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Biomedical subjects

I Rolfe

Publications and source records attributed to I Rolfe.

8 recordsLinked to original sources
PubMed2000

The effect of a Structured Question Grid on the validity and perceived fairness of a medical long case assessment.

PROBLEM: A perception that the reliability of our oral assessments of clinical competence was vitiated by lack of consistency in questioning. DESIGN: Parallel group controlled trial of a Structured Question Grid for use in clinical assessments. The Structured Question Grid required assessors to see the patient personally in advance of the student and to write down for each case the points they wished to examine. The Structured Question Grid limited assessors to two questions on each point, one designated a pass question and one at a higher level. Three basic science and three clinical reasoning issues were required, so that a total of 12 questions was allowed. SETTING: Small (70 students/year) undergraduate medical school with an integrated, problem-based curriculum. SUBJECTS: Sixty-seven students in the fourth year of a 5-year course were assessed, each seeing one patient and being examined by a pair of assessors. Assessor pairs were allocated to use the Structured Question Grid or to assess according to their usual practice. RESULTS: After the assessment but before being informed of the result the students completed a questionnaire on their experience and gave their performance a score between 0 and 100. The questions asked were based on focus group discussions with a previous student cohort, and concerned principally the perceived fairness and subjective validity of the assessment. The assessors independently completed a similar questionnaire, gave the student's performance a score between 0 and 100, and assigned an overall pass/fail grade. CONCLUSIONS: No difference was detected between students' or assessors' views of the fairness of the assessment for assessors who had used the Structured Question Grid compared to those who had not. Students whose assessors used the Structured Question Grid considered the assessment less representative of their ability. No difference was detected in the chance of students being assessed as failing or on the likelihood of a discrepancy between students' and assessors' ratings of students as passing or failing.

Clinical Competence↗
PubMed2000

Factors affecting progress of Australian and international students in a problem-based learning medical course.

CONTEXT: Research on the factors affecting progress in medical schools has typically focused on mainstream (non-Indigenous Australian, non-international) students in traditional, didactic programmes. These results may not be applicable to students, particularly those from culturally diverse backgrounds, undertaking problem-based learning courses. OBJECTIVE: This study used qualitative methodology to explore and compare factors affecting progress for mainstream Australian students (non-Indigenous Australian, non-international) and international students (full fee-paying students who had relocated countries to study) in a problem-based learning medical course. Intervention strategies were devised on the basis of the participants' experiences. METHODS: Six focus group discussions were conducted (three with mainstream Australian and three with international participants). Transcripts of these discussions were coded and analysed independently by two researchers and discussed until consensus was attained. RESULTS: Participants identified both positive and negative experiences related to the course structure, which were consistent with previous findings. The participants' experiences demonstrated a relationship between sense of 'belongingness' to the medical school community, participation in learning opportunities and progress through the course. CONCLUSIONS: The results suggest that interventions aimed at reducing barriers to progress need to promote students' confidence, motivation and subsequent participation in course learning opportunities. These results have application to other problem-based learning courses particularly those which face the challenge of providing an optimal learning environment for students from diverse backgrounds.

Adult↗
PubMed1994

Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis.

OBJECTIVE: To examine the relationship between disease severity and bone density as well as vertebral fracture risk in patients with ankylosing spondylitis (AS). METHODS: Measurements were taken for bone mineral density (BMD) and vertebral fracture rates in 87 patients with AS. BMD was measured at the hip (femoral neck -FN), lumbar spine (L1-L4-LS) and for the whole body using a hologic-QDR-1000/W absorptiometer. An algorithm based on normal female ranges of vertebral heights was used to define a fracture as occurring when two vertebral ratios were each three standard deviations below the calculated mean of the controls. RESULTS: Patients with AS had significantly lower FN-BMD in proportion to disease severity (based on a Schober index) and disease duration. LS-BMD was also reduced in early disease, but in patients with advanced AS it had increased considerably. Nine vertebral fractures (10.3%) were identified which was considerably higher than expected when compared with a fracture of 1.9% in a control population of 1035 females of a similar age range. Patients with AS with fractures were significantly older, more likely to be male, had longer disease duration and more advanced spinal limitation with less mobility. There was no significant reduction in lumbar spine or femoral neck bone density in the fracture group. CONCLUSIONS: Vertebral fractures that result from osteoporosis are a feature of longstanding AS. BMD used as a measure of osteoporosis of the spine in advanced AS is unreliable probably as a result of syndesmophyte formation and does not predict the risk of vertebral fracture. Alternative sites such as the neck of the femur should be used for sequential assessment of BMD in AS.

