Greater Number Of Problems Research Articles

Adherence to gluten free diet and problems faced by children with celiac disease and type 1 diabetes mellitus

ABSTRACT Introduction: Celiac disease (CD) in children can be associated with Type 1 Diabetes Mellitus (T1DM) as both share autoimmune etiology. Mainstay of treatment in celiac disease is total avoidance of gluten in diet whereas treatment in child with both the diseases will be Insulin therapy, exercise along with gluten free diet (GFD). There is dearth of literature regarding adherence to GFD and barriers for children with both T1DM and CD. Methods: A questionnaire-based study was done at a tertiary care institute so as to compare the self-reported gluten adherence and the problems faced by children with dual diseases (TIDM and CD) and CD alone. Thirty children of age group 5-14 years each withType 1 DM and CD (T1DMCD group) and celiac disease (CD group) were selected consecutively. A questionnairewas filled by asking questions from either children (above 8 years) or parents (below 8 years) and the results were compiled, compared and further analysed. Results: Baseline demographic parameters were comparable in both the groups. Gluten adherence was found to be worse in T1DMCD group as compared to CD group. Greater number of problems were experienced by children with both TIDM and CD as compared to children with CD alone (P < 0.05). Financial burden more so in T1DMCD group, unawareness about disease and benefits of GFD, less availability and social isolation were found to be the most significant barriers to diet adherence. Conclusion: As these children face dual diseases, they should be made more aware regarding benefits of GFD. Such information is valuable to primary care physicians for better management and rehabilitation of children suffering from these chronic diseases.

Public Catering at Logging Sites in the Middle Volga Region during the Pre-War Five-Year Plans

The article examines one of the most important aspects of the industrial and domestic components of the logging process in the 1930s. The work of canteens and food stations for lumberjacks is considered using the example of the Middle Volga region, whose logging was typical for the European part of the USSR. At the same time, the article compares regional problems of catering at logging sites with all-Union trends. The source base for the article was the funds of regional archives of the Penza, Samara and Ulyanovsk regions and materials from periodicals of the 1930s. In general, the catering system at the logging sites of the largest logger in the Middle Volga region, the Sredles trust, was organized already at the end of the first five-year plan. The greatest number of problems in the public catering system in the third five-year plan were recorded in the Kuibyshevles sections. Typical methods for supplying the canteens of timber industry enterprises with products in the 1930s. began to organize their own subsidiary farms and purchase food. There are numerous complaints about the quality of food prepared in the forestry industry canteens. In some cases, the shortcomings of catering at logging sites were associated not with the general food shortage in the USSR, but with the low professionalism of canteen workers.

NCOG-23. PATTERNS OF DISTRESS IN OLDER PATIENTS WITH GLIOBLASTOMA: A FOLLOW-UP TO A SINGLE INSTITUTION CROSS-SECTIONAL STUDY OF DISTRESS IN PRIMARY BRAIN TUMOR PATIENTS

Abstract INTRODUCTION We previously reported to SNO, high levels of psychosocial distress in adult patients with primary brain tumors (PBTs), particularly during the first 6 months following diagnosis. The purpose of this follow-up study was to identify patterns of distress among older (≥ 65 years) patients with glioblastoma (GBM) compared to their younger (ages 18-64) counterparts. METHODS In our initial cross-sectional study, we collected the National Comprehensive Cancer Network’s Distress Thermometer (NCCN-DT) and problem list from adult patients with PBTs (WHO grades I-IV) seen at our institution between December 2013 and February 2016. We performed subsequent analyses on a subset of patients with GBM. RESULTS We identified 343 patients with GBM from the original dataset, of which 23.0% (n= 78) were ≥ 65 years old. The proportion of patients ≥ 65 years old with elevated distress (i.e. DT ≥ 4) was greater than the proportion of younger patients reporting elevated distress (47.4% vs 30.6%; p= 0.0068). Elevated distress was significantly greater during the first 6 months post diagnosis for all ages (p= 0.008). In subgroup analyses, a decrease in distress beyond 6 months was seen in younger patients (45.7% vs 27.4%; p= 0.021), but not in older patients. In older patients, a greater number of problems were selected on the NCCN DT and problem list tool: emotional and physical concerns were reported more frequently compared to their younger counterparts. Older patients were more likely to report difficulty with “bathing” and “getting around” (p= 0.009, p< 0.001, respectively). There were no differences in older versus younger GBM patients with regard to housing, transportation, treatment decisions, depression, fatigue, or memory. CONCLUSIONS In contrast to their younger counterparts, older patients with GBM experienced elevated levels of distress and a greater absolute number of specific psychosocial problems, mostly related to emotional and physical concerns.

