm. We found that individuals with schizophrenia had diminished motivation as measured by the PRT, which significantly and selectively related to clinical amotivation as measured by the CAINS. Critically, lower PRT motivation in schizophrenia was also dimensionally related to VS hypofunction. Our results demonstrate robust dimensional associations between behavioral amotivation, clinical amotivation, and VS hypofunction in schizophrenia. Integrating behavioral measures such as the PRT will facilitate translational efforts to identify biomarkers of amotivation and to assess response to novel therapeutic interventions. PMID:24657876
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Effect of tDCS on task relevant and irrelevant perceptual learning of complex objects.
Van Meel, Chayenne; Daniels, Nicky; de Beeck, Hans Op; Baeck, Annelies
2016-01-01
During perceptual learning the visual representations in the brain are altered, but these changes' causal role has not yet been fully characterized. We used transcranial direct current stimulation (tDCS) to investigate the role of higher visual regions in lateral occipital cortex (LO) in perceptual learning with complex objects. We also investigated whether object learning is dependent on the relevance of the objects for the learning task. Participants were trained in two tasks: object recognition using a backward masking paradigm and an orientation judgment task. During both tasks, an object with a red line on top of it were presented in each trial. The crucial difference between both tasks was the relevance of the object: the object was relevant for the object recognition task, but not for the orientation judgment task. During training, half of the participants received anodal tDCS stimulation targeted at the lateral occipital cortex (LO). Afterwards, participants were tested on how well they recognized the trained objects, the irrelevant objects presented during the orientation judgment task and a set of completely new objects. Participants stimulated with tDCS during training showed larger improvements of performance compared to participants in the sham condition. No learning effect was found for the objects presented during the orientation judgment task. To conclude, this study suggests a causal role of LO in relevant object learning, but given the rather low spatial resolution of tDCS, more research on the specificity of this effect is needed. Further, mere exposure is not sufficient to train object recognition in our paradigm.
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The role of executive functioning in children's attentional pain control: an experimental analysis.
Verhoeven, Katrien; Dick, Bruce; Eccleston, Christopher; Goubert, Liesbet; Crombez, Geert
2014-02-01
Directing attention away from pain is often used in children's pain treatment programs to control pain. However, empirical evidence concerning its effectiveness is inconclusive. We therefore sought to understand other influencing factors, including executive function and its role in the pain experience. This study investigates the role of executive functioning in the effectiveness of distraction. School children (n=164) completed executive functioning tasks (inhibition, switching, and working memory) and performed a cold-pressor task. One half of the children simultaneously performed a distracting tone-detection task; the other half did not. Results showed that participants in the distraction group were engaged in the distraction task and were reported to pay significantly less attention to pain than controls. Executive functioning influenced distraction task engagement. More specifically, participants with good inhibition and working memory abilities performed the distraction task better; participants with good switching abilities reported having paid more attention to the distraction task. Furthermore, distraction was found to be ineffective in reducing pain intensity and affect. Executive functioning did not influence the effectiveness of distraction. However, a relationship was found between executive functioning and pain affect, indicating that participants with good inhibition and working memory abilities experienced the cold-pressor task as less stressful and unpleasant. Our findings suggest that distraction as a process for managing pain is complex. While it appears that executive function may play a role in adult distraction, in this study it did not direct attention away from pain. It may instead be involved in the overall pain experience. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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Time and interference: Effects on working memory.
Botto, Marta; Palladino, Paola
2016-05-01
This study tested predictions from the time-based resource-sharing (TBRS) model with a classical verbal working memory (WM) task, where target and non-target information interfere strongly with each other. Different predictions can be formulated according to the dominant perspectives (TBRS and interference hypothesis) on the role of inhibitory control in WM task performance. Here, we aimed to trace the activation of irrelevant information, examining priming effects in a lexical decision task immediately following WM recall. Results indicate the roles of both time and interference constraints in determining task performance. In particular, the role of time available seemed crucial at the highest WM loads (i.e., 3 and 4 memoranda). These were also associated with a higher activation of no-longer-relevant information but, in this case, independently from time available for processing. © 2015 The British Psychological Society.
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Relationship between intra-abdominal pressure and trunk EMG.
McGill, S M; Sharratt, M T
1990-05-01
Intra-abdominal pressure (IAP) has been proposed as an important mechanism in manual lifting and breathing mechanics. Direct (invasive) measures of IAP have required the swallowing of a radio transducer or insertion of a pressure sensor into the rectum or down the oesophagus to the stomach. The purpose of this study was to investigate the relationship between a non-invasive method (EMG) and IAP. Several tasks involving abdominal muscle activation were performed to assess whether or not IAP played a common role in these tasks. IAP and EMG from rectus abdominis, the abdominal obliques, intercostals and erector spinae were measured. Peak IAP reached 340 mmHg (valsalva) for one subject but most values were less than 100 mmHg for tasks other than valsalva. The IAP and EMG data provide some insight into the role of IAP during the performance of specific tasks. Peak IAP within 60 ms of the onset of vigorous abdominal activation indicated the importance of a very rapid pressure response to abdominal muscle activation. The correlations between various muscle EMG time histories and IAP exceeded 0·80 for only two activities (i.e. r(2) = 0·82 between the intercostals and IAP during valsalva manoeuvres). These data suggest that no unifying hypothesis exists to explain the role of IAP for a wide variety of movement tasks; rather, the role of IAP is task specific. Copyright © 1990. Published by Elsevier Ltd.
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Yang, Kyeongra; Woomer, Gail Ratliff; Agbemenu, Kafuli; Williams, Lynne
2014-11-01
The study aim was to evaluate the effectiveness of a poverty simulation in increasing understanding of and attitudes toward poverty and resulting in changes in clinical practice among nursing seniors. A poverty simulation was conducted using a diverse group of nursing professors and staff from local community agencies assuming the role of community resource providers. Students were assigned roles as members of low-income families and were required to complete tasks during a simulated month. A debriefing was held after the simulation to explore students' experiences in a simulated poverty environment. Students' understanding of and attitude toward poverty pre- and post-simulation were examined. Changes in the students' clinical experiences following the simulation were summarized into identified categories and themes. The poverty simulation led to a greater empathy for the possible experiences of low income individuals and families, understanding of barriers to health care, change in attitudes towards poverty and to those living in poverty, and changes in the students' nursing practice. Use of poverty simulation is an effective means to teach nursing students about the experience of living in poverty. The simulation experience changed nursing students' clinical practice, with students providing community referrals and initiating inter-professional collaborations. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Szumowska, Ewa; Kossowska, Małgorzata; Roets, Arne
2018-01-01
In three studies, we examined the role task rules play in multitasking performance. We postulated that rules should be especially important for individuals highly motivated to have structure and clear answers, i.e., those high on need for cognitive closure (NFC). High NFC should thus be related to greater compliance with task rules. Specifically, given high goal importance, NFC should be more strongly related to a multitasking strategy when multitasking is imposed by the rules, and to a mono-tasking strategy when monotasking is imposed by the rules. This should translate into better multitasking or mono-tasking performance, depending on condition. Overall, the results were supportive as NFC was related to a more mono-tasking strategy in the mono-tasking condition (Studies 1 and 2 only) and more dual-tasking strategy in the dual-tasking condition (Studies 1-3). This translated into respective differences in performance. The effects were significant only when goal importance was high (Study 1) and held when cognitive ability was controlled for (Study 2).
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Morgan, Karen; Burke, Helen; McGee, Hannah
2013-02-01
The Fourth Joint Societies' Task Force (4th JTF) Guidelines on Cardiovascular Disease Prevention in Clinical Practice are agreed, evidence-based standards of care across European countries and professions. In advance of the publication of the 5th JTF Guidelines in 2012, this work assesses the extent to which the 4th JTF guidelines have been implemented. Qualitative study of guideline implementation in 13 European countries, focusing on the themes of guideline implementation structures, processes, and outcomes. Key personnel in 13 selected countries completed interviews or comparable questionnaires: they were national coordinators for CVD prevention (n = 14) and representatives of the national cardiac society (n = 9), heart foundations (n = 11), health ministry (n = 8), and service providers (n = 3). Interview and service-related data from each country were compiled to provide a detailed overview. Ten of the 13 countries used European Society of Cardiology (ESC) guidelines on prevention at a national level, where three broad approaches to implementation were identified. In all 10 countries, multidisciplinary alliances oversaw implementation, but ongoing promotion of the guidelines was not evident, with just two of the 10 countries conducting evaluation of implementation. Barriers to implementation included weak health authority support, the unwieldy nature of the guidelines, guideline fatigue, and the lesser role of prevention in national healthcare systems. Substantial progress had been made in implementing the guidelines, but countries struggled with the task. Some rebalancing of the ESC focus may be warranted so that part of the effort dedicated to improving guidelines might be redirected at translating them into practice.
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Research Challenges and Opportunities for Clinically Oriented Academic Radiology Departments.
Decker, Summer J; Grajo, Joseph R; Hazelton, Todd R; Hoang, Kimberly N; McDonald, Jennifer S; Otero, Hansel J; Patel, Midhir J; Prober, Allen S; Retrouvey, Michele; Rosenkrantz, Andrew B; Roth, Christopher G; Ward, Robert J
2016-01-01
Between 2004 and 2012, US funding for the biomedical sciences decreased to historic lows. Health-related research was crippled by receiving only 1/20th of overall federal scientific funding. Despite the current funding climate, there is increased pressure on academic radiology programs to establish productive research programs. Whereas larger programs have resources that can be utilized at their institutions, small to medium-sized programs often struggle with lack of infrastructure and support. To address these concerns, the Association of University Radiologists' Radiology Research Alliance developed a task force to explore any untapped research productivity potential in these smaller radiology departments. We conducted an online survey of faculty at smaller clinically funded programs and found that while they were interested in doing research and felt it was important to the success of the field, barriers such as lack of resources and time were proving difficult to overcome. One potential solution proposed by this task force is a collaborative structured research model in which multiple participants from multiple institutions come together in well-defined roles that allow for an equitable distribution of research tasks and pooling of resources and expertise. Under this model, smaller programs will have an opportunity to share their unique perspective on how to address research topics and make a measureable impact on the field of radiology as a whole. Through a health services focus, projects are more likely to succeed in the context of limited funding and infrastructure while simultaneously providing value to the field. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
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Shoulder Arthroscopy Simulator Training Improves Shoulder Arthroscopy Performance in a Cadaver Model
Henn, R. Frank; Shah, Neel; Warner, Jon J.P.; Gomoll, Andreas H.