Adult↗
PubMed1991

Pressure-volume properties of the upper airway in man.

We report a method of measuring the static pressure-volume properties of the upper airway in unanesthetised humans. In 10 normal subjects the pressure in the upper airway was measured during aspiration of air in 10 ml decrements from 30-40 ml above resting volume to 30-40 ml below resting volume, with the glottis closed voluntarily and the oro-pharyngeal muscles relaxed. The pressure-volume properties of the upper airway were well described by the pressure-volume rate upper airway elastance (UAE, cmH2O/ml). The mean (+/- 95% CI) UAE measured at near total lung capacity and with the neck in neutral position for all runs in all subjects was 0.22 +/- 0.06 cmH2O/ml. When UAE was measured repeatedly on different days the greatest change observed was from a mean value of 0.17 cmH2O/ml on one day to 0.25 cmH2O/ml on another, and the standard deviation of the means from different days ranged from 0.01 to 0.04. Neither hypoxia (SaO2 80-85%) nor hyperoxic hypercapnia (PETCO2 65-75 mmHg) had any influence on UAE. Maximal extension of the neck did not affect UAE, but flexion of the neck was associated with a rise in UAE from a mean of 0.23 +/- 0.05 cmH2O/ml to a mean of 0.53 +/- 0.14 cmH2O/ml. UAE was not affected by the lung volume at which measurements were made. We conclude that upper airway pressure-volume properties can be measured non-invasively in man, and that in their linearity, reproducibility and lack of sensitivity to hypoxia and hypercapnia they resemble those of experimental animals.

Adult↗
PubMed1991

Long-term nasal CPAP does not ameliorate obstructive sleep apnoea.

Fifty-seven patients with obstructive sleep apnoea (OSA) were treated for at least six months with nasal continuous positive airway pressure (CPAP). At follow-up, sleep studies were performed in which CPAP was not used for the first half of the night. We compared the severity of OSA at follow-up without CPAP to the severity of OSA during the patient's initial diagnostic study. Apnoea and hypopnoea index (AHI) fell from 41.4 +/- 7.5 (mean +/- 95% CI) to 34.8 +/- 7.9 (p = 0.06 by Wilcoxon test) and minimum oxygen saturation rose from 71.6 +/- 3.2 to 78.5 +/- 2.6 (p less than 0.001). Some of this change may have been due to reduced REM sleep in the follow-up study (10.5 +/- 2.1% Total Sleep Time vs 7.4 +/- 2.4% TST, p less than 0.05). Long-term nasal CPAP was not associated with any reduction of obesity (BMI before CPAP 31.9 +/- 1.0, after CPAP 31.7 +/- 1.0 (p = 0.39). Systolic arterial pressure fell (before CPAP 143.0 +/- 4.5 mmHg, after CPAP 136.3 +/- 4.6, p less than 0.05) but diastolic pressure did not (before CPAP 88.5 +/- 3.0 mmHg, after CPAP 85.6 +/- 2.9 mmHg, p = 0.11). We concluded that the effect of CPAP treatment for six or more months was a small fall in AHI and a small rise in minimum SaO2, but that this would be of marginal clinical significance, and may be artefactual.

Aged↗
PubMed1991

Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea.

We studied the long-term acceptability of nasal continuous positive airway pressure (CPAP) treatment in 168 consecutive patients, 147 with obstructive sleep apnea (OSA) and 21 with snoring. Follow-up was between 1.5 and 78 months. At latest follow-up 107 of 168 (64%) were still using CPAP. Acceptance of CPAP was least for patients with snoring alone (6 of 21 persisted) and best for patients with both excessive daytime somnolence and severe hypoxemia (minimum SaO2 less than 75%), of whom 40 of 45 (89%) persisted with treatment. Patients with excessive daytime somnolence but without severe hypoxemia were less tolerant of CPAP (39 of 71, 55%, persisted) than patients with no symptoms of excessive somnolence but with severe hypoxemia (21 of 30, 70%, persisted). The most common reasons for discontinuing CPAP were intolerance of the mask (26 of 61), the inconvenience of treatment (16 of 61), and the lack of symptomatic benefit from treatment (10 of 61). We concluded that long-term acceptance of CPAP was difficult to predict in advance but that it was most likely in patients with the most severe sleep apnea. Because intolerance of the mask and inconvenience were the most common reasons for ceasing treatment, improvements in the design of CPAP systems and careful patient training may improve the acceptability of CPAP substantially.

Female↗