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1.
Ophthalmology ; 131(7): 855-863, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38185285

RESUMEN

TOPIC: This systematic review examined geographical and temporal trends in medical school ophthalmology education in relationship to course and student outcomes. CLINICAL RELEVANCE: Evidence suggesting a decline in ophthalmology teaching in medical schools is increasing, raising concern for the adequacy of eye knowledge across the rest of the medical profession. METHODS: Systematic review of Embase and SCOPUS, with inclusion of studies containing data on medical school ophthalmic course length; 1 or more outcome measures on student ophthalmology knowledge, skills, self-evaluation of knowledge or skills, or student course appraisal; or both. The systematic review was registered prospectively on the International Prospective Register of Systematic Reviews (identifier, CRD42022323865). Results were aggregated with outcome subgroup analysis and description in relationship to geographical and temporal trends. Descriptive statistics, including nonparametric correlations, were used to analyze data and trends. RESULTS: Systematic review yielded 4596 publication titles, of which 52 were included in the analysis, with data from 19 countries. Average course length ranged from 12.5 to 208.7 hours, with significant continental disparity among mean course lengths. Africa reported the longest average course length at 103.3 hours, and North America reported the shortest at 36.4 hours. On average, course lengths have been declining over the last 2 decades, from an average overall course length of 92.9 hours in the 2000s to 52.9 hours in the 2020s. Mean student self-evaluation of skills was 51.3%, and mean student self-evaluation of knowledge was 55.4%. Objective mean assessment mark of skills was 57.5% and that of knowledge was 71.7%, compared with an average pass mark of 66.7%. On average, 26.4% of students felt confident in their ophthalmology knowledge and 34.5% felt confident in their skills. DISCUSSION: Most evidence describes declining length of courses devoted to ophthalmology in the last 20 years, significant student dissatisfaction with courses and content, and suboptimal knowledge and confidence. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.


Asunto(s)
Oftalmología , Facultades de Medicina , Oftalmología/educación , Humanos , Competencia Clínica , Curriculum , Educación de Pregrado en Medicina/tendencias , Estudiantes de Medicina , Evaluación Educacional
2.
JAMA Dermatol ; 160(3): 281-289, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38294793

RESUMEN

Importance: Evolving evidence suggests that patients receiving Janus kinase-signal transducer and activator of transcription inhibitors (JAK-STATi) may be at higher risk of major adverse cardiovascular events (MACE) and venous thromboembolism (VTE). Most existing literature has focused on indications that may confer a higher MACE and VTE risk than that among patients with isolated dermatological indications. Objective: To evaluate risk of MACE, VTE, serious adverse events (SAEs), and tolerability of systemic JAK-STATi compared with placebo, in those with a dermatologic indication. Data Sources: A systematic review of the literature was carried out to June 2023, using databases Embase, MEDLINE, SCOPUS, Cochrane Library of Registered Trials, and registered Clinical Trials. The analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The analysis itself took place in June 2023. Study Selection: Placebo-controlled randomized clinical trials that compared systemic JAK-STATi with placebo, and investigated the safety in patients with alopecia areata, psoriasis, vitiligo, atopic dermatitis, lichen planus or hidradenitis suppurativa. Data Extraction and Synthesis: Study selection and data extraction by 2 authors working independently using a standardized template. Crude numbers for MACE, VTE, SAEs, and study discontinuation due to treatment emergent adverse events (TEAEs) were pooled and underwent meta-analysis. Main Outcomes and Measures: Incidence of MACE, VTE, SAE, and study discontinuation due to TEAEs. Analysis of these values against person exposure years to determine the incidence rate (IR). Risk ratios (RRs) compared incidence rates among treatment and placebo comparator arms. Results: Forty-five randomized clinical trials were eligible for inclusion, with 12 996 patients receiving active JAK-STATi therapy and 4925 allocated to placebo treatment. Meta-analysis found no significant increase in MACE (I2 = 0.00%; RR, 0.47; 95% CI, 0.28-0.80) or VTE (I2 = 0.00%; RR, 0.46; 95% CI, 0.26-0.80) between placebo and JAK-STATi comparator arms. There was also no significant difference in SAEs (I2 = 12.38%; RR, 0.92; 95% CI, 0.72-1.20) and discontinuations between JAK-STATi and placebo (I2 = 23.55%; RR, 0.94; 95% CI, 0.76-1.19). Conclusions and Relevance: This meta-analysis did not identify a significant increase in the risk of MACE and VTE in dermatology patients receiving JAK-STATi for median duration of 16 weeks. The results of this review suggest there is insufficient evidence that JAK-STATi confer an increased risk of cardiovascular complications in dermatological patients, especially when used for short time frames.

