Evaluation of an OSCE assessment tool for abdominal ultrasound courses.

PURPOSE: The purpose of this study was the conception and evaluation of a standardized and reliable assessment tool in the OSCE format to measure the performance and practical skills of abdominal ultrasound users in PGME. MATERIALS AND METHODS: The design, logistics, pacing and the choice of tested competencies of a rotating OSCE parcours, as well as the options for quality control using detailed checklists versus global rating scales and different approaches to the training of the involved raters are described. Over the last 15 years the parcours has undergone incremental improvement and has been used in final examinations of abdominal ultrasound courses with approximately 5000 medical students and 2000 residents and fellows. For evaluation, all item difficulties and discrimination coefficients of the individual stations and the reliability (Cronbach's alpha) were calculated for the last 626 assessments. RESULTS: All 14 hands-on stations showed discrimination coefficients from 0.31 to 0.65 (mean 0.48; SD 0.09). The 13 diagram stations showed mean values of 0.50 (SD 0.16). Data analysis revealed mean homogeneous item difficulties of 0.78 (SD 0.02) and 0.62 (SD 0.04), respectively. Cronbach's alpha was 0.69 with five stations and reached values above 0.8 when more than 8 stations are combined in one parcours. CONCLUSION: The homogeneous distribution of item difficulties provides an opportunity for designing different OSCE versions with different levels of reliability. Several options to adjust the cut-off values, the choice of the examined contents and factors that influence the examinees' acceptance of this assessment tool for PGME or CME ultrasound courses are discussed. Overall, the values of reliability and accuracy of this assessment tool are high enough to be used also for high-stakes examinations in the field of abdominal ultrasound.

[Performance-related middle management in medical teaching. Attractiveness of incentive tools from the perspective of the teachers]. / Leistungsorientierte Mittelvergabe (LOM) in der Medizinischen Lehre. Attraktivität von Anreizinstrumenten aus Sicht der Lehrpersonen.

BACKGROUND AND OBJECTIVE: German medical schools are increasingly challenged by the competition for public funds and talented students. Therefore. many curriculum planners, deans and school administrators plan to implement a systematic and comprehensive awarding system for good teaching. The OBJECTIVE of this study was to elaborate which specific incentives would be most effective to increase the motivation and enthusiasm for teaching among basic scientists as well as residents and attendings involved in medical education. In addition, a cost-effective model should be developed, which could be used as an adjustable blue-print for an awarding system. METHODS: Based on literature search, existing approaches to rewards and incentives for medical teachers were analysed by an interdisciplinary committee in coordination with the members' department heads. According to german teaching methods and available resources, a catalogue of specific incentives has been designed and ranked by a representative sample of 200 medical teachers / faculty at two universities. Thus, a variety of favourite rewarding instruments could be elaborated, which were preferred by teachers in theoretical versus clinical disciplines. RESULTS: The majority of the medical teachers prefer heterogeneously monetary incentives and additional protected time, followed by career-effective incentives (tenure & promotion). The discussion reflects on a transferable catalogue of different rewarding instruments, including a cost-/benefit-analysis and prerequisite students' evaluation data. CONCLUSION: A single alteration of departmental teaching budgets does not seem to be sufficient. It seems rather advisable, also to strive for a variety of different incentives on a level that predominantly affects individual teaching personnel. Even with comparatively small amounts of money, significant effects on teachers' motivation can be achieved.

[The use of nitric oxide in the treatment of acute respiratory failure]. / NO v lécbe respiracního selhání.

BACKGROUND: Nitric oxide was used as an important selective vasodilator in the treatment of acute respiratory failure accompanied with high pulmonary resistance in children and adults since late 80's. METHODS AND RESULTS: Paper includes remarks about nitric oxide physiology in organism. Group of 33 patients is presented (group I 26 newborns, group II 7 children) in which selective pulmonary vasodilation with nitric oxide was used. According to response to NO subject were classified into subgroups of responders, non-responders. In evaluation of oxygenation status OI (oxygenation index, A-a DO2 (alveoloarterial difference) and paO2/FiO2 were used. CONCLUSIONS: Significant differences of above mentioned values were revealed between responders and non-responders in group I (newborns). Significant differences were not revealed in group II (children). Results are in accordance with other papers.

[Sodium nitrite poisoning in a neonate]. / Otrava novorozence dusitanem sodným.

Natrium nitrosum intoxication is usually associated with a subsequent methemoglobinemia. Beside it, nitrates can cause also some other pathological states. Treatment with the toluidine blue may have various adverse side effects. Newborn intoxication by natrium nitrosum developing after the intoxication of the bearing mother before the parturition has not been described yet. Our own observation is referred.

Reduced food intake in response to CGP 71683A may be due to mechanisms other than NPY Y5 receptor blockade.

INTRODUCTION: The purpose of this study was to test the continuing validity of the hypothesis that neuropeptide Y (NPY) produced in the brain controls food intake through an interaction with the NPY Y(5) receptor subtype. METHODS: The hypothesis was tested using CGP 71683A a potent and highly selective non-peptide antagonist of the NPY Y(5) receptor which was administered into the right lateral ventricle of obese Zucker fa/fa rats. RESULTS: Intraventricular injection of 3.4 nmol/kg NPY increased food intake during a 2 h test period. Doses of CGP 71683A in excess of 15 nmol/kg (i.cv.) resulted in blockade of the increase in food intake produced by NPY. Repeated daily injection of CGP 71683A (30--300 nmol/kg, i.cv.) immediately before the dark phase produced a dose-dependent and slowly developing decrease in food intake. CGP 71683A has a low affinity for NPY Y(1), Y(2) and Y(4) receptors but a very high affinity for the NPY Y(5) receptor (Ki, 1.4 nM). Surprisingly, CGP 71683A had similarly high affinity for muscarinic receptors (Ki, 2.7 nM) and for the serotonin uptake recognition site (Ki, 6.2 nM) in rat brain. Anatomic analysis of the brain after treatment with CGP 71683A demonstrated an inflammatory response associated with the fall in food intake. CONCLUSIONS: While the fall in food intake in response to CGP 71683A may have a Y(5) component, interactions with other receptors or inflammatory mediators may also play a role. It is concluded that CGP 71683A is an imprecise tool for investigating the role of the NPY Y(5) receptor in the control of physiological processes including food intake. International Journal of Obesity (2001) 25, 84-94