Informed Strategies for Learning: A program to improve children's reading awareness and comprehension.

Examined the role of awareness about their own cognitive skills on the learning and development of 87 3rd graders and 83 5th graders. Half of the Ss were given an experimental curriculum—informed strategies for learning (ISL)—designed to increase Ss' awareness and use of effective reading strategies. The remainder of the Ss were used as controls. Results show that Ss who participated in ISL made larger gains than did controls on cloze and error detection tasks. No differences between groups were found on 2 standardized tests of reading comprehension. Findings demonstrate that metacognition can be promoted through direct instruction in classrooms and that increased awareness can lead to better use of reading strategies. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing a patient education program: overcoming physician resistance

Scientific expertise in the management of diabetes was an important factor in overcoming physician resistance to the education program. Nurses have expertise, and their expertise must be acknowledged for them to be viewed as leaders. Not only are nurses responsible for sharing their expertise with other nurses, it is equally important for them to share their expertise with the physicians, who may appreciate receiving any information that can help them improve their patients' outcomes. The components that are essential for success in pioneering a new program are good listening skills, a willingness to cooperate, self-confidence, scientific knowledge, vigilance, determination, and a clear vision. Patient outcomes will improve when nurses use their scientific knowledge base and leadership skills through patient-centered nursing practice, planned change strategies, and advanced practice nursing.     

A program to decrease hospital stay in acute burn patients

We describe a case of successful laparoscopic resection of a left adrenal neuroblastoma (NB) detected by mass screening (MS) in an 8-month-old boy. Cases with MS NBs are supposed to be potential candidates for laparoscopic surgery in the pediatric age group.     

Low vision: physician screening helps to improve patient function

Low vision is a common problem of older patients. As a primary care practitioner, you are not expected to treat most ocular problems, but you can play an important role by identifying patients with visual impairment. Familiarize yourself with the normal visual changes that occur with aging as well as the more common age-related ocular diseases, including glaucoma, cataracts, age-related macular degeneration, and diabetic retinopathy. You can identify patients with visual problems with a careful history and basic in-office tests of visual acuity. Refer patients found to have visual impairment to an eye care specialist for further evaluation.     

Sessions of a cardiac rehabilitation program in coronary disease--the hospital phase (phase I)

Cardiac rehabilitation is nowadays an integral part of global treatment of the coronary disease. It has the goals to restore a cardiac patient to the maximum level of physical, mental and social condition, so that to achieve the best possible sociofamilial reintegration, and of secondary prevention. The cardiac rehabilitation programs integrate three major components: physical exercise, risk factor control and psychosocial intervention. They start during the period of hospitalization (Phase I), after medical stabilization. In this initial phase the aims are: risk factor education and motivation for healthier life-styles, psychological support, and physical training for early ambulation and self-care, for preventing the deleterious physiological effects of immobilization and for progressive reconditioning.     

Evaluation of a program to teach phonemic awareness to young children: A 1-year follow-up.

A follow-up of a study evaluating a program to teach young children about phonemic structure is reported. In the original study (B. Byrne and R. Fielding-Barnsley; see record 1992-10755-001), preschoolers were trained with the program for 12 wks and gained in phonemic awareness and knowledge of the alphabetic principle as compared with a control group. The children were retested at the end of kindergarten on phonemic awareness, word identification, decoding, and spelling. Children who entered school with advanced levels of phonemic awareness scored significantly higher on each of the measures. Alphabetic knowledge predicted literacy development, but phonemic awareness accounted for significant additional variance in decoding and spelling. Verbal intelligence did not influence reading and spelling performance. Other parts of the data led to the conclusion that some aspects of phonemic awareness may be a consequence of literacy instruction rather than a cause. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of an interactive computer program for the education of parents of asthmatic children