2013-01-01
Purpose The purpose of this study was to quantify the benefits of shoulder arthroscopy simulator training with a cadaver model of shoulder arthroscopy. Methods Seventeen first year medical students with no prior experience in shoulder arthroscopy were enrolled and completed this study. Each subject completed a baseline proctored arthroscopy on a cadaveric shoulder, which included controlling the camera and completing a standard series of tasks using the probe. The subjects were randomized, and nine of the subjects received training on a virtual reality simulator for shoulder arthroscopy. All subjects then repeated the same cadaveric arthroscopy. The arthroscopic videos were analyzed in a blinded fashion for time to task completion and subjective assessment of technical performance. The two groups were compared with students t-tests, and change over time within groups was analyzed with paired t-tests. Results There were no observed differences between the two groups on the baseline evaluation. The simulator group improved significantly from baseline with respect to time to completion and subjective performance (p<0.05). Time to completion was significantly faster in the simulator group compared to controls at final evaluation (p<0.05). No difference was observed between the groups on the subjective scores at final evaluation (p=0.98). Conclusions Shoulder arthroscopy simulator training resulted in significant benefits in clinical shoulder arthroscopy time to task completion in this cadaver model. This study provides important additional evidence of the benefit of simulators in orthopaedic surgical training. Clinical Relevance There may be a role for simulator training in shoulder arthroscopy education. PMID:23591380
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Urbanski, Marika; Bréchemier, Marie-Laure; Garcin, Béatrice; Bendetowicz, David; Thiebaut de Schotten, Michel; Foulon, Chris; Rosso, Charlotte; Clarençon, Frédéric; Dupont, Sophie; Pradat-Diehl, Pascale; Labeyrie, Marc-Antoine; Levy, Richard; Volle, Emmanuelle
2016-06-01
SEE BURGESS DOI101093/BRAIN/AWW092 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE : Analogical reasoning is at the core of the generalization and abstraction processes that enable concept formation and creativity. The impact of neurological diseases on analogical reasoning is poorly known, despite its importance in everyday life and in society. Neuroimaging studies of healthy subjects and the few studies that have been performed on patients have highlighted the importance of the prefrontal cortex in analogical reasoning. However, the critical cerebral bases for analogical reasoning deficits remain elusive. In the current study, we examined analogical reasoning abilities in 27 patients with focal damage in the frontal lobes and performed voxel-based lesion-behaviour mapping and tractography analyses to investigate the structures critical for analogical reasoning. The findings revealed that damage to the left rostrolateral prefrontal region (or some of its long-range connections) specifically impaired the ability to reason by analogies. A short version of the analogy task predicted the existence of a left rostrolateral prefrontal lesion with good accuracy. Experimental manipulations of the analogy tasks suggested that this region plays a role in relational matching or integration. The current lesion approach demonstrated that the left rostrolateral prefrontal region is a critical node in the analogy network. Our results also suggested that analogy tasks should be translated to clinical practice to refine the neuropsychological assessment of patients with frontal lobe lesions. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Are we under-utilizing the talents of primary care personnel? A job analytic examination
Hysong, Sylvia J; Best, Richard G; Moore, Frank I
2007-01-01
Background Primary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care. This article aims to (1) catalogue the domain of primary care tasks, (2) explore the complexity associated with these tasks, and (3) examine how tasks performed by different job titles differ in function and complexity, using Functional Job Analysis to develop a new tool for making evidence-based staffing decisions. Methods Seventy-seven primary care personnel from six US Department of Veterans Affairs (VA) Medical Centers, representing six job titles, participated in two-day focus groups to generate 243 unique task statements describing the content of VA primary care. Certified job analysts rated tasks on ten dimensions representing task complexity, skills, autonomy, and error consequence. Two hundred and twenty-four primary care personnel from the same clinics then completed a survey indicating whether they performed each task. Tasks were catalogued using an adaptation of an existing classification scheme; complexity differences were tested via analysis of variance. Results Objective one: Task statements were categorized into four functions: service delivery (65%), administrative duties (15%), logistic support (9%), and workforce management (11%). Objective two: Consistent with expectations, 80% of tasks received ratings at or below the mid-scale value on all ten scales. Objective three: Service delivery and workforce management tasks received higher ratings on eight of ten scales (multiple functional complexity dimensions, autonomy, human error consequence) than administrative and logistic support tasks. Similarly, tasks performed by more highly trained job titles received higher ratings on six of ten scales than tasks performed by lower trained job titles. Contrary to expectations, the distribution of tasks across functions did not significantly vary by job title. Conclusion Primary care personnel are not being utilized to the extent of their training; most personnel perform many tasks that could reasonably be performed by personnel with less training. Primary care clinics should use evidence-based information to optimize job-person fit, adjusting clinic staff mix and allocation of work across staff to enhance efficiency and effectiveness. PMID:17397534
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Roles of the eye care workforce for task sharing in management of diabetic retinopathy in Cambodia
Shah, Mufarriq; Ormsby, Gail M.; Noor, Ayesha; Chakrabarti, Rahul; Mörchen, Manfred; Islam, Fakir M Amirul; Harper, C Alex; Keeffe, Jill E
2018-01-01
AIM To identify the current roles of eye and health care workers in eye care delivery and investigate their potential roles in screening and detection for management of diabetic retinopathy (DR) through task sharing. METHODS Purposive sampling of 24 participants including health administrators, members from non-government organizations and all available eye care workers in Takeo province were recruited. This cross sectional mixed method study comprised a survey and in-depth interviews. Data were collected from medical records at Caritas Takeo Eye Hospital (CTEH) and Kiri Vong District Referral Hospital Vision Centre, and a survey and interviews with participants were done to explore the potential roles for task sharing in DR management. Qualitative data were transcribed into a text program and then entered into N-Vivo (version 10) software for data management and analysis. RESULTS From 2009 to 2012, a total of 105 178 patients were examined and 14 030 eye surgeries were performed in CTEH by three ophthalmologists supported by ophthalmic nurses in operating and eye examination for patients. Between January 2011 and September 2012, 151 patients (72 males) with retinal pathology including 125 (83%) with DR visited CTEH. In addition 170 patients with diabetes were referred to CTEH for eye examinations from Mo Po Tsyo screening programs for people with diabetes. Factors favouring task sharing included high demand for eye care services and scarcity of ophthalmologists. CONCLUSION Task sharing and team work for eye care services is functional. Participants favor the potential role of ophthalmic nurses in screening for DR through task sharing. PMID:29375999
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Organizational Leadership: Some Conceptual Models.
ERIC Educational Resources Information Center
Bernthal, Wilmar F.
In this address, the speaker examines several different types of organization (charismatic, traditional, bureaucratic, and task-oriented) and the role of the leader in each. In the modern, task-oriented system, his role can hardly be generalized as decision-making, direction and control, problem-solving, inspiration, communication, or any other…
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Writing in the Air: Contributions of Finger Movement to Cognitive Processing
Itaguchi, Yoshihiro; Yamada, Chiharu; Fukuzawa, Kazuyoshi
2015-01-01
The present study investigated the interactions between motor action and cognitive processing with particular reference to kanji-culture individuals. Kanji-culture individuals often move their finger as if they are writing when they are solving cognitive tasks, for example, when they try to recall the spelling of English words. This behavior is called kusho, meaning air-writing in Japanese. However, its functional role is still unknown. To reveal the role of kusho behavior in cognitive processing, we conducted a series of experiments, employing two different cognitive tasks, a construction task and a stroke count task. To distinguish the effects of the kinetic aspects of kusho behavior, we set three hand conditions in the tasks; participants were instructed to use either kusho, unrelated finger movements or do nothing during the response time. To isolate possible visual effects, two visual conditions in which participants saw their hand and the other in which they did not, were introduced. We used the number of correct responses and response time as measures of the task performance. The results showed that kusho behavior has different functional roles in the two types of cognitive tasks. In the construction task, the visual feedback from finger movement facilitated identifying a character, whereas the kinetic feedback or motor commands for the behavior did not help to solve the task. In the stroke count task, by contrast, the kinetic aspects of the finger movements influenced counting performance depending on the type of the finger movement. Regardless of the visual condition, kusho behavior improved task performance and unrelated finger movements degraded it. These results indicated that motor behavior contributes to cognitive processes. We discussed possible mechanisms of the modality dependent contribution. These findings might lead to better understanding of the complex interaction between action and cognition in daily life. PMID:26061273
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Writing in the Air: Contributions of Finger Movement to Cognitive Processing.
Itaguchi, Yoshihiro; Yamada, Chiharu; Fukuzawa, Kazuyoshi
2015-01-01
The present study investigated the interactions between motor action and cognitive processing with particular reference to kanji-culture individuals. Kanji-culture individuals often move their finger as if they are writing when they are solving cognitive tasks, for example, when they try to recall the spelling of English words. This behavior is called kusho, meaning air-writing in Japanese. However, its functional role is still unknown. To reveal the role of kusho behavior in cognitive processing, we conducted a series of experiments, employing two different cognitive tasks, a construction task and a stroke count task. To distinguish the effects of the kinetic aspects of kusho behavior, we set three hand conditions in the tasks; participants were instructed to use either kusho, unrelated finger movements or do nothing during the response time. To isolate possible visual effects, two visual conditions in which participants saw their hand and the other in which they did not, were introduced. We used the number of correct responses and response time as measures of the task performance. The results showed that kusho behavior has different functional roles in the two types of cognitive tasks. In the construction task, the visual feedback from finger movement facilitated identifying a character, whereas the kinetic feedback or motor commands for the behavior did not help to solve the task. In the stroke count task, by contrast, the kinetic aspects of the finger movements influenced counting performance depending on the type of the finger movement. Regardless of the visual condition, kusho behavior improved task performance and unrelated finger movements degraded it. These results indicated that motor behavior contributes to cognitive processes. We discussed possible mechanisms of the modality dependent contribution. These findings might lead to better understanding of the complex interaction between action and cognition in daily life.
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Colateralization of Broca's area and the visual word form area in left-handers: fMRI evidence.
Van der Haegen, Lise; Cai, Qing; Brysbaert, Marc
2012-09-01
Language production has been found to be lateralized in the left hemisphere (LH) for 95% of right-handed people and about 75% of left-handers. The prevalence of atypical right hemispheric (RH) or bilateral lateralization for reading and colateralization of production with word reading laterality has never been tested in a large sample. In this study, we scanned 57 left-handers who had previously been identified as being clearly left (N=30), bilateral (N=7) or clearly right (N=20) dominant for speech on the basis of fMRI activity in the inferior frontal gyrus (pars opercularis/pars triangularis) during a silent word generation task. They were asked to perform a lexical decision task, in which words were contrasted against checkerboards, to test the lateralization of reading in the ventral occipitotemporal region. Lateralization indices for both tasks correlated significantly (r=0.59). The majority of subjects showed most activity during lexical decision in the hemisphere that was identified as their word production dominant hemisphere. However, more than half of the sample (N=31) had bilateral activity for the lexical decision task without a clear dominant role for either the LH or RH, and three showed a crossed frontotemporal lateralization pattern. These findings have consequences for neurobiological models relating phonological and orthographic processes, and for lateralization measurements for clinical purposes. Copyright © 2011 Elsevier Inc. All rights reserved.
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The roles of social stress and decision-making in non-suicidal self-injury.
Schatten, Heather T; Andover, Margaret S; Armey, Michael F
2015-10-30
Research suggests that individuals with a history of non-suicidal self-injury (NSSI) do not have difficulty generating alternatives to social problems but choose more negative solutions, suggesting a deficit in decision-making. However, studies report no significant differences in risky decision-making on a performance-based task among individuals with and without NSSI histories. A limitation of these studies is that decision-making was only assessed at baseline. As individuals with a history of NSSI typically self-injure when experiencing negative emotions, decision-making ability may become impaired specifically in the presence of these emotions. The aim of the current study was to investigate decision-making ability among individuals with and without NSSI histories both at baseline and following a distressing social exclusion task. We compared individuals with (n=48) and without (n=72) NSSI histories on the Iowa Gambling Task, a behavioral measure of risky decision-making, before and after exclusion or inclusion on the Cyberball task. Results indicated no significant group differences in performance regardless of condition. When participants were grouped by racial/ethnic minority status, results indicated that non-Hispanic White individuals with a history of NSSI exhibited deterioration in risky decision-making ability following social exclusion. Potential explanations for these findings and clinical implications are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Lichtenberger, John P; Tatum, Peter S; Gada, Satyen; Wyn, Mark; Ho, Vincent B; Liacouras, Peter
2018-03-01
This work describes customized, task-specific simulation models derived from 3D printing in clinical settings and medical professional training programs. Simulation models/task trainers have an array of purposes and desired achievements for the trainee, defining that these are the first step in the production process. After this purpose is defined, computer-aided design and 3D printing (additive manufacturing) are used to create a customized anatomical model. Simulation models then undergo initial in-house testing by medical specialists followed by a larger scale beta testing. Feedback is acquired, via surveys, to validate effectiveness and to guide or determine if any future modifications and/or improvements are necessary. Numerous custom simulation models have been successfully completed with resulting task trainers designed for procedures, including removal of ocular foreign bodies, ultrasound-guided joint injections, nerve block injections, and various suturing and reconstruction procedures. These task trainers have been frequently utilized in the delivery of simulation-based training with increasing demand. 3D printing has been integral to the production of limited-quantity, low-cost simulation models across a variety of medical specialties. In general, production cost is a small fraction of a commercial, generic simulation model, if available. These simulation and training models are customized to the educational need and serve an integral role in the education of our military health professionals.
