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Evaluation von multimedialen e-Lernkursen zur Vorbereitung auf ein biochemisches Praktikum [Evaluation of multimedia e-Learning preparatory courses for a practial course in Biochemistry]
Rost, Birgit,Koolman, Jan
GMS Zeitschrift für Medizinische Ausbildung , 2009, DOI: 10.3205/zma000603
Abstract: [english] The present study examined whether the application of multimedia learning courses is also suitable for preparing students for practical laboratory courses, both in terms of theory and practice. For this purpose, multimedia e-learning courses were provided and evaluated within the k-MED project. These courses were particularly tailored to the practical training in biochemistry, a mandatory course for third-semester students of medicine and dentistry in Marburg. Two weeks prior to the beginning of the practical course, one-half of the participants received the theoretical e-courses “lipid basics” and “lipid metabolism”, the other half was provided with the e-course “lipid methods”, which contained relevant laboratory techniques and digital guidance to the experiments. All participants were surveyed on user-friendliness and acceptance, and “hard” facts were collected with respect to success in learning for and attendance to the practical course. Assessment grades, test results, user-tracking data for the learning platform, and questionnaires were evaluated. Use of the e-courses led to a significant improvement in the level of achievement in terms of the assessment grades. Certain influencing factors, such as diligence or prior biochemical knowledge, were excluded by covariance analysis. The e-course led to improved levels of achievement in the practical training: groups to whom the methods course was provided made fewer experimental errors and needed less assistance from supervisors. Conclusion: e-learning courses cannot replace practical experience in laboratory courses; they can, however, as this extensive study shows, improve the level of achievement in classes by allowing more efficient preparation. Not only does this save time, but it also saves on expensive materials, relieves the burden on staff, and leads to a general improvement in teaching quality. [german] In der vorliegende Studie wurde untersucht, ob der Einsatz multimedialer Lernkurse auch zur Vorbereitung auf Laborpraktika geeignet ist, und zwar sowohl im theoretischen als auch im praktischen Bereich. Dazu wurden im Rahmen des k-MED Projektes multimediale e-Lernkurse erstellt und evaluiert, die speziell auf das biochemische Praktikum zugeschnitten waren, das die Studierenden im dritten Semester der Medizin und der Zahnmedizin in Marburg absolvieren. Zur Vorbereitung des Versuchsblocks Lipide“ bekam die H lfte der Teilnehmer jeweils zwei Wochen vor Praktikumsbeginn die Theoriekurse "Lipide - Grundlagen" und "Lipide - Stoffwechsel" zur Verfügung gestellt, die andere H lfte den Kurs
Dutch healthcare reform: did it result in better patient experiences in hospitals? a comparison of the consumer quality index over time
David E Ikkersheim, Xander Koolman
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-76
Abstract: We analyzed 8,311 respondents covering 31 hospitals in 2006, 22,333 respondents covering 78 hospitals in 2007 and 24,246 respondents covering 94 hospitals in 2009. We describe CQI trends over the period 2006-2009. In addition we compare hospitals that varied in the level of competition they faced and hospitals that were forced to publish CQI results publicly and those that were not. We corrected for observable covariates between hospital respondents using a multi level linear regression. We used the Herfindahl Hirschman Index to indicate the level of competition.Between 2006 and 2009 hospitals showed a CQI improvement of 0.034 (p < 0.05) to 0.060 (p < 0.01) points on a scale between one and four. Hospitals that were forced to publish their scores showed a further improvement of 0.027 (p < 0.01) to 0.030 (p < 0.05). Furthermore, hospitals that faced more competition from geographically close competitors showed a more pronounced improvement of CQI-scores 0.004 to 0.05 than other hospitals (p < 0.001).Our results show that patients reported improved experiences measured by the CQI between 2006 and 2009. CQI levels improve at a faster rate in areas with higher levels of competition. Hospitals confronted with forced public publication of their CQI responded by enhancing the experiences of their patients.In the last two decades, several Western countries introduced some form of managed competition in their health care system [1,2]. Common goal of these reforms is creating a demand driven system that provides more patient centered care [3]. To achieve this goal the quality of health care providers needs to be assessed and publicly reported [4,5]. Patients and health plans may then use quality information to make informed choices between health care providers.The public reporting of provider quality can stimulate quality improvement through informed patient choice, quality contracting of providers by health plans and/or by intrinsic motivation of health care providers [6].
