Both simulation-based education and training (SBET) and Web-based Learning (WBL) are increasingly used in medical education. We developed a Web-based learning course on "Observational Practice and ...Educational Networking" (OPEN), to augment SBET for central venous catheterization (CVC), a complex clinical skill, for novice learners. This pilot study aimed to firstly, understand the perspectives of novice learners on using WBL in preparation for SBET for a psychomotor skill and secondly, to observe how learners use the OPEN courseware to learn more about how to perform this skill.
A significant amount of research has been conducted regarding the design of Internet applications for the elderly. Concomitantly, researchers have been applying online technologies to healthcare for ...older adults. The oldest old (for our purposes, defined as older adults aged 80+) are increasingly adopting the use of the Internet and likely have different needs than those who are between 55 and 80 years old. The main results from a literature review on the existing research in human factors and design for older adults is presented. These results highlight the need for more research in human factors and design in the much neglected population group, the oldest old.
This study explored the activities of trainees learning technical skills using an educational networking tool with and without expert facilitation. Medical students (participants) were video-recorded ...practicing suturing and knot tying techniques and the resulting videos were uploaded to an educational networking site. Participants were then divided into two groups (one group containing an expert facilitator while the other group did not) and encouraged to comment on the videos within their group. We monitored the number of logins and comments posted and all participants completed an exit survey. There were no differences between the activities the two groups (p = 0.387). We conclude that the presence of an expert within collaborative Internet environments in not necessary to promote interactivity amongst the learners.
Mechanical deflection of the sensory hair bundles of receptor cells in the inner ear causes ion channels located at the tips of the bundle to open, thereby initiating the perception of sound. ...Although some protein constituents of the transduction apparatus are known, the mechanically gated transduction channels have not been identified in higher vertebrates. Here, we investigate TRP (transient receptor potential) ion channels as candidates and find one, TRPA1 (also known as ANKTM1), that meets criteria for the transduction channel. The appearance of TRPA1 messenger RNA expression in hair cell epithelia coincides developmentally with the onset of mechanosensitivity. Antibodies to TRPA1 label hair bundles, especially at their tips, and tip labelling disappears when the transduction apparatus is chemically disrupted. Inhibition of TRPA1 protein expression in zebrafish and mouse inner ears inhibits receptor cell function, as assessed with electrical recording and with accumulation of a channel-permeant fluorescent dye. TRPA1 is probably a component of the transduction channel itself.
There are currently no proven treatments to reduce the risk of mild cognitive impairment and dementia.
To evaluate the effect of intensive blood pressure control on risk of dementia.
Randomized ...clinical trial conducted at 102 sites in the United States and Puerto Rico among adults aged 50 years or older with hypertension but without diabetes or history of stroke. Randomization began on November 8, 2010. The trial was stopped early for benefit on its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. The final date for follow-up of cognitive outcomes was July 22, 2018.
Participants were randomized to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment group; n = 4678) or less than 140 mm Hg (standard treatment group; n = 4683).
The primary cognitive outcome was occurrence of adjudicated probable dementia. Secondary cognitive outcomes included adjudicated mild cognitive impairment and a composite outcome of mild cognitive impairment or probable dementia.
Among 9361 randomized participants (mean age, 67.9 years; 3332 women 35.6%), 8563 (91.5%) completed at least 1 follow-up cognitive assessment. The median intervention period was 3.34 years. During a total median follow-up of 5.11 years, adjudicated probable dementia occurred in 149 participants in the intensive treatment group vs 176 in the standard treatment group (7.2 vs 8.6 cases per 1000 person-years; hazard ratio HR, 0.83; 95% CI, 0.67-1.04). Intensive BP control significantly reduced the risk of mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years; HR, 0.81; 95% CI, 0.69-0.95) and the combined rate of mild cognitive impairment or probable dementia (20.2 vs 24.1 cases per 1000 person-years; HR, 0.85; 95% CI, 0.74-0.97).
