Introducing a performance-based objective clinical examination into the pharmacy curriculum for students of Northern Cyprus

Purpose: To describe how a formative Objective Structured Clinical Examination was applied to fourth year pharmacy students at a university in Northern Cyprus.Methods: A blueprint-guided performance-based objective clinical examination was implemented. Group-prepared case scenarios based on course objectives were used to develop 12 exam stations. Scenarios were discussed in common training sessions for both assessors (faculty members) and senior students (standardized patients). Pilot testing of all stations was carried out on the day of the examination. Competencies tested included medical history taking, pharmacotherapeutic  knowledge application, systemic client assessment, evidence-based drug  information (DI) manipulation, drug related problems (DRP) management, patient counseling and communication skills.Results: The exam revealed that students were better in performing patient  counseling (4.4 ± 0.23) and identification/resolution of DRPs (3.68 ± 0.18) than in DI tasks (2.00 ± 0.21) (p < 0.05). The students’ perceptions were positive with no significant differences in their average general performance compared to a written exam that had been previously carried out (p = 1.0).Conclusion: The evaluation revealed that undergraduate pharmacy students in a Turkish school of pharmacy were better in performing patient counseling and identification/ resolution of DRPs than in drug information manipulation tasks.  Student satisfaction with OSCEs was higher compared to the written examination. The design and implementation of the formative assessment was successful with minimum cost, using only the existing available space and personnel.Keywords: Objective structured clinical examination, Formative assessment,  Pharmacy students assessment, Competency, Examinatio

BIM aplicado ao projeto de fôrmas de madeira em estrutura de concreto armado

ResumoO Projeto Construtivo de Fôrmas de Madeira (PCFM) faz uso tradicionalmente de ferramentas CAD na representação bidimensional, limitando sua inserção no contexto de Building Information Modeling (BIM). Considerando que BIM se encontra em grande expansão no mercado nacional esta pesquisa visa apontar um caminho para se vencer esta limitação. Propõe-se uma biblioteca de componentes para o projeto de fôrmas de madeira, incluindo usos de BIM tais como a Modelagem, a Quantificação, a Simulação 4D e procedimentos associados. O método de pesquisa utilizado foi a Constructive Research. Os componentes para a biblioteca foram desenvolvidos na ferramenta BIM Revit Structure. A proposta foi validada: em ambiente de ensino, escritório de projeto e na prática. Verifica-se que a pesquisa é consonante com os poucos estudos internacionais pioneiros e semelhantes, sendo contextualizada para o cenário nacional. Observa-se também que todas as pesquisas que tratam de BIM associado a fôrmas requerem um modelo de informação que inclua a modelagem de fôrmas no mesmo. Desta forma, este estudo é também fundamental, pois amplia desdobramentos da incorporação de BIM na cadeia produtiva da construção civil

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Tubal rupture in ectopic pregnancy: is it predictable?

Aim. Ectopic pregnancies account for 10-15% of all maternal deaths. Rupture of an ectopic pregnancy is an urgent medical situation, therefore prediction of any tubal rupture before its occurrence is extremely important. The aim of this study was to evaluate the tubal rupture rate in different treatment modalities in EP cases and to find a hCG level on admission and/or size of ectopic mass predictive for tubal rupture

RUPTURED SPONTANEOUS HETEROTROPIC PREGNANCY

Introduction: Heterotropic pregnancy is a condition of the co-existence of different gestations. With the widespread use of assisted reproductive techniques its incidence is increasing

IN THE SUBJUNCTIVE MODE - EPILEPSY NARRATIVES IN TURKEY

Careful analysis of transcripts of interviews we conducted with a sample of persons identified as suffering epilepsy or seizure disorders in an epidemiological study in Turkey revealed not only that life stories of illness have an overall narrative structure but that the interviews were composed as a corpus of shorter stories. Analytic concepts from reader response theory bring attention to aspects of both the overall life story and the stories told about illness. In particular, we identify 'subjunctivizing tactics' present in the narrative representation of illness that allow sufferers and their families to justify continued care-seeking and to maintain hope for positive, even 'miraculous,' outcomes. In particular, these narratives maintain multiple perspectives and the potential for multiple readings, suggesting alternative plots about source and outcome of illness, and they represent potency and the possibilities for healing through stories of encounters with the mysterious