OBJECTIVES: To evaluate the effect of a single evening meal (gorging) on plasma lipids and lipoproteins in normal individuals observing the Ramadan Fast. During the Ramadan month, Muslims refrain from food and liquids during the day and eat a large meal after sundown. DESIGN: Sequential measurement of plasma lipids and lipoproteins in Muslims observing the Ramadan Fast and non-fasting individuals. SETTING: The study was conducted in the Bedouin town of Rahat, in the northern Negev area of Israel. SUBJECTS: Twenty-two healthy subjects who fasted during Ramadan and 16 non-fasting laboratory workers, were studied before Ramadan, at week 1, 2 and 4 of the Ramadan month, and again four weeks after the end of Ramadan. RESULTS: Plasma high-density lipoprotein cholesterol (HDL) rose significantly (P < 0.001) at the week 4 measurement, returning to basal levels 4 weeks after the end of Ramadan. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL), very-low density lipoprotein cholesterol (VLDL), and lipoprotein (a) [Lp(a)] did not change significantly. CONCLUSIONS: Plasma HDL increased by 23% after four weeks of gorging. The dietary change did not affect the composition of other lipoproteins, such as LDL, VLDL or Lp(a), other plasma biochemical parameters, or BMI. Prolonged gorging, well tolerated by all individuals, is a very effective non-pharmacological method to increase plasma HDL-cholesterol.     

A computer program for fitting multimodal probability density functions

A FORTRAN IV program is described, which may be run interactively with tutorial assistance or in batch and which allows a user to selectively fit any of seven probability density functions (p.d.f.'s) or a combination of the p.d.f.'s to a unimodal or multimodal histogram of empirical data. A "best-fit", uni- or multimodal p.d.f., which may be obtained by a method of nonlinear least squares or a generated p.d.f. may be displayed on a Tektronix 4010 terminal as a continuous curve against the background of a bar, square wave, symbol or point-plot histogram. The following, supportive statistical information is also displayed: (1) Kolmogorov-Smirnov probability of goodness of fit, (2) mean square error, (3) correlation coefficient, and (4) parameter estimates. The resident driver program and six overlayable segments have been implemented on a Digital Equipment Corporation LAB-11 minicomputer (PDP-11/20).     

Neural network computer program to determine photorefractive keratectomy nomograms

PURPOSE: To evaluate a commercially available neural network program for calculation of photorefractive keratectomy treatment nomograms. SETTING: University referral refractive surgery clinic. METHODS: PRK/LASIK Brain, a commercial neural network computer program, was trained using the demographics, preoperative clinical data, surgical parameters, and 1 year postoperative clinical data of 44 patients treated with a Summit Technology excimer laser using a 5.0 mm optical zone. The neural-network derived nomogram was compared with the standard treatment nomogram for each patient. The relative contribution of age, sex, keratometry, and intraocular pressure (IOP) to the predicted nomograms was also assessed. RESULTS: Nomograms produced by the neural network were qualitatively similar to the standard nomogram. The sequence of data entry during training affected the network's predictions. Entry ordered by outcome (as opposed to entry by chronological order) yielded a nomogram that was more consistent with the standard nomogram. However, both outcome- and chronologically ordered network-derived nomograms diverged from the standard nomogram in individual patients, including a subset for whom use of the standard nomogram yielded desired refractive results (within 0.25 diopter of emmetropia). Further analysis of the neural-network-derived nomograms revealed marked sensitivity to sex, age, keratometry readings, and IOP. CONCLUSIONS: Neural networks offer a potential means of individualizing treatment nomograms, to account for patient demographics, preoperative examination, surgeon style, and equipment bias. However, a data set of 44 patients was not sufficient to train the PRK/LASIK Brain network to accurately predict treatment parameters in individual cases in the training set. A larger training set or a different learning algorithm may be required to improve the neural network's performance.     

How education can work to improve care standards

Community care provision often fails elderly and vulnerable people because of a lack of coordination between health and social services and increasing pressure on budgets. With the closure of many long-stay beds in the NHS, more people with greater dependencies are being cared for in independent sector residential and nursing homes. The quality of their care cannot be guaranteed and the role of nursing is often under threat. This paper outlines how an educational framework for health professionals and care workers could work towards improving care standards.     

