Imperial College London

Professor Amir H Sam

Faculty of MedicineFaculty of Medicine Centre

Head of Imperial College School of Medicine, Professor
 
 
 
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Contact

 

+44 (0)20 7594 3617a.sam

 
 
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Location

 

148Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

68 results found

Sam AH, Fung CY, Barth J, Raupach Tet al., 2021, A weighted evaluation study of clinical teacher performance at five hospitals in the UK, Advances in Medical Education and Practice, Vol: 2021, Pages: 957-963, ISSN: 1179-7258

Introduction: Evaluation of individual teachers in undergraduate medical education helps clinical teaching fellows identify their own strengths and weaknesses; in addition, evaluation data can be used to guide career decisions. In order for evaluation results to adequately reflect true teaching performance, a range of parameters should be considered when designing data collection tools.Methods: Clinical teaching fellows at five London teaching hospitals were evaluated by third-year students they had supervised during a ten-week clinical attachment. The questionnaire addressed (1) general teaching skills and (2) student learning outcomes measured via comparative self-assessments. Teachers were ranked using different algorithms with various weights assigned to these two factors.Results: A total of 133 students evaluated 14 teaching fellows. Overall, ratings on teaching skills were largely favourable while the perceived increase in student performance was modest. Considerable variability across teachers was observed for both factors. Teacher rankings were strongly influenced by the weighting algorithm used. Depending on the algorithm, one teacher was assigned any rank between #2 and #10.Conclusions: Both parts of the questionnaire address different outcomes and thus highlight specific strengths and weaknesses of individual teachers. Programme directors need to carefully consider the weight assigned to individual components of teacher evaluations so as to ensure a fair appraisal of teacher performance.

Journal article

Tekkis NP, Rafi D, Brown S, Courtney A, Kawka M, Howell A-M, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios Cet al., 2021, The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey, MEDICAL TEACHER, ISSN: 0142-159X

Journal article

Bala L, Kinross J, Martin G, Koizia LJ, Kooner AS, Shimshon GJ, Hurkxkens TJ, Pratt PJ, Sam AHet al., 2021, A remote access mixed reality teaching ward round, The Clinical Teacher, Vol: 18, Pages: 386-390, ISSN: 1743-4971

BackgroundHeterogeneous access to clinical learning opportunities and inconsistency in teaching is a common source of dissatisfaction among medical students. This was exacerbated during the COVID‐19 pandemic, with limited exposure to patients for clinical teaching.MethodsWe conducted a proof‐of‐concept study at a London teaching hospital using mixed reality (MR) technology (HoloLens2™) to deliver a remote access teaching ward round.ResultsStudents unanimously agreed that use of this technology was enjoyable and provided teaching that was otherwise inaccessible. The majority of participants gave positive feedback on the MR (holographic) content used (n = 8 out of 11) and agreed they could interact with and have their questions answered by the clinician leading the ward round (n = 9). Quantitative and free text feedback from students, patients and faculty members demonstrated that this is a feasible, acceptable and effective method for delivery of clinical education.DiscussionWe have used this technology in a novel way to transform the delivery of medical education and enable consistent access to high‐quality teaching. This can now be integrated across the curriculum and will include remote access to specialist clinics and surgery. A library of bespoke MR educational resources will be created for future generations of medical students and doctors to use on an international scale.

Journal article

Sam AH, Wilson R, Westacott R, Gurnell M, Melville C, Brown CAet al., 2021, Thinking differently - Students' cognitive processes when answering two different formats of written question, MEDICAL TEACHER, ISSN: 0142-159X

Journal article

Zaman S, Almazrouei R, Sam AH, DiMarco AN, Todd JF, Palazzo FF, Tan T, Dhillo WS, Meeran K, Wernig Fet al., 2021, Synacthen stimulation test following unilateral adrenalectomy needs to be interpreted with caution, Frontiers in Endocrinology, Vol: 12, Pages: 1-7, ISSN: 1664-2392

Background: Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center.Methods: Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing’s syndrome were excluded.Results: The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement.Conclusions: Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them.