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Dawson, Angela J; Buchan, James; Duffield, Christine; Homer, Caroline S E; Wijewardena, Kumudu
2014-05-01
Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives. Findings indicate that shifting and sharing these tasks may increase access to and availability of maternal and reproductive health (MRH) services without compromising performance or patient outcomes and may be cost effective. However, a number of issues and barriers were identified with health workers calling for improved in-service training, supervision, career progression and incentive packages to better support their practice. Collaborative approaches involving community members and health workers at all levels have the potential to deliver MRH interventions effectively if accompanied by ongoing investment in the health care system.
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Fitzgerald, G K; Hinman, R S; Zeni, J; Risberg, M A; Snyder-Mackler, L; Bennell, K L
2015-05-01
A Task Force of the Osteoarthritis Research Society International (OARSI) has previously published a set of guidelines for the conduct of clinical trials in osteoarthritis (OA) of the hip and knee. Limited material available on clinical trials of rehabilitation in people with OA has prompted OARSI to establish a separate Task Force to elaborate guidelines encompassing special issues relating to rehabilitation of OA. The Task Force identified three main categories of rehabilitation clinical trials. The categories included non-operative rehabilitation trials, post-operative rehabilitation trials, and trials examining the effectiveness of devices (e.g., assistive devices, bracing, physical agents, electrical stimulation, etc.) that are used in rehabilitation of people with OA. In addition, the Task Force identified two main categories of outcomes in rehabilitation clinical trials, which include outcomes related to symptoms and function, and outcomes related to disease modification. The guidelines for rehabilitation clinical trials provided in this report encompass these main categories. The report provides guidelines for conducting and reporting on randomized clinical trials. The topics include considerations for entering patients into trials, issues related to conducting trials, considerations for selecting outcome measures, and recommendations for statistical analyses and reporting of results. The focus of the report is on rehabilitation trials for hip, knee and hand OA, however, we believe the content is broad enough that it could be applied to rehabilitation trials for other regions as well. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
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Caes, L; Vervoort, T; Eccleston, C; Vandenhende, M; Goubert, L
2011-01-01
Recent research has demonstrated that parental behaviors have an important impact upon child and adolescent pain outcomes. At present, however, we do not know which parents engage in particular behaviors and why. In 2 studies, the impact of parental catastrophizing about their child's pain upon parental tendency to stop their child's pain-inducing activity was investigated. Further, the mediating role of parental distress was explored. In study 1, a sample of schoolchildren (n=62; M=12.48 years; SD=1.72) took part in a cold-pressor task. In study 2, a clinical sample of adolescents with chronic pain (n=36; M=15.68 years; SD=1.85) performed a 2-min walking task designed as a pain-inducing activity. In both studies, the accompanying parent was asked to watch their child performing the pain task. Findings revealed, for both studies, that parents with a high level of catastrophic thinking about their child's pain experienced more distress and a greater behavioral tendency of wanting to stop their child's pain-inducing activity. Further, parental feelings of distress mediated the relationship between parental catastrophic thinking and parents' tendency to restrict their child's activity. The findings are discussed in light of an affective-motivational conceptualization of pain and pain behavior. Parental catastrophizing was associated with parental tendency to restrict their child's engagement in a painful test, and this relationship was mediated by parental distress. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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Rapid-Response Impulsivity: Definitions, Measurement Issues, and Clinical Implications
Hamilton, Kristen R.; Littlefield, Andrew K.; Anastasio, Noelle C.; Cunningham, Kathryn A.; Fink, Latham H.; Wing, Victoria C.; Mathias, Charles W.; Lane, Scott D.; Schutz, Christian; Swann, Alan C.; Lejuez, C.W.; Clark, Luke; Moeller, F. Gerard; Potenza, Marc N.
2015-01-01
Impulsivity is a multi-faceted construct that is a core feature of multiple psychiatric conditions and personality disorders. However, progress in understanding and treating impulsivity in the context of these conditions is limited by a lack of precision and consistency in its definition and assessment. Rapid-response-impulsivity (RRI) represents a tendency toward immediate action that occurs with diminished forethought and is out of context with the present demands of the environment. Experts from the International Society for Research on Impulsivity (InSRI) met to discuss and evaluate RRI-measures in terms of reliability, sensitivity, and validity with the goal of helping researchers and clinicians make informed decisions about the use and interpretation of findings from RRI-measures. Their recommendations are described in this manuscript. Commonly-used clinical and preclinical RRI-tasks are described, and considerations are provided to guide task selection. Tasks measuring two conceptually and neurobiologically distinct types of RRI, “refraining from action initiation” (RAI) and “stopping an ongoing action” (SOA) are described. RAI and SOA-tasks capture distinct aspects of RRI that may relate to distinct clinical outcomes. The InSRI group recommends that: 1) selection of RRI-measures should be informed by careful consideration of the strengths, limitations, and practical considerations of the available measures; 2) researchers use both RAI and SOA tasks in RRI studies to allow for direct comparison of RRI types and examination of their associations with clinically relevant measures; and, 3) similar considerations should be made for human and non-human studies in an effort to harmonize and integrate pre-clinical and clinical research. PMID:25867840
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Cerebellum and Integration of Neural Networks in Dual-Task Processing
Wu, Tao; Liu, Jun; Hallett, Mark; Zheng, Zheng; Chan, Piu
2014-01-01
Performing two tasks simultaneously (dual-task) is common in human daily life. The neural correlates of dual-task processing remain unclear. In the current study, we used a dual motor and counting task with functional MRI (fMRI) to determine whether there are any areas additionally activated for dual-task performance. Moreover, we investigated the functional connectivity of these added activated areas, as well as the training effect on brain activity and connectivity. We found that the right cerebellar vermis, left lobule V of the cerebellar anterior lobe and precuneus are additionally activated for this type of dual-tasking. These cerebellar regions had functional connectivity with extensive motor- and cognitive-related regions. Dual-task training induced less activation in several areas, but increased the functional connectivity between these cerebellar regions and numbers of motor- and cognitive-related areas. Our findings demonstrate that some regions within the cerebellum can be additionally activated with dual-task performance. Their role in dual motor and cognitive task processes is likely to integrate motor and cognitive networks, and may be involved in adjusting these networks to be more efficient in order to perform dual-tasking properly. The connectivity of the precuneus differs from the cerebellar regions. A possible role of the precuneus in dual-task may be monitoring the operation of active brain networks. PMID:23063842
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Guastello, Stephen J; Gorin, Hillary; Huschen, Samuel; Peters, Natalie E; Fabisch, Megan; Poston, Kirsten
2012-10-01
It has become well established in laboratory experiments that switching tasks, perhaps due to interruptions at work, incur costs in response time to complete the next task. Conditions are also known that exaggerate or lessen the switching costs. Although switching costs can contribute to fatigue, task switching can also be an adaptive response to fatigue. The present study introduces a new research paradigm for studying the emergence of voluntary task switching regimes, self-organizing processes therein, and the possibly conflicting roles of switching costs and minimum entropy. Fifty-four undergraduates performed 7 different computer-based cognitive tasks producing sets of 49 responses under instructional conditions requiring task quotas or no quotas. The sequences of task choices were analyzed using orbital decomposition to extract pattern types and lengths, which were then classified and compared with regard to Shannon entropy, topological entropy, number of task switches involved, and overall performance. Results indicated that similar but different patterns were generated under the two instructional conditions, and better performance was associated with lower topological entropy. Both entropy metrics were associated with the amount of voluntary task switching. Future research should explore conditions affecting the trade-off between switching costs and entropy, levels of automaticity between task elements, and the role of voluntary switching regimes on fatigue.
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A Validated Task Analysis of the Single Pilot Operations Concept
NASA Technical Reports Server (NTRS)
Wolter, Cynthia A.; Gore, Brian F.
2015-01-01
The current day flight deck operational environment consists of a two-person Captain/First Officer crew. A concept of operations (ConOps) to reduce the commercial cockpit to a single pilot from the current two pilot crew is termed Single Pilot Operations (SPO). This concept has been under study by researchers in the Flight Deck Display Research Laboratory (FDDRL) at the National Aeronautics and Space Administration's (NASA) Ames (Johnson, Comerford, Lachter, Battiste, Feary, and Mogford, 2012) and researchers from Langley Research Centers (Schutte et al., 2007). Transitioning from a two pilot crew to a single pilot crew will undoubtedly require changes in operational procedures, crew coordination, use of automation, and in how the roles and responsibilities of the flight deck and ATC are conceptualized in order to maintain the high levels of safety expected of the US National Airspace System. These modifications will affect the roles and the subsequent tasks that are required of the various operators in the NextGen environment. The current report outlines the process taken to identify and document the tasks required by the crew according to a number of operational scenarios studied by the FDDRL between the years 2012-2014. A baseline task decomposition has been refined to represent the tasks consistent with a new set of entities, tasks, roles, and responsibilities being explored by the FDDRL as the move is made towards SPO. Information from Subject Matter Expert interviews, participation in FDDRL experimental design meetings, and study observation was used to populate and refine task sets that were developed as part of the SPO task analyses. The task analysis is based upon the proposed ConOps for the third FDDRL SPO study. This experiment possessed nine different entities operating in six scenarios using a variety of SPO-related automation and procedural activities required to guide safe and efficient aircraft operations. The task analysis presents the roles and responsibilities in a manner that can facilitate testing future scenarios. Measures of task count and workload were defined and analyzed to assess the impact of transitioning to a SPO environment.
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Vervoort, Tine; Trost, Zina; Sütterlin, Stefan; Caes, Line; Moors, Agnes
2014-08-01
We investigated the function of parental attention to child pain in regulating parental distress and pain control behaviour when observing their child performing a painful (cold pressor) task (CPT); we also studied the moderating role of parental state anxiety. Participants were 62 schoolchildren and one of their parents. Parental attention towards or away from child pain (ie, attend to pain vs avoid pain) was experimentally manipulated during a viewing task pairing unfamiliar children's neutral and pain faces. Before and after the viewing task, parental distress regulation was assessed by heart rate (HR) and heart rate variability (HRV). In a subsequent phase, parents observed their own child perform a CPT task, allowing assessment of parental pain control behaviour (indexed by latency to stop their child's CPT performance) and parental distress, which was assessed via self-report before and after observation of child CPT performance. Eye tracking during the viewing task and self-reported attention to own child's pain confirmed successful attention manipulation. Further, findings indicated that the effect of attentional strategy on parental emotion regulation (indexed by HR, self-report) and pain control behaviour depended on parents' state anxiety. Specifically, whereas low anxious parents reported more distress and demonstrated more pain control behaviour in the Attend to Pain condition, high anxious parents reported more distress and showed more pain control behaviour in the Avoid Pain condition. This inverse pattern was likewise apparent in physiological distress indices (HR) in response to the initial viewing task. Theoretical/clinical implications and further research directions are discussed. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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ERIC Educational Resources Information Center
Rezazadeh, Mohsen; Tavakoli, Mansoor; Rasekh, Abbas Eslami
2011-01-01
The aim of this study was to investigate the effects of two task types on foreign language written production. Particularly it addressed the issue of how three aspects of language production (i.e. fluency, complexity, and accuracy) vary among two different task types (i.e. argumentative writing task and instruction writing task). One hundred sixty…
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The Dot Pattern Expectancy Task: Reliability and Replication of Deficits in Schizophrenia
ERIC Educational Resources Information Center
Jones, Jessica A. H.; Sponheim, Scott R.; MacDonald, Angus W., III
2010-01-01
The dot pattern expectancy (DPX) task was created to efficiently assess context-processing deficits in patients with schizophrenia. Three studies investigated the characteristics of the DPX relevant for clinical applications. To answer questions regarding the psychometric properties of the task, performance on this task was studied in 2 healthy…
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Cameron, Clare; Kaplan, Ryan A; Rossell, Susan L
2014-01-01
Although several theories of delusions have been put forward, most do not offer a comprehensive diagnosis-independent explanation of delusion aetiology. This study used a non-clinical sample to provide empirical support for a novel transdiagnostic model of delusions that implicates aberrant semantic memory and emotion perception processes as key factors in delusion formation and maintenance. It was hypothesised that among a non-clinical sample, people high in schizotypy would demonstrate differences in semantic memory and emotion perception, relative to people low in schizotypy. Using the Cognitive Disorganisation subscale of the Oxford-Liverpool Inventory of Feelings and Experiences, 41 healthy participants were separated into high and low schizotypy groups and completed facial emotion perception and semantic priming tasks. As expected, participants in the high schizotypy group demonstrated different performance on the semantic priming task and reduced facial affect accuracy for the emotion anger, and reaction time differences to fearful faces. These findings suggest that such processes may be involved in the development of the sorts of unusual beliefs which underlie delusions. Investigation of how emotion perception and semantic memory may interrelate in the aetiology of delusions would be of value in furthering our understanding of their role in delusion formation.