A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months

AIM: In this study, the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program (HRP) are compared with those of a 12-week home-care rehabilitation program (HCRP) in COPD patients. A control group received no rehabilitation therapy. METHODS: After randomization and stratification, effects on lung function, exercise performance (4-min walking test and cycle ergometer test), dyspnea, and leg effort during exercise, and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation (mean [SD] FEV1 percent predicted, 42.8 [8.4]). RESULTS: After HRP and HCRP, at 3 to 6 months after the start of the study, equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test. However, whereas after HRP at longer term values tended to return to baseline outcome, after HCRP a further ongoing significant improvement in exercise capacity was observed, while Borg dyspnea scores remained significantly improved over 18 months. Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP. Lung function, arterial oxygen saturation, and heart frequency during exercise did not change. A significant improvement in well-being was maintained over 18 months in both rehabilitation groups. CONCLUSION: Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation. Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting.     

Understanding prognosis to improve rehabilitation: the example of lateral elbow pain

OBJECTIVE: A systematic overview of evidence aimed at determining the clinical course of lateral elbow pain and prognostic factors that affect elbow pain duration and outcomes. DATA SOURCES: Online bibliographic database searches from 1983 to 1994; information requests from selected authors and bibliography screenings. STUDY SELECTION: One author reviewed 424 articles; 40 met the following eligibility criteria: any study with primary data on soft tissue injuries specific to the elbow which referred to prognosis or reported use of any outcome measure. DATA ABSTRACTION: Strength of evidence grade based on clinical epidemiological validity assessment. Criteria included in the validity assessment included case definition, patient selection, follow-up, outcome, prognostic factors, and analysis. All eligible studies were independently assessed by two investigators. DATA SYNTHESIS: Four studies (10%) were judged to provide moderate strength of evidence; no studies were graded as providing strong evidence on prognosis. All four moderate-quality studies were clinical trials of short duration. One study indicated that site of lesion and prior occurrence may be predictive of poorer outcome in patients with lateral epicondylitis. CONCLUSION: The majority of studies on lateral elbow pain were limited by methodological weaknesses in selection and definition of the study population, length of follow-up, and analysis of prognostic factors. Estimates of duration were only available from weaker studies with longer follow-up times; significant subject heterogeneity in the weaker studies prevented a determination of usual clinical course. More methodologically rigorous research on prognosis could assist clinicians in patient care and evaluation of interventions.     

关于加快发展我国职业教育的思考

职业教育是教育事业中与经济社会发展联系最直接、最密切的部分,职业教育的改革与发展,是提升我国综合国力、构建和谐社会的重要途径。在新形势下,要把加快发展职业教育与繁荣经济、促进就业等紧密结合起来,增强紧迫感和使命感,采取强有力措施,大力推动职业教育快速健康发展。     

The physician decision-making process in transferring nursing home patients to the hospital

BACKGROUND: Each year more than 25% of nursing home patients are transferred to the emergency department or hospital for evaluation and treatment of infection. These transfers may have an adverse impact on the quality and cost of patient care. This study examined physician assessment and management of acute infections in the nursing home. METHODS: A cross-sectional study was conducted of all acute urinary tract infections and lower respiratory tract infections occurring from February through June 1991 in eight randomly selected urban nursing homes. The numbers of transfers to the emergency department of hospital were recorded along with identification of the clinical, psychosocial, and institutional factors that influenced the physician's decision to transfer. RESULTS: Three hundred fifty-nine patients had 258 urinary tract infections and 219 respiratory tract infections. Eighty-one (17%) of these events resulted in transfer to a hospital for evaluation (16/81) and/or admission (65/81). Less than one third (30.4%) of the events caused the patient to be examined in the nursing home by a physician before the decision to transfer to the hospital. The mean time between the staff notification of an acute event and physician response by telephone was 5.12 hours. Independent mobility (P < or = .05), a transfer to the hospital during the previous 6 months (P < or = .01), and fewer nursing home laboratory tests and treatments (P < or = .01) were all associated with hospital transfer. CONCLUSIONS: In this sample of acutely ill nursing home patients, physicians collected limited clinical data before the decision to transfer. Although some transfers may be appropriate, a reduction in the transfer rate may reduce health care costs and limit the risk of iatrogenesis, thus improving the outcome of acute illnesses occurring in the nursing home.