Rasch analysis of professional behavior in medical education.

The use of students' "consumer feedback" to assess faculty behavior and improve the process of medical education is a significant challenge. We used quantitative Rasch measurement to analyze pre-categorized student comments listed by 385 graduating medical students. We found that students differed little with respect to the number of comments they provided and that their comments indeed form a probabilistic Rasch hierarchy. However, different hierarchies were found across medical departments and faculty. An analysis of these interactions provides valuable, detailed, and quantitative information that can augment qualitative research approaches. In addition, we suggest how the Rasch scaling of student comments can assist researchers in the design and implementation of new faculty evaluation instruments. Finally, the interactions between student and department identified a subset of behaviors that appear to guide and possibly elicit students' comments.

Segregation of autoantibodies with disease in monozygotic twin pairs discordant for systemic sclerosis. Three further cases.

OBJECTIVE: To study the serologic status of 3 previously unreported monozygotic twin pairs discordant for systemic sclerosis (SSc). METHODS: Autoantibodies were measured by indirect immunofluorescence, immunodiffusion, and immunoprecipitation of 35S-labeled cell lines. Major histocompatibility complex (MHC) class II allele typing and DNA fingerprinting were used to confirm monozygosity. RESULTS: Anti-PM-Scl, anti-threonyl transfer RNA synthetase, and anti-topoisomerase I antibodies, respectively, were found in each of the twins with SSc. None of the unaffected twin siblings had an identifiable autoantibody, although serum from 1 unaffected twin precipitated several unknown proteins. The MHC class II genotype in each twin was the genotype expected for the autoantibody that was present. CONCLUSION: Autoantibodies of certain defined specificities are intimately linked with the development of SSc, because they segregate with SSc in individuals who start life with identical germline genes.

Effect of anonymous test grading on passing rates as related to gender and race.

BACKGROUND: Concerns about potential bias in the grading of medical students at the Southern Illinois University School of Medicine led to a major institutional policy change whereby students' identities were masked during the test-grading process. The present study assessed the effect of this anonymous test grading policy by comparing the performance of men and women students and of white and African American students prior to and after adoption of the policy change. METHOD: A test-passing rate was determined for each of 476 freshmen students in the comparison groups from the eight classes of 1988 through 1995. Mean test-passing rates for the four student cohorts prior to policy implementation (1988-1991) were compared with mean passing rates after the policy was implemented (1992-1995). RESULTS: The pre-post change in the mean test-passing rate of men was not significantly different from the pre-post change of women, and a nonsignificant effect was also found when the pre-post change in the mean test-passing rate of white students was compared with that of African American students. No significant pre-post change was found for white men, white women, African American men, or African American women. CONCLUSION: The results showed no effect of the anonymous test-grading policy, which suggests that there was no widespread gender or racial bias in the grading of freshman medical students before the change in institutional grading policy.

Nicardipine for the treatment of Raynaud's phenomena: a double blind crossover trial of a new calcium entry blocker.

Fifteen patients with Raynaud's phenomenon [systemic lupus erythematosus (6), progressive systemic sclerosis (8) and rheumatoid arthritis (1)] and 12 patients with Raynaud's disease participated in a parallel, 4-week/arm, double blind, crossover study of nicardipine, an experimental calcium channel blocker. Nicardipine significantly improved pain (p = 0.03), decreased number of Raynaud's attacks (p less than 0.03), and was preferred over placebo (p less than 0.05) in the patients with Raynaud's disease, but showed an effect only in the number of attacks (p = 0.049) among the group with Raynaud's phenomenon. Plethysmography showed no drug effects. One patient discontinued the trial after developing headaches while taking placebo. Nonlimiting toxicity occurred more commonly with drug than placebo (15 vs 9 times, p less than 0.05). Our study demonstrated that nicardipine improves symptoms in Raynaud's disease, but is not effective in Raynaud's phenomenon.

Pregnancy among patients with systemic lupus erythematosus receiving immunosuppressive therapy.

We evaluated retrospectively the effect of superimposed pregnancy upon the course of systemic lupus erythematosus (SLE) in patients receiving glucocorticoids or azathioprine at conception. About equal numbers of flares (10 vs 12) occurred among 22 pregnant patients with lupus and 22 nonpregnant control patients with lupus matched by disease duration and prior organ system involvement. Pregnancy per se did not appear to accelerate SLE in patients receiving immunosuppressive therapy.