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A model for critical thinking measurement of dental student performance.
Johnsen, David C; Finkelstein, Michael W; Marshall, Teresa A; Chalkley, Yvonne M
2009-02-01
The educational application of critical thinking has increased in the last twenty years with programs like problem-based learning. Performance measurement related to the dental student's capacity for critical thinking remains elusive, however. This article offers a model now in use to measure critical thinking applied to patient assessment and treatment planning across the four years of the dental school curriculum and across clinical disciplines. Two elements of the model are described: 1) a critical thinking measurement "cell," and 2) a list of minimally essential steps in critical thinking for patient assessment and treatment planning. Issues pertaining to this model are discussed: adaptations on the path from novice to expert, the role of subjective measurement, variations supportive of the model, and the correlation of individual and institutional assessment. The critical thinking measurement cell consists of interacting performance tasks and measures. The student identifies the step in the process (for example, chief complaint) with objective measurement; the student then applies the step to a patient or case with subjective measurement; the faculty member then combines the objective and subjective measurements into an evaluation on progress toward competence. The activities in the cell are then repeated until all the steps in the process have been addressed. A next task is to determine consistency across the four years and across clinical disciplines.
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Serotonergic and dopaminergic modulation of attentional processes.
Boulougouris, Vasileios; Tsaltas, Eleftheria
2008-01-01
Disturbances in attentional processes are a common feature of several psychiatric disorders such as schizophrenia, attention deficit/hyperactivity disorder and Huntington's disease. The use of animal models has been useful in defining various candidate neural systems thus enabling us to translate basic laboratory science to the clinic and vice-versa. In this chapter, a comparative and integrated account is provided on the neuroanatomical and neurochemical modulation of basic behavioural operations such as selective attention, vigilance, set-shifting and executive control focusing on the comparative functions of the serotonin and dopamine systems in the cognitive control exerted by the prefrontal cortex. Specifically, we have reviewed evidence emerging from several behavioural paradigms in experimental animals and humans each of which centres on a different aspect of the attentional function. These paradigms offering both human and animal variants include the five-choice serial reaction time task (5CSRTT), attentional set-shifting and stop-signal reaction time task. In each case, the types of operation that are measured by the given paradigm and their neural correlates are defined. Then, the role of the ascending dopaminergic and serotonergic systems in the neurochemical modulation of its behavioural output are examined, and reference is made to clinical implications for neurological and neuropsychiatric disorders which exhibit deficits in these cognitive tests.
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Maloney, Stephen; Storr, Michael; Morgan, Prue; Ilic, Dragan
2013-03-01
Emerging technologies and student information technology literacy are enabling new methods of teaching and learning for clinical skill performance. Facilitating experiential practice and reflection on performance through student self-video, and exposure to peer benchmarks, may promote greater levels of skill competency. This study examines the impact of student self-video on the attainment of clinical skills. A total of 60 Physiotherapy students (100%) consented to participate in the randomised controlled trial. One group (50%) was taught a complex clinical skill with regular practical tutoring, whilst the other group (50%) supplemented the tutoring with a self-video task aimed at promoting reflection on performance. Student skill performance was measured in an objective structured clinical examination (OSCE). Students also completed an anonymous questionnaire, which explored their perception of their learning experiences. Students received significantly higher scores in the OSCE when the examined clinical skill had been supplemented with a self-video of performance task (P = 0.048). Descriptive analysis of the questionnaires relating to student perceptions on the teaching methods identified that the self-video of performance task utilised contributed to improvement in their clinical performance and their confidence for future clinical practice. Students identified a number of aspects of the submission process that contributed to this perception of educational value. The novel results of this study demonstrate that greater clinical skill competency is achieved when traditional tutoring methods are supplemented with student self-video of performance tasks. Additional benefits included the ability of staff and students to monitor longitudinal performance, and an increase in feedback opportunities.
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Exploring Primary Student's Problem-Solving Ability by Doing Tasks Like PISA's Question
ERIC Educational Resources Information Center
Novita, Rita; Zulkardi; Hartono, Yusuf
2012-01-01
Problem solving plays an important role in mathematics and should have a prominent role in the mathematics education. The term "problem solving" refers to mathematics tasks that have the potential to provide intellectual challenges for enhancing students' mathematical understanding and development. In addition, the contextual problem…
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Role of Working Memory in Children's Understanding Spoken Narrative: A Preliminary Investigation
ERIC Educational Resources Information Center
Montgomery, James W.; Polunenko, Anzhela; Marinellie, Sally A.
2009-01-01
The role of phonological short-term memory (PSTM), attentional resource capacity/allocation, and processing speed on children's spoken narrative comprehension was investigated. Sixty-seven children (6-11 years) completed a digit span task (PSTM), concurrent verbal processing and storage (CPS) task (resource capacity/allocation), auditory-visual…
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Encoding Processes and Sex-Role Preferences
ERIC Educational Resources Information Center
Kail, Robert V., Jr.; Levine, Laura E.
1976-01-01
Seven and 10-year-olds were tested on memory and sex-role preference tasks. The memory task was the Wickens release from proactive inhibition paradigm in which short-term recall of words is tested on successive trials. Children selected favorite pictures from an array including masculine and feminine items. (JH)
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Effective feedback strategies for teaching in pediatric and adolescent gynecology.
Kaul, Paritosh; Gong, Jennifer; Guiton, Gretchen
2014-08-01
The clinical setting of pediatric and adolescent gynecology poses complex tasks for the physician with its numerous procedures and the communication demands of interacting with an adolescent and/or guardian. Needless to say, teaching within this setting is highly demanding. Regardless of the level of learner or the professional role (e.g., nurse, medical student, resident, physician assistant) represented, clinical teaching requires that the instructor provide feedback in ways that benefit the student. Recent research on feedback suggests a more complex understanding of feedback than in the past. This article highlights key research and its implication for effective feedback by presenting a three part framework; know your learner, understand what is to be learned, and plan for improvement. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
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Reestablishing Clinical Psychology's Subjective Core
ERIC Educational Resources Information Center
Hunsberger, Peter Hume
2007-01-01
Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. The Task Force is to be commended for their report valuing evidence from "clinical expertise" on a par with "research data" (p. 272) in guiding psychological practices. The current author…
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Sentence Repetition: What Does the Task Measure?
ERIC Educational Resources Information Center
Polišenská, Kamila; Chiat, Shula; Roy, Penny
2015-01-01
Background: Sentence repetition is gaining increasing attention as a source of information about children's sentence-level abilities in clinical assessment, and as a clinical marker of specific language impairment. However, it is widely debated what the task is testing and therefore how informative it is. Aims: (1) To evaluate the effects of…
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Gutiérrez-Clellen, Vera F.; Simon-Cereijido, Gabriela
2012-01-01
The purpose of this study was twofold: (a) to evaluate the clinical utility of a verbal working memory measure, specifically, a nonword repetition task, with a sample of Spanish-English bilingual children and (b) to determine the extent to which individual differences in relative language skills and language use had an effect on the clinical differentiation of these children by the measures. A total of 144 Latino children (95 children with typical language development and 49 children with language impairment) were tested using nonword lists developed for each language. The results show that the clinical accuracy of nonword repetition tasks varies depending on the language(s) tested. Test performance appeared related to individual differences in language use and exposure. The findings do not support a monolingual approach to the assessment of bilingual children with nonword repetition tasks, even if children appear fluent speakers in the language of testing. Nonword repetition may assist in the screening of Latino children if used bilingually and in combination with other clinical measures. PMID:22707854
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Dynamic Decision-Making in Multi-Task Environments: Theory and Experimental Results.
1981-03-15
The operator’s primary responsibility in this new role is to extract information from his environment, and to integrate it for’ action selection and its...of the human operator from one of a controller to one of a supervisory decision-maker. The operator’s primary responsibility in this new role is to...troller to that of a monitor of multiple tasks, or a supervisor of sev- ~ I eral semi-automated subsystems. The operator’s primary task in these
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Clinical support role for a pharmacy technician within a primary care resource center.
Fera, Toni; Kanel, Keith T; Bolinger, Meghan L; Fink, Amber E; Iheasirim, Serah
2018-02-01
The creation of a clinical support role for a pharmacy technician within a primary care resource center is described. In the Primary Care Resource Center (PCRC) Project, hospital-based care transition coordination hubs staffed by nurses and pharmacist teams were created in 6 independent community hospitals. At the largest site, patient volume for targeted diseases challenged the ability of the PCRC pharmacist to provide expected elements of care to targeted patients. Creation of a new pharmacy technician clinical support role was implemented as a cost-effective option to increase the pharmacist's efficiency. The pharmacist's work processes were reviewed and technical functions identified that could be assigned to a specially trained pharmacy technician under the direction of the PCRC pharmacist. Daily tasks performed by the pharmacy technician included maintenance of the patient roster and pending discharges, retrieval and documentation of pertinent laboratory and diagnostic test information from the patient's medical record, assembly of patient medication education materials, and identification of discrepancies between disparate systems' medication records. In the 6 months after establishing the PCRC pharmacy technician role, the pharmacist's completion of comprehensive medication reviews (CMRs) for target patients increased by 40.5% ( p = 0.0223), driven largely by a 42.4% ( p < 0.0001) decrease in the time to complete each chart review. The addition of a pharmacy technician to augment pharmacist care in a PCRC team extended the reach of the pharmacist and allowed more time for the pharmacist to engage patients. Technician support enabled the pharmacist to complete more CMRs and reduced the time required for chart reviews. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
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Six principles to enhance health workforce flexibility.
Nancarrow, Susan A
2015-04-07
This paper proposes approaches to break down the boundaries that reduce the ability of the health workforce to respond to population needs, or workforce flexibility. Accessible health services require sufficient numbers and types of skilled workers to meet population needs. However, there are several reasons that the health workforce cannot or does not meet population needs. These primarily stem from workforce shortages. However, the health workforce can also be prevented from responding appropriately and efficiently because of restrictions imposed by professional boundaries, funding models or therapeutic partitions. These boundaries limit the ability of practitioners to effectively diagnose and treat patients by restricting access to specific skills, technologies and services. In some cases, these boundaries not only reduce workforce flexibility, but they introduce inefficiencies in the form of additional clinical transactions and costs, further detracting from workforce responsiveness. Several new models of care are being developed to enhance workforce flexibility by enabling existing staff to work to their full scope of practice, extend their roles or by introducing new workers. Expanding on these concepts, this theoretical paper proposes six principles that have the potential to enhance health workforce flexibility, specifically: 1. Measure health system performance from the perspective of the patient. 2. Minimise training times. 3. Regulate tasks (competencies), not professions. 4. Match rewards and indemnity to the levels of skill and risk required to perform a particular task, not professional title. 5. Ensure that practitioners have all the skills they need to perform the tasks required to work in the environment in which they work 6. Enable practitioners to work to their full scope of practice delegate tasks where required These proposed principles will challenge some of the existing social norms around health-care delivery; however, many of these principles are already being applied, albeit on a small scale. This paper discusses the implications of these reforms. 1. Is person-centred care at odds with professional monopolies? 2. Should the state regulate professions and, by doing so, protect professional monopolies or, instead, regulate tasks or competencies? 3. Can health-care efficiency be enhanced by reducing the number of clinical transactions required to meet patient needs?
