The excitatory neurotransmitters glutamate and aspartate are an important factor in the causation of ischemic brain damage. The concentration of glutamate and aspartate was serially measured in extracellular fluid using in vivo microdialysis after induction of a subdural hematoma or after a sham operation in the rat. Measurements were made in the cortex underlying the hematoma and in the ipsilateral hippocampus, and these findings were correlated with regional cerebral blood flow (CBF), measured autoradiographically 2 hours after hematoma induction. In the severely ischemic cortex underlying the hematoma (mean CBF less than 25 ml/100 gm/min), glutamate and aspartate content increased more than 750% over basal levels. In individual animals the magnitude of glutamate release correlated with the extent of the focal ischemic zone under the hematoma (r = 0.907). Hippocampal glutamate levels rose 339%, yet regional CBF was preserved (114 ml/100 gm/min). This accords with focal hypermetabolism in this model, and may imply a glutamate-mediated "excitotoxic" process after subdural hematoma.
Primary care physicians were trained on three rheumatology topics to assess the effectiveness of an educational strategy for continuing medical education. Algorithm training was shown to be at least as effective as that based on standard prose monographs. Both training groups improved their knowledge of patient management skills but there were no statistically significant differences between groups in the amount learned. When algorithms were used to design text materials, the designed texts required less study time than did the annotated clinical algorithms alone. That difference was significant for the shoulder pain materials (P < 0.05) but not for the osteoporosis materials. The ratio of knowledge gained to study time was significantly higher for the algorithm group on the low back pain topic (P < 0.05) but not for the other topics. Taped interview problems tests were studied as a method for assessing patient management skills related to problem-specific indicator conditions and were found to produce interrater reliability greater than 0.80 on five of the six tests.Continuing Medical Education (CME) is a critical link in the process of transferring the knowledge gained from arthritis research into the clinic environment where it can benefit patients. Improvements in patient care and outcomes frequently depend upon the education of health care providers on improved techniques, medications, and treatment strategies. This paper presents data obtained from a study sponsored by the National Fund for Medical Education. That study sought to assess the effectiveness of clinical algorithms (i.e., decision-making flow charts) as an instructional methodology in a CME environment for primary care physicians. The specific research question addressed was: "Do practitioners learn more effectively and efficiently from clinical algorithms than from standard prose texts?" In connection with the CME training experiments conducted with three annotated clinical algorithms covering rheumatology topics, this study also provided the opportunity to examine the reliability of a taped interview problems (TIP) test of patient management skills and the impact of clinical algorithms in helping to construct educational materials.
Primary care physicians were trained on three rheumatology topics to assess the effectiveness of an educational strategy for continuing medical education. Algorithm training was shown to be at least as effective as that based on standard prose monographs. Both training groups improved their knowledge of patient management skills but there were no statistically significant differences between groups in the amount learned. When algorithms were used to design text materials, the designed texts required less study time than did the annotated clinical algorithms alone. That difference was significant for the shoulder pain materials (P < 0.05) but not for the osteoporosis materials. The ratio of knowledge gained to study time was significantly higher for the algorithm group on the low back pain topic (P < 0.05) but not for the other topics. Taped interview problems tests were studied as a method for assessing patient management skills related to problem-specific indicator conditions and were found to produce interrater reliability greater than 0.80 on five of the six tests.Continuing Medical Education (CME) is a critical link in the process of transferring the knowledge gained from arthritis research into the clinic environment where it can benefit patients. Improvements in patient care and outcomes frequently depend upon the education of health care providers on improved techniques, medications, and treatment strategies. This paper presents data obtained from a study sponsored by the National Fund for Medical Education. That study sought to assess the effectiveness of clinical algorithms (i.e., decision-making flow charts) as an instructional methodology in a CME environment for primary care physicians. The specific research question addressed was: "Do practitioners learn more effectively and efficiently from clinical algorithms than from standard prose texts?" In connection with the CME training experiments conducted with three annotated clinical algorithms covering rheumatology topics, this study also provided the opportunity to examine the reliability of a taped interview problems (TIP) test of patient management skills and the impact of clinical algorithms in helping to construct educational materials.
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