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Biomedical subjects

C J Rosebraugh

Publications and source records attributed to C J Rosebraugh.

12 recordsLinked to original sources
PubMed2001

Visual hallucination and tremor induced by sertraline and oxycodone in a bone marrow transplant patient.

The authors report a case of probable serotonin syndrome caused by the coadministration of sertraline and oxycodone. A 34 year-old male patient experienced visual hallucinations and severe tremor after dramatically increasing his dosage of oxycodone while on stable amounts of sertraline and cyclosporin. Discontinuation of cyclosporin did not result in resolution of his symptoms. Consideration of a possible sertraline-oxycodone interaction led to withholding sertraline, which resulted in symptom resolution. Serotonin syndrome has been noted with sertraline in combination with other drugs, but this is the first report in combination with a narcotic analgesic. Possible pharmacological mechanisms are discussed. In complicated patients that are taking multiple medications, physicians should be aware of this possible interaction to avoid delay in the diagnosis of serotonin syndrome.

Adult↗
PubMed2001

Olanzapine-induced rhabdomyolysis.

OBJECTIVE: To report a possible case of olanzapine-induced rhabdomyolysis with concomitant lithium-induced pseudo-infarction electrocardiogram changes. CASE SUMMARY: A 13-year-old white boy was admitted to the hospital with profound weakness and electrocardiogram (EGG) changes suggestive of myocardial damage after starting olanzapine and lithium. An adverse medication effect was not considered at the time of the patient's admission. The time course of onset of weakness was coincident with administration of olanzapine. ECG abnormalities are a known manifestation of lithium therapy DISCUSSION: This is a case description of olanzapine-induced rhabdomyolysis. Although other antipsychotic agents have been reported to cause rhabdomyolysis, an adverse drug reaction was not initially part of this patient's differential diagnosis. The patient had begun reporting rnyalgias six days after starting olanzapine. Fourteen days later, these symptoms forced him to bed rest; lithium was added for behavior misinterpreted as disobedience and oppositional disorder. Only when medications were considered as cause of the weakness and EGG changes, was the true nature of the patient's illness discovered. CONCLUSIONS: Olanzapine, like other neuroleptic agents, can cause rhabdomyolysis. Lithium can cause multiple EGG changes that can be misinterpreted as myocardial damage. Medication effects and adverse effects must always be considered in any disease complex.

Adolescent↗
PubMed2000

Learning disabilities and medical schools.

Learning disabilities are a group of disorders that affect 10-15% of the general population and 3% of United States medical students. Medical students with learning disabilities are typically unaware of their disorder and may only learn of it when the pace of medical school curriculum overtakes what were previously successful study techniques. Despite the significant prevalence of this disorder, medical educators' awareness, understanding and provision of services for people with these disabilities are inadequate. This paper will present a medical student with a learning disability as a basis for discussion of the prevalence, classification systems and diagnostic testing methods for this disorder. Finally, recommendations for medical school administrative preparedness and accommodation of learning disability students will be presented, followed by a list of celebrated physicians with learning disabilities.

Aptitude↗
PubMed2000

Quantification of human H1 histamine receptor mRNA from peripheral blood.

STUDY OBJECTIVE: To develop a reverse transcription (RT)-polymerase chain reaction (PCR) technique to detect and quantify human histamine1 (H1) receptor mRNA in peripheral blood. METHODS: Primer pairs were based on the human H1 receptor nucleotide sequence. A competitive reference standard (CRS) was developed that used the same primers as wild-type mRNA but contained a 92-bp deletion. RT-PCR was performed with 5 microg of total RNA obtained from venous blood of six subjects that was added to known concentrations of CRS RNA. Linear regression comparing wild-type with CRS product was used to quantify wild-type mRNA. MEASUREMENTS AND MAIN RESULTS: Three subjects had detectable H1 mRNA, with a range of 31-435 pg. In three subjects PCR product was not detected, although the presence of RNA was confirmed. Redesigned primer pairs showed mRNA to H1 receptor in two of the remaining subjects, but it was undetectable in the third. CONCLUSION: RT-PCR can be used to detect and quantify human H1 receptor mRNA from peripheral blood.