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Cardiovascular reactivity in a simulated job interview: the role of gender role self-concept.
Sieverding, Monika; Weidner, Gerdi; von Volkmann, Bettina
2005-01-01
This study investigated the relation of gender role self-concept (G-SC) to cardiovascular and emotional reactions to an ecologically relevant stressor in a sample of graduating male and female university students. Thirty-seven men and 37 women completed the Personal Attribute Questionnaire and worked on four tasks designed to reflect common features of a job interview. Blood pressure and heart rate were measured at baseline, during, and after each task; subjective stress was measured at baseline and after each task. Subjective and objective stress scores were averaged across tasks and analyzed by sex and G-SC (i.e., instrumentality, expressiveness). Results indicated that women as a group demonstrated greater emotional reactivity, but did not differ in their physiological reactions when compared to men. Regardless of sex, participants' instrumentality scores contributed significantly to the variation in subjective stress response: those scoring high on instrumentality reported less stress, but evidenced greater blood pressure reactivity than those scoring low on instrumentality. These results suggest that gender roles, particularly an instrumental self-concept, may play an important role in both subjective and objective reactions to an ecologically relevant stressor.
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Interdisciplinary teamwork and leadership: issues for psychiatrists.
Rosen, Alan; Callaly, Tom
2005-09-01
To review the constructs and applications of interdisciplinary teams in mental health services, with a particular view to ascertaining the most effective types of teams and their leadership. Some of the most challenging questions from a psychiatrist's viewpoint regarding the functions of interdisciplinary teams in the mental health service are addressed. The effectiveness of the interdisciplinary team in mental health services is supported by an extensive literature that is much more qualitative and descriptive than quantitative and empirically rigorous, except as part of packages of variables subjected to randomized controlled trials. Effective interdisciplinary teamwork in mental health services involves both retaining differentiated disciplinary roles and developing shared core tasks. It requires sound leadership, effective team management, clinical supervision and explicit mechanisms for resolving role conflicts and ensuring safe practices. No one profession should hold a monopoly on leadership.
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Tarrant, Carolyn; O'Donnell, Barbara; Martin, Graham; Bion, Julian; Hunter, Alison; Rooney, Kevin D
2016-11-16
Implementation of the 'Sepsis Six' clinical care bundle within an hour of recognition of sepsis is recommended as an approach to reduce mortality in patients with sepsis, but achieving reliable delivery of the bundle has proved challenging. There remains little understanding of the barriers to reliable implementation of bundle components. We examined frontline clinical practice in implementing the Sepsis Six. We conducted an ethnographic study in six hospitals participating in the Scottish Patient Safety Programme Sepsis collaborative. We conducted around 300 h of non-participant observation in emergency departments, acute medical receiving units and medical and surgical wards. We interviewed a purposive sample of 43 members of hospital staff. Data were analysed using a constant comparative approach. Implementation strategies to promote reliable use of the Sepsis Six primarily focused on education, engaging and motivating staff, and providing prompts for behaviour, along with efforts to ensure that equipment required was readily available. Although these strategies were successful in raising staff awareness of sepsis and engagement with implementation, our study identified that completing the bundle within an hour was not straightforward. Our emergent theory suggested that rather than being an apparently simple sequence of six steps, the Sepsis Six actually involved a complex trajectory comprising multiple interdependent tasks that required prioritisation and scheduling, and which was prone to problems of coordination and operational failures. Interventions that involved allocating specific roles and responsibilities for completing the Sepsis Six in ways that reduced the need for coordination and task switching, and the use of process mapping to identify system failures along the trajectory, could help mitigate against some of these problems. Implementation efforts that focus on individual behaviour change to improve uptake of the Sepsis Six should be supplemented by an understanding of the bundle as a complex trajectory of work in which improving reliability requires attention to coordination of workflow, as well as addressing the mundane problems of interruptions and operational failures that obstruct task completion.
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The safer clinical systems project in renal care.
Weale, Andy R
2013-09-01
Current systems in place in healthcare are designed to detect harm after it has happened (e.g critical incident reports) and make recommendations based on an assessment of that event. Safer Clinical Systems, a Health Foundation funded project, is designed to proactively search for risk within systems, rather than being reactive to harm. The aim of the Safer Clinical Systems project in Renal Care was to reduce the risks associated with shared care for patients who are undergoing surgery but are looked after peri-operatively by nephrology teams on nephrology wards. This report details our findings of the diagnostic phase of Safer Clinical Systems: the proactive search for risk. We have evaluated the current system of care using a set of risk evaluation and process mapping tools (Failure Modes and Effects Analysis (FMEA) and Hierarchical Task Analysis HTA). We have engaged staff with the process mapping and risk assessment tools. We now understand our system and understand where the highest risk tasks are undertaken during a renal in-patient stay during which a patient has an operation. These key tasks occur across the perioperaive period and are not confined to one aspect of care. A measurement strategy and intervention plan have been designed around these tasks. Safer Clinical Systems has identified high risk, low reliability tasks in our system. We look forward to fully reporting these data in 2014. © 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.
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Differences in day and night shift clinical performance in anesthesiology.
Cao, Caroline G L; Weinger, Matthew B; Slagle, Jason; Zhou, Chuan; Ou, Jennie; Gillin, Shakha; Sheh, Bryant; Mazzei, William
2008-04-01
This study examined whether anesthesia residents (physicians in training) performed clinical duties in the operating room differently during the day versus at night. Fatigue from sleep deprivation and working through the night is common for physicians, particularly during residency training. Using a repeated-measures design, we studied 13 pairs of day-night matched anesthesia cases. Dependent measures included task times, workload ratings, response to an alarm light latency task, and mood. Residents spent significantly less time on manual tasks and more time on monitoring tasks during the maintenance phase at night than during the day. Residents reported more negative mood at night than during the day, both pre- and postoperation. However, time of day had no effect on the mood change between pre- and postoperation. Workload ratings and the response time to an alarm light latency task were not significantly different between night and day cases. Because night shift residents had been awake and working for more than 16 hr, the observed differences in task performance and mood may be attributed to fatigue. The changes in task distribution during night shift work may represent compensatory strategies to maintain patient care quality while keeping perceived workload at a manageable level. Fatigue effects during night shifts should be considered when designing work-rest schedules for clinicians. This matched-case control scheme can also be applied to study other phenomena associated with patient safety in the actual clinical environment.
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Butler, Pamela D.; Chen, Yue; Ford, Judith M.; Geyer, Mark A.; Silverstein, Steven M.; Green, Michael F.
2012-01-01
The sixth meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) focused on selecting promising imaging paradigms for each of the cognitive constructs selected in the first CNTRICS meeting. In the domain of perception, the 2 constructs of interest were “gain control” and “visual integration.” CNTRICS received 6 task nominations for imaging paradigms for gain control and 3 task nominations for integration. The breakout group for perception evaluated the degree to which each of these tasks met prespecified criteria. For gain control, the breakout group believed that one task (mismatch negativity) was already mature and was being incorporated into multisite clinical trials. The breakout group recommended that 1 visual task (steady-state visual evoked potentials to magnocellular- vs parvocellular-biased stimuli) and 2 auditory measures (an event-related potential (ERP) measure of corollary discharge and a functional magnetic resonance imaging (fMRI) version of prepulse inhibition of startle) be adapted for use in clinical trials in schizophrenia research. For visual integration, the breakout group recommended that fMRI and ERP versions of a contour integration test and an fMRI version of a coherent motion test be adapted for use in clinical trials. This manuscript describes the ways in which each of these tasks met the criteria used in the breakout group to evaluate and recommend tasks for further development. PMID:21890745
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Zharikova, A V; Zhavoronkova, L A; Maksakova, O A; Kuptsova, S V
2012-01-01
Dual tasks with voluntary postural control and calculation have been done by 14 patients (25.7 +/- 4.7 yo.) after traumatic brain injury and 40 healthy volunteers (29.8 +/- 2.5 y.o.). Complex clinical (MMSE, FIM, MPAI-3 and Berg scales) and stabilographic evaluation has been performed. According to clinical evaluation 8 patients were included into group 1 with less severe functional deficit and 6 patients formed group 2 with more severe deficit. Parameters of motor and especially cognitive sub-tasks in patients were lower than in healthy subjects in both separate and dual tasks. In group 2 these parameters were lower than in group 1. Certain types of dual task where the quality of sub-tasks, especially of the motor-one increased in healthy subjects and patients of the first group were revealed. The complex of stabilographic parameters which could be used for estimation of quality of sub-tasks performance has been revealed. Dual tasks could be an additional method of evaluation of patients' adaptive possibilities and certain type of dual task could become a promising approach to recovery at late period of rehabilitation.
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On the role of verbalization during task set selection: switching or serial order control?
Bryck, Richard L; Mayr, Ulrich
2005-06-01
Recent task-switching work in which paper-and-pencil administered single-task lists were compared with task-alternation lists has demonstrated large increases in task-switch costs with concurrent articulatory suppression (AS), implicating a crucial role for verbalization during switching (Baddeley, Chincotta, & Adlam, 2001; Emerson & Miyake, 2003). Experiment 1 replicated this result, using computerized assessment, albeit with much smaller effect sizes than in the original reports. In Experiment 2, AS interference was reduced when a sequential cue (spatial location) that indicated the current position in the sequence of task alternations was given. Finally, in Experiment 3, switch trials and no-switch trials were compared within a block of alternating runs of two tasks. Again, AS interference was obtained mainly when the endogenous sequencing demand was high, and it was comparable for no-switch and switch trials. These results suggest that verbalization may be critical for endogenous maintenance and updating of a sequential plan, rather than exclusively for the actual switching process.
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Modeling of Depth Cue Integration in Manual Control Tasks
NASA Technical Reports Server (NTRS)
Sweet, Barbara T.; Kaiser, Mary K.; Davis, Wendy
2003-01-01
Psychophysical research has demonstrated that human observers utilize a variety of visual cues to form a perception of three-dimensional depth. However, most of these studies have utilized a passive judgement paradigm, and failed to consider depth-cue integration as a dynamic and task-specific process. In the current study, we developed and experimentally validated a model of manual control of depth that examines how two potential cues (stereo disparity and relative size) are utilized in both first- and second-order active depth control tasks. We found that stereo disparity plays the dominate role for determining depth position, while relative size dominates perception of depth velocity. Stereo disparity also plays a reduced role when made less salient (i.e., when viewing distance is increased). Manual control models predict that position information is sufficient for first-order control tasks, while velocity information is required to perform a second-order control task. Thus, the rules for depth-cue integration in active control tasks are dependent on both task demands and cue quality.