Journal article

Millar KR, Reid MD, Rajalingam P, Canning CA, Halse O, Low-Beer N, Sam AHet al., 2021, Exploring the feasibility of using very short answer questions (VSAQs) in team-based learning (TBL), CLINICAL TEACHER, Vol: 18, Pages: 404-408, ISSN: 1743-4971

Journal article

Bogomolova K, Sam AH, Misky AT, Gupte CM, Strutton PH, Hurkxkens TJ, Hierck BPet al., 2021, Development of a Virtual Three-Dimensional Assessment Scenario for Anatomical Education, ANATOMICAL SCIENCES EDUCATION, Vol: 14, Pages: 385-393, ISSN: 1935-9772

Journal article

Sam AH, Reid MD, Thakerar V, Gurnell M, Westacott R, Yeates P, Reed MWR, Brown CAet al., 2021, The influence of candidates' physical attributes on assessors' ratings in clinical practice, MEDICAL TEACHER, Vol: 43, Pages: 554-559, ISSN: 0142-159X

Journal article

Wynn-Lawrence LS, Bala L, Fletcher RJ, Wilson RK, Sam AHet al., 2021, Question-based collaborative learning for constructive curricular alignment, Advances in Medical Education and Practice, Vol: 2020, Pages: 1047-1053, ISSN: 1179-7258

IntroductionWe designed a curriculum mapping tool which enables medical students to access intended learning outcomes (ILOs) on their iPads in the workplace. Students were encouraged to use the online curriculum map in a specially planned teaching session: Question-Based Collaborative Learning (QBCL). The aim of the session was to empower medical students to constructively align their experiential learning with the learning outcomes of the undergraduate curriculum. In doing so, our session aimed to provide students with a greater understanding of the curriculum, improve their insights into assessment and their question-writing abilities. MethodsThe QBCL pre-session preparation involved reviewing a patient with a presentation that aligned to the year-specific ILOs. During a 150 minute QBCL session, students received training on how to write high quality multiple choice questions (MCQs) delivered by a faculty member of Imperial College School of Medicine. They then worked collaboratively in groups and created MCQs based on their clinical encounters. Their questions were tagged to the relevant learning objective and submitted online via the curriculum map. The student-generated MCQs were analyzed using an adjusted version of Bloom’s taxonomy. We also conducted a quantitative evaluation of the session.ResultsOne hundred and sixty-three questions were submitted, with 81% of questions being tagged to ILOs considered to show evidence of learning consistent with the ‘Apply’ tier of Bloom’s taxonomy. The majority of students agreed that the session was interactive (80%), thought-provoking (77%) and improved their team-working skills (70%). It gave them a greater understanding of the undergraduate curriculum (65%), improved their question-writing and insight into assessments (76%), and provided an opportunity to learn from their peers (86%). Students agreed that this session covered a variety of cases (82%) and deepened their understanding of medical c

Journal article

Sam AH, Millar KR, Lupton MGF, 2021, In Reply to Guragai, Academic Medicine, Pages: E1-E2, ISSN: 1040-2446

Journal article

Bala L, Wynn-Lawrence LS, Sam AH, 2021, Supplementation: An Improved Approach to Question-Based Collaborative Learning [Response to Letter], ADVANCES IN MEDICAL EDUCATION AND PRACTICE, Vol: 12, Pages: 251-252, ISSN: 1179-7258

Journal article

Sam AH, Millar KR, Lupton MGF, 2021, "Digital Clinical Placements": Challenges in a Lower Middle-Income Country Reply, ACADEMIC MEDICINE, Vol: 96, Pages: E1-E2, ISSN: 1040-2446

Journal article

Fung CY, Tan ZM, Savage A, Rahim M, Osman F, Adnan M, Peleva E, Sam AHet al., 2020, Undergraduate exposure to patient presentations on the acute medical placement: a prospective study in a London teaching hospital., BMJ Open, Vol: 10, Pages: 1-5, ISSN: 2044-6055