El papel de la Biblioteca Nacional de España en la preservación y digitalización del patrimonio sonoro

La misión de la Biblioteca Nacional de España es conservar y difundir el patrimonio documental español en todos los soportes. Probablemente salvaguardar las grabaciones sonoras y la memoria oral sea la que plantea mayor número de problemas a las instituciones patrimoniales, que los custodian, pues no solo deben conservar el documento en sí, sino lo que en ellos se contiene.
 La colección de grabaciones sonoras de la Biblioteca Nacional de España asciende a unos 600.000 documentos, desde los antiguos rollos de pianola, cilindros de cera, cintas magnéticas, discos de vinilo, discos de pizarra, etc., hasta las más modernas grabaciones en soporte digital. La digitalización y preservación de las grabaciones sonoras musicales y Archivo de la palabra es uno de los objetivos prioritarios de la política de gestión de la colección, debido a la fragilidad de los documentos y a la obsolescencia de los aparatos que los reproducen. A ello se une el reto actual de asumir como biblioteca patrimonial la incorporación a sus colecciones de cualquier tipo de documento sonoro físico como virtual, además de la recolección y conservación de las páginas web, respetando el marco legal que les afecta. La colaboración con productores, distribuidores y plataformas digitales de distribución, permitirá que la BNE continúe su papel primordial de recopilar, preservar y difundir los documentos sonoros patrimoniales e integrantes indiscutibles del patrimonio cultural español. De ahí que la biblioteca participe activamente en los cambios propuestos en la nueva ley del Patrimonio Histórico Español, para que este tipo de documentos tengan un reconocimiento y protección más específico y amplio al amparo de la ley.

Evaluation of Classification Techniques for Land Use Change Mapping of Indian Cities

This study looks into the development of multi-level classification approach for land use change mapping in Indian cities using Landsat imageries. In this study, we mapped 47 Indian cities at different time frames 1990, 2000, 2010, and 2017. We started with traditional classification methods, but results provided unsatisfactory accuracy levels. Thus, we employed multiple classification techniques to achieve results with higher accuracy. The paper captures the evaluation of different classification techniques—hybrid, unsupervised, decision tree classification (DTC), and object-based image analysis (OBIA). The results suggest improvement in accuracy levels by using multi-level classification for different cities at different stages of the classification process. The most prominent is the hybrid classification technique; 14 cities out of 47 reached to accuracy above 72% through hybrid classification. For problematic classes, we used DTC, OBIA, and unsupervised classification techniques after masking the datasets. DTC was used in cities with a greater number of problems in datasets. For example, in the case of Kochi City, the accuracy at the initial level was reported 51% through unsupervised classification which improved to 77% (supervised classification), and finally, it reached 90% by DTC technique. The overall accuracy achieved through the multi-level classification approach described in this paper for the 47 Indian cities ranges from 81 to 93%.

The needs of patients with rare disease in Serbia. Why do we need National Strategy for rare disease?

The patients with rare diseases in Serbia face the difficulties in procurement of medications as the Health insurance fund does not cover reimbursement for some medications, they face difficulties in receiving proper diagnosis which makes their position specific and complex. In an attempt to provide more support for the patients with rare diseases, their families and caregivers the helpline for rare diseases was established in October 2015. The aim of this research was to identify, examine and systematise needs of helpline users and forms of assistance provided by the team from the free helpline. The research was designed as a cross-sectional study and was conducted between October 2015 and December 2016. The electronic database of National Organization for rare disease in Serbia helpline users was used as a data source. The user was the person who contacted helpline (patient, relative, friend, physician, etc). The "need" refers to the reasons for addressing the helpline. Helpline users had 549 needs in total; about healthcare-236 (42.98%), social care-113 (20.58%), psychological support-56 (10.20%) and other-144 (26.22%). Services were provided by the lawyer-130 (23.70%), social worker-71 (12.93%), Psychologist-56 (10.20%) and by all employees-292 (53.19%). The most common need for legal assistance among needs on healthcare was on legal aspects of access to and reimbursement of expenses for medications (32/74%-43.24%) and procedures for reimbursement of treatment abroad (11/74%-14.86%). The problems of patients with rare diseases and their families result primarily from the lack of relevant information and knowledge, as well as the non-recognition of rare diseases in the laws and regulations of health and social care. Some problems can simply be solved by legal changes and by a better organisation and do not require additional funding. Only by adopting and implementing the National Strategy and Action Plan for Rare Diseases, the greatest number of problems and needs of people with rare diseases can be systematised and solved.