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Applicability Evaluation of Job Standards for Diabetes Nutritional Management by Clinical Dietitian
2017-01-01
This study was conducted to evaluate applicability of job standards for diabetes nutrition management by hospital clinical dietitians. In order to promote the clinical nutrition services, it is necessary to present job standards of clinical dietitian and to actively apply these standardized tasks to the medical institution sites. The job standard of clinical dietitians for diabetic nutrition management was distributed to hospitals over 300 beds. Questionnaire was collected from 96 clinical dietitians of 40 tertiary hospitals, 47 general hospitals, and 9 hospitals. Based on each 5-point scale, the importance of overall duty was 4.4 ± 0.5, performance was 3.6 ± 0.8, and difficulty was 3.1 ± 0.7. ‘Nutrition intervention’ was 4.5 ± 0.5 for task importance, ‘nutrition assessment’ was 4.0 ± 0.7 for performance, and ‘nutrition diagnosis’ was 3.4 ± 0.9 for difficulty. These 3 items were high in each category. Based on the grid diagram, the tasks of both high importance and high performance were ‘checking basic information,’ ‘checking medical history and therapy plan,’ ‘decision of nutritional needs,’ ‘supply of foods and nutrients,’ and ‘education of nutrition and self-management.’ The tasks with high importance but low performance were ‘derivation of nutrition diagnosis,’ ‘planning of nutrition intervention,’ ‘monitoring of nutrition intervention process.’ The tasks of both high importance and high difficulty were ‘derivation of nutrition diagnosis,’ ‘planning of nutrition intervention,’ ‘supply of foods and nutrients,’ ‘education of nutrition and self-management,’ and ‘monitoring of nutrition intervention process.’ The tasks of both high performance and high difficulty were ‘documentation of nutrition assessment,’ ‘supply of foods and nutrients,’ and ‘education of nutrition and self-management.’ PMID:28503506
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NASA Astrophysics Data System (ADS)
Putnam, Nicole Marie
In order to study the limits of spatial vision in normal human subjects, it is important to look at and near the fovea. The fovea is the specialized part of the retina, the light-sensitive multi-layered neural tissue that lines the inner surface of the human eye, where the cone photoreceptors are smallest (approximately 2.5 microns or 0.5 arcmin) and cone density reaches a peak. In addition, there is a 1:1 mapping from the photoreceptors to the brain in this central region of the retina. As a result, the best spatial sampling is achieved in the fovea and it is the retinal location used for acuity and spatial vision tasks. However, vision is typically limited by the blur induced by the normal optics of the eye and clinical tests of foveal vision and foveal imaging are both limited due to the blur. As a result, it is unclear what the perceptual benefit of extremely high cone density is. Cutting-edge imaging technology, specifically Adaptive Optics Scanning Laser Ophthalmoscopy (AOSLO), can be utilized to remove this blur, zoom in, and as a result visualize individual cone photoreceptors throughout the central fovea. This imaging combined with simultaneous image stabilization and targeted stimulus delivery expands our understanding of both the anatomical structure of the fovea on a microscopic scale and the placement of stimuli within this retinal area during visual tasks. The final step is to investigate the role of temporal variables in spatial vision tasks since the eye is in constant motion even during steady fixation. In order to learn more about the fovea, it becomes important to study the effect of this motion on spatial vision tasks. This dissertation steps through many of these considerations, starting with a model of the foveal cone mosaic imaged with AOSLO. We then use this high resolution imaging to compare anatomical and functional markers of the center of the normal human fovea. Finally, we investigate the role of natural and manipulated fixational eye movements in foveal vision, specifically looking at a motion detection task, contrast sensitivity, and image fading.
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Current State of the Regulatory Trajectory for Whole Slide Imaging Devices in the USA
Abels, Esther; Pantanowitz, Liron
2017-01-01
The regulatory field for digital pathology (DP) has advanced significantly. A major milestone was accomplished when the FDA allowed the first vendor to market their device for primary diagnostic use in the USA and published in the classification order that this device, and substantially equivalent devices of this generic type, should be classified into class II instead of class III as previously proposed. The Digital Pathology Association (DPA) regulatory task force had a major role in the accomplishment of getting the application request for Whole Slide Imaging (WSI) Systems recommended for a de novo. This article reviews the past and emerging regulatory environment of WSI for clinical use in the USA. A WSI system with integrated subsystems is defined in the context of medical device regulations. The FDA technical performance assessment guideline is also discussed as well as parameters involved in analytical testing and clinical studies to demonstrate that WSI devices are safe and effective for clinical use. PMID:28584684
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Current State of the Regulatory Trajectory for Whole Slide Imaging Devices in the USA.
Abels, Esther; Pantanowitz, Liron
2017-01-01
The regulatory field for digital pathology (DP) has advanced significantly. A major milestone was accomplished when the FDA allowed the first vendor to market their device for primary diagnostic use in the USA and published in the classification order that this device, and substantially equivalent devices of this generic type, should be classified into class II instead of class III as previously proposed. The Digital Pathology Association (DPA) regulatory task force had a major role in the accomplishment of getting the application request for Whole Slide Imaging (WSI) Systems recommended for a de novo . This article reviews the past and emerging regulatory environment of WSI for clinical use in the USA. A WSI system with integrated subsystems is defined in the context of medical device regulations. The FDA technical performance assessment guideline is also discussed as well as parameters involved in analytical testing and clinical studies to demonstrate that WSI devices are safe and effective for clinical use.
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Development of a new Clinical Engineering Management Tool & Information System (CLE-MANTIS).
Panousis, S G; Malataras, P; Patelodimou, C; Kolitsi, Z; Pallikarakis, N
1997-01-01
The evolution of the field of biomedical technology has led to the diffusion of an impressive number of medical devices into healthcare institutions. In this environment, Clinical Engineering Departments (CEDs) are expanding their role in healthcare technology management, by changing their structure and introducing quality systems in order to improve their services and monitor the outcomes. In the framework of the national project BIOTECHNET II, a software tool for the management of biomedical technology, named CLE-MANTIS, has been developed, with the aim to assist CEDs in their tasks. CLE-MANTIS functions include the upkeep of an inventory, the support and monitoring of scheduled maintenance, corrective maintenance, vigilance, equipment acquisition and replacement, service contract management and user training. The system offers clinical engineers the possibility to monitor and evaluate the quality and cost-effectiveness of their departments through the monitoring of quality and cost indicators. This paper presents the main features and functions of the system.
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Information systems: the key to evidence-based health practice.
Rodrigues, R. J.
2000-01-01
Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195
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Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision-making
Bechara, A.; Damasio, H.; Aitken, M. R. F.; Sahakian, B. J.; Robbins, T. W.
2008-01-01
The ventromedial prefrontal cortex (vmPFC) and insular cortex are implicated in distributed neural circuitry that supports emotional decision-making. Previous studies of patients with vmPFC lesions have focused primarily on decision-making under uncertainty, when outcome probabilities are ambiguous (e.g. the Iowa Gambling Task). It remains unclear whether vmPFC is also necessary for decision-making under risk, when outcome probabilities are explicit. It is not known whether the effect of insular damage is analogous to the effect of vmPFC damage, or whether these regions contribute differentially to choice behaviour. Four groups of participants were compared on the Cambridge Gamble Task, a well-characterized measure of risky decision-making where outcome probabilities are presented explicitly, thus minimizing additional learning and working memory demands. Patients with focal, stable lesions to the vmPFC (n = 20) and the insular cortex (n = 13) were compared against healthy subjects (n = 41) and a group of lesion controls (n = 12) with damage predominantly affecting the dorsal and lateral frontal cortex. The vmPFC and insular cortex patients showed selective and distinctive disruptions of betting behaviour. VmPFC damage was associated with increased betting regardless of the odds of winning, consistent with a role of vmPFC in biasing healthy individuals towards conservative options under risk. In contrast, patients with insular cortex lesions failed to adjust their bets by the odds of winning, consistent with a role of the insular cortex in signalling the probability of aversive outcomes. The insular group attained a lower point score on the task and experienced more ‘bankruptcies’. There were no group differences in probability judgement. These data confirm the necessary role of the vmPFC and insular regions in decision-making under risk. Poor decision-making in clinical populations can arise via multiple routes, with functionally dissociable effects of vmPFC and insular cortex damage. PMID:18390562
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Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision-making.
Clark, L; Bechara, A; Damasio, H; Aitken, M R F; Sahakian, B J; Robbins, T W
2008-05-01
The ventromedial prefrontal cortex (vmPFC) and insular cortex are implicated in distributed neural circuitry that supports emotional decision-making. Previous studies of patients with vmPFC lesions have focused primarily on decision-making under uncertainty, when outcome probabilities are ambiguous (e.g. the Iowa Gambling Task). It remains unclear whether vmPFC is also necessary for decision-making under risk, when outcome probabilities are explicit. It is not known whether the effect of insular damage is analogous to the effect of vmPFC damage, or whether these regions contribute differentially to choice behaviour. Four groups of participants were compared on the Cambridge Gamble Task, a well-characterized measure of risky decision-making where outcome probabilities are presented explicitly, thus minimizing additional learning and working memory demands. Patients with focal, stable lesions to the vmPFC (n = 20) and the insular cortex (n = 13) were compared against healthy subjects (n = 41) and a group of lesion controls (n = 12) with damage predominantly affecting the dorsal and lateral frontal cortex. The vmPFC and insular cortex patients showed selective and distinctive disruptions of betting behaviour. VmPFC damage was associated with increased betting regardless of the odds of winning, consistent with a role of vmPFC in biasing healthy individuals towards conservative options under risk. In contrast, patients with insular cortex lesions failed to adjust their bets by the odds of winning, consistent with a role of the insular cortex in signalling the probability of aversive outcomes. The insular group attained a lower point score on the task and experienced more 'bankruptcies'. There were no group differences in probability judgement. These data confirm the necessary role of the vmPFC and insular regions in decision-making under risk. Poor decision-making in clinical populations can arise via multiple routes, with functionally dissociable effects of vmPFC and insular cortex damage.
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Dissociable roles of default-mode regions during episodic encoding.
Maillet, David; Rajah, M Natasha
2014-04-01
We investigated the role of distinct regions of the default-mode network (DMN) during memory encoding with fMRI. Subjects encoded words using either a strategy that emphasized self-referential (pleasantness) processing, or one that emphasized semantic (man-made/natural) processing. During encoding subjects were intermittently presented with thought probes to evaluate if they were concentrated and on-task or exhibiting task-unrelated thoughts (TUT). After the scanning session subjects performed a source retrieval task to determine which of two judgments they performed for each word at encoding. Source retrieval accuracy was higher for words encoded with the pleasantness vs. the man-made/natural task and there was a trend for higher performance for words preceding on-task vs. TUT reports. fMRI results show that left anterior medial PFC and left angular gyrus activity was greater during successful vs. unsuccessful encoding during both encoding tasks. Greater activity in left anterior cingulate and bilateral lateral temporal cortex was related successful vs. unsuccessful encoding only in the pleasantness task. In contrast, posterior cingulate, right anterior cingulate and right temporoparietal junction were activated to a greater extent in unsuccessful vs. successful encoding across tasks. Finally, activation in posterior cingulate and bilateral dorsolateral prefrontal cortex was related to TUT across tasks; moreover, we observed a conjunction in posterior cingulate between encoding failure and TUT. We conclude that DMN regions play dissociable roles during memory formation, and that their association with subsequent memory may depend on the manner in which information is encoded and retrieved. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.
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ERIC Educational Resources Information Center
van der Molen, Hugo H.
1984-01-01
Describes a study designed to demonstrate that child pedestrian training objectives may be identified systematically through various task analysis methods, making use of different types of empirical information. Early approaches to analysis of pedestrian tasks are reviewed, and an outline of the Traffic Research Centre's pedestrian task analysis…
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The Role of Task Complexity, Modality, and Aptitude in Narrative Task Performance
ERIC Educational Resources Information Center
Kormos, Judit; Trebits, Anna
2012-01-01
The study reported in this paper investigated the relationship between components of aptitude and the fluency, lexical variety, syntactic complexity, and accuracy of performance in two types of written and spoken narrative tasks. We also addressed the question of how narrative performance varies in tasks of different cognitive complexity in the…
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The Role of Response Repetition in Task Switching
ERIC Educational Resources Information Center
Cooper, Stephen; Mari-Beffa, Paloma
2008-01-01
When switching between tasks, participants are sometimes required to use different response sets for each task. Thus, task switch and response set switch are confounded. In 5 experiments, the authors examined transitions of response within a linear 4-finger arrangement. A random baseline condition was compared with the cuing of specific response…
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An improved task-role-based access control model for G-CSCW applications
NASA Astrophysics Data System (ADS)
He, Chaoying; Chen, Jun; Jiang, Jie; Han, Gang
2005-10-01
Access control is an important and popular security mechanism for multi-user applications. GIS-based Computer Supported Cooperative Work (G-CSCW) application is one of such applications. This paper presents an improved Task-Role-Based Access Control (X-TRBAC) model for G-CSCW applications. The new model inherits the basic concepts of the old ones, such as role and task. Moreover, it has introduced two concepts, i.e. object hierarchy and operation hierarchy, and the corresponding rules to improve the efficiency of permission definition in access control models. The experiments show that the method can simplify the definition of permissions, and it is more applicable for G-CSCW applications.