OBJECTIVES: To identify the availability and variability of learning opportunities through patient presentations on an acute medical placement at a teaching hospital. DESIGN: A prospective study evaluating all acute admissions to the Acute Medical Unit over 14 days (336 hours). Clinical presentations and the day and time of admission were recorded and compared with the learning outcomes specified in the medical school curriculum. SETTING: An Acute Medical Unit at a London teaching hospital. OUTCOMES: (1) Number of clinical presentations to the Acute Medical Unit over 14 days and (2) differences between the availability and variation of admissions and presentations between in-hours and out-of-hours. RESULTS: There were 359 admissions, representing 1318 presentations. Of those presentations, 76.6% were admitted out-of-hours and 23.4% in-hours. Gastrointestinal bleeding, tachycardia, oedema and raised inflammatory markers were over three times more common per hour out-of-hours than in-hours. Hypoxia was only seen out-of-hours. Important clinical presentations in the curriculum such as chest pain and hemiparesis were not commonly seen. CONCLUSIONS: There is greater availability of presentations seen out-of-hours and a changing landscape of presentations seen in-hours. The out-of-hours presentation profile may be due to expanded community and specialist services. Medical schools need to carefully consider the timing and location of their clinical placements to maximise undergraduate learning opportunities.

Journal article

Sam AH, Reid MD, Thakerar V, Gurnell M, Westacott R, Reed MWR, Brown CAet al., 2020, National inter-rater agreement of standardised simulated-patient-based assessments, MEDICAL TEACHER, Vol: 43, Pages: 341-346, ISSN: 0142-159X

Journal article

Reid MD, Sam AH, 2020, Reflections on assessment in the wake of change from the COVID-19 pandemic, MEDICAL EDUCATION, Vol: 55, Pages: 128-130, ISSN: 0308-0110

Journal article

Sam AH, Reid MD, Amin A, 2020, High-stakes remote-access open-book examinations, Medical Education, Vol: 54, Pages: 767-768, ISSN: 0308-0110

The COVID-19 pandemic has led to unprecedented challenges in medical school assessments. Final year high-stakes assessments have classically used closed book examinations (CBEs). Alternative methods of assessment such as open book examinations (OBEs) are emerging but are not routinely used in final year medical school exams. OBEs encourage the use of problem-solving skills more akin to those used in real-life. There is currently limited data comparing OBEs with CBEs. A systematic review showed there was insufficient evidence to support the exclusive use of either CBEs or OBEs in assessment, however the studies conducted to date have rarely looked at high-stakes assessments due to concerns about the validity of OBEs1 .

Journal article

Sam AH, Millar KR, Lupton MGF, 2020, Digital Clinical Placement for Medical Students in Response to COVID-19, ACADEMIC MEDICINE, Vol: 95, Pages: 1126-1126, ISSN: 1040-2446

Journal article

Buitendijk S, Ward H, Shimshon G, Sam AH, Sharma D, Harris Met al., 2020, COVID-19: an opportunity to rethink global cooperation in higher education and research, BMJ Global Health, Vol: 5, Pages: e002790-e002790, ISSN: 2059-7908

Journal article

Bala L, van der Vleuten C, Freeman A, Torre D, Heeneman S, Sam AHet al., 2020, COVID-19 and programmatic assessment, The Clinical Teacher, Vol: 17, Pages: 420-422, ISSN: 1743-4971

Journal article

Abbara A, Clarke S, Brewster R, Simmonard A, Eng PC, Phylactou M, Papadopoulou D, Izzi-Engbeaya C, Sam A, Wernig F, Jonauskyte E, Comninos A, Meeran K, Kelsey T, Dhillo Wet al., 2020, Pharmacodynamic response to anti-thyroid drugs in Graves’ hyperthyroidism, Frontiers in Endocrinology, Vol: 11, ISSN: 1664-2392

Objective: Graves' disease is the commonest cause of hyperthyroidism in populations with sufficient dietary iodine intake. Anti-thyroid drugs (ATD) are often used as the initial treatment for Graves' hyperthyroidism, however there is a paucity of data relating the dose of ATD therapy to the effect on thyroid hormone levels, increasing the risk of both over- and under-treatment. We aimed to determine the pharmacodynamic response to the ATD carbimazole.Design: Retrospective cohort study.Methods: Participants were patients (n = 441) diagnosed with Graves' disease at Imperial College Healthcare NHS Trust between 2009 and 2018. The main outcome measure was change in thyroid hormone levels in response to ATD.Results: Baseline thyroid hormone levels were positively associated with TSH receptor antibody titres (P < 0.0001). Baseline free triiodothyronine (fT3) were linearly related to free thyroxine (fT4) levels in the hyperthyroid state (fT3 = fT4*0.97–11), and fell proportionately with carbimazole. The percentage falls in fT4 and fT3 per day were associated with carbimazole dose (P < 0.0001). The magnitude of fall in thyroid hormones after the same dose of carbimazole was lower during follow up than at the initiation visit. The fall in thyroid hormone levels approximated to a linear response if assessed at least 3 weeks after commencement of carbimazole. Following withdrawal of antithyroid drug treatment, the risk of relapse was greater in patients with higher initial fT4, initial TSH receptor antibody titre, males, smokers, and British Caucasian ethnicity.Conclusion: We identify a dose-response relationship for fall in thyroid hormones in response to carbimazole to aid in the selection of dose for Graves' hyperthyroidism.

