A summary of research in study skills

Thesis (Ed.M.)--Boston Universit

Development and Evaluation of an Internet-Based Airway Evaluation Tutorial

Airway evaluation and basic management are essential skills for all physicians. Identifying patients for whom mask ventilation or endotracheal intubation will be difficult to impossible is vital for patient safety. Despite this, training in airway evaluation is minimal in the curricula of most medical schools. To ensure a thorough understanding of airway anatomy and evaluation, as well as exposure to various abnormal findings, we developed an Internet-based module including interactive components, graphics, animation, video, and a self-assessment tool. The site received more than 1800 visits in its first nine months of operation, with uniformly laudatory comments. Eighty subjects over a six-month period completed a pre- and post-test quiz structured to evaluate the utility of the site. Of those completing the on-line survey, more than 76% rated the site very useful. Most felt their knowledge of airway examination improved after completion of the site (p<0.00004). The median amount of time spent on the site was 29.5 minutes. Judging from the overwhelming response to this site from around the world and across disciplines, such interactive training tools that exploit the technological capabilities of the Internet provide useful adjuncts to traditional teaching methods

Het Rijksvaccinatieprogramma in Nederland : Surveillance en ontwikkelingen in 2014-2015

In Nederland is de vaccinatiegraad binnen het Rijksvaccinatieprogramma (RVP) hoog, waardoor weinig mensen de ziekten krijgen waartegen zij worden ingeënt. Alleen de deelname aan de vaccinatie van meisjes tegen het humaan papillomavirus (HPV) ligt lager. Na de vaccinaties komen weinig ernstige bijwerkingen voor. Bijwerkingen die gerapporteerd worden zijn doorgaans niet ernstig van aard zijn. Continue monitoring is nodig om een optimaal vaccinatieprogramma te behouden. Wijzigingen in het vaccinatieschema in 2014-2015 Sinds januari 2014 is de vaccinatie tegen het HPV-virus, dat baarmoederhalskanker kan veroorzaken, teruggebracht naar twee prikken. De vaccinatie wordt aan alle twaalfjarige meisjes aangeboden. Ontwikkelingen voor RVP-ziekten Door de uitbreiding van het pneumokokkenvaccin met drie typen in 2011 is het aantal kinderen gedaald dat van deze drie typen ziek werd. Deze daling was ook te zien onder volwassenen, die mogelijk indirect door de vaccinatie van kinderen zijn beschermd.Kinkhoest nam in 2014 weer toe na een daling in 2013. Het aantal zieken was minder hoog dan tijdens de epidemie in 2012. De bof kwam weinig voor in 2014, al steeg het aantal meldingen weer in de eerste maanden van 2015. De meeste mazelengevallen zijn in de eerste twee maanden van 2014 gerapporteerd, aan het einde van de epidemie die in 2013 begon. De mazelen kwam voor in gebieden waar mensen zich om religieuze redenen vaak niet laten vaccineren. Er zijn geen gevallen van polio gemeld. Vorig jaar waren de controles op polio geïntensiveerd in regio's in Nederland waar vluchtelingen worden opgevangen. Dit betrof vluchtelingen uit enkele niet-Europese landen waar het aantal poliogevallen was gestegen, zoals Syrië. Aangezien polio in die landen in 2014 minder voorkwam zijn de controles tot een normaal niveau teruggebracht. Ontwikkelingen voor toekomstige RVP-kandidaten De Gezondheidsraad kan de minister adviseren om het aantal ziekten die onder het RVP vallen uit te breiden. Het RIVM houdt in de gaten hoe ziekten die hiervoor in aanmerking komen, zich ontwikkelen. In 2014 kwamen uitzonderlijk weinig infecties met het rotavirus voor. Ook daalde het aantal zieken door meningokokken serogroep B. Het aantal mensen met het waterpokken, gordelroos en hepatitis A is de afgelopen jaren stabiel gebleven.In the Netherlands, participation in the National Immunisation Programme (NIP) is high, resulting in low incidences of most diseases included in the NIP. Yet coverage for vaccination against human papillomavirus (HPV) in girls is lower. Only a few severe adverse events following immunisation occurred. Reported adverse events are mostly mild and transient. Continuous monitoring of effectiveness and safety is necessary for the programme to remain optimal. Changes in the vaccination schedule in 2014-2015 Since 2014, girls have been receiving a reduced number of doses against human papillomavirus (HPV). Two doses of HPV vaccine are offered to 12-year-old girls. Developments for diseases included in the NIP The switch to the 10-valent pneumococcal vaccine (PCV10) in 2011 reduced the number of invasive pneumococcal diseases caused by the additional PCV10 serotypes in the vaccinated age groups. A decrease in the incidence of IPD caused by the additional PCV10 serotypes was also seen in the adult age groups, which is probably due to indirect protection. The incidence of pertussis increased in 2014 after a lower incidence in 2013, but was somewhat lower than during the epidemic year 2012. The incidence of mumps was low in 2014, but a resurgence of mumps and an endemic transmission were encountered in the first few months of 2015. The majority of the measles cases reported in 2014 belonged to the measles epidemic in the Bible Belt, which started in 2013. No cases of polio were reported. The environmental routine surveillance, which was intensified in the region where refugees were first cared for in 2013, was changed to routine level again in April 2015. Developments for future NIP candidates The Health Council could advise the Dutch Minister of Health, Welfare and Sports on expansion of the NIP. The National Institute for Public Health and the Environment in the Netherlands (RIVM) investigates developments in potential future NIP candidates. In 2014, the rotavirus season was exceptionally low. A decrease in meningococcal serogroup B disease was seen in 2014. Incidences of varicella zoster virus and hepatitis A remained stable over the previous years.Ministerie van VW