Prevalence and Impact of Functional and Psychosocial Problems in Hospitalized Adults: A Prospective Cohort Study

ObjectivesUnderpinning standards for delivering comprehensive care in hospital is the need to identify issues contributing to patient complexity and risk of harm. The study aimed to investigate the prevalence of functional and psychosocial problems in hospitalized adults, to compare prevalence rates across age groups, and to assess their impact on discharge outcomes. Design, setting, and participantsA prospective cohort study was conducted in 4 hospitals in Australia during September 2015 to June 2016, recruiting patients aged 18 and over. MeasuresResearch nurses assessed patients at admission using the interRAI Acute Care instrument, which includes algorithms for diagnostic and risk screening and measuring problem severity. Length of stay and discharge outcome were recorded from medical records. ResultsThe median age of the study population (n = 910) was 66 (range 18-99 years), and 47.7% were female. Although 64.6% of patients aged ≥70 years had at least 1 classic geriatric syndrome (cognitive impairment, dependency in activities of daily living, history of falls, or incontinence), similar problems were prevalent in younger cohorts (34.6% in those aged <50 and 38.9% in those aged 50-69 years). Of 17 health issues assessed across multiple domains, only 26 patients (2.9%) had no problems. Independent of age, gender, and Comorbidity Index, having a greater number of problems was significantly associated with an adverse discharge outcome, odds ratio 1.19 (95% confidence interval (CI) 1.09-1.29); for each additional problem, the length of stay increased by 6.7% (95% CI 4.3%-9.2%). Conclusions/ImplicationsThe high prevalence of functional and psychosocial problems across the age range of patients indicates that universal screening and assessment is warranted for all adult patients to aid in care planning to meet patient needs both in acute care and post discharge.

Positive excessive drinker prototypes predict greater drinking and alcohol problems.

According to the prototype willingness model, risky behaviours such as heavy drinking may be influenced by images of others who engage in this behaviour. In this study, we examined whether college students' prototypes of an individual who frequently drinks "over the limit" were associated with their own alcohol consumption and experience of alcohol-related problems during their first 2years in college. We assessed students' (N=340) prototypes of excessive drinkers and their own alcohol consumption and problems at four time points, across their first 2years in college. Along with examining the trajectory of prototypes, consumption, and problems, we tested whether prototypes significantly predicted consumption and problems across the 2years. Additional analyses examined whether the predictive value of prototypes was unique from related variables including perceived descriptive norms, perceived injunctive norms, and peer pressure to drink alcohol. Primary analyses indicated that more positive prototypes of an excessive drinker were significantly associated with greater alcohol consumption in both year 1 and year 2. More positive prototypes were also significantly associated with experiencing more alcohol-related problems in year 2. These findings held when controlling for perceived descriptive and injunctive norms, and peer pressure. Findings further support the importance of drinker prototypes to one's own drinking behaviour. By examining prototypes over time and their relationship to alcohol-related problems, this study makes a novel contribution to the existing research. Statement of contribution What is already known on this subject? Perceived norms (beliefs about how much others drink and what they approve of) are associated with own drinking. Individuals construct "risk prototypes," or images of people who engage in risky behaviours like drinking alcohol. Positive risk prototypes of drinkers have been associated with own willingness to drink and subsequent drinking. What does this study add? This study shows the trajectory of drinker prototypes across the first 2years of college. Findings highlight consistent patterns of positive associations between drinker prototypes and own drinking. More positive drinker prototypes are associated with a greater number of problems with alcohol.

Factors associated with referral offer and acceptance following supportive care problem identification in a comprehensive cancer service.

To improve understanding of the triage process following distress and problem identification and the factors associated with offer and acceptance of supportive care referrals. Review of patient records/charts at a metropolitan hospital in Melbourne, Australia. Data were collected on problem identifications from 1/1/13 to 30/6/14, including patient demographics, disease and treatment information, responses to the NCCN Distress Thermometer (DT) and Problem Checklist (PC), whether referrals to supportive care services were offered and accepted/declined. Logistic regressions examined factors associated with referral offer and acceptance. Of patients completing the DT/PC, 50.1% reported a high level of distress. Overall, 61% of patients were offered referral(s), with the majority (71%) being accepted. Referrals were more likely to be offered to patients with a greater number of problems (Odds Ratio[OR]=1.18, 95%CI=1.12-1.25) and higher distress (OR=1.68, 95%CI=1.07-2.64). Referrals were more likely to be accepted by patients with a greater number of problems (OR=1.12, 95%CI=1.06-1.19) and lower distress (OR=0.58, 95%CI=0.34-1.00). The type of problem experienced by the patient was strongly related to the type of referral they were offered. At a large metropolitan hospital with in-house supportive care services, simple problem identification with the DT/PC enabled triage to services that reflected patients' needs. The findings suggest that clear referral pathways and an organisational emphasis on supportive care may facilitate service use.

