Search

Background Static eyelid reconstruction surgery, such as ptosis repair or brow lift, is widely performed for patients with facial paralysis. Complications include exposure keratitis and possible vision loss mainly due to eyelid closure impairment in spontaneous blinking. However, no quantitative evaluation data has been available regarding postoperative closure deterioration. Methods To elucidate factors associated with postoperative eyelid closure impairment, a retrospective study was performed for 51 patients who underwent an initial static eyelid reconstruction surgery from October 2017 to August 2020. A static eyelid reconstruction surgery consisted of either 1 or more of the following: (1) levator advancement, (2) brow lift, and (3) orbicularis oculi myectomy. Eyelid closure ratios (0% for complete closure impairment and 100% for perfect closure) at spontaneous blinks were measured on 6 occasions: before operation and at postoperative 1, 3, 6, 9, and 12 months. Comparison was made between preoperative and postoperative values by using mixed-effects model. Results Overall, average closure ratio was significantly increased. However, 10 patients had >10% closure ratio decreases at at least 1 postoperative measurement point, and all those patients had undergone brow lift procedures. Conclusions Although eyelid closure at spontaneous blinks may, contrary to assumptions, generally be improved after static eyelid reconstruction surgery, brow lift was suggested to be associated with eyelid closure impairment.

Worldwide, an estimated 4 million youth, ages 15-24 years, are living with HIV. Youth in Kenya experience a high HIV disease burden. HIV-related stigma is a known barrier to HIV prevention. We evaluated the HIV Stigma-reduction through Education, Empowerment, and Research (SEERs) Project, a conceptually driven program that emerged from community-based participatory research and was designed with and for youth ages 13-24 years in Kenya. We analyzed existing evaluation data from 641 SEERs participants who completed pre-, post-, and 3-month follow-up surveys to evaluate changes in HIV knowledge and stigma. Findings revealed a significant increase in HIV knowledge and a significant decrease in HIV-related stigma over time. Despite strong preliminary evidence, research is needed to refine the program and better determine its effectiveness using a randomized controlled trial. Programs such as SEERs can be used in Kenya and other low- to middle-income countries to improve HIV-related health outcomes.

Blackboard-style videos with simple drawings illustrating concepts have become immensely popular in recent years. However, there has been no published research evaluating their efficacy in nursing education. This pilot study evaluates the use of blackboard-style videos in an online pathophysiology course. Quantitative and qualitative evaluation data were analyzed to evaluate student satisfaction. The data indicated that students were highly satisfied with the course and the delivery of content using blackboard-style videos. The qualitative analysis uncovered two key themes explaining the high level of satisfaction: visual plus narrative explanations support learning and student control over pacing enhances learning.

Purpose The Spina Bifida Transition Project (SBTP) was developed by partners from pediatric and adult health care settings using existing best practice information in an effort to transition adolescents to adult health care providers. The purpose of this manuscript is to present the results of an initial evaluation of the SBTP from the adolescent/young adult (AYA) and family perspective. Design and Methods Qualitative evaluation data were obtained from telephone interviews with 40 individuals (24 AYA and 16 parents representing 28 families) two-three weeks after initial adult clinic visits using a semi-structured interview guide. Findings Interview analysis yielded six overall themes: Positive experience, Developing Trust, Unexpected Benefits, Communication, Potential Worries, and Suggestions for Improvement. The study supported both the effectiveness of the SBTP as well as patient desire for earlier initiation of transition activities Conclusion and Clinical Relevance SBTP is well-received by participants and their parents and may be useful model for other chronic health conditions.

Oklahoma's health status has been ranked among the worst in the country. In 1972, the University of Oklahoma established the Tulsa branch of its College of Medicine (COM) to expand the physician workforce for northeastern Oklahoma and to provide care for the uninsured patients of the area. In 2008, the Tulsa branch launched a distinct educational track, the University of Oklahoma COM's School of Community Medicine (SCM), to prepare providers equipped and committed to addressing prevalent health disparities.The authors describe the Tulsa branch's Summer Institute (SI), a signature program of the SCM, and how it is part of SCM's process of institutional transformation to align its education, service, and research missions toward improving the health status of the entire region. The SI is a weeklong, prematriculation immersion experience in community medicine. It brings entering medical and physician assistant students together with students and faculty from other disciplines to develop a shared culture of community medicine. The SI uses an unconventional curriculum, based on Scharmer's Theory U, which emphasizes appreciative inquiry, critical thinking, and collaborative problem solving. Also, the curriculum includes Professional Meaning conversations, small-group sessions to facilitate the integration of students' observations into their professional identities and commitments. Development of prototypes of a better health care system enables participants to learn by doing and to bring community medicine to life.The authors describe these and other curricular elements of the SI, present early evaluation data, and discuss the curriculum's incremental evolution. A longitudinal outcomes evaluation is under way.