Criteria for priority setting of HIV/AIDS interventions in Thailand: a discrete choice experiment
Sitaporn Youngkong, Rob Baltussen, Sripen Tantivess, Xander Koolman, Yot Teerawattananon
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-197
Abstract: Criteria for priority setting of HIV/AIDS interventions in Thailand were identified in group discussions with policy makers, people living with HIV/AIDS (PLWHA), and community members (i.e. village health volunteers (VHVs)). On the basis of these, discrete choice experiments were designed and administered among 28 policy makers, 74 PLWHA, and 50 VHVs.In order of importance, policy makers expressed a preference for interventions that are highly effective, that are preventive of nature (as compared to care and treatment), that are based on strong scientific evidence, that target high risk groups (as compared to teenagers, adults, or children), and that target both genders (rather than only men or women). PLWHA and VHVs had similar preferences but the former group expressed a strong preference for care and treatment for AIDS patients.The study has identified criteria for priority setting of HIV/AIDS interventions in Thailand, and revealed that different stakeholders have different preferences vis-à-vis these criteria. This could be used for a broad ranking of interventions, and as such as a basis for more detailed priority setting, taking into account also qualitative criteria.While the number of new HIV positive cases in Thailand decreases [1-3], HIV/AIDS continues to take a large toll in the country with 610,000 prevalent cases and approximately 30,000 deaths in 2007 [2]. A wide array of HIV/AIDS control programmes has been implemented to confront the epidemic since the first wave of infections in the mid-1980s [1,4]. Thailand's current national plan for HIV/AIDS prevention and alleviation, 2007-2011 [3] aims to: (i) integrate AIDS prevention, care, treatment, and impact reduction implementation into service provision at all levels; (ii) strengthen community's education about AIDS; (iii) enhance capacity of local administration in taking responsibility on local HIV/AIDS interventions; and (iv) prevent HIV transmission among children in schools and high-risk populatio
Pracital examination in biochemistry: topics and procedures?
Vocke, Nils-Daniel,Zwinger, Matthias,Koolman, Jan
GMS Zeitschrift für Medizinische Ausbildung , 2005,
Abstract: Under the new revision of the German licensing regulations for physicians ("Approbationsordnung") the rules for the first national examinations (i.e. "Physikum", equivalent to medical school entrance exams) have been changed. In addition to the written exam a novel "oral-practical" part is required. Here we describe the implications of this oral-practical exam on the examination procedures in the field of biochemistry/molecular biology. A strategy for its realization is proposed.
Measuring and explaining mortality in Dutch hospitals; The Hospital Standardized Mortality Rate between 2003 and 2005
Richard Heijink, Xander Koolman, Daniel Pieter, André van der Veen, Brian Jarman, Gert Westert
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-73
Abstract: HSMRs were estimated using data from the complete population of discharged patients during 2003 to 2005. We used binary logistic regression to indirectly standardize for differences in case-mix. Out of a total of 101 hospitals 89 hospitals remained in our explanatory analysis. In this analysis we explored the association between HSMRs and determinants that can and cannot be influenced by hospitals. For this analysis we used a two-level hierarchical linear regression model to explain variation in yearly HSMRs.The average HSMR decreased yearly with more than eight percent. The highest HSMR was about twice as high as the lowest HSMR in all years. More than 2/3 of the variation stemmed from between-hospital variation. Year (-), local number of general practitioners (-) and hospital type were significantly associated with the HSMR in all tested models.HSMR scores vary substantially between hospitals, while rankings appear stable over time. We find no evidence that the HSMR cannot be used as an indicator to monitor and compare hospital quality. Because the standardization method is indirect, the comparisons are most relevant from a societal perspective but less so from an individual perspective. We find evidence of comparatively higher HSMRs in academic hospitals. This may result from (good quality) high-risk procedures, low quality of care or inadequate case-mix correction.It is well-known that hospital quality varies widely, yet it remains difficult to measure. In the past, various studies tried to measure health outcomes as measures of hospital quality [1-10]. The most accurately and completely registered outcome seems to be mortality.A comparison of hospital mortality between hospitals does not show hospital quality directly, because the number of hospital deaths is likely to be influenced by the characteristics of admitted patients. These characteristics will not be distributed evenly across hospitals. Consequently, hospitals that treat more severe patients will have
