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Biomedical subjects

P R Fleming

Publications and source records attributed to P R Fleming.

At least 19 recordsLinked to original sources
PubMed2001

Neuro-ophthalmological sequelae of horse-related accidents.

PURPOSE: The aim of this study was to highlight the neuro-ophthalmological dangers associated with horse riding, and working around horses, and the importance of wearing adequate headgear to protect the rider from neuro-ophthalmic injuries. It raises the questions of whether the current laws regarding helmet use are satisfactory, and whether helmets currently used are of an adequate standard. METHODS: The records over a 20-year period of one neuro-ophthalmologist in Adelaide were reviewed producing 22 patients with neuro-ophthalmological sequelae of head injuries as a result of horse-related accidents. RESULTS: There were 22 patients (16 female, six male), one of whom was involved in three separate accidents, Of these, seven were professional riders and 15 amateur. In 20 of the 24 accidents, patients were either thrown or fell from the horse. Helmets were worn in 15 of the accidents. All the patients had closed head injuries of varying severity. The most common neuro-ophthalmological complication found was a fourth-nerve palsy in 11 patients. Five patients had a significant loss of vision and two of these were severe enough to warrant a blind pension. CONCLUSIONS: Horse riding and working around horses constitute an occupation or recreation with inherent dangers. Previous studies have shown that wearing of protective headgear reduces the risk and severity of head injuries, and helmet use should be vigorously promoted. The current laws and practices regarding helmet use are not uniform and seem to be inadequate. The current standard for equestrian safety helmets (AS/NZS 3838:1998) embodies improvements on earlier helmet standards and certainly increases the rider's chances of surviving a severe impact. Nevertheless, serious brain injuries have occurred in wearers of approved helmets, and further research is desirable to ensure the optimum degree of protection compatible with rider acceptance.

Accidental Falls↗
PubMed2000

Development of a novel class of monocyclic and bicyclic alkyl amides that exhibit CB1 and CB2 cannabinoid receptor affinity and receptor activation.

CB1 and CB2 cannabinoid receptors can be activated by several different classes of agonists, including cannabinoids such as delta9-tetrahydrocannabinol and 9-nor-9beta-hydroxyhexahydrocannabinol, and eicosanoids such as arachidonylethanolamide. Structure-activity relationship studies have identified potential pharmacophoric elements for binding to cannabinoid receptors by both cannabinoids and eicosanoids. Molecular models have hypothesized conformational, spatial, and pharmacophoric distance requirements based upon radioligand binding data whereby overlap of pharmacophoric elements of the two classes disclose a low energy conformation of arachidonylethanolamide that can occupy the same receptor space as cannabinoid ligands. To test this model, we have developed a novel class of monocyclic and bicyclic alkyl amide cannabinoid receptor ligands. Further, we predicted a spatial conformation for these compounds in a molecular model based on the pharmacophoric and structural requirements for binding to the CB1 cannabinoid receptor.

Adenylyl Cyclase Inhibitors↗
PubMed1989

An audit of doctor's management of patients with chest pain in the accident and emergency department.

In a series of 604 patients attending an accident and emergency department with chest pain, the decisions made by casualty officers about admission to the coronary care unit were compared with the retrospective opinions of experienced clinical assessors who knew the results of any subsequent investigations. Of the 119 patients whom the assessors judged should have been admitted to the coronary care unit, 14 (11.8 per cent) were judged to have been discharged in error. Of the 485 patients whom the assessors judged should not have been admitted to the coronary care unit, 32 (16 per cent) were judged to have been advised admission unnecessarily. Misinterpretation of the electrocardiographic results was apparently the reason for five of the 14 false negative errors and four of the 32 false positive errors. The median time that patients who were eventually admitted to the coronary care unit spent in the accident and emergency department was 78 min.

Chest Pain↗
PubMed1988

The profitability of 'guessing' in multiple choice question papers.

Candidates taking multiple choice question (MCQ) papers in which marks are deducted for wrong answers often omit many items for fear of losing marks. In an MCQ paper in 1985 candidates who omitted many items made relatively few errors; they were not necessarily much less able than those who omitted few items. Those who had omitted many items were interviewed and advised to answer more, including those about which they were uncertain but not totally ignorant; the same advice was given to the whole group before they took another MCQ paper in the same subject in 1987. In 1987 there were large changes in the numbers of items omitted and, in particular, those who had omitted many items in 1985 answered many more in 1987. They also made more errors; despite this they tended to improve their performance in relation to their colleagues. A clear relationship was shown, for the whole group, between an increase in the number of items attempted and a rise in the rank order. The effects on candidates' behaviour of deducting marks for wrong answers and of permitting them to omit items are reviewed and the nature of the advice which should be given to candidates taking such examinations is discussed.

Clinical Clerkship↗
PubMed1984

The administration of a multiple choice question bank.

The widespread use of multiple choice questions (MCQs) in examinations in medicine has introduced a new dimension into the administration of examinations. The need for the storage and retrieval of large numbers of questions, together with the considerable volume of numerical data generated by item-analysis, has led to the development of a new part-time occupation for many medical teachers--that of administrators of MCQ banks. This paper is based on over 10 years' experience with the bank used for the production of the papers for Part I of the MRCP (U.K.) and is naturally biased in favour of the system developed by the Colleges. It is hoped, however, that the principles outlined are of general application in the procedures adopted by other examining bodies.

Educational Measurement↗
PubMed1979

The national qualifying examination for certification of nurse anesthetists: a report covering six examinations--November, 1975-June, 1978.

Since 1975, the Council on Certification of Nurse Anesthetists has been responsible for the National Qualifying Examination Program, an essential component of the process whereby graduates of accredited nurse anesthesia educational programs gain certification in this nursing specialty. The following report has been prepared to share information about the examination program, including the results of the past six examinations.

Achievement↗
PubMed1975

M.L.Q.: a supplement to M.C.Q.

A method of testing candidates' ability to recall and manipulate factual information is described. It comprises the insertion of a term which forms a logical link between two other, given, terms and probably tests higher cognitive attributes than do multiple-choice questions. This method seems to discriminate quite reliably between good and poor candidates.

Education, Medical↗
PubMed1974

Evolution of an examination: M.R.C.P. (U.K.).

Recent changes in the structure of the examination for M.R.C.P. (U.K.) have prompted a review of these together with a historical outline of the examinations which preceded it at the Royal Colleges of Physicians of Edinburgh, Glasgow, and London.Part I of the examination continues to fulfil its role as a screen and a slight change in the marking system appears to have improved its discriminating powers still further. The major change in part II is the substitution of a more objective written test in place of the essay papers.

Education, Medical, Undergraduate↗