7 research outputs found
Extended optical treatment versus early patching with an intensive patching regimen in children with amblyopia in Europe (EuPatch): a multicentre, randomised controlled trial
Background
Amblyopia, the most common visual impairment of childhood, is a public health concern. An extended period of optical treatment before patching is recommended by the clinical guidelines of several countries. The aim of this study was to compare an intensive patching regimen, with and without extended optical treatment (EOT), in a randomised controlled trial.
Methods
EuPatch was a randomised controlled trial conducted in 30 hospitals in the UK, Greece, Austria, Germany, and Switzerland. Children aged 3–8 years with newly detected, untreated amblyopia (defined as an interocular difference ≥0·30 logarithm of the minimum angle of resolution [logMAR] best corrected visual acuity [BCVA]) due to anisometropia, strabismus, or both were eligible. Participants were randomly assigned (1:1) via a computer-generated sequence to either the EOT group (18 weeks of glasses use before patching) or to the early patching group (3 weeks of glasses use before patching), stratified for type and severity of amblyopia. All participants were initially prescribed an intensive patching regimen (10 h/day, 6 days per week), supplemented with motivational materials. The patching period was up to 24 weeks. Participants, parents or guardians, assessors, and the trial statistician were not masked to treatment allocation. The primary outcome was successful treatment (ie, ≤0·20 logMAR interocular difference in BCVA) after 12 weeks of patching. Two primary analyses were conducted: the main analysis included all participants, including those who dropped out, but excluded those who did not provide outcome data at week 12 and remained on the study; the other analysis imputed this missing data. All eligible and randomly assigned participants were assessed for adverse events. This study is registered with the International Standard Randomised Controlled Trial Number registry (ISRCTN51712593) and is no longer recruiting.
Findings
Between June 20, 2013, and March 12, 2020, after exclusion of eight participants found ineligible after detailed screening, we randomly assigned 334 participants (170 to the EOT group and 164 to the early patching group), including 188 (56%) boys, 146 (44%) girls, and two (1%) participants whose sex was not recorded. 317 participants (158 in the EOT group and 159 in the early patching group) were analysed for the primary outcome without imputation of missing data (median follow-up time 42 weeks [IQR 42] in the EOT group vs 27 weeks [27] in the early patching group). 24 (14%) of 170 participants in the EOT group and ten (6%) of 164 in the early patching group were excluded or dropped out of the study, mostly due to loss to follow-up and withdrawal of consent; ten (6%) in the EOT group and three (2%) in the early patching group missed the 12 week visit but remained on the study. A higher proportion of participants in the early patching group had successful treatment (107 [67%] of 159) than those in the EOT group (86 [54%] of 158; 13% difference; p=0·019) after 12 weeks of patching. No serious adverse events related to the interventions occurred.
Interpretation
The results from this trial indicate that early patching is more effective than EOT for the treatment of most children with amblyopia. Our findings also provide data for the personalisation of amblyopia treatments.
Funding
Action Medical Research, NIHR Clinical Research Network, and Ulverscroft Foundation
Förderung der Kommunikation und Kooperation via e-Learning durch Lösung und Erstellung interdisziplinärer Fallszenarien
Background: An increasing number of patients to treat combined with a rapidly growing amount of knowledge to integrate, is challenging for future doctors. To take the medical history and diagnose effectively, to send the patient to an expert, to create a relevant expert to expert communication, to discuss with the patient, the time needed for a decision, should be as short as possible. Investigating medical students' cognitive processes while solving a patient's case leads to the conclusion that educators should help and facilitate these reasoning and communication processes. Developments in information technology offer a large variety of tools for educators. Method: Practicing repeated memory retrieval in clinically relevant virtual settings leads to more durable storage of theoretical knowledge, especially when applying the theoretical knowledge to meaningful cases. The cases in the present e-learning tool are only solvable when knowledge is coherent, communicated and well-organized, as they demand combination of different interdisciplinary knowledge-fields. Thus, by practicing in the virtual environment, prospective memory (i.e. the ability to remember to do something in the future) is changed and the intention and attention in learning processes is shaped and adapted to the core requirements of clinical practice. Conclusion: Case-based learning can be a promising approach to teach students how to investigate and ask for important information. This paper focuses on undergraduate education and provides an outlook on possible concepts that can be used in different health care sectors.Hintergrund: Die immer größer werdende Anzahl an Patienten, sowie eine ständige Zunahme des medizinischen Wissens, das integriert werden soll, stellt für angehende Ärzte eine große Herausforderung dar. Die Zeit, die für eine Anamnese und Diagnosestellung, für eine korrekte Überweisung, für das Expertengespräch untereinander, für den Diskussionsprozess mit dem Patienten, aufgewendet werden muss, sollte so kurz wie möglich gehalten werden. Untersuchungen der kognitiven Prozesse von Medizinstudenten*innen, die sich einen Patientenfall angesehen haben, zeigten, dass der Kommunikations- und Entscheidungsprozess bzw. die Entscheidungsfindung im klinischen Alltag besser gelehrt werden sollte. Entwicklungen neuer Technologien für die Ausbildung bieten eine Vielzahl von Möglichkeiten für die medizinische Lehre. Methode: In einer virtuellen Lernumgebung wird anhand von Fallbeispielen theoretisches Wissen angewandt. Fazit: Fallbasiertes Lernen kann ein Ansatz sein, um den Studierenden zu vermitteln, wie sie einen Patientenfall adäquat bearbeiten und die wesentlichen Informationen abfragen und systemrelevant kommunizieren. Die Arbeit gibt einen Einblick in die Medizinausbildung und kann für Weiterbildung in anderen Gesundheitsberufen verwendet werden
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32nd International Austrian Winter Symposium : Zell am See, the Netherlands. 20-23 January 2016.
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