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Expression of TASK-1 in brainstem and the occurrence of central sleep apnea in rats.
Wang, Jing; Zhang, Cheng; Li, Nan; Su, Li; Wang, Guangfa
2008-03-20
Recent studies revealed that unstable ventilation control is one of mechanisms underlying the occurrence of sleep apnea. Thus, we investigated whether TASK-1, an acid-sensitive potassium channel, plays a role in the occurrence of sleep apnea. First, the expression of TASK-1 transcriptions on brainstem was checked by in situ hybridization. Then, the correlation between the central apneic episodes and protein contents of TASK-1 measured by western blot was analyzed from 27 male rats. Results showed that TASK-1 mRNAs were widely distributed on the putative central chemoreceptors such as locus coeruleus, nucleus tractus solitarius and medullary raphe, etc. Both the total spontaneous apnea index (TSAI) and spontaneous apnea index in NREM sleep (NSAI) were positively correlated with TASK-1 protein contents (r=0.547 and 0.601, respectively, p<0.01). However, the post-sigh sleep apnea index (PAI) had no relationship with TASK-1 protein. Thus, we concluded that TASK-1 channels may function as central chemoreceptors that play a role in spontaneous sleep apneas in rats.
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Initial Development of a Brief Behavioral Economic Assessment of Alcohol Demand
Owens, Max M.; Murphy, Cara M.; MacKillop, James
2015-01-01
Due to difficulties with definition and measurement, the role of conscious craving in substance use disorders remains contentious. To address this, behavioral economics is increasingly being used to quantify aspects of an individual’s acute motivation to use a substance. Doing so typically involves the use of a purchase task, in which participants make choices about consuming alcohol or other substances at various prices and multiple indices of alcohol demand are generated. However, purchase tasks can be limited by the time required to administer and score them. In the current study, a brief 3-item measure, designed to capture three important indices of demand that are derived from demand curve modeling (intensity, Omax, and breakpoint), was investigated in a group of 84 heavy drinkers. Participants underwent a cue-reactivity paradigm that is established to increase both conscious craving and alcohol demand on traditional purchase tasks. All three indices of demand for alcohol measured using the abbreviated measure increased significantly in response to alcohol cues, analogous to what has been observed using a traditional purchase task. Additionally, the correlations between these indices and subjective craving were modest-to-moderate, as has been found in studies comparing craving to the indices derived from purchase tasks. These findings suggest that this abbreviated measure may be a useful and efficient way to capture important and distinct aspects of motivation for alcohol. If these results are confirmed, this measure may be able to help increase the portability of behavioral economic indices of demand into novel research and clinical contexts. PMID:27135038
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Predicting the reading skill of Japanese children.
Ogino, Tatsuya; Hanafusa, Kaoru; Morooka, Teruko; Takeuchi, Akihito; Oka, Makio; Ohtsuka, Yoko
2017-02-01
To clarify cognitive processes underlining the development of reading in children speaking Japanese as their first language, we examined relationships between performances of cognitive tasks in the preschool period and later reading abilities. Ninety-one normally developing preschoolers (41 girls and 50 boys; 5years 4months to 6years 4months, mean 5years 10months) participated as subjects. We conducted seven cognitive tasks including phonological awareness tasks, naming tasks, and working memory tasks in the preschool period. In terms of reading tasks, the hiragana naming task was administered in the preschool period; the reading times, which is a composite score of the monomoraic syllable reading task, the word and the non-word reading tasks, and the single sentence reading task, was evaluated in first and second grade; and the kanji reading task (naming task) was tested in second grade. Raven's colored progressive matrices and picture vocabulary test revised were also conducted in first grade. Correlation analyses between task scores and stepwise multiple regression analyses were implemented. Tasks tapping phonological awareness, lexical access, and verbal working memory showed significant correlations with reading tasks. In the multiple regression analyses the performances in the verbal working memory task played a key role in predicting character naming task scores (the hiragana naming task and the kanji reading task) while the digit naming task was an important predictor of reading times. Unexpectedly, the role of phonological (mora) awareness was modest among children speaking Japanese. Cognitive functions including phonological awareness, digit naming, and verbal working memory (especially the latter two) were involved in the development of reading skills of children speaking Japanese. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.
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[The gastrointestinal tract microbiom in connective tissue diseases].
Krajewska-Włodarczyk, Magdalena
Factors such as genetics, the environment, infections, and the human body microbiota, mainly gastrointestinal tract microbiota may play a role in the pathogenesis of autoimmune disorders. There is an increasing evidence that suggest an association between gastrointestinal tract dysbiosis, and in particular gut dysbiosis, and connective tissue diseases but it still remains unclear whether alterations in the microbiome are a pathogenic cause or an effect of autoimmune disease. Given the strong variability and abundance of microbes living in close relation with human host, it becomes a difficult task to define what should be considered the normal or the favorable microbiome. Further studies are needed to establish how the human microbiome contributes to disease susceptibility, and to characterize the role of microbial diversity in the pathogenesis of connective tissue diseases and their clinical manifestations. The identification of dysbiosis specific for certain connective tissue diseases may help in the development of an individualized management for each patient. This review aims to summarize current data on the role of the gastrointestinal tract microbiome in connective tissue diseases.
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Hripcsak, George; Wilcox, Adam
2002-01-01
Medical informatics systems are often designed to perform at the level of human experts. Evaluation of the performance of these systems is often constrained by lack of reference standards, either because the appropriate response is not known or because no simple appropriate response exists. Even when performance can be assessed, it is not always clear whether the performance is sufficient or reasonable. These challenges can be addressed if an evaluator enlists the help of clinical domain experts. 1) The experts can carry out the same tasks as the system, and then their responses can be combined to generate a reference standard. 2)The experts can judge the appropriateness of system output directly. 3) The experts can serve as comparison subjects with which the system can be compared. These are separate roles that have different implications for study design, metrics, and issues of reliability and validity. Diagrams help delineate the roles of experts in complex study designs.
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Jennings, Larissa; Yebadokpo, André Sourou; Affo, Jean; Agbogbe, Marthe; Tankoano, Aguima
2011-01-06
Shifting the role of counseling to less skilled workers may improve efficiency and coverage of health services, but evidence is needed on the impact of substitution on quality of care. This research explored the influence of delegating maternal and newborn counseling responsibilities to clinic-based lay nurse aides on the quality of counseling provided as part of a task shifting initiative to expand their role. Nurse-midwives and lay nurse aides in seven public maternities were trained to use job aids to improve counseling in maternal and newborn care. Quality of counseling and maternal knowledge were assessed using direct observation of antenatal consultations and patient exit interviews. Both provider types were interviewed to examine perceptions regarding the task shift. To compare provider performance levels, non-inferiority analyses were conducted where non-inferiority was demonstrated if the lower confidence limit of the performance difference did not exceed a margin of 10 percentage points. Mean percent of recommended messages provided by lay nurse aides was non-inferior to counseling by nurse-midwives in adjusted analyses for birth preparedness (β = -0.0, 95% CI: -9.0, 9.1), danger sign recognition (β = 4.7, 95% CI: -5.1, 14.6), and clean delivery (β = 1.4, 95% CI: -9.4, 12.3). Lay nurse aides demonstrated superior performance for communication on general prenatal care (β = 15.7, 95% CI: 7.0, 24.4), although non-inferiority was not achieved for newborn care counseling (β = -7.3, 95% CI: -23.1, 8.4). The proportion of women with correct knowledge was significantly higher among those counseled by lay nurse aides as compared to nurse-midwives in general prenatal care (β = 23.8, 95% CI: 15.7, 32.0), birth preparedness (β = 12.7, 95% CI: 5.2, 20.1), and danger sign recognition (β = 8.6, 95% CI: 3.3, 13.9). Both cadres had positive opinions regarding task shifting, although several preferred 'task sharing' over full delegation. Lay nurse aides can provide effective antenatal counseling in maternal and newborn care in facility-based settings, provided they receive adequate training and support. Efforts are needed to improve management of human resources to ensure that effective mechanisms for regulating and financing task shifting are sustained.
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2011-01-01
Background Shifting the role of counseling to less skilled workers may improve efficiency and coverage of health services, but evidence is needed on the impact of substitution on quality of care. This research explored the influence of delegating maternal and newborn counseling responsibilities to clinic-based lay nurse aides on the quality of counseling provided as part of a task shifting initiative to expand their role. Methods Nurse-midwives and lay nurse aides in seven public maternities were trained to use job aids to improve counseling in maternal and newborn care. Quality of counseling and maternal knowledge were assessed using direct observation of antenatal consultations and patient exit interviews. Both provider types were interviewed to examine perceptions regarding the task shift. To compare provider performance levels, non-inferiority analyses were conducted where non-inferiority was demonstrated if the lower confidence limit of the performance difference did not exceed a margin of 10 percentage points. Results Mean percent of recommended messages provided by lay nurse aides was non-inferior to counseling by nurse-midwives in adjusted analyses for birth preparedness (β = -0.0, 95% CI: -9.0, 9.1), danger sign recognition (β = 4.7, 95% CI: -5.1, 14.6), and clean delivery (β = 1.4, 95% CI: -9.4, 12.3). Lay nurse aides demonstrated superior performance for communication on general prenatal care (β = 15.7, 95% CI: 7.0, 24.4), although non-inferiority was not achieved for newborn care counseling (β = -7.3, 95% CI: -23.1, 8.4). The proportion of women with correct knowledge was significantly higher among those counseled by lay nurse aides as compared to nurse-midwives in general prenatal care (β = 23.8, 95% CI: 15.7, 32.0), birth preparedness (β = 12.7, 95% CI: 5.2, 20.1), and danger sign recognition (β = 8.6, 95% CI: 3.3, 13.9). Both cadres had positive opinions regarding task shifting, although several preferred 'task sharing' over full delegation. Conclusions Lay nurse aides can provide effective antenatal counseling in maternal and newborn care in facility-based settings, provided they receive adequate training and support. Efforts are needed to improve management of human resources to ensure that effective mechanisms for regulating and financing task shifting are sustained. PMID:21211045
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Test-retest reliability of cognitive EEG
NASA Technical Reports Server (NTRS)
McEvoy, L. K.; Smith, M. E.; Gevins, A.
2000-01-01
OBJECTIVE: Task-related EEG is sensitive to changes in cognitive state produced by increased task difficulty and by transient impairment. If task-related EEG has high test-retest reliability, it could be used as part of a clinical test to assess changes in cognitive function. The aim of this study was to determine the reliability of the EEG recorded during the performance of a working memory (WM) task and a psychomotor vigilance task (PVT). METHODS: EEG was recorded while subjects rested quietly and while they performed the tasks. Within session (test-retest interval of approximately 1 h) and between session (test-retest interval of approximately 7 days) reliability was calculated for four EEG components: frontal midline theta at Fz, posterior theta at Pz, and slow and fast alpha at Pz. RESULTS: Task-related EEG was highly reliable within and between sessions (r0.9 for all components in WM task, and r0.8 for all components in the PVT). Resting EEG also showed high reliability, although the magnitude of the correlation was somewhat smaller than that of the task-related EEG (r0.7 for all 4 components). CONCLUSIONS: These results suggest that under appropriate conditions, task-related EEG has sufficient retest reliability for use in assessing clinical changes in cognitive status.
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[Application of portfolio in teaching dermatology clinic: an experience in teaching of medicine].
de Cabalier, M E; Chalub, D M
2009-01-01
We present a learning experience conducted in the Chair of Dermatology Clinic of the Faculty of Medical Sciences, National University of Cordoba in the context of curriculum change. For comprehension,present a theoretical framework and practical from the conceptualization of the "portfolio" teaching and its role teaching and learning paradigms sustained constructivist medical education. The portfolio Teach-ing is not a collection of papers, but a coherent set of experiences led thoughtful learning between teachers and students. This resource allows to account for the "qualitative achievements" of students from their work produced, sorted and evaluated in a carefully planned sequence of experiences and case Dermatology Clinic. To introduce the teaching portfolio, the planned new student grouping shapes and a sequence of learning experiences for the construction of this resource, namely: "The development of theoretical material iconographic resources and working guidelines for students. "The clinical reasoning on a case or laboratory experience-Clinical case Discussion and bibliography. -The development of records to from observation of patients. "The study of clinical cases: diagnosis and evolution of clinical cases. Interconsultations-Registration and referrals. "The magazine room and sharing experiences. In each of these, production, tutorial feedback Team teaching and assessment tasks allowed assessment approach to learning and improving he achievements of the students to the approval of the subject.