Adult↗
PubMed1999

The impact of the location and structure of an ambulatory rotation on cognitive knowledge and performance.

With the increasing shift to community-based ambulatory education, it is essential to gain a better understanding of the impact of these changes. To assess the impact of the location and structure of an ambulatory internal medicine clerkship rotation on cognitive knowledge and clinical performance, students were assigned to one of the following: (a) a multidisciplinary ambulatory clerkship (MAC), (b) the office of a community-based general internist, or (c) a university-based internal medicine ambulatory clinic. The groups were compared on the internal medicine clerkship examination and preceptor ratings controlling for introduction to clinical medicine course performance via analysis of covariance. MAC students were rated lower than the other two groups by their preceptors. There were no other statistically significant differences. The structure and location of the rotation had little impact on cognitive knowledge. The impact of the structure of the rotation on clinical performance is less clear suggesting that further research is needed.

Ambulatory Care↗
PubMed1998

Creating and evaluating an independent ambulatory internal medicine clerkship.

Patient care is shifting from an inpatient setting to an ambulatory setting. Despite this shift, most internal medicine clerkships provide the majority of medical student training in inpatient settings or in university tertiary care clinics, which are not representative of patient care in a community setting. We created a separate ambulatory clerkship that used volunteer community faculty at local and distant sites. The steps involved are described here, including finding time within the clerkship, reaching consensus within the department, defining the curriculum, identifying sites, and developing preceptors. Various parameters were measured to ensure quality in educational design. Comparisons of the 1-year pilot program, the full implementation program, and the inpatient program revealed that use of community sites does not affect cognitive knowledge acquisition but does influence students' satisfaction level.

Clinical Competence↗
PubMed1997

Setting standards and defining quality of performance in the validation of a standardized-patient examination format.

PURPOSE: To evaluate whether written standards increase the reproducibility of a physician-facilitated station in an objective structured clinical examination (OSCE) designed to assess history, physical-examination, and communication skills. METHOD: The OSCE examination at the University of Texas Medical Branch-Galveston consists of ten eight-minute stations. Six of these stations consist of three History, Physical-examination, Problem-solving, and Plan (HPPP) station pairs. Each existing clinical-problem HPPP station was given to two content experts to develop standards for faculty rating scales appropriate for the evaluation of third-year medical students. Three pairs of faculty members were used to determine interrater reliability by scoring videotapes of three HPPP stations' presentation and problem-solving components. Faculty pairs scored tapes of 15 students without using standards and tapes of 15 students using the standards developed. Differences between the reliabilities without and with the standards were tested for significance using Fisher's R to Z transformation. The reproducibility and standard error of measurement (SEM) were extrapolated for increasing amounts of testing time. The HPPP component scores were also correlated with the written examination scores and preceptors' ratings. Data were obtained from the three HPPP stations used in the 1995-96 internal medicine clerkship SP examination. RESULTS: In all, 196 students completed the OSCE examination. The standards developed improved interrater reliability and reached statistical significance (p < .01) for one HPPP station. Reproducibility for the presentation and problem-solving components of the HPPP stations were > .80 after five hours of testing. The problem-solving component correlated at .37 and .19 with written examinations and with ward grades, respectively. CONCLUSION: The data from this study suggest that standards increase the reproducibility of presentation and problem-solving components of an OSCE to a level as high as, or higher than, that associated with the history, physical-examination, and communication components of traditional standardized-patient examinations.

Clinical Clerkship↗
PubMed1997

The reliability of medical student ratings of clinical teaching.

This study estimated the interrater reliability of medical student evaluations of clinical teaching. Data consisted of 1,570 ratings evaluating 147 faculty over a 4-year period in a 3rd-year internal medicine clerkship. The number of ratings a typical faculty member receives in a year was also calculated and used to extrapolate the standard error of measurement for data typically available to evaluate faculty at different time intervals. The data available to evaluate a faculty member after 1 year was not adequate, but improved substantially at the 5- to 7-year mark, when a faculty member is typically evaluated for promotion and tenure.

Clinical Clerkship↗