3.
Int J Dermatol ; 63(4): 413-421, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38009338

RESUMEN

INTRODUCTION: Many patients undergoing cutaneous surgery are prescribed at least one anticoagulant or antiplatelet agent. With the recent emergence of direct oral anticoagulants (DOACs), there is a deficit of knowledge regarding optimal perioperative management. This review aims to evaluate the evidence and risk surrounding management of DOACs in patients undergoing skin surgeries. METHODS: Systematic review of EMBASE, Scopus, and PubMed, with inclusion of studies that detailed perioperative management of DOACs in those undergoing skin surgery. Primary outcome measures were perioperative hemorrhagic and thromboembolic complications. RESULTS: Seven thousand seven hundred and forty-one abstracts were identified, with 13 articles meeting inclusion criteria. Two studies investigated complication risk associated with DOAC continuation in skin surgery and found an average rate of hemorrhagic complications of 1.74%. Two studies evaluated complications associated with DOAC cessation prior to skin surgery, with a pooled thromboembolic complication rate of 0.15%. Articles comparing continuation and cessation discovered no decreased risk of bleeding with DOAC cessation prior to surgery (P = 0.93). Seven of the 13 articles compared complications in a control vs a DOAC group undergoing cutaneous procedures. Evidence was conflicting but may have suggested a small increase in bleeding risk in those on DOAC therapy. CONCLUSION: Optimal management of anticoagulants perioperatively is difficult because of conflicting information, complicated by advent of novel agents. Risk of hemorrhagic complications with both continuation and interruption of DOAC therapy was low. Perioperative DOAC management can be guided by procedural bleeding and patient clotting risk and can often be continued in minor dermatologic procedures.


Asunto(s)
Anticoagulantes , Hemorragia , Humanos , Hemorragia/inducido químicamente , Inhibidores de Agregación Plaquetaria/efectos adversos , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Administración Oral
4.
Australas J Dermatol ; 64(2): e145-e151, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-36752180

RESUMEN

BACKGROUND: Despite a high frequency of dermatological general practice and emergency department presentations, including serious and potentially fatal skin conditions, evidence suggests that undergraduate dermatological education remains sparse. Given this, there exists a need to gauge dermatology-relevant knowledge and skill in our new doctors. METHODS: An online survey was completed by final-phase medical students and junior doctors from Australian medical schools. The survey appraised self-perceived confidence of dermatology knowledge and skills, in addition to 5 knowledge-based multiple-choice questions. RESULTS: Nine hundred and forty-two eligible responses were completed. Respondents reported low confidence in identifying dermatological conditions in people with skin of colour (µ = 1.69), handing over to dermatology colleagues (µ = 2.00) and in diagnosing and managing acute/emergency dermatology conditions (µ = 1.84). In contrast, participants felt most confident in counselling sun-protective behaviours (µ = 3.95) and suturing small wounds (µ = 3.43). 76.4% of respondents had not undertaken any dermatology placement, and 70.9% had never been formally assessed in dermatology. Those who received dermatology placement had a significantly higher aggregated self-reported confidence (p < 0.0001) and answered significantly more MCQs correctly (p = 0.0419). Those who had been formally assessed had a significantly higher self-reported confidence (p < 0.001) and answered significantly more MCQs correctly (p = 0.007). CONCLUSION: Final-phase medical students and junior doctors exhibit low confidence across many dermatology competencies. Participants believed they need more dermatology education, and seldom feel prepared when exposed to dermatologic pathologies. Introduction of a standardised curriculum, formal assessments and increased clinical exposure are possible solutions.


