Introducing Objective Structured Clinical Examinations for Undergraduate Orthoptic Education

Aim: Introducing the objective structured clinical examination (OSCE) to improve orthoptic education and clinical competence including the clinical attitude and skills of orthoptic students.Methods: Subjects were thirty-one fourth grade orthoptic students from our department. Six basic examinations were included in stations for trial use of OSCE. The OSCE were performed and compared before and after the eight weeks clinical training. Ten items of clinical attitude and six examinations were evaluated respectively. Six experienced orthoptists evaluated students\u27 clinical attitude and examination techniques while they were performing simulated patient (SPs) examinations according to the evaluation sheets we designed.Results: After clinical training, both students\u27 attitudes toward SPs and examination techniques including correction of refractive errors improved significantly (p<0.05). However, the refractive correction score did not reach sixty. Attitudes toward SPs improved in eight areas out of ten. Safety procedures during examination and signaling the end of examinations did not attain a score of sixty.Conclusion: We were able to evaluate objectively the effect of clinical training on the clinical competence (attitude toward patients and examination techniques) of students by OSCE. Improvements in the evaluation sheets and crossed-check system are still necessary

Feasibility of methotrexate discontinuation following tocilizumab and methotrexate combination therapy in patients with long-standing and advanced rheumatoid arthritis: a 3-year observational cohort study

Objectives: Methotrexate (MTX) is associated with extensive side effects, including myelosuppression, interstitial pneumonia, and infection. It is, therefore, critical to establish whether its administration is required after achieving remission with tocilizumab (TCZ) and MTX combination therapy in patients with rheumatoid arthritis (RA). Therefore, the aim of this multicenter, observational, cohort study was to evaluate the feasibility of MTX discontinuation for the safety of these patients. Methods: Patients with RA were administered TCZ, with or without MTX, for 3 years; those who received TCZ+MTX combination therapy were selected. After remission was achieved, MTX was discontinued without flare development in one group (discontinued [DISC] group, n = 33) and continued without flare development in another group (maintain [MAIN] group, n = 37). The clinical efficacy of TCZ+MTX therapy, patient background characteristics, and adverse events were compared between groups. Results: The disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) at 3, 6, and 9 months was significantly lower in the DISC group (P < .05, P < .01, and P < .01, respectively). Further, the DAS28-ESR remission rate at 6 and 9 months and Boolean remission rate at 6 months were significantly higher in the DISC group (P < .01 for all). Disease duration was significantly longer in the DISC group (P < .05). Furthermore, the number of patients with stage 4 RA was significantly higher in the DISC group (P < .01). Conclusions: Once remission was achieved, MTX was discontinued in patients who responded favorably to TCZ+MTX therapy, despite the prolonged disease duration and stage progression

Persistent seropositivity for yellow fever in a previously vaccinated autologous hematopoietic stem cell transplantation recipient

The duration of a protective level of yellow fever antibodies after autologous hematopoietic stem cell transplantation in a previously vaccinated person is unclear. The case of a patient who had previously been vaccinated for yellow fever and who remained seropositive for 22 months after autologous peripheral blood stem cell transplantation for malignant lymphoma is described herein

Analysis of prophylactic Bakri balloon tamponade failure in patients with placenta previa

Objective: Recently, Bakri balloon (BBT) was effective for women with placenta previa to reduce hemorrhage. However, about 10% of women needed to receive an invasive strategy. Thus, the identification of risk factors and the development of additional measurements for BBT failure was needed. The aim of our study is to investigate the cause and measurements of failing prophylactic BBT in women with placenta previa. Materials and methods: Women with placenta previa who underwent cesarean section and had a prophylactic BBT inserted during the operation at our institution between January 2015 and December 2017 were enrolled. Patients requiring additional procedures after cesarean section for massive hemorrhage were defined as BBT failures. Additionally, the patterns and risk factors of BBT failure were retrospectively evaluated. Results: Seventy women met the inclusion criteria. Of them, 9 (13%) were in the balloon failure group and 61 (87%), in the balloon success group. Between two groups, the median of postoperative blood loss was 1153 g vs. 70 g (p < 0.01) and the total blood loss 2409 g vs. 971 g (p < 0.01). There were two types of failures in the balloon failure group: balloon prolapse in eight patients (89%) and accidental placental retention in one patient (11%). The hemorrhage was controlled in all patients with balloon prolapse by reinsertion and inflation of the balloon. The patient with placental retention required a uterine artery embolization (UAE). Although three patients required a blood transfusion, none required a hysterectomy. The logistic regression for the risk of balloon failure revealed classification of major previa to be the highest risk factor (Hazard Ratio; 19.1, 95% Confidence Interval; 3.17–367.9, p < 0.01). Conclusion: The major cause of BBT failure was balloon prolapse. It could be treated with non-invasive methods; however, patients with placental retention could not avoid invasive treatment to stop the hemorrhage. Keywords: Bakri balloon, Cesarean section, Placenta previa, Postpartum hemorrhage, Uterine aton