Clinical and serologic expression of localized scleroderma. Case report and review of the literature.

A patient is presented in whom both linear scleroderma and eosinophilic fasciitis developed. The latter is rare in childhood. A positive antinuclear antibody, a positive rheumatoid factor, and seizures also developed. In reviewing the literature, we concluded that the clinical and histologic pattern of cutaneous sclerosis may be more valuable than serologic findings in predicting both the likelihood of, and the expected sites for, systemic involvement. The literature also suggests that central nervous system (CNS) involvement is rare in most sclerosing syndromes but that linear scleroderma may be associated with CNS or spinal disease. The ipsilateral association of linear scleroderma and seizure focus in this patient, as well as the focal onset of these seizures, is unusual and suggests an association between the seizure disorder and the linear cutaneous sclerosis.

Effects of nifedipine on baroreflex modulation of vascular resistance in man.

Studies in animals have demonstrated that, in addition to their vascular effects, calcium channel blockers have important effects on baroreceptor function. We performed a series of experiments to determine if nifedipine, in doses employed clinically, alters baroreflex control of vascular resistance in normal humans. Forearm vasoconstrictor responses of 14 normal subjects to unloading of baroreceptors with lower body negative pressure (LBNP), to a cold pressor test and during intra-arterial infusions of norepinephrine were studied in the control state and following administration of nifedipine. Nifedipine had no effect on baseline mean arterial pressure or central venous pressure. Heart rate and forearm blood flow (FBF) increased significantly following nifedipine: heart rate = 59.7 +/- 2.4 bpm before and 72.6 +/- 4.4 bpm after nifedipine (mean +/- SE, p less than 0.001, n = 14); FBF = 4.6 +/- 0.4 ml X min-1 X 100 ml-1 before and 6.7 +/- 1.0 ml X min1 X 100 ml-1 after nifedipine (p less than 0.02, n = 14). Forearm vascular resistance (FVR) tended to decrease following nifedipine but the difference was not significant: FVR = 21.1 +/- 1.4 units before and 17.8 +/- 2.3 units after nifedipine (p = 0.07, n = 14). Nifedipine attenuated forearm vasoconstrictor responses to cold pressor stimulus: delta FVR during cold pressor test = +10.3 +/- 2.4 units before and +4.7 +/- 1.4 units after nifedipine (p less than 0.02, n = 14). Likewise, nifedipine depressed vasoconstrictor responses to intra-arterial infusion of norepinephrine: delta FVR during norepinephrine = +15.5 +/- 3.4 units before and +10.2 +/- 2.9 units after nifedipine (p less than 0.05, n = 7).(ABSTRACT TRUNCATED AT 250 WORDS)

The association of hairy cell leukemia with unusual immunologic disorders.

Hairy cell leukemia is a rare disease, probably of B-lymphocyte origin, that has been reported to rarely occur with polyarteritis nodosa. The records of 31 patients with hairy cell leukemia were reviewed for an association with other disorders of the immune system; such an association was found more often than previously suspected. Four cases are discussed--one with hepatitis B surface antigen-positive polyarteritis nodosa and another with an IgA (kappa) monoclonal gammopathy and amyloidosis of the kidney, liver, and small bowel. The other two patients had cutaneous vasculitis, one of which was a rare form of leukocytoclastic angiitis--erythema elevatum diutinum. Because the number of patients in this study is small, it is impossible to say whether the association of hairy cell leukemia with any of these immunologic disorders adversely affects survival.

Thermal behavior of HeLa and KB cells in suspension and attached to glass.

HeLa S-3 and KB cells were grown in a LKB Batch Microcalorimeter under a variety of nutrient medium conditions amd mixing intervals. These conditions produced rather large apparent endothermic and exothermic responses on mixing that could be correlated with the presence of suspended cells (unattached) as well as cells attached to the glass calorimeter vessel. Cells capable of being resuspended upon mixing of the calorimeter vessel produces first an endothermic followed by an exothermic signal while attached cells produced only an apparent endothermic response. The exothermic response is believed to be associated with increased metabolic heat on suspending the cells followed by partial suppression of the steady state metabolic heat on cell settling. Rates of cell settling correlated well with the rate of decay of the exothermic signal. The rapid appearance of endothermicity on mixing suggests it is associated with rapid events such as binding of nutrients to cell surfaces. The response in the endothermic direction on mixing is discussed in terms of the disruption of mechanisms which tend to exclude nutrients from the surface of the cell.