Journal article

Sam AH, Wilson RK, Lupton M, Melville C, Halse O, Harris J, Meeran Ket al., 2019, Clinical prioritisation questions: A novel assessment tool to encourage tolerance of uncertainty?, Medical Teacher, Pages: 1-6, ISSN: 0142-159X

Uncertainty is a common and increasingly acknowledged problem in clinical practice. Current single best answer (SBA) style assessments test areas where there is one correct answer, and as the approach to assessment impacts on the approach to learning, these exams may poorly prepare our future doctors to handle uncertainty. We therefore, need to modify our approach to assessment to emphasize reasoning and introduce the possibility of more than one ‘correct’ answer. We have developed clinical prioritization questions (CPQs), a novel formative assessment tool in which students prioritize possible responses in order of likelihood. This assessment format was piloted with a group of medical students and evaluated in comparison with the more traditional SBA question format in a team-based learning setting. Students reported that they felt ongoing use would help improve their tolerance of uncertainty (p < 0.01). Furthermore, over 80% of students felt that CPQs were more reflective of real-life clinical practice. Group based discussions were significantly longer when answering CPQs (p < 0.01), suggesting they may promote richer discourse. CPQs may have a role in formative assessment to help equip students with the skills to cope with ambiguity and strengthen clinical reasoning and decision-making. Institutions may find them more practical to implement compared with other clinical reasoning assessment tools.

Journal article

Sam SA, Peleva E, Fung CY, Cohen N, Benbow EW, Meeran Ket al., 2019, Very short answer questions: a novel approach to summative assessments in pathology, Advances in Medical Education and Practice, Vol: 10, Pages: 943-948, ISSN: 1179-7258

BackgroundA solid understanding of the science underpinning treatment is essential for all doctors. Pathology teaching and assessment are fundamental components of the undergraduate medicine curriculum. Assessment drives learning and the choice of assessments influences students’ learning behaviours. The use of multiple-choice questions is common but is associated with significant cueing and may promote ‘rote learning’. Essay-type questions and Objective Structured Clinical Examinations (OSCEs) are resource-intensive in terms of delivery and marking, and do not allow adequate sampling of the curriculum. To address these limitations, we used a novel online tool to administer Very Short Answer questions (VSAQs) and evaluated the utility of the VSAQs in an undergraduate summative pathology assessment.MethodsA group of 285 medical students took the summative assessment, comprising 50 VSAQs, 50 single best answer questions (SBAQs), and 75 extended matching questions (EMQs). The VSAQs were machine-marked against pre-approved responses, and subsequently reviewed by a panel of pathologists, with the software remembering all new marking judgements.ResultsThe total time taken to mark all 50 VSAQs for all 285 students was 5 hours, compared to 70 hours required to manually mark an equivalent number of questions in a paper-based pathology exam. The median percentage score for the VSA test (72%) was significantly lower than that of the SBAQs (80%) and EMQs (84%), p <0.0001. VSAQs had a higher Cronbach alpha (0.86) than SBAQs (0.76), and EMQs (0.77). VSAQs, SBAQs and EMQs had a mean point-biserial of 0.35, 0.30 and 0.28, respectively.ConclusionsVSAQs are an acceptable, reliable and discriminatory method for assessing pathology, and may enhance students’ understanding of how pathology supports clinical decision-making and clinical care by changing learning behaviour.

