An experimental study on the effects of a simulation game on students’ clinical cognitive skills and motivation

textabstractSimulation games are becoming increasingly popular in education, but more insight in their critical design features is needed. This study investigated the effects of fidelity of open patient cases in adjunct to an instructional e-module on students’ cognitive skills and motivation. We set up a three-group randomized post-test-only design: a control group working on an e-module; a cases group, combining the e-module with low-fidelity text-based patient cases, and a game group, combining the e-module with a high-fidelity simulation game with the same cases. Participants completed questionnaires on cognitive load and motivation. After a 4-week study period, blinded assessors rated students’ cognitive emergency care skills in two mannequin-based scenarios. In total 61 students participated and were assessed; 16 control group students, 20 cases students and 25 game students. Learning time was 2 h longer for the cases and game groups than for the control group. Acquired cognitive skills did not differ between groups. The game group experienced higher intrinsic and germane cognitive load than the cases group (p = 0.03 and 0.01) and felt more engaged (p < 0.001). Students did not profit from working on open cases (in adjunct to an e-module), which nonetheless challenged them to study longer. The e-module appeared to be very effective, while the high-fidelity game, although engaging, probably distracted students and impeded learning. Medical educators designing motivating and effective skills training for novices should align case complexity and fidelity with students’ proficiency level. The relation between case-fidelity, motivation and skills development is an important field for further study

The possible impact of aortic stiffness on quality of late life: An exploratory study

Purpose: Aortic stiffness (AS) is associated with cardiovascular events and all-cause mortality in the older population. AS might also influence the health-related quality of life (HRQOL) as a result of the negative effects of AS on cognitive and physical morbidity. We aimed to investigate the possible association between AS and HRQOL in people aged 75 years and over. Patients and Methods: This cross-sectional study was part of the SCOPE study, an international multicenter cohort observational study. The indicators for AS were aortic pulse wave velocity (aPWV) and central pulse pressure (cPP). HRQOL was assessed using the EQ-5D index and the EQ-5D visual analog scale (VAS). ANCOVA and multivariate regression models were used to investigate possible associations. Results: We included 280 Dutch participants of the SCOPE study. Median age was 79 years (IQR 76–83) and 42.1% were women. Participants reporting any problem on the EQ-5D index (n=214) had higher values of aPWV (12.6 vs 12.2 m/s, p = 0.024) than participants not experiencing any problem (n=66) and comparable values of cPP (44.4 vs 42.0 mmHg, p = 0.119). Estimates only slightly changed after adjustments. No association was found between indicators of AS and EQ-5D VAS. Conclusion: Aortic stiffness was associated with impaired quality of late life. This association could be mediated by subclinical vascular pathology affecting mental and physical health

Whole body vibration compared to conventional physiotherapy in patients with gonarthrosis: a protocol for a randomized, controlled study

<p>Abstract</p> <p>Background</p> <p>Osteoarthritis (OA) is the most common degenerative arthropathy. Load-bearing joints such as knee and hip are more often affected than spine or hands. The prevalence of gonarthrosis is generally higher than that of coxarthrosis.</p> <p>Because no cure for OA exists, the main emphasis of therapy is analgesic treatment through either mobility or medication. Non-pharmacologic treatment is the first step, followed by the addition of analgesic medication, and ultimately by surgery.</p> <p>The goal of non-pharmacologic and non-invasive therapy is to improve neuromuscular function, which in turn both prevents formation of and delays progression of OA. A modification of conventional physiotherapy, whole body vibration has been successfully employed for several years. Since its introduction, this therapy is in wide use at our facility not only for gonarthrosis, but also coxarthrosis and other diseases leading to muscular imbalance.</p> <p>Methods/Design</p> <p>This study is a randomized, therapy-controlled trial in a primary care setting at a university hospital. Patients presenting to our outpatient clinic with initial symptoms of gonarthrosis will be assessed against inclusion and exclusion criteria. After patient consent, 6 weeks of treatment will ensue. During the six weeks of treatment, patients will receive one of two treatments, conventional physiotherapy or whole-body-vibration exercises of one hour three times a week. Follow-up examinations will be performed immediately after treatment and after another 6 and 20 weeks, for a total study duration of 6 months. 20 patients will be included in each therapy group.</p> <p>Outcome measurements will include objective analysis of motion and ambulation as well as examinations of balance and isokinetic force. The Western Ontario and McMaster Universities Arthritis Index and SF-12 scores, the patients' overall status, and clinical examinations of the affected joint will be carried out.</p> <p>Discussion</p> <p>As new physiotherapy techniques develop for the treatment of OA, it is important to investigate the effectiveness of competing strategies. With this study, not only patient-based scores, but also objective assessments will be used to quantify patient-derived benefits of therapy.</p> <p>Trial registration</p> <p>Deutsches Register Klinischer Studien (DRKS) DRKS00000415</p> <p>Clinicaltrials.gov NCT01037972</p> <p>EudraCT 2009-017617-29</p

Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses

BACKGROUND: Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients. METHODS: We performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses. RESULTS: Diagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement. CONCLUSION: GPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed

Conscious thought beats deliberation without attention in diagnostic decision-making: at least when you are an expert