Asunto(s)
Dermatología , Educación de Pregrado en Medicina , Estudiantes de Medicina , Humanos , Dermatología/educación , Australia , Curriculum , Encuestas y Cuestionarios
6.
Ocul Surf ; 21: 64-65, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33940169

RESUMEN

The COVID-19 pandemic has piqued interest in spontaneous face-touch as a possible route of microbial infection, with eye-touch of particular importance since the ocular surface is a likely portal of human Coronavirus infection. Spontaneous face-touching is a poorly understood, ingrained habit for humans, who engage in this activity on average between 9 to 162 times per hour. Nearly half of spontaneous face-touches involve mucous membranes, and one third of those involve the eyes. The infective sequelae of self-touch are well documented in ophthalmological conditions such as infectious conjunctivitis, with risks for ocular surface disease beyond primary infection from pathogens such as human papillomavirus. Through tear film conveyance via the nasolacrimal duct, ocular surface pathogens may furthermore have access to the nasopharynx, oropharynx, and respiratory/gastrointestinal systems beyond. Ocular surface and face self-touch therefore represent a concerning possible method of not only local, but also systemic, self-inoculation. Conversely, microbial diversity in the mutualistic microbiome is being increasingly implicated as integral for developing immunity, and protecting against endocrinological and neurodegenerative disease, including those that affect the eye. Spontaneous face-touch brings the hands, the part of the body most in contact with the external world and with the highest temporal diversity, into direct contact with the body's multiple microbiomes. The authors hypothesise that spontaneous self-touch may represent an important mechanism by which the skin, ocular surface, gastrointestinal, and respiratory tracts maintains microbial diversity and prevents dysbiosis. It may be that whilst the eyes are at risk of infection through self-touch, they may paradoxically benefit through the acquisition of a mutualistic microbiome, protective not only for the eyes, but for the body as a whole.


Asunto(s)
COVID-19 , Microbiota , Enfermedades Neurodegenerativas , Humanos , Pandemias , SARS-CoV-2 , Tacto
7.
Am J Otolaryngol ; 42(3): 102914, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33486209

RESUMEN

Bell's palsy during pregnancy and the immediate post-partum period represents a unique clinical entity requiring an individualised management approach. Whilst the exact link between Bell's palsy and pregnancy is still unclear, the majority of cases occur in the third trimester and immediate post-partum period. These patients have been demonstrated to experience worse long term outcomes and are less likely to receive early corticosteroid therapy. This review suggests a contemporary management algorithm to ensure that these patients receive early therapy that is safe for the patient and foetus and meets the unique physical needs of the expecting or new mother.


Asunto(s)
Parálisis de Bell/diagnóstico , Parálisis de Bell/terapia , Glucocorticoides/administración & dosificación , Periodo Posparto , Prednisolona/administración & dosificación , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/terapia , Adulto , Antivirales/administración & dosificación , Biosimilares Farmacéuticos , Diagnóstico Precoz , Femenino , Humanos , Imagen por Resonancia Magnética , Procedimientos Quirúrgicos Oftalmológicos , Modalidades de Fisioterapia , Embarazo , Rehabilitación Psiquiátrica , Seguridad , Factores de Tiempo , Tomografía Computarizada por Rayos X , Adulto Joven
8.
Cureus ; 12(8): e9566, 2020 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-32905542