Journal article

Bhatt PS, Sam AH, Meeran KM, Salem Vet al., 2019, The relevance of cortisol co-secretion from aldosterone-producing adenomas, Hormones (Athens, Greece), Vol: 18, Pages: 307-313, ISSN: 1109-3099

AIMS AND OBJECTIVES: Adrenal adenomas are usually non-functioning, but can secrete aldosterone or cortisol. It has recently been suggested that many more adenomas than previously thought secrete more than one hormone. This has important implications for their clinical management. Our aim was to determine the frequency of cortisol co-secretion in primary hyperaldosteronism at our institution and investigate the difference in metabolic profiles and clinical outcomes between co-secreting and non-co-secreting patients. DESIGN AND PATIENTS: A retrospective study of 25 patients with primary hyperaldosteronism who also underwent formal dexamethasone suppression tests to determine cortisol co-secretion. MEASUREMENTS: Post-dexamethasone suppression test cortisol, serum ALT, total cholesterol, HDL-cholesterol, LDL-cholesterol, HbA1C (were recorded) and mean arterial pressure are reported in this cohort of patients with primary hyperaldosteronism. RESULTS: Four out of 25 patients with primary hyperaldosteronism failed dexamethasone suppression tests. This suggests a frequency of co-secretion ranging between 4 and 16%. No significant difference was found in serum ALT, total cholesterol, serum HDL-cholesterol, LDL-cholesterol and mean arterial blood pressure at presentation between co-secretors and non-co-secretors. CONCLUSION: A frequency range of 4-16% suggests that a significant proportion of patients with primary hyperaldosteronism co-secrete cortisol. Co-secretors did not have a worse metabolic profile than non-secretors. The impact of co-secretion on metabolic profile and surgical management remains unclear and warrants further study.

Journal article

Field SM, Burstow NJ, Owen DR, Sam SAHet al., 2019, Using team-based revision to prepare medical students for the prescribing safety assessment, Advances in Medical Education and Practice, Vol: 2019, Pages: 501-506, ISSN: 1179-7258

BackgroundThe Prescribing Safety Assessment (PSA) is an online assessment of safe and effective prescribing, taken by final-year UK medical students. To prepare students for the PSA, we used a modified form of team-based learning, team-based revision (TBR), in which students consolidate previously learned prescribing knowledge and skills across a broad range of topics. We evaluated students’ response to TBR and their perceptions of team working. MethodsEight TBR sessions based on the PSA blueprint were conducted over two days by three faculty members for final year medical students. During TBR sessions, students worked in small groups answering individual multiple-choice questions, followed by group multiple-choice questions. They subsequently answered open-ended questions in their groups, with answers written on a drug chart to increase authenticity. Students completed surveys using Likert-type items to determine views on TBR and their confidence in prescribing. ResultsThe majority of respondents agreed that the sessions were useful for preparation both for the PSA (82%) and Foundation Year 1 (78%). 92% agreed that using drug-charts aided learning. Prescribing confidence increased significantly after TBR (median pre-TBR: 2, post-TBR: 5, p<0.0001). TBR significantly improved attitudes towards ‘team experience’ (p<0.001), ‘team impact on quality of learning’ (p<0.01) and ‘team impact on clinical reasoning ability’ (p <0.001). ConclusionsTeam-based revision is a resource-efficient addition to undergraduate prescribing teaching and can help with preparation for the PSA. A short course of TBR was effective in influencing students’ attitudes towards teamwork.

Journal article

Sam SA, Fung CY, Wilson R, Peleva E, Kluth D, Lupton M, Owen D, Melville C, Meeran Met al., 2019, Using prescribing very short answer questions to identify sources of medication errors: a prospective study in two UK medical schools, BMJ Open, Vol: 9, Pages: 1-5, ISSN: 2044-6055