Attitudes of Dutch general practitioners towards vaccinating the elderly:less is more?

Background: In many European countries, vaccinations are offered to the elderly. Expanding the programme to include routine vaccination against pneumococcal disease, herpes zoster, and pertussis, for example, could reduce disease burden amongst the growing population of persons aged 50 years and older. Since most countries involve general practitioners (GPs) in the programmes, the potential success of such new vaccinations depends on the attitude of GPs towards these vaccinations. This qualitative study explores Dutch GPs' attitudes regarding vaccination in general, and their attitudes regarding the incorporation of additional vaccines in the current Dutch influenza vaccination programme. Methods: Interviews were held with ten Dutch GPs (five men and five women) that worked either in an academic hospital, in a practice based in a health center, or in individual practice. All interviews were recorded with a digital voice recorder and transcribed verbatim. Transcripts were analysed according to thematic analysis. Results: GPs perceived prevention as part as their job and believed vaccination to be effective for preventing infectious diseases. However, influenza vaccination was not always perceived as effective. Doubts regarding the usefulness of additional vaccinations were identified. If additional vaccines would be offered, this should be based on scientific evidence and the severity of the infectious disease. Selection of patients for vaccination should not be based solely on age, but more on risk factors. The GP should be the central point of contact for new vaccination campaigns; however, high workload was seen as a concern. Several GPs questioned their ability to refuse to distribute the vaccinations. Conclusions: A positive attitude towards implementing additional vaccinations is not apparent. Achieving the most health benefits seems to be the most important consideration of Dutch GPs regarding vaccinating older adults. Questions regarding the usefulness of vaccinating older adults should be taken into consideration. More research is necessary to confirm the results among a wider range of Dutch GPs

Cracks in turnout sleepers -- Conclusions from a questionnaire to the UIC Track Expert Group

To investigate the occurrence of cracks in turnout sleepers, how these were assessed and handled, a questionnaire was sent out to 15 members of the UIC Track expert group in December 2020. By February 20, 2021, eleven responses have been received. The responses are summarised and commented below

Seroepidemiology of diphtheria, tetanus, poliomyelitis and pertussis : evaluation of the national immunisation programme in the Netherlands