Contrary to what common sense makes us believe, deliberation without attention has recently been suggested to produce better decisions in complex situations than deliberation with attention. Based on differences between cognitive processes of experts and novices, we hypothesized that experts make in fact better decisions after consciously thinking about complex problems whereas novices may benefit from deliberation-without-attention. These hypotheses were confirmed in a study among doctors and medical students. They diagnosed complex and routine problems under three conditions, an immediate-decision condition and two delayed conditions: conscious thought and deliberation-without-attention. Doctors did better with conscious deliberation when problems were complex, whereas reasoning mode did not matter in simple problems. In contrast, deliberation-without-attention improved novices’ decisions, but only in simple problems. Experts benefit from consciously thinking about complex problems; for novices thinking does not help in those cases

A coherent picture of cancer: the disease, care, people and society

Jaarlijks krijgen 100.000 mensen in Nederland te horen dat ze kanker hebben. De afgelopen decennia is de behandeling van kanker steeds effectiever geworden waardoor er steeds minder mensen aan overlijden. Er is echter weinig informatie over de ingrijpende langetermijneffecten van de ziekte en de behandeling op de kwaliteit van leven en de maatschappelijke participatie van (ex)patiënten. De beschikbare informatie is nu zo veel mogelijk samengevoegd en in beeld gebracht. Het is van belang deze informatie te integreren in de zorg en in wetenschappelijk onderzoek. Lange tijd lag de focus op behandelen en overleven, en daar is wel veel informatie over. Informatie over de samenhang tussen alle betrokken onderdelen in de zorgketen - van huisarts tot oncoloog, fysiotherapeut en psycholoog - is vaak beperkt en versnipperd. Hetzelfde geldt voor de kwaliteit van leven tijdens en na de ziekte, de impact op gezinsleden en maatschappelijke gevolgen zoals het (on)vermogen om te werken. In een bijbehorende illustratie is informatie over de overlevingskansen, de zorgketen, en 'mens en maatschappij' in beeld gebracht. Hierin wordt zichtbaar waar nog kennislacunes zijn, en waar losstaande gegevens op een zinvolle manier gekoppeld zouden kunnen worden. Daarnaast worden vier vormen van kanker nader uitgediept: borstkanker, dikkedarmkanker, longkanker en acute lymfatische leukemie bij kinderen. Dit is gedaan omdat de wijze van ontstaan, de gemiddelde leeftijd van de patiënt, de gevolgen, de behandeling en de kans op overleven, per type kanker sterk verschilt. De rapportage is geschreven in opdracht van het ministerie van VWS en maakt deel uit van de Staat van Volksgezondheid en Zorg. Ze is het product van samenwerking tussen RIVM, NIVEL, Zorginstituut Nederland, Trimbos Instituut en CBS.Every year, 100,000 people in the Netherlands are told that they have cancer. Treatments for cancer have become increasingly effective over recent decades, as a result of which fewer people are now dying from the disease. However, there is not much information about the drastic long-term effects of the disease and its treatment on the quality of life and on social participation among current and former patients. The available information has now been bundled together and charted as much as possible. It is important that this information is integrated into care and into scientific research. For a long time, the focus was on treatment and survival, and there is a lot of information available on that. Information about the relationship between all the elements involved in the care chain - from GPs to oncologists, physiotherapists and psychologists - is often limited and fragmentary. The same applies to the quality of life during and after the disease, the impact on family members and the social consequences such as the capacity to work (or not). The adjacent illustration depicts information about the survival rates, the care chain, and 'people and society'. This shows where there are still gaps in our knowledge and where unrelated data items could be linked together sensibly. In addition, four forms of cancer are explained in greater depth: cancer of the breast, large intestine and lungs, and acute lymphatic leukaemia in children. This has been done because the way in which they arise, the average age of the patient, the consequences, the treatments and the survival rates vary enormously depending on the type of cancer. The report has been written on the instructions of the Dutch Ministry of Health, Welfare and Sport. It is part of the State of Public Health and Health Services project. It is the result of cooperation between RIVM (the National Institute for Public Health and the Environment), NIVEL (the Netherlands Institute for Health Services Research), Zorginstituut Nederland (the National Health Care Institute), the Trimbos Institute (the Netherlands Institute of Mental Health and Addiction) and CBS (Statistics Netherlands).Ministerie van VW

Why do doctors make mistakes? A study of the role of salient distracting clinical features

PURPOSE: Diagnostic errors have been attributed to faulty reasoning and cognitive biases, but minimizing errors requires understanding the mechanisms underlying biases. The authors investigated whether salient distracting features (SDFs) - case findings that tend to grab physicians' attention because they are strongly associated with a particular disease, but are indeed unrelated to the problem - misdirect diagnostic reasoning, causing errors. METHOD: In a 2012 study conducted at Erasmus Medical Centre, Rotterdam, 72 internal medicine residents diagnosed 12 clinical cases (6 simple, 6 complex) in three different formats: without a SDF, with a SDF in the beginning, and with a SDF at the end. In a within-subjects design, each participant solved 2 simple cases and 2 complex cases in each format. Proportions of correct diagnoses in each case type were compared by performing repeated-measures analysis of variance (ANOVA). RESULTS: There was a significant main effect of SDFs and a significant interaction effect between SDFs and case complexity. The presence of SDFs in the beginning of complex cases caused errors decreasing the proportion of correct diagnoses in comparison both with cases without SDFs (0.18, 95% CI, 0.13-0.23 versus 0.43, 95% CI, 0.35-0.51; P < .001) or with SDFs at the end (0.18, 95% CI, 0.13-0.23 versus 0.36, 95% CI, 0.29-0.43; P < .001). SDFs did not affect performance when presented near the end of cases. CONCLUSIONS: SDFs early in a case are apparently an important source of diagnostic errors. Physicians should be aware of the need to overcome their influence