Comparing the development of the multiplication of fractions in Turkish and American textbooks

ABSTRACTThis study analyzed the methods used to teach the multiplication of fractions in Turkish and American textbooks. Two Turkish textbooks and two American textbooks, Everyday Mathematics (EM) and Connected Mathematics 3 (CM), were analyzed. The analyses focused on the content and the nature of the mathematical problems presented in the textbooks. The findings of the study showed that the American textbooks aimed at developing conceptual understanding first and then procedural fluency, whereas the Turkish textbooks aimed at developing both concurrently. The American textbooks provided more opportunities for different computational strategies. The solutions to most problems in all textbooks required a single computational step, a numerical answer, and procedural knowledge. Furthermore, compared with the Turkish textbooks, the American textbooks contained a greater number of problems that required high-level cognitive skills such as mathematical reasoning.

Taro (Colocasia esculenta)-An Important Staple Food for the General Population of Fiji Islands

Taro production in Fiji is fluctuating in a yearly basis due to presence of devastating pests and diseases. Lack of knowledge in controlling these pests and diseases and the availability of controlling resources is another problem, which farmers in Fiji are currently facing. Taveuni being the largest supplier of taro in Fiji, is experiencing problems related to mono-cropping which in cooperates problems like soil degradation, unwanted weeds and minor pests and diseases. This research article mainly focuses on pests and diseases associated with taro production in Fiji and possible control measures to help farmers in Fiji to enhance their knowledge in controlling these pests and diseases. A thorough survey of taro farmers and exporting companies in Fiji was done to evaluate the problems that have directly or indirectly affected taro production in Fiji in previous years. As shown in figure 2, Fiji has experienced the shortages of taro in the year 2010, 2012 and 2014 as a result of increasing pest and diseases. This shortage not only has affected the demand from overseas market but also farmers in terms of earning for their livelihood. If these problems are not solved at an earliest, the taro industry in Fiji may collapse resulting in greater number of problems in future.

Depth of the patient-doctor relationship and content of general practice consultations: cross-sectional study.

Patient-doctor continuity is valued by both parties, yet the effect of the depth of the patient-doctor relationship on the content of consultations in general practice is unknown. To assess whether differences in the depth of relationship between a patient and their GP affects the length of consultations, and the number and type of problems and issues raised during a consultation. Cross-sectional study in 22 GP practices in the UK. GP consultations (n = 229) were videotaped and the number of problems and aspects of those problems and issues identified. Patients completed the Patient-Doctor Depth of Relationship (PDDR) and General Practice Assessment Questionnaire-communication (GPAQc) scales. Associations were explored using multivariable linear and logistic regression. Complete data were available on 190 participants consulting 30 GPs. In unadjusted analysis, patients with a deep relationship with their GP discussed more problems (mean 2.8) and issues (mean 4.7) compared with those with a moderate (2.4 problems; 4.0 issues) or shallow (2.3 problems; 3.8 issues) relationship. Patients with deep relationships had consultations that were on average 118 seconds (95% CI = 1 to 236) longer than those with shallow relationships. Adjustment for participant and GP factors attenuated these relationships, although the main trends persisted. A greater number of problems and issues may be raised in a consultation when patients have a deeper relationship with their GP. Over several clinical encounters each year, this may be associated with significant benefits to patients and efficiencies in GP consultations and warrants further investigation.

Heterogeneous dose-response and college student drinking: examining problem risks related to low drinking levels.