Decomposing cross-country differences in quality adjusted life expectancy: the impact of value sets
Richard Heijink, Pieter van Baal, Mark Oppe, Xander Koolman, Gert Westert
Population Health Metrics , 2011, DOI: 10.1186/1478-7954-9-17
Abstract: We calculated Quality Adjusted Life Expectancy (QALE) at age 20 for 15 countries in which EQ-5D population surveys had been conducted. We applied the Sullivan approach to combine the EQ-5D based HRQoL data with life tables from the Human Mortality Database. Mean HRQoL by country-gender-age was estimated using a parametric model. We used nonparametric bootstrap techniques to compute confidence intervals. QALE was then compared across the six country-specific time trade-off value sets that were available. Finally, three counterfactual estimates were generated in order to assess the contribution of mortality, health states and health-state values to cross-country differences in QALE.QALE at age 20 ranged from 33 years in Armenia to almost 61 years in Japan, using the UK value set. The value sets of the other five countries generated different estimates, up to seven years higher. The relative impact of choosing a different value set differed across country-gender strata between 2% and 20%. In 50% of the country-gender strata the ranking changed by two or more positions across value sets. The decomposition demonstrated a varying impact of health states, health-state values, and mortality on QALE differences across countries.The choice of the value set in SMPH may seriously affect cross-country comparisons of health expectancy, even across populations of similar levels of wealth and education. In our opinion, it is essential to get more insight into the drivers of differences in health-state values across populations. This will enhance the usefulness of health-expectancy measures.Summary measures of population health (SMPH) have been calculated to represent the health of a particular population in a single number, combining information on fatal and nonfatal health outcomes [1,2]. SMPH have been applied to various purposes, e.g., to monitor changes in population health over time, to compare population health across countries, to investigate health inequalities (the distrib
Socioeconomic status and self-reported tuberculosis: a multilevel analysis in a low-income township in the Eastern Cape, South Africa
Jane Murray Cramm,Xander Koolman,Valerie M?ller,Anna P. Nieboer
Journal of Public Health in Africa , 2011, DOI: 10.4081/jphia.2011.e34
Abstract: Few studies have investigated the interplay of multiple factors affecting the prevalence of tuberculosis in developing countries. The compositional and contextual factors that affect health and disease patterns must be fully understood to successfully control tuberculosis. Experience with tuberculosis in South Africa was examined at the household level (overcrowding, a leaky roof, social capital, unemployment, income) and at the neighbourhood level (Gini coefficient of inequality, unemployment rate, headcount poverty rate). A hierarchical random-effects model was used to assess household-level and neighbourhood-level effects on self-reported tuberculosis experience. Every tenth household in each of the 20 Rhini neighbourhoods was selected for inclusion in the sample. Eligible respondents were at least 18 years of age and had been residents of Rhini for at least six months of the previous year. A Kish grid was used to select one respondent from each targeted household, to ensure that all eligible persons in the household stood an equal chance of being included in the survey. We included 1020 households within 20 neighbourhoods of Rhini, a suburb of Grahamstown in the Eastern Cape, South Africa. About one-third of respondents (n=329; 32%) reported that there had been a tuberculosis case within the household. Analyses revealed that overcrowding (P≤0.05) and roof leakage (P≤ 0.05) contributed significantly to the probability of a household TB experience, whereas higher social capital (P≤0.01) significantly reduced this probability. Overcrowding, roof leakage and the social environment affected tuberculosis prevalence in this economically disadvantaged community. Policy makers should consider the possible benefits of programs that deal with housing and social environments when addressing the spread of tuberculosis in economically poor districts.