Objective To assess the utility and ability of the novel prescribing very short answer (VSA) question format to identify the sources of undergraduate prescribing errors when compared with the conventional single best answer (SBA) question format and assess the acceptability of machine marking prescribing VSAs.Design A prospective study involving analysis of data generated from a pilot two-part prescribing assessment.Setting Two UK medical schools.Participants 364 final year medical students took part. Participation was voluntary. There were no other inclusion or exclusion criteria.Outcomes (1) Time taken to mark and verify VSA questions (acceptability), (2) differences between VSA and SBA scores, (3) performance in VSA and (4) SBA format across different subject areas and types of prescribing error made in the VSA format.Results 18 200 prescribing VSA questions were marked and verified in 91 min. The median percentage score for the VSA test was significantly lower than the SBA test (28% vs 64%, p<0.0001). Significantly more prescribing errors were detected in the VSA format than the SBA format across all domains, notably in prescribing insulin (96.4% vs 50.3%, p<0.0001), fluids (95.6% vs 55%, p<0.0001) and analgesia (85.7% vs 51%, p<0.0001). Of the incorrect VSA responses, 33.1% were due to the medication prescribed, 6.0% due to the dose, 1.4% due to the route and 4.8% due to the frequency.Conclusions Prescribing VSA questions represent an efficient tool for providing detailed insight into the sources of significant prescribing errors, which are not identified by SBA questions. This makes the prescribing VSA a valuable formative assessment tool to enhance students’ skills in safe prescribing and to potentially reduce prescribing errors.

Journal article

Hall C, Peleva E, Vithlani RH, Shah S, Bashyam M, Ramadas M, Horsburgh J, Sam AHet al., 2019, FEEDBK: a novel approach for providing feedback., Clin Teach

BACKGROUND: High-quality feedback is fundamental to students' learning. We describe and evaluate FEEDBK, a novel feedback tool that encompasses the focus of learning, student self-evaluation (reflection), the encounter with the patient (professionalism), one task that the student should continue to do (reinforcement), one task that they could do better (improvement) and a key take-home message for self-directed learning. METHODS: Medical students received regular bedside teaching and feedback during a 9-week clinical placement at a teaching hospital. Teaching fellows gave feedback in their usual style during weeks 1-3 and then used the FEEDBK tool during weeks 4-9. Questionnaires and focus groups were used to evaluate the students' experience of feedback before and after the introduction of FEEDBK. RESULTS: FEEDBK significantly enhanced the feedback experience across six domains: identifying learning objectives, chance to reflect, feedback on communication skills/professionalism, specific suggestions for improvement, clear take-home message and personalised feedback. The analysis of the feedback from focus groups yielded four categories: (i) FEEDBK influenced the feedback process (delivering timely feedback); (ii) the nature of the feedback (enhancing both the quantity and the quality of the feedback received); (iii) the structure of the feedback; and (iv) the evolution of teaching and learning. DISCUSSION: FEEDBK may enhance both the quantity and the quality of feedback and has the potential to improve the quality of teaching. It provides teachers with a quick and easy-to-follow framework to signpost curriculum-aligned feedback.

Journal article

Almazrouei RA, Sam AH, Meeran K, Palazzo Fet al., 2019, PARATHYROID SESTAMIBI REVEALS MENINGIOMA., Endocr Pract, ISSN: 1530-891X

Journal article

Abbara A, Clarke S, Eng PC, Milburn J, Devavrata J, Comninos A, Ramli R, Mehta A, Jones B, Wernig F, Nair R, Mendoza N, Sam SH, Hatfield E, Meeran MK, Dhillo W, Martin Net al., 2018, Clinical and biochemical characteristics of patients presenting with pituitary apoplexy, Endocrine Connections, Vol: 7, Pages: 1058-1066, ISSN: 2049-3614

PurposeTo review the clinical and biochemical characteristics and clinical outcome of patients presenting with pituitary apoplexy to a tertiary centre.MethodsWe retrospectively reviewed the clinical features, predisposing factors, biochemistry and clinical outcome of patients presenting with pituitary apoplexy to Imperial College Healthcare NHS Trust between 1991 and 2015.ResultsWe identified 64 patients with pituitary apoplexy (more complete clinical records were available in 52 patients). The median age at presentation was 46.7 years (IQR 31.5–57.0 years). Pituitary apoplexy was the first presentation of pituitary disease in 38/52 of patients and predisposing factors were identified in 28/52. Pituitary apoplexy predominantly occurred in patients with non-functioning pituitary adenomas (47/52). Headache was most commonly described as sudden onset, severe, lateralising to the frontal or temporal regions. Symptoms of meningeal irritation were reported in 7/18 and visual abnormalities in 22/35. A pre-treatment serum cortisol <100 nmol/L was recorded in 12/31 of patients. All patients with visual disturbance had some resolution of their visual symptoms whether managed surgically (14/14) or conservatively (5/5), although pituitary endocrine function did not fully recover in any patient.ConclusionsIn conclusion, these data describe the clinical features of pituitary apoplexy to aid the clinician in diagnosing this rare emergency presentation of pituitary disease. Prospective multicentre studies of the presentation of pituitary apoplexy are required to further characterise presentation and outcomes.