Previous research demonstrates that the number of problems related to each additional drink consumed on any drinking occasion, dose-response, varies non-linearly across average drinking quantities. We test predictions from a dynamic model of drinking behavior that locates this heterogeneity in drinkers' efforts to equilibrate between costs and benefits of use. Equations derived from the theoretical model are used to assess dose-response across drinking quantity subgroups using censored regressions. Fourteen California, USA, college campuses surveyed from 2003 to 2011. A total of 37 762 undergraduate college students 18 years of age and older. Drinking patterns, five physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) and student demographics. The number of physiological problems related to each additional drink consumed was an inverse function of average drinking quantities (b = 0.2947, Z = 21.92, P<0.001), differed by drinker age (of-age drinker b = -0.1144, Z = -3.95, P < 0.001) and gender (male b = -0.3379, Z = -18.56, P<0.001) and, at the population level, drinking three drinks per occasion was associated with the greatest number of problems. Among US college students, all drinkers exhibit greater risks for physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) when drinking greater amounts of alcohol, but heavier drinkers (those who consume more on average) exhibit fewer problems for each additional drink consumed (less dose-response) than light and moderate drinkers. Light and moderate drinkers exhibit greater dose-response, with three drinks per occasion associated with the greatest number of problems.

Assessing the Impact of a Multiyear Marriage Education Program

This study measured marital satisfaction of low-income couples in a Western state following participation in the Building Healthy Marriages program, which aimed to educate couples and increase relationship satisfaction. The researchers’ goals were the following: To determine the areas in which participants experienced the greatest number of problems before entering the program, to assess the program’s impact on marital satisfaction, and to examine the differences in program impact between various demographic groups. To assess the program’s impact, participants were administered the Marital Satisfaction Inventory–Revised before beginning the program and 1 year after completing the pretest. Before starting the program, couples experienced the greatest number of challenges in relationships within their families of origin and problem-solving communication and the fewest problems in areas related to their children. Couples reported significant improvements in marital satisfaction. These changes did not differ significantly between different gender and ethnicity groups.

Working memory and impulsivity predict marijuana-related problems among frequent users

BackgroundAlthough marijuana is the most commonly used illicit substance in the US, only a small portion of users go on to develop dependence, suggesting that there are substantial individual differences in vulnerability to marijuana-related problems among users. Deficits in working memory and high trait impulsivity are two factors that may place marijuana users at increased risk for experiencing related problems. MethodsUsing baseline data from an experimental study that recruited 104 frequent marijuana users (M=71.86% of prior 60 days, SD=22%), we examined the associations of working memory and trait impulsivity with marijuana-related problems. ResultsLower working memory, as measured by Trail Making Test B, but not short-term memory capacity, predicted more marijuana-related problems. Higher trait impulsivity scores were independently associated with greater number of problems. ConclusionsResults suggest that marijuana users with reduced executive cognitive ability are more susceptible to developing problems related to their use. Trait impulsivity and executive working memory appear to be independent risk factors for experiencing marijuana-related problems.

Validation of Malaysian translated distress thermometer with problem checklist among the breast cancer survivors in Malaysia

IntroductionDistress thermometer (DT) is a single-item measure generated to assess the psychological distress among cancer patients. The aim of this study was to validate the translated DT as a tool to determine the psychological distress level and assess the factors associated with distress among the working breast cancer survivors and also to compare with the Hospital Anxiety and Depression Scale (HADS). Methods150 working breast cancer survivors were interviewed using the Malay and Chinese language translated version of DT and HADS. ResultsBased on HADS, 23.3% were anxious, 19.3% were depressed whereas 15.3% experienced both anxiety and depression. About 14.7% of the respondents reported distress (cutoff≥5) on DT. A significant association was found between the DT and HADS which indicated that both were measuring the same construct, Hospital Anxiety and Depression Scale-T (F=71.34, p<0.001), Hospital Anxiety and Depression Scale-A (F=65.81, p<0.001), Hospital Anxiety and Depression Scale-D (F=74.28, p<0.001). This study also showed that a cut-off of ≥5 on DT yielded an area under Receiver analysis characteristic curve (AUC) of 0.95 with a sensitivity of 90.9% and specificity of 89.8% for HADS-T score defined as cases. On the problem checklist, respondents scoring above the cut-off of 5 on DT had a greater number of problems with family (70.0%), emotional (65.0%), physical (60.0%), practical (50.0%) and spiritual/religious (15.0%) issues. DiscussionOverall, DT was a useful and simple screening tool to indicate psychological distress. The translated DT has a good sensitivity and specificity for screening psychological distress among the Malaysian breast cancer survivors.