In view of the evaluation of the National Immunisation Programme in the Netherlands the main objectives were to obtain insight into the immunity to diphtheria, tetanus and poliomyelitis, into the occurrence of pertussis and to improve serodiagnosis of pertussis.In a population-based nationwide sampling, 8359 sera (response 55%) were collected, and to gain access to orthodox reformed individuals refusing vaccination, in a sample from municipalities with low vaccine coverage 1589 sera (response 52.5%). In the nationwide sample, the prevalence of diphtheria and tetanus antibodies (≥0.01 IU/ml in toxin inhibition assay) was 88% and 84%, resp. In at least 90% antibodies (titre≥1:8 in neutralisation assay) against poliovirus types 1, 2 and 3 were measured. For those born after mass vaccination was introduced (&lt;45 years) the prevalence of antibodies to diphtheria, tetanus, poliovirus types 1 and 2 was at least 92.5% and for poliovirus type 3 at least 80%. Diphtheria and tetanus antibodies decreased with age for those born before vaccination was introduced (≥45 years). Only 40% of orthodox reformed individuals had diphtheria and 60% had tetanus antibodies. Less than 70% had poliovirus type 1, 2 and/or 3 antibodies. We concluded that the Dutch immunisation programme induced long-term diphtheria, tetanus and poliomyelitis immunity. While adults are very well protected against poliomyelitis, a great number of adults lack diphtheria or tetanus antitoxin antibodies. These adults might benefit from diphtheria (re)vaccination; however, offering a primary tetanus vaccination to cohorts born before the introduction of vaccination would probably be more effective than routine revaccination. Introduction of C. diphtheriae or poliovirus in socio-geographically clustered orthodox reformed groups might constitute a danger of spread of these pathogens.Pertussis surveillance data from notifications, positive serology and hospital admissions (1976-98) showed a sudden increase in the number of pertussis cases in 1996-97. According to notifications and serology data, the increase among, mostly unvaccinated, children less than 1 year was similar to the increase in hospital admissions. For older, mostly vaccinated, individuals the increase in hospital admissions was relatively small. The increase of reported vaccinated patients of all ages was higher than for unvaccinated patients. We postulated that the proportion of pertussis infections resulting in recognizable symptoms has increased among vaccinated individuals due to a mismatch of the vaccine strain and circulating B. pertussis strains.To investigate at which level IgG antibodies against pertussis toxin (IgG-PT) in a single serum sample are indicative for recent pertussis, IgG-PT was analysed in 7756 population-based sera, in sera of 3491 patients with at least a fourfold IgG-PT increase, in paired sera of 89 patients with positive cultures or polymerase chain reactions and in sera of 57 pertussis patients with a median follow-up of 1.4 years. IgG-PT levels of at least 100 U/ml were present in less than 1% of the population, are reached by most pertussis patients within 4 weeks after disease onset and persist only temporarily. We concluded that such levels are diagnostic for recent or actual infection with B. pertussis .Our results not only show that childhood vaccination should be sustained, but that adult vaccination could be considered. We have to anticipate long-term effects of mass vaccination, such as gaps in immunity as a result of decreased circulation of the pathogens and waning immunity. Epidemiological studies directed towards evaluation of vaccination should continue to provide a scientific basis for vaccination strategy.</p

Effects of fear and attention on human balance control

A fall is one of the main causes of injury-related hospitalisation and injury-related deaths. Besides physical degeneration, fear of falling and attentional focus strategies are related to fall risk and decline of balance performance. The aim of this research was to expose the mechanisms by which fear of falling and attentional focus affect human balance control. We used galvanic vestibular stimulation (GVS) to induce vestibular balance reflexes while participants stood at ground level and on a narrow walkway at 3.85 m height to induce fear of falling. Using questionnaires and skin conductance measurements, a fear of falling at height was confirmed. Full-body kinematics was collected to measure the vestibular balance response. We concluded that fear modifies vestibular balance control and proposed a mechanism in which both the short- and medium-latency reflexes functionally contribute to whole body balance. Furthermore, the literature suggests that fear of falling could impair balance mechanisms in elderly through changes in attentional focus. Therefore, we also investigated the effect of attentional focus (internal vs. external focus and reinvestment) and fall history on walking stability in healthy older adults. Participants’ gait was perturbed through randomly occurring unilateral treadmill decelerations to evoke balance recovery movements. Using full body kinematics, coefficients of variation of spatiotemporal gait parameters and local divergence exponents were calculated to assess gait performance of balance recovery responses and unperturbed gait. Fallers showed increased gait variability and decreased gait stability, however no effects of attentional focus were found. The benefits of an external focus of attention on motor performance do not seem to apply to gait in elderly. Continued investigation into attentional focus effects and fear of falling on gait including holistic and partial internal focus and continuous gait perturbations, might further clarify the relations between fear of falling and attentional focus and how they could affect fall risk. Follow-up studies with clinical subgroups could further clarify the relation between fear of falling, attentional focus and balance performance