Assessing practicing physicians in two settings using standardized patients.
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Clinical Competence↗
Biomedical subjects
D J Klass
Publications and source records attributed to D J Klass.
The accuracy of standardized patient presentation.
The accuracy of standardized patient clinical problem presentation was evaluated by videotape rating of a random sample of 839 student-patient encounters, representing 88 patients, 27 cases and two university test sites. Patient-student encounters were sampled from a collaborative inter-university final-year clinical examination of fourth-year medical students which was conducted at the University of Manitoba and Southern Illinois University in 1987 and 1988. The accuracy, replicability and portability of standardized patient cases were evaluated. The average accuracy of patient presentation was 90.2% in 1987 and 93.4% in 1988. Perfect accuracy scores were obtained by 15 patients; however, 11 patients had average scores below 80% with the accuracy of presentation in some encounters being as low as 30%. There were significant differences in the accuracy score achieved by patients trained together for the same case in 6 of 35 possible comparisons. There was also a systematic trend for patients trained at Southern Illinois to be more accurate in their presentation than patients trained at the University of Manitoba. These differences were significant in 5 of the 15 cases used in the examination.
Clinical Clerkship↗
Performance and perception in a simulated clinical encounter.
The feasibility of using data arising from a simulated patient encounter to determine the nature of the relationship between patient satisfaction and examinee performance during a clinical examination is explored. Satisfaction (on dimensions of sensitivity, participation and thoroughness) is shown to be related to aspects of the physical examination and the history taking.
Clinical Competence↗
The pulmonary disposition of theophylline and its influence on human alveolar macrophage bactericidal function.
We studied the pulmonary disposition of theophylline by performing bronchoalveolar lavage on 19 normal, nonsmoking volunteers who had taken theophylline orally for 14 days. In addition, we determined the influence of theophylline on human alveolar macrophage bacterial phagocytosis, intracellular killing, and hydrogen peroxide release. We found a 1:1 relationship between serum and bronchoalveolar lavage theophylline concentrations when lavage fluid concentrations were corrected for saline dilution. We found marked impairment of the bactericidal activity of alveolar macrophages from theophylline-treated subjects (intracellular killing efficiency of 24.7 +/- 1.5% compared with 60.2 +/- 0.9% by macrophages from control subjects; p less than 0.001). This defect in alveolar macrophage bactericidal activity was inversely correlated with the bronchoalveolar lavage theophylline concentrations, and was corrected after the alveolar macrophages were cultured under serum-free conditions for 48 h. Theophylline significantly impaired alveolar macrophage release of hydrogen peroxide. Hence, theophylline may compromise lung host defenses by suppressing alveolar macrophage bactericidal activity and oxidative metabolite release.
Adult↗
Dibutyryl cyclic GMP and hyperventilation promote rat lung phospholipid release.
Ventilation of rats at high inspiratory pressures raises lung tissue content of guanosine 3',5'-cyclic monophosphate (cGMP). Hyperventilation in rabbits augments release of phospholipid into lavage fluid. Can cGMP, in the absence of hyperventilation, increase lung phospholipid release? Sprague-Dawley rats are injected with [14C]palmitate, and after 1.5 h are anesthetized and ventilated for 20 min. Three groups are ventilated at peak inspiratory pressures (PIP) of 10 cmH2O, while saline, dibutyryl adenosine 3',5'-cyclic monophosphate (DBcAMP), or dibutyryl cGMP (DBcGMP) is infused into the pulmonary artery. In a fourth group, saline is infused into the pulmonary artery, but ventilation is performed with PIP of 25 cmH2O. Lung tissue and lavage fluid are then analyzed for phospholipid (PL) content and for incorporation of [14C]palmitate into lavage and tissue PL fractions. Ventilation at increased pressure and infusion of DBcGMP are associated with increases in release of labeled PL into lavage fraction. The findings suggest that the increase in lavage PL release associated with hyperventilation is, at least in part, mediated by cGMP.
Animals↗
Lung tissue guanosine 3',5'-monophosphate: effects of ventilation and anesthesia.
In vivo levels of guanosine 3',5'-cyclic monophosphate (cGMP) in rat lung were measured by radioimmunoassay. The basal levels of this agent were found to change depending on the method of killing or anesthesia used. Lowest values were found after microwave irradiation to the head (10.2 fmol/mg wet wt). Values after pentobarbitol anesthesia, with or without atropine, were significantly higher (19-24 fmol/mg). In animals anesthetized with pentobarbital and ventilated at pressures of 7 cmH2O with no end-expiratory pressure, lung cGMP was 42-49 fmol/mg. Ventilation at higher pressures resulted in much higher levels of cGMP (20 cmH2O, 105 fmol/mg; 30 cmH2O, 233 fmol/mg). The response of cGMP to ventilation was not blocked by pretreatment of the animals with atropine. High-pressure ventilation was without effect on lung adenosine 3',5'-cyclic monophosphate.
Animals↗
Effects of prednisolone on the differentiation of mouse lung adenomas in culture.
Explants of pulmonary adenomas, induced in mice by urethan, were cultured with or without prednisolone for 72 hr. After this time, the cuboidal epithelial cells of the tumor contained many more lamellar bodies than the nonsteroid control cultures. Incorporation of labeled palmitic acid into saturated phosphatidylcholine was not significantly increased in these short-term steroid-treated cultures. The results indicate that steroid enhances the maturation of cultured pulmonary adenoma cells into cells morphologically indistinguishable from type II alveolar epithelial cells of normal lung.
Adenoma↗