Feasibility of an evidence-based literature search service for general practitioners

Objective: To test the feasibility of an evidence-based clinical literature search service to help answer general practitioners' (GPs') clinical questions. Design: Two search services supplied GPs who submitted questions with the best available empirical evidence to answer these questions. The GPs provided feedback on the value of the service, and concordance of answers from the two search services was assessed. Setting: Two literature search services (Queensland and Victoria), operating for nine months from February 1999. Main outcome measures: Use of the service; time taken to locate answers; availability of evidence; value of the service to GPs; and consistency of answers from the two services. Results: 58 GPs asked 160 questions (29 asked one, 11 asked five or more). The questions concerned treatment (65%), aetiology (17%), prognosis (13%), and diagnosis (5%). Answering a question took a mean of 3 hours 32 minutes of personnel time (95% Cl, 2.67-3.97); nine questions took longer than 10 hours each to answer, the longest taking 23 hours 30 minutes. Evidence of suitable quality to provide a sound answer was available for 126 (79%) questions. Feedback data for 84 (53%) questions, provided by 42 GPs, showed that they appreciated the service, and asking the questions changed clinical care. There were many minor differences between the answers from the two centres, and substantial differences in the evidence found for 4/14 questions. However, conclusions reached were largely similar, with no or only minor differences for all questions. Conclusions: It is feasible to provide a literature search service, but further assessment is needed to establish its cost effectiveness.

Memory awareness and schematization: Learning in the university context

Following the application of the remember/know paradigm to student learning by Conway et al. (1997), this study examined changes in learning and memory awareness of university students in a lecture course and a research methods course. The proposed shift from a dominance of 'remember' awareness in early learning to a dominance of 'know' awareness as learning progresses and schematization occurs was evident for the methods course but not for the lecture course. The patterns of remember and know awareness and proposed associated levels of schematization were supported by a separate measure of the quality of student learning using the SOLO (Structure of Observed Learning Outcomes) Taxonomy. As found by previous research, the remember-to-know shift and schematization of knowledge is dependent upon type of course and level of achievement. Findings are discussed in terms of the utility of the methodology used, the theoretical implications and the applications to educational practice. Copyright (C) 2001 John Wiley & Sons, Ltd.

Does affective learning exist in the absence of contingency awareness?

The proposal that affective learning, the learning of likes and dislikes, can exist in the absence of contingency awareness, whereas signal learning, the learning of stimulus relationships, cannot, was investigated in a differential conditioning paradigm that was embedded in a visual masking task. Startle magnitude modulation and changes in verbal ratings served as measures of affective learning, whereas skin conductance was taken to reflect signal learning. Awareness was assessed online with an expectancy dial and in a postexperimental questionnaire. Both between-subject comparisons of verbalizers and nonverbalizers and within-subject comparisons of verbalizers before and after verbalization failed to reveal any evidence for learning, whether affective or otherwise, in the absence of knowledge of the stimulus contingencies. (C) 2001 Academic Press.

Mindreading and moral awareness in popular and rejected preschoolers

This study sought to examine links among young children's peer relations, their moral understanding in terms of the ability to distinguish lies from mistakes, and their theory-of-mind development. Based on sociometric measures, 109 children with a mean age of 4.8 years were divided into groups of popular and rejected preschoolers. Rejected children who had a stable mutual friend scored higher on measures of moral understanding and theory of mind than did rejected children without such friendships. Similarly, popular children who had a stable mutual friendship outperformed other popular children on mindreading, although their moral understanding was no better than that of the popular group who lacked mutual friends. Hierarchical multiple regression analyses revealed that peer popularity was a significant independent predictor of children's moral understanding after any effects of verbal maturity, age and theory-of-mind were statistically controlled. Moreover, having a reciprocal stable friendship made a significant independent contribution to the explanation of individual differences in mindreading, over and above age and verbal maturity, which also contributed significantly. These results are discussed in terms of conversational, cognitive, and emotional processes in the development of social cognition.

Telemedicine and clinical genetics: establishing a successful service

There is a surprising lack of published experience on the use of videoconferencing in clinical genetics. Patients were randomly allocated to either a telegenetic (cases) or face-to-face (control) conventional clinic. The telegenetic consultation was done by videoconferencing, using ISDN lines at 384 kbit/s. Evaluation by the doctor and counsellor took place immediately after each appointment. The patient was asked to evaluate the appointment by telephone questionnaire about four weeks after the event. Forty-two patients were invited to participate and 33 (79%) returned their consent forms. Four patients declined to participate and were seen in ordinary face-to-face clinics. Preliminary results showed that the assessment of the telegenetics consultations by doctors, counsellors and patients was very favourable, and they responded positively when asked if they would be happy to use telemedicine in the future. For use in selected consultations, videoconferencing does appear to fulfil a useful role in clinical genetics.

Videoconferencing in the Queensland health service

Videoconferencing was introduced in the Queensland health service in 1995. By the end of 1999, there were more than 150 videoconferencing units in health facilities around the state. Six audits of videoconferencing usage were conducted using similar methodology at six-month intervals from November 1997 to May 2000. Between November 1997 and November 1999, the number of calls more than doubled, from 566 to 1378. Hours of usage almost trebled, from 671 to 1724. The average duration of calls remained similar, at about I h 12 min. The proportion of calls involving more than two sites (multipoint videoconferences) increased from 44% to 65%. The majority of the activity was for education (including training). Videoconferencing was also used for administration and clinical care. Mental health staff were the heaviest users, but use by health professionals from other specialty areas increased during the study period. The Queensland health service has realized a number of important benefits from telehealth.