Adaptive instruction and learner interactivity in online learning: a randomized trial.

The purpose of this study was to evaluate two online instructional design features, namely adaptation to learner prior knowledge and use of questions to enhance interactivity in online portrayals of physician-patient encounters, in the context of instructing surgical specialists to deliver perioperative tobacco interventions. An online learning module on perioperative tobacco control was developed, in formats incorporating permutations of adaptive/non-adaptive and high/low interactivity (i.e., 2 × 2 factorial design). Participants (a national sample of US anesthesiology residents) were randomly assigned to module format. Primary outcomes included tobacco knowledge, time to complete the module, and self-efficacy in delivering tobacco interventions. One hundred fourteen residents completed the module, which required a median of 60 min (interquartile range 49, 138). The difference in post-module tobacco knowledge score was similar for adaptive and non-adaptive formats [mean difference 0.3 of 10 possible (95% CI - 0.3, 1.0), p = 0.25] but time was shorter for the adaptive format [- 7 min (95% CI - 14, 0), p = 0.01] and knowledge efficiency (knowledge score divided by time) was higher [0.08 units (95% 0.03, 0.14), p = 0.004]. The level of interactivity had no significant effect on self-efficacy [- 0.1 on a 5-point scale (95% CI - 0.3, 0.1), p = 0.50] in delivering tobacco interventions (both outcomes using 5-point scales). Adapting online instruction to learners' prior knowledge appears to improve the efficiency of learning; adaptation should be implemented when feasible. Adding features that encourage learner interaction in an online course does not necessarily improve learning outcomes.

Training for perioperative smoking cessation interventions: a national survey of anesthesiology program directors and residents.

STUDY OBJECTIVE: To ascertain current knowledge, attitudes, and practices of anesthesiology residents regarding tobacco control, and to determine the characteristics of current residency training offered in tobacco control. DESIGN: Electronically distributed survey instrument of anesthesiology residency program directors and residents. SETTING: University medical center. MEASUREMENTS AND MAIN RESULTS: The program director and resident response rates were 75/131 (57.3%) and 490/1182 (41.4%), respectively. Programs currently provide education regarding the perioperative consequences of smoking and, with the exception of the effect of smoking cessation shortly before surgery, resident knowledge reflected this curricular emphasis. However, the strong majority of programs did not offer education on how to ask about smoking status and advise cessation (79.5%) or help tobacco users quit before surgery (89.0%), though both program directors and residents felt these topics should be covered. A strong majority of residents (87.8%) felt the perioperative period was an effective time to assist in long-term smoking cessation, and desired education on tobacco control. Barriers to helping patients quit preoperatively included lack of time and low confidence in counseling abilities. CONCLUSIONS: A need exists for expanded formal education on perioperative tobacco cessation interventions for anesthesiology residents.

Postoperative outcome of cerebral amyloid angiopathy-related lobar intracerebral hemorrhage: case series and systematic review.

BACKGROUND: Despite its accessible superficial location, the indication for surgical evacuation in cases of lobar intracerebral hemorrhage (LICH) suspected to be related to cerebral amyloid angiopathy (CAA) is controversial because of advanced patient age and concerns about postoperative hemostasis. OBJECTIVE: To examine factors associated with postoperative outcome in CAA-related LICH. METHODS: Review of consecutive patients with pathologically proven CAA who underwent LICH evacuation at Saint Marys Hospital, Rochester, Minnesota, between 1987 and 2006. End points were length of stay and postoperative outcome at discharge and last follow-up using the Glasgow Outcome Scale. We also performed a systematic review of all published studies evaluating the outcome of surgically treated CCA-related LICH published between 1984 and 2010. RESULTS: We identified 23 patients with CAA-related LICH treated surgically. Favorable outcome (Glasgow Outcome Scale >3) at discharge was noted in 5 patients (22%), and at 6- to 12-month follow-up (n = 15) in 7 patients (47%). Three (13%) died in the hospital, including 1 of 4 patients with postoperative hemorrhage. Intraventricular hemorrhage (IVH) was associated with poor outcome at discharge. Older age (≥75 years), history of hypertension, and degree of preoperative midline shift were associated with more prolonged length of stay. In our systematic review, we identified 14 studies including 278 cases. Overall mortality rate was 25%, and poor postoperative outcome was associated with older age, IVH, and preoperative dementia. CONCLUSION: Neurosurgical evacuation may be performed with acceptable safety in patients with CAA-related LICH. A systematic literature review indicates that older age, preexistent dementia, and presurgical IVH portend poor postoperative outcome.

Development of a hospital-based trauma registry in Haiti: an approach for improving injury surveillance in developing and resource-poor settings.

BACKGROUND: Trauma-related morbidity and mortality are a growing burden in the developing world. However, usable injury data in resource-poor and developing settings is lacking. Trauma registries can improve injury surveillance to enhance trauma care, outcomes, and prevention. This article provides, by example from Haiti, an approach to developing a hospital-based trauma registry in a resource-poor setting. METHODS: An assessment of trauma documentation was performed retrospectively with subsequent development and pilot testing of two injury surveillance systems. The system most promising for meeting the needs and capabilities of the institution was implemented. RESULTS: Retrospective medical record review from 1999 (n = 43) and 2002 (n = 43) revealed limitations in available data for trauma surveillance. Specific mechanism of injury was documented in 39.3% and 57.1% of 1999 and 2002 groups, respectively. Injury date and arrival vital signs were infrequently recorded. Two injury surveillance models were designed and pilot tested: provider-based (PTR) (pilot n = 19) and coordinator-based (CTR) (pilot n = 37) trauma registries. Analysis of the pilot testing resulted in revisions to operations and the trauma registry forms. Both registry models showed improved data collection compared with the retrospective study with CTR and PTR documenting specific mechanism of injury in 94.6% and 100% of patients, respectively. The PTR model was chosen for implementation at the hospital. CONCLUSIONS: Trauma registries in developing settings are plausible tools for injury surveillance. Successful trauma registries will be resource- and setting-specific in design and can potentially be the means by which trauma care and outcomes are improved, prevention programs are developed, and capacity-building goals realized.