Developing quality indicators for the care of HIV-infected pregnant women in the Dutch Caribbean
Hillegonda S Hermanides, Lonneke A van Vught, Ralph Voigt, Fred D Muskiet, Aimée Durand, Gerard van Osch, Sharline Koolman-Wever, Isaac Gerstenbluth, Colette Smit, Ashley J Duits
AIDS Research and Therapy , 2011, DOI: 10.1186/1742-6405-8-32
Abstract: A multidisciplinary expert panel of 19 experts reviewed and prioritized recommendations extracted from locally used international PMTCT guidelines according to a 3-step-modified-Delphi procedure. Subsequently, the feasibility, sample size, inter-observer reliability, sensitivity to change and case mixed stability of the potential indicators were tested for a data set of 153 HIV-infected women, 108 pregnancies of HIV-infected women and 79 newborns of HIV-infected women in Aruba, Cura?ao and St Maarten from 2000 to 2010.The panel selected and prioritized 13 potential indicators. Applicability could not be tested for 4 indicators regarding HIV-screening in pregnant women because of lack of data. Four indicators performed satisfactorily for Cura?ao ('monitoring CD4-cell count', 'monitoring HIV-RNA levels', 'intrapartum antiretroviral therapy and infant prophylaxis if antepartum antiretroviral therapy was not received', 'scheduled caesarean delivery') and 3 for St Maarten ('monitoring CD4-cell count', 'monitoring HIV-RNA levels', 'discuss and provide combined antiretroviral therapy to all HIV-infected pregnant women') whilst none for Aruba.A systemic evidence-and consensus-based approach was used to develop quality indicators in 3 Dutch Caribbean settings. The varying results of the applicability testing accentuate the necessity of applicability testing even in, at first, comparable settings.Acquired immunodeficiency syndrome (AIDS) is a leading cause of illness and death among women and children in countries with high rates of human immunodeficiency virus (HIV) infection [1]. Mother-To-Child HIV Transmission (MTCT) is by far the most significant route of HIV-infection in children. Several interventions have proven to be effective in reducing MTCT, including elective caesarean delivery [2,3], substitution of breastfeeding [4-6] and access to antiretroviral therapy during pregnancy, labour and post-partum [7]. If properly applied, these interventions reduce the MTCT rates
Resistance to diet-induced adiposity in cannabinoid receptor-1 deficient mice is not due to impaired adipocyte function
Maaike H Oosterveer, Anniek H Koolman, Pieter T de Boer, Trijnie Bos, Aycha Bleeker, Theo H van Dijk, Vincent W Bloks, Folkert Kuipers, Pieter JJ Sauer, Gertjan van Dijk
Nutrition & Metabolism , 2011, DOI: 10.1186/1743-7075-8-93
Abstract: We evaluated adipose tissue differentiation/proliferation markers and quantified lipogenic and lipolytic activities in fat tissues of CB1-/- and CB1+/+ mice fed a high-fat (HF) or a high-fat/fish oil (HF/FO) diet as compared to animals receiving a low-fat chow diet. Comparison between HF diet and HF/FO diet allowed to investigate the influence of dietary fat quality on adipose tissue biology in relation to CB1 functioning.The adiposity-resistant phenotype of the CB1-/- mice was characterized by reduced fat mass and adipocyte size in HF and HF/FO-fed CB1-/- mice in parallel to a significant increase in energy expenditure as compared to CB1+/+ mice. The expression levels of adipocyte differentiation and proliferation markers were however maintained in these animals. Consistent with unaltered lipogenic gene expression, the fatty acid synthesis rates in adipose tissues from CB1-/- and CB1+/+ mice were unchanged. Whole-body and adipose-specific lipoprotein lipase (LPL) activities were also not altered in CB1-/- mice.These findings indicate that protection against diet-induced adiposity in CB1-deficient mice is not related to changes in adipocyte function per se, but rather results from increased energy dissipation by oxidative and non-oxidative pathways.The endocannabinoid system (ECS) comprises the endogenous cannabinoids (endocannabinoids or ECs), the cannabinoid receptors and the enzymes involved in the synthesis and degradation of endocannabinoids [1]. The two most studied ECs anandamide (AEA) and 2-arachidonoyl glycerol (2-AG) are amides and esters, respectively, of long-chain polyunsaturated fatty acids (PUFAs) [2]. To date, two G protein-coupled cannabinoid receptors have been identified. Because of its role in the central regulation of food intake and energy balance, the cannabinoid 1 (CB1)-receptor has emerged as an interesting drug target for treatment of obesity, dyslipidemia and insulin resistance. CB2-receptors, on the other hand, are mainly involved in immu
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