A mixed-method educational evaluation project to increase learning through testing was conducted in a required senior nursing course.The Immediate Feedback Assessment Technique (IF-AT) was used to motivate preparation for optimal final examination performance. Students took multiple-choice final exams in small groups, used critical thinking and collaboration to select best answers, and then used scratch-off answer sheets indicating correct answers. A causal-comparative evaluation design was used to assess effectiveness of the IF-AT technique in improving learning as measured by final exam scores compared with results of traditional individual multiple-choice final exams.Results indicated that the IF-AT format was significantly more effective than traditional testing in enhancing learning.Descriptive and qualitative evaluation data from students indicated students increased their learning, engaged in critical thinking, and prepared adequately for the exam. Students evaluated the test method as superior to standard testing. Implementation information is included.

Practice-based evidence arises from programs implemented in real-world settings. Program success may be judged on the basis of experience; however, formal evaluation studies of methodological rigor can provide a high level of credible evidence to inform public health practice. Such studies can be lengthy and expensive. Furthermore, even well-designed studies may not reach conclusive findings, for example, when a program lacks full implementation, when data systems do not have capacity to collect evaluation data, or when program implementation has not attained stability. An evaluability assessment is used to determine the capacity and readiness of a program for full-scale effectiveness evaluation. Evaluators at the Centers for Disease Control and Prevention use evaluability assessment as a preevaluation consisting of brief, focused, criteria-based assessments, document review, and a site visit. Evaluability assessment is used to guide investments in subsequent rigorously designed evaluations that yield conclusive findings to build strong and credible practice-based evidence.

The evaluation data collected during an orientation in an acute care setting were examined for themes and shared with the educational setting for enhancing the preparation of the new nurse. Responses of the new graduates identified teaching strategies that may be useful in education contribute to their transition. These responses are shared with educators for possible implementation of similar strategies in the baccalaureate setting. Strategies included more clinical immersion, exploration of various roles of the healthcare team, priority setting, and role modeling with more preceptorships. A discussion of ways for possible adoption of these strategies is presented.

Heart failure is a high prevalence, high burden disease with an unpredictable trajectory. Given that approximately 50% of persons with the diagnosis die within 5 years, the implications for communication about advance planning and end of life, although simultaneously providing hope and treatment, are extremely challenging. This article reports on a feasibility trial of a modest continuing education seminar to increase awareness and communication skills of inpatient nurses. Curriculum design details, including objectives and methods, are described. Needs assessment and evaluation data are reported. At the 2-month posttest, a summary communications skill score showed significant improvement. Data also illustrated that the challenge of facing issues about dying are complicated by a work force of relatively young staff and low exposure to few actual deaths during relatively short lengths of stay.

Implementation models, such as the national Put Prevention Into Practice program, have produced small to moderate changes in the delivery of preventive services in primary care. More recently, researchers concluded that guides and tools, such as the PPIP toolkit, are helpful, but are not sufficient to facilitate substantive change in clinical preventive practice. Successful implementation of clinical preventive services, according to the Texas Department of Health-PPIP (TDH-PPIP) initiative, involves creating or altering systems to produce change in service delivery for a specific setting. This article describes the ways in which the guidelines and instruments that were developed and refined through the collaborative efforts among public and private health systems were used to implement systems change and improve clinical preventive services at one community primary health care clinic in Texas. The process and empirical results of using the TDH-PPIP Implementation Model in the field are also presented, as well as a discussion of one-year evaluation data.

Medical schools throughout the world are increasingly adopting problem-based learning (PBL) pedagogies. PBL is a student-centered model that stimulates clinical reasoning, promotes the application and retention of knowledge, and encourages self-directed, lifelong learning. Few physician assistant (PA) programs have adopted this innovative methodology, perhaps owing to the lack of research on the efficacy of PBL in PA education. HRSA funding was obtained to address this deficit. A research project was designed and implemented, in which a PBL curricular track was established in parallel with a traditional lecture-based learning (LBL) curricular track during the first year of a master’s degree program. Evaluation data will be collected over a 5-year period to compare the educational outcomes of the PBL and LBL tracks. The present article describes the rationale behind PBL, its advantages and disadvantages, the PBL model chosen for this comparative study; and the evaluation plan adopted.

An experiential learning assignment was imPlemented in an undergraduate nursing course. The purpose of the assignment was to integrate theory and research into a nursing practice activity. The authors describe the development, implementation, and evaluation of the assignment. Evaluation data indicated that the assignment was an appropriate way to prepare beginning nursing students for building knowledge about nursing as a scholarly discipline.

