Reliability of a seminar grading rubric in a grand rounds course.

PURPOSE: Formal presentations are a common requirement for students in health professional programs, and evaluations are often viewed as subjective. To date, literature describing the reliability or validity of seminar grading rubrics is lacking. The objectives of this study were to characterize inter-rater agreement and internal consistency of a grading rubric used in a grand rounds seminar course. METHODS: Retrospective study of 252 student presentations given from fall 2007 to fall 2008. Data including student and faculty demographics, overall content score, overall communication scores, subcomponents of content and communication, and total presentation scores were collected. Statistical analyses were performed using SPSS, 16.0. RESULTS: The rubric demonstrated internal consistency (Cronbach's alpha = 0.826). Mean grade difference between faculty graders was 4.54 percentage points (SD = 3.614), with ≤ 10-point difference for 92.5% of faculty evaluations. Student self evaluations correlated with faculty scores for content, communication, and overall presentation (r = 0.513, r = 0.455, and r = 0.539; P < 0.001 for all respectively). When comparing mean faculty scores to student's self-evaluations between quintiles, students with lower faculty evaluations overestimated their performance, and those with high faculty evaluations underestimated their performance (P < 0.001). CONCLUSION: The seminar evaluation rubric demonstrated inter-rater agreement and internal consistency.

Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly.

A rising concern among clinicians is treatment of unplanned weight loss in the elderly, especially given the predicted growth of this population over the next few decades. Unexpected weight loss in the geriatric patient worsens overall health outcomes. A variety of pharmacotherapeutic options are available for treatment; however, evidence underlying their use is limited, and none has gained approval from the United States Food and Drug Administration for this indication. At present, no guidelines support the choice of one agent over another. Although several drug interventions have been employed for this problem, megestrol acetate and mirtazapine are becoming increasingly used for appetite stimulation. These drugs represent two feasible options for geriatric patients because of their generally favorable adverse-effect profiles and few drug interactions, but they are often misused. In a comprehensive search of the MEDLINE and International Pharmaceutical Abstracts databases, we identified all published reports on the use of megestrol acetate or mirtazapine for the treatment of weight loss and on any adverse events associated with these drugs. Special emphasis was placed on trials performed in an elderly population. Results were conflicting, most likely because of differing study designs and small numbers of patients. Megestrol acetate and mirtazapine appear to be effective for appetite stimulation and weight gain in some settings. However, applicability of the data to elderly individuals is unclear, and adverse events reported in a few of the trials and in case reports were not benign. Therefore, the use of megestrol acetate or mirtazapine for weight loss should be thoroughly evaluated on an individual basis. Pharmacotherapy should be used only after all underlying causes of weight loss are assessed and treated.