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NASA Astrophysics Data System (ADS)
Dohaney, J. A.; kennedy, B.; Brogt, E.; Gravley, D.; Wilson, T.; O'Steen, B.
2011-12-01
This qualitative study investigates behaviors and experiences of upper-year geosciences undergraduate students during an intensive role-play simulation, in which the students interpret geological data streams and manage a volcanic crisis event. We present the development of the simulation, its academic tasks, (group) role assignment strategies and planned facilitator interventions over three iterations. We aim to develop and balance an authentic, intensive and highly engaging capstone activity for volcanology and geo-hazard courses. Interview data were collected from academic and professional experts in the fields of Volcanology and Hazard Management (n=11) in order to characterize expertise in the field, characteristics of key roles in the simulation, and to validate the authenticity of tasks and scenarios. In each iteration, observations and student artifacts were collected (total student participants: 68) along with interviews (n=36) and semi-structured, open-ended questionnaires (n=26). Our analysis of these data indicates that increasing the structure (i.e. organization, role-specific tasks and responsibilities) lessens non-productive group dynamics, which allows for an increase in difficulty of academic tasks within the simulation without increasing the cognitive load on students. Under these conditions, students exhibit professional expert-like behaviours, in particular in the quality of decision-making, communication skills and task-efficiency. In addition to illustrating the value of using this simulation to teach geosciences concepts, this study has implications for many complex situated-learning activities.
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Role of autobiographical memory in social problem solving and depression.
Goddard, L; Dritschel, B; Burton, A
1996-11-01
Depressed patients frequently exhibit deficiencies in social problem solving (SPS). A possible cause of this deficit is an impairment in patients' ability to retrieve specific autobiographical memories. A clinically depressed group and a hospital control group performed the Means-End Problem-Solving (MEPS; J. J. Platt & G. Spivack, 1975a) task, during which they were required to attend to the memories retrieved during solution generation. Memories were categorized according to whether they were specific, categoric, or extended and whether the valence of the memories was positive or negative. Results support the general hypothesis that SPS skill is a function of autobiographical memory retrieval as measured by a cuing task and by the types of memories retrieved during the MEPS. However, the dysfunctional nature of categoric memories in SPS, rather than the importance of specific memories, was highlighted in the depressed group. Valence proved to be an unimportant variable in SPS ability. The cyclical links among autobiographical memory retrieval, SPS skills, and depression are discussed.
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Hudec, Kristen L; Alderson, R Matt; Kasper, Lisa J; Patros, Connor H G
2014-05-01
The relationship between working memory (WM) and objectively measured motor activity was examined in adults with ADHD and healthy controls (HCs). Thirty-five adults (ADHD = 20, HC = 15) were grouped using self-report and collateral-report measures in addition to a semistructured clinical interview. All participants completed control conditions with minimal WM demands, and separate phonological (PH) and visuospatial (VS) WM tasks with recall demands ranging from four to seven stimuli. The ADHD group exhibited significantly more motor activity relative to the HC group, and both groups exhibited greater activity during PH and VS WM tasks, relative to control conditions. Finally, the central executive (CE) and PH storage/rehearsal subsystems were associated with large-magnitude between-group differences in activity. Findings suggest that increased demands on WM, particularly the CE and PH storage/rehearsal, contribute to ADHD-related hyperactivity, though a portion of excessive motor activity in adults with ADHD may occur independently of WM demands.
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Choi, Jeeyae; Bakken, Suzanne; Lussier, Yves A; Mendonça, Eneida A
2006-01-01
Medical logic modules are a procedural representation for sharing task-specific knowledge for decision support systems. Based on the premise that clinicians may perceive object-oriented expressions as easier to read than procedural rules in Arden Syntax-based medical logic modules, we developed a method for improving the readability of medical logic modules. Two approaches were applied: exploiting the concept-oriented features of the Medical Entities Dictionary and building an executable Java program to replace Arden Syntax procedural expressions. The usability evaluation showed that 66% of participants successfully mapped all Arden Syntax rules to Java methods. These findings suggest that these approaches can play an essential role in the creation of human readable medical logic modules and can potentially increase the number of clinical experts who are able to participate in the creation of medical logic modules. Although our approaches are broadly applicable, we specifically discuss the relevance to concept-oriented nursing terminologies and automated processing of task-specific nursing knowledge.
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Interrelating Behavioral Measures of Distress Tolerance with Self-Reported Experiential Avoidance.
Schloss, Heather M; Haaga, David A F
2011-03-01
Experiential avoidance and distress intolerance play a central role in novel behavior therapies, yet they appear to overlap considerably the REBT concept of low frustration tolerance. Using baseline data from 100 adult cigarette smokers enrolled in a clinical trial of smoking cessation therapies, the present study evaluated the convergent validity of common questionnaire measures of experiential avoidance (Acceptance and Action Questionnaire; AAQ; Hayes et al. 2004, and Avoidance and Inflexibility Scale: AIS; Gifford et al. 2004) and behavioral measures of distress tolerance (computerized Mirror Tracing Persistence Task: MTPT-C: Strong et al. 2003; computerized Paced Auditory Serial Addition Task; PASAT-C; Lejuez et al. 2003). The distress tolerance measures correlated significantly (r = .29) with one another. However, the questionnaire measures of experiential avoidance did not correlate with each other, nor with the behavioral measures. Further research is needed on the validity of measuring experiential avoidance by self-report and of the overlap versus distinctiveness of seemingly similar constructs such as experiential avoidance, distress tolerance, and frustration tolerance.
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Interrelating Behavioral Measures of Distress Tolerance with Self-Reported Experiential Avoidance
Schloss, Heather M.
2011-01-01
Experiential avoidance and distress intolerance play a central role in novel behavior therapies, yet they appear to overlap considerably the REBT concept of low frustration tolerance. Using baseline data from 100 adult cigarette smokers enrolled in a clinical trial of smoking cessation therapies, the present study evaluated the convergent validity of common questionnaire measures of experiential avoidance (Acceptance and Action Questionnaire; AAQ; Hayes et al. 2004, and Avoidance and Inflexibility Scale: AIS; Gifford et al. 2004) and behavioral measures of distress tolerance (computerized Mirror Tracing Persistence Task: MTPT-C: Strong et al. 2003; computerized Paced Auditory Serial Addition Task; PASAT-C; Lejuez et al. 2003). The distress tolerance measures correlated significantly (r = .29) with one another. However, the questionnaire measures of experiential avoidance did not correlate with each other, nor with the behavioral measures. Further research is needed on the validity of measuring experiential avoidance by self-report and of the overlap versus distinctiveness of seemingly similar constructs such as experiential avoidance, distress tolerance, and frustration tolerance. PMID:21448252
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Muir-Hunter, Susan W; Clark, Jennifer; McLean, Stephanie; Pedlow, Sam; Van Hemmen, Alysia; Montero Odasso, Manuel; Overend, Tom
2014-01-01
The mechanisms linking cognition, balance function, and fall risk among older adults are not fully understood. An evaluation of the effect of cognition on balance tests commonly used in clinical practice to assess community-dwelling older adults could enhance the identification of at-risk individuals. The study aimed to determine (1) the association between cognition and clinical tests of balance and (2) the relationship between executive function (EF) and balance under single- and dual-task testing. Participants (24 women, mean age of 76.18 [SD 16.45] years) completed six clinical balance tests, four cognitive tests, and two measures of physical function. Poor balance function was associated with poor performance on cognitive testing of EF. In addition, the association with EF was strongest under the dual-task timed up-and-go (TUG) test and the Fullerton Advanced Balance Scale. Measures of global cognition were associated only with the dual-task performance of the TUG. Postural sway measured with the Standing Balance Test, under single- or dual-task test conditions, was not associated with cognition. Decreased EF was associated with worse performance on functional measures of balance. The relationship between EF and balance was more pronounced with dual-task testing using a complex cognitive task combined with the TUG.
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Scalable and Axiomatic Ranking of Network Role Similarity
Jin, Ruoming; Lee, Victor E.; Li, Longjie
2014-01-01
A key task in analyzing social networks and other complex networks is role analysis: describing and categorizing nodes according to how they interact with other nodes. Two nodes have the same role if they interact with equivalent sets of neighbors. The most fundamental role equivalence is automorphic equivalence. Unfortunately, the fastest algorithms known for graph automorphism are nonpolynomial. Moreover, since exact equivalence is rare, a more meaningful task is measuring the role similarity between any two nodes. This task is closely related to the structural or link-based similarity problem that SimRank addresses. However, SimRank and other existing similarity measures are not sufficient because they do not guarantee to recognize automorphically or structurally equivalent nodes. This paper makes two contributions. First, we present and justify several axiomatic properties necessary for a role similarity measure or metric. Second, we present RoleSim, a new similarity metric which satisfies these axioms and which can be computed with a simple iterative algorithm. We rigorously prove that RoleSim satisfies all these axiomatic properties. We also introduce Iceberg RoleSim, a scalable algorithm which discovers all pairs with RoleSim scores above a user-defined threshold θ. We demonstrate the interpretative power of RoleSim on both both synthetic and real datasets. PMID:25383066
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Harnessing the Wandering Mind: The Role of Perceptual Load
ERIC Educational Resources Information Center
Forster, Sophie; Lavie, Nilli
2009-01-01
Perceptual load is a key determinant of distraction by task-irrelevant stimuli (e.g., Lavie, N. (2005). "Distracted and confused?: Selective attention under load." "Trends in Cognitive Sciences," 9, 75-82). Here we establish the role of perceptual load in determining an internal form of distraction by task-unrelated thoughts (TUTs or…
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ERIC Educational Resources Information Center
Hall, Janie L.; Frederickson, William A.
1979-01-01
The Hall Sex Role Stereotyping Test (HSRST) was used to explore male attitudes toward specified tasks which have traditionally been assigned to either males or females and to determine if men of different ages and educational backgrounds hold different views toward these tasks. (Author/EB)
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ERIC Educational Resources Information Center
Benati, Alessandro
2017-01-01
In this paper, a review of the role of input, output and instruction in second language acquisition is provided. Several pedagogical interventions in grammar instruction (e.g., processing instruction, input enhancement, structured output and collaborative output tasks) are presented and their effectiveness reviewed. A final and overall evaluation…
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The Role of the Vo-Ag Teacher: Task Force Report.
ERIC Educational Resources Information Center
Murray, John; And Others
This task force report of the agricultural educational policy committee of the American Vocational Association focuses on the role of the vocational agriculture teacher. The first part of this report summarizes the philosophy needed by all teachers, major program objectives perceived by teachers of agriculture for their students, functions of an…
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ERIC Educational Resources Information Center
Magimairaj, Beula M.; Montgomery, James W.
2012-01-01
Purpose: This study investigated the role of processing complexity of verbal working memory tasks in predicting spoken sentence comprehension in typically developing children. Of interest was whether simple and more complex working memory tasks have similar or different power in predicting sentence comprehension. Method: Sixty-five children (6- to…
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ERIC Educational Resources Information Center
Koubek, Richard J.
The roles of training, problem representation, and individual differences on performance of both automated (simple) and controlled (complex) process tasks were studied. The following hypotheses were tested: (1) training and cognitive style affect the representation developed; (2) training and cognitive style affect the development and performance…
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ERIC Educational Resources Information Center
Boz, Umit
2014-01-01
Much research has examined how different patterns of social interaction shape language learners' interactional roles (e.g., collaborative, dominant, passive) in peer-to-peer conversations. However, little or no research has investigated the co-construction of such roles in multiparty, online task-based dialogues within the framework of discursive…