Journal article

Abbara A, Clarke S, Nesbitt A, Ali S, Comninos A, Hatfield E, Martin NM, Sam AH, Meeran K, Dhillo Wet al., 2018, Interpretation of serum gonadotropin levels in hyperprolactinemia, Neuroendocrinology, Vol: 107, Pages: 105-113, ISSN: 0028-3835

Background/Aims: Hyperprolactinemia is a common cause of amenorrhea due to hypogonadotropic hypogonadism. Prolactin is hypothesized to impede the reproductive axis through an inhibitory action at the hypothalamus. However, limited data exists to aid the interpretation of serum gonadotropins in the context of hyperprolactinemia. Methods: Serum gonadotropin values were reviewed in 243 patients with elevated serum monomeric prolactin due to discrete etiologies at a tertiary reproductive endocrine centre between 2012 and 2015. The cause of hyperprolactinemia was categorized by an experienced endocrinologist / pituitary multidisciplinary team, unless superseded by histology. The most frequently encountered diagnoses were Microprolactinoma (n=88), Macroprolactinoma (n=46), Non-Functioning Pituitary Adenoma (NFPA) (n=72), Drug-Induced Hyperprolactinemia (DIH) (n=22) and Polycystic Ovarian Syndrome (PCOS) (n=15). Results: In patients with prolactinoma and modestly raised serum prolactin levels (<4000 mU/L), increasingly FSH-predominant gonadotropin values were observed with rising prolactin level, consistent with a progressive reduction in hypothalamic GnRH pulsatility. Patients with prolactinoma and higher prolactin values (>4000 mU/L) were more likely to have a reduction in serum levels of both FSH and LH, consistent with direct pituitary gonadotrope dysfunction. Patients with macroadenoma and extremes of serum gonadotropin values (either serum FSH or LH >8 IU/L) were more likely to have NFPA than prolactinoma. Patients with polycystic ovarian syndrome (PCOS) and hyperprolactinemia had LH-predominant secretion in keeping with increased GnRH pulsatility despite a raised prolactin level. Conclusion: The pattern of gonadotropin secretion in patients may reflect the etiology of hyperprolactinemia.

Journal article

Sam AH, Field SM, Collares CF, van der Vleuten CPM, Wass VJ, Melville C, Harris J, Meeran Ket al., 2018, Very-short-answer questions: reliability, discrimination and acceptability, MEDICAL EDUCATION, Vol: 52, Pages: 447-455, ISSN: 0308-0110

ContextSingle‐best‐answer questions (SBAQs) have been widely used to test knowledge because they are easy to mark and demonstrate high reliability. However, SBAQs have been criticised for being subject to cueing.ObjectivesWe used a novel assessment tool that facilitates efficient marking of open‐ended very‐short‐answer questions (VSAQs). We compared VSAQs with SBAQs with regard to reliability, discrimination and student performance, and evaluated the acceptability of VSAQs.MethodsMedical students were randomised to sit a 60‐question assessment administered in either VSAQ and then SBAQ format (Group 1, n = 155) or the reverse (Group 2, n = 144). The VSAQs were delivered on a tablet; responses were computer‐marked and subsequently reviewed by two examiners. The standard error of measurement (SEM) across the ability spectrum was estimated using item response theory.ResultsThe review of machine‐marked questions took an average of 1 minute, 36 seconds per question for all students. The VSAQs had high reliability (alpha: 0.91), a significantly lower SEM than the SBAQs (p < 0.001) and higher mean item–total point biserial correlations (p < 0.001). The VSAQ scores were significantly lower than the SBAQ scores (p < 0.001). The difference in scores between VSAQs and SBAQs was attenuated in Group 2. Although 80.4% of students found the VSAQs more difficult, 69.2% found them more authentic.ConclusionsThe VSAQ format demonstrated high reliability and discrimination and items were perceived as more authentic. The SBAQ format was associated with significant cueing. The present results suggest the VSAQ format has a higher degree of validity.

Journal article

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