Objective: To develop a method for automatically detecting non-convulsive seizures in ICU. Background Seizures are found in at least 8% of ICU patients; of these, 50-100% have only non-convulsive seizures detectable only by continuous EEG monitoring. Non-convulsive seizure duration and delay to treatment have been shown to be associated with increased mortality [1]. Seizure detection and management is problematic: a skilled electroencephalographer is not always available, generating a need for an automated seizure detection system. Design/Methods: Using a database of 179 ICU patients undergoing continuous EEG (148d) monitoring, we have developed a method that quantifies seizure-related evolution in a two-dimensional feature space consisting of EEG frequency and power. The method was evaluated in an independent data set of 53 ICU and epilepsy monitoring unit (EMU) patients (50d) [2]. All data were analyzed by an experienced electroencephalographer (BY), who marked the onsets and offsets of ten first seizures in each recording using commonly accepted seizure criteria [1]. Seizure detection was classified successful, if it took place within 15 minutes of the first marked seizure. Results: 10/19 seizure patients of the development data set were detected (false positive rates (FPR): median 0.00/hour, mean 0.34/hour). In the evaluation data set 6/8 seizure patients were detected (FPRs: 0.06/hour, 0.52/hour). Undetected patients were either in status epilepticus (SE) or had no seizures with evolutionary characteristics. Most false detections were caused by EMG. Conclusions: The method demonstrates good potential in detecting seizures with evolution, which further can be visualized in 2-D plane, facilitating seizure recognition at the bedside. To cover the full range of seizure disorders, the method needs to be integrated with methods suitable for spike detection and SE monitoring, such as WSE [3]. Further work will focus also on reducing FPR. Supported by: GE Healthcare, Finland OY. Disclosure: Dr. Tanner has received research support from GE Healthcare. Dr. Sarkela has received research support from GE Healthcare. Dr. Tolonen has received personal compensation for activities with GE Healthcare as an employee. Dr. Norton has nothing to disclose. Dr. Davies-Schinkel has nothing to disclose. Dr. Sharpe has nothing to disclose. Dr. Young has nothing to disclose.

Objective: To develop an educational video game that is both appealing and effective in learning localization in neurology. Background Neurology requires learning to localize nervous system pathology based on exam findings. This can be a challenging task. Video games are currently being applied in many medical fields with great success. Indeed, video gaming has been reported to have a high level of acceptance and interest among medical students apart from having the ability to be efficient and accurate in their teaching. Design/Methods: First part of this pilot study includes beta testing by medical students a mini-game that addresses the visual pathways in neurology. Results: A visually appealing game available which will be available for demo at the meeting with evaluation data from medical students will be presented at the meeting. Conclusions: Video games in teaching are becoming more common among the medical field. This pilot game is interactive, engaging and systematically covers localization in neurology. Further development of gaming in different neurological pathways are underway. Supported by: American Academy of Neurology Educational Award. Disclosure: Dr. Brizuela has nothing to disclose. Dr. Jaycox has nothing to disclose. Dr. Ingersoll has nothing to disclose. Dr. Amezcua has received personal compensation for activities with Bayer Pharmaceuticals Corporation, Biogen Idec, Teva Neuroscience, and Serono/Pfizer Inc.

R.J. Andrews, P.B. Berry: The evaluation of services for the handicapped: Promoting community living.Int. J. Rehab. Research, 1 (4, October 1978)451-461 The research reported in this paper is based on the premise that the evaluation of community services for the handicapped makes an important contribution to their quality. It involved an evaluation of 36 residential, vocational and educational programs in three Australian states. All the facilities were funded al least in part through the Handicapped Persons’ (Assistance) Act. The study sought to assess the extent to which programs for the moderately and severely mentally handicapped in Australia prepared their clients for more effective integration into community life and sought to increase awareness among providers of services of some aspects of quality service delivery. The major evaluation data source was the Program Analysis of Service System (PASS) (Wolfensberger & Glenn, 1975), a procedure which employs characteristics of programs for the handicapped judged to be important in preparing them for community living as the major criteria against which to measure the performance of the facilities. 1116 results indicated that although the mean PASS score (+316) for the total group of facilities, and the mean scores for each group of facilities were above the minimally acceptable level, there were large within-group differences between programs. An analysis was also undertaken of the results for the groups of facilities on individual items to highlight areas of low performance by more than one facility group. Recommendations resulting from the evaluations are made for the development of provisions for the handicapped in Australia, including the area of staff preparation and training, the need for increased numbers of small-living units within the total pattern of residential services, and increased community contacts as part of the programs in the 36 facilities.

This paper describes the operation of a community-based rehabilitation programme specifically for mentally handicapped children and young adults living with their families in rural areas of Zimbabwe. Details are given of the clients enrolled in the programme and the teaching goals used with them. Evaluation data on the programme's effectiveness is also presented. Three features are identified as being central to the programme's success, 1) partnership with existing agencies in the area, 2) the training and monitoring that is provided by specialist staff in mental handicap, and 3) the provision of resource materials -- forms, cards, videos -- which are tailored to the cultural, linguistic and literacy needs of the recipients. The efficient use of specialist staff is highlighted as are future areas for research and development.

Traditionally, human gross anatomy teaching has revolved around anatomical dissection. Unfortunately, during the last decade a number of medical schools have experienced a decrease in the number of hours allotted to gross anatomy instruction compounded by a shortage of anatomical donors. This, in turn, has served to increase the difficulties of providing students with truly effective anatomical instruction. To help overcome this problem, a stereoscopic slide-based auto-instructional program has been developed as a substitute for dissection. Evaluation data suggest that this program, while having minor limitations in terms of anatomical orientation, does provide a viable alternative to dissection.