Among ambulatory adults with hypertension, treating to a systolic blood pressure goal of less than 120 mm Hg compared with a goal of less than 140 mm Hg did not result in a significant reduction in the risk of probable dementia. Because of early study termination and fewer than expected cases of dementia, the study may have been underpowered for this end point.
ClinicalTrials.gov Identifier: NCT01206062.
There is a lack of evidence for the use of Web-based Learning (WBL) and Computer Supported Collaborative Learning (CSCL) for acquiring psychomotor skills in medical education. In this study, we ...surveyed medical undergraduate students attending a simulation based training session for central line insertion on their perspectives and utilization of WBL and CSCL for acquisition of a complex psychomotor skill.
Simulation-augmented education and training (SAET) is an expensive educational tool that may be facilitated through social networking technologies or Computer Supported Collaborative Learning (CSCL). ...This study examined the perceptions of medical undergraduates participating in SAET for knot tying skills to identify perceptions and barriers to implementation of social networking technologies within a broader medical education curriculum. The majority of participants (89%) found CSCL aided their learning of the technical skill and identified privacy and accessibility as major barriers to the tools implementation.
The effect of intensive blood pressure lowering on brain health remains uncertain.
To evaluate the association of intensive blood pressure treatment with cerebral white matter lesion and brain ...volumes.
A substudy of a multicenter randomized clinical trial of hypertensive adults 50 years or older without a history of diabetes or stroke at 27 sites in the United States. Randomization began on November 8, 2010. The overall trial was stopped early because of benefit for its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. Brain magnetic resonance imaging (MRI) was performed on a subset of participants at baseline (n = 670) and at 4 years of follow-up (n = 449); final follow-up date was July 1, 2016.
Participants were randomized to a systolic blood pressure (SBP) goal of either less than 120 mm Hg (intensive treatment, n = 355) or less than 140 mm Hg (standard treatment, n = 315).
The primary outcome was change in total white matter lesion volume from baseline. Change in total brain volume was a secondary outcome.
Among 670 recruited patients who had baseline MRI (mean age, 67.3 SD, 8.2 years; 40.4% women), 449 (67.0%) completed the follow-up MRI at a median of 3.97 years after randomization, after a median intervention period of 3.40 years. In the intensive treatment group, based on a robust linear mixed model, mean white matter lesion volume increased from 4.57 to 5.49 cm3 (difference, 0.92 cm3 95% CI, 0.69 to 1.14) vs an increase from 4.40 to 5.85 cm3 (difference, 1.45 cm3 95% CI, 1.21 to 1.70) in the standard treatment group (between-group difference in change, -0.54 cm3 95% CI, -0.87 to -0.20). Mean total brain volume decreased from 1134.5 to 1104.0 cm3 (difference, -30.6 cm3 95% CI, -32.3 to -28.8) in the intensive treatment group vs a decrease from 1134.0 to 1107.1 cm3 (difference, -26.9 cm3 95% CI, 24.8 to 28.8) in the standard treatment group (between-group difference in change, -3.7 cm3 95% CI, -6.3 to -1.1).
Among hypertensive adults, targeting an SBP of less than 120 mm Hg, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small.
ClinicalTrials.gov Identifier: NCT01206062.
This pilot study explored the use of tensiometry as a measure of retention of knot tying skills. Medical students learned a one-handed square knot tying technique. Their final performances were video ...recorded and these videos were uploaded on to a website. Students were divided into two groups: an observational learning group that had access to videos before a retention test, and a control group that did not. After a two-week retention period, all students came back and performed one more trial to test the amount of retention of the skill. Tensiometry was used to measure strengths of the knots before and after the retention period. The scores showed no significant difference between the groups (p>0.308) or tests (p>0.737). We interpret the results to suggest that tensiometry is not sensitive enough to detect degradation in the performance of fundamental clinical skills as they are forgotten after being taught.
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