The Green Card Clinic: Overview of a Brief Patient-Centred Intervention Following Deliberate Self-Harm

The aim of this study was to present an overview of the Green Card Clinic, a novel brief intervention service for patients presenting to the emergency department following deliberate self-harm (DSH) or with suicidal ideation, to examine its effectiveness in terms of service utilization, and patient and clinician feedback, and to explore the correlates of repeated DSH. The aims and structure of the Green Card Clinic are described. We highlight our patient-centred approach involving self-identification of difficulties from a list of problem areas, coupled with tailored intervention strategies. Relevant data are presented and characteristics of repeat DSH patients are compared to the first-episode group. Between 1998 and 2005, 456 DSH patients were referred to the clinic. Of these, 75% (n = 344) attended the first session, 43% (n = 197) the second session, 26% (n = 117) the third session, and 16% (n = 73) completed a 3-15 month follow-up. Clinic attenders (mean age 31.6 years, 57% female) reported a diverse range of self-identified problems and repeat DSH patients reported worse depression, poorer health-related behaviours, and a greater number of problems than those presenting after first-episode DSH. The clinic achieved high rates of first session attendance. This may have been attributable to the use of a few specific strategies aimed at increasing compliance, such as the green card, next-day appointments and assertive follow-up of non-attenders. For repeat self-harmers, we advocate an approach aimed at 'lifestyle change' rather than based on current psychological stressors. The Green Card Clinic service, involving a range of interventions tailored to meet the multitude of presenting needs, appears to be an acceptable and flexible approach to brief intervention for DSH.

Self-Reported Problems After Spinal Cord Injury: Implications for Rehabilitation Practice

The purpose of this study was to identify self-reported problems among people with spinal cord injury (SCI), their relationship with aging after SCI, and how they change over time. Data on self-reported problems were collected during the second and third stages of a longitudinal aging study. Factor analysis of the stage 2 data revealed 4 factors reflective of emotional adaptation, dependency, health problems, and the environment. Four scales were developed based on this analysis. Comparisons of scale scores over time and between cohorts based on years post injury failed to reach significance. Areas in which participants cited the greatest number of problems included pain, lack of income and money problems, spasticity, stress and worries, and their sex lives. The results of these comparisons suggest that at least a portion of people with SCI experience significant problems in a number of areas of life, resulting in ongoing stress. These problems do not appear to be highly correlated with aging, suggesting ...

Development of a teletechnology protocol for in-home rehabilitation

Our ability to provide in-home rehabilitation is limited by distance and available personnel. We may be able to meet some rehabilitation needs with videoconferencing technology. This article describes the feasibility of teletechnology for delivering multifactorial, in-home rehabilitation interventions to community-dwelling adults recently prescribed a mobility aid. We used standard telephone lines to provide two-way video and audio interaction. The interventions included prescription of and/or training in functionally based exercises, home-hazard assessment, assistive technology, environmental modifications, and adaptive strategies. Patients were evaluated in three transfer and three mobility tasks, and appropriate treatment was provided over the course of four visits. To date, 13 of the 14 subjects enrolled in the rehabilitation study have completed all four visits (56 visits total). Equipment-related problems were most common early in the study, particularly on the initial visit to a subject's house. We identified (mean +/- standard deviation [SD]) 13.1 +/- 7.9 mobility/self-care problems per subject and made 12.5 +/- 8.3 recommendations per subject to address those problems. At 6-week follow-up, 60.1 percent of our recommendations had been implemented. The greatest number of problems was identified for tub transfers (mean +/- SD = 3.4 +/- 1.4), the greatest number of recommendations was made for toilet transfers (mean +/- SD = 3.1 +/- 3.4), and the most frequently implemented recommendations were for transition between locations. Overall, our results show promise that both the telerehabilitation technology and intervention procedures are feasible.

Facilitation of Problem Finding Among First Year Medical School Students Undergoing Problem-Based Learning

Background: Adaptation to problem-based learning (PBL) is a difficult process for high school graduates who are not used to self-directed learning, especially in the freshmen year of medical school. The difficulty includes finding problems from a given case.Purpose: Evaluate the effect of an intervention to facilitate case-based problem finding among medical school freshmen undergoing a PBL tutorial.Methods: Medical school freshmen in 2000 (nonintervened group) and 2001 (intervened group) participated in the study. The intervened group received the modified problem-based program by (a) having briefings on the importance of problem finding, (b) encouragement by the tutors in problem finding, and (c) reinforcement using a self-assessment sheet. At the end of the year, the ability of students to extract problems from a short case was evaluated and compared with the nonintervened students.Results: The intervened group extracted a significantly greater number of problems than the nonintervened group. When extracted problems were categorized, the intervened group was able to generate more questions in a greater number of specified categories.Conclusions: Interventions to foster problem finding significantly facilitated acquisition of problem extraction skills among young medical students.