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Biomedical subjects

R F Gledhill

Publications and source records attributed to R F Gledhill.

At least 73 records · Page 4Linked to original sources
PubMed1985

Factors affecting the reliability of an objective structured clinical examination (OSCE) test in neurology.

Inconsistencies in individual student scores from one year to the next prompted attempts to produce a more accurate objective structured clinical examination (OSCE) test in neurology. A study of factors affecting the reliability of this test revealed that in spite of efforts to control patient and examiner variability, residual inaccuracies due to these effects remained. Also, the use of a uniform test structure may have led to student cueing. Student performance did not appear to be affected by the OSCE format per se. Innovations that might improve test reliability in subsequent OSCEs were identified.

Clinical Competence↗
PubMed1983

Formative (in-course) graduate assessment. Design of an accurate multiple-choice question examination and the training merits thereof.

Medical graduate learning is being appraised to an increasing extent during training. The adequacy of these formative (in-course) assessments has not been widely studied. The performances and opinions of junior specialists were used to evaluate the accuracy of a graduate multiple-choice question examination (MCQE) and the merits of such in-course assessments. Methods used in verifying the validity and reliability of this MCQE are detailed. In-course assessments were rated as being valuable in graduate training. Issues pertinent to sound appraisals of graduate learning are discussed.

Education, Medical, Graduate↗
PubMed1983

Task analysis in neurosciences programme design--neurological problems in general practice.

Defining educational objectives is the key to achieving the goal of professional competence in students. The technique of task analysis was selected to determine components of competence in clinical neurology appropriate to the needs of primary care. A survey of neurological problems in general practice revealed that these constitute a significant proportion of consultations, and that teaching programmes have failed to provide the appropriate knowledge and skills to manage the commonest problems effectively. Consideration is given to innovations in curriculum and programme design whereby the graduating student might be more suitably prepared to give primary care.

Clinical Competence↗
PubMed1979

The metabolic fate of 13N-labeled ammonia in rat brain.

13N-labeled ammonia was used to study the cerebral uptake and metabolism of ammonia in conscious rats. After infusion of physiological concentrations of [13N]ammonia for 10 min via one internal carotid artery, the relative specific activities of glutamate, glutamine (alpha-amino), and glutamine (amide) in brain were approximately 1:5:400, respectively. The data are consistent with the concept that ammonia, entering the brain from the blood, is metabolized in a small pool of glutamate that is both rapidly turning over and distinct from a larger tissue glutamate pool (Berl, S., Takagaki, G., Clarke, D.D., and Waelsch, H. (1962) J. Biol. Chem. 237, 2562-2569). Analysis of 13N-metabolites, after infusion of [13N]ammonia into one lateral cerebral ventricle, indicated that ammonia entering the brain from the cerebrospinal fluid is also metabolized in a small glutamate pool. Pretreatment of rats with methionine sulfoximine led to a decrease in the label present in brain glutamine (amide) following carotid artery infusion of [13N]ammonia. On the other hand, 13N activity in brain glutamate was greater than that in the alpha-amino group of glutamine, i.e. following methionine sulfoximine treatment the expected precursor-product relationship was observed, indicating that the two pools of glutamate in the brain were no longer metabolically distinct. The amount of label recovered in the right cerebral hemisphere, 5 s after a rapid bolus injection of [13N]ammonia via the right common carotid artery, was found to be independent of ammonia concentration within the bolus over a 1000-fold range. This finding indicates that ammonia enters the brain from the blood largely by diffusion. In normal rats that were killed by a freeze-blowing technique 5 s after injection of an [13N]ammonia bolus, approximately 60% of the label recovered in brain had already been incorporated into glutamine, indicating that the t1/2 for conversion of ammonia to glutamine in the small pool is in the range of 1 to 3 s or less. The data emphasize the importance of the small pool glutamine synthetase as a metabolic trap for the detoxification of blood-borne and endogenously produced brain ammonia. The possibility that the astrocytes represent the anatomical site of the small pool is considered.

Ammonia↗