RESUMEN

Objective Our goal was to evaluate upper eyelid laxity by digital distraction, with the aim to determine sleeping laterality and the likelihood of obstructive sleep apnoea (OSA), and correlate these findings with polysomnography (PSG). Design We conducted a prospective, single-centre multidisciplinary study in a large sleep and respiratory department and an ophthalmology department within a tertiary referral university teaching hospital. Methods Patients with known OSA were evaluated using techniques based on the Lateralising Eyelid Sleep Compression (LESC) study. Upper eyelid laxity was assessed by two masked investigators, and the eyelid side with greater laxity was regarded as indicative of that patient's sleeping laterality: 'investigator-detected sleeping laterality' (ID SL). Each patient was then asked about the laterality of his or her accustomed sleeping position: 'patient-reported sleeping laterality' (PR SL). PSG was conducted according to the standard protocol of the Department of Sleep and Respiratory Medicine (DSRM). 'Polysomnography-detected sleeping laterality' (PSG SL) permitted the extraction of sleep positional data by two masked sleep scientists. Results The reliability of the LESC technique for diagnosing ID SL was demonstrated to be statistically significant (p<0.01). Upper eyelid laxity was significantly greater on the patients' sleeping side (t=6.340, df=45, p<0.01, two-tailed). There was a significant correlation between PR SL and ID SL (rs =0.33). However, PSG SL did not correlate with sleeping laterality compared with both ID SL and PR SL. Conclusion This study confirms that there is a statistically significant correlation of sleeping laterality with increasing upper eyelid laxity in OSA. Counterintuitively, PSG SL correlated poorly with ID SL and PR SL. This may likely be explained by the technical limitations implicit in current PSG techniques.

9.
Neuroophthalmology ; 44(2): 71-75, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32395153

RESUMEN

Saccades are a key component for the assessment and diagnosis of Neuro-ophthalmological disorders. Traditionally, clinicians have been taught to use large amplitude saccades (LAS) to assess saccadic velocity (SV), when small amplitude saccades (SAS) may be more effective. This study aimed to evaluate the advantages of SAS over LAS by presenting a video to 108 clinicians where both methods were used to assess a patient with a unilateral partial 6th nerve palsy. SAS was the preferred method in identifying the 6th nerve palsy by 43/55 (78.2%) of Neurologists, and 36/53 (67.9%) of Ophthalmologists. These findings indicate that SAS may be a more effective method than LAS for determining SV.

12.
Ophthalmol Glaucoma ; 2(2): 86-93, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-32672609

RESUMEN

PURPOSE: To assess which factors in the lives and disease of patients with glaucoma affect their adherence to topical glaucoma therapy and the quantitative significance of this effect. To assess qualitatively the most influential barriers to adherence from the perspective of the patient. DESIGN: Multicenter, prospective, cross-sectional pilot study. PARTICIPANTS: A total of 145 patients, attending outpatient metropolitan glaucoma clinics in Sydney, Australia, who were prescribed topical glaucoma medications. METHODS: A structured interview-based questionnaire was conducted with 145 individuals using glaucoma eye drops that had been prescribed at least 2 weeks previously. The questionnaire involved 2 novel questions on adherence, 29 questions on factors identified or postulated in the literature as affecting adherence for quantitative analysis, and 1 open-response question on patient-identified causes of nonadherence for qualitative analysis. This questionnaire represents the broadest coverage of factors hypothesized to affect adherence in a single study in the glaucoma medication adherence literature to date. MAIN OUTCOME MEASURES: Adherence rate, risk factors for poor adherence, and patient-identified barriers to adherence. RESULTS: In response to the question "How many days have you missed a drop in the last 2 weeks," 69.7% of patients reported total adherence. Four factors were significantly related to an increased likelihood of reporting having missed drops in the last 2 weeks. These were difficulty applying drops (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.02-5.44; P < 0.05), a past or current diagnosis of depression (OR, 3.61; 95% CI, 1.53-8.52; P < 0.01), patient self-rating of own memory ≤ 7 of 10 (OR, 3.15; 95% CI, 1.36-7.30; P < 0.01), and self-reported motivation score ≤ 6 of 10 (OR, 10.94; 95% CI, 3.00-39.81; P < 0.01). Patient understanding of glaucoma, ethnicity, and socioeconomic status were among the 25 factors found not to have a statistically significant correlation with adherence. CONCLUSIONS: There is a significant proportion of patients taking their topical glaucoma medications less often than prescribed. Adherence to topical glaucoma therapies is negatively correlated to several factors: difficulty applying drops, a past or current diagnosis of depression, poor self-rating of own memory, and poor self-rating of own motivation. These may prove useful in designing interventions to improve adherence in these patients.


Asunto(s)
Antihipertensivos/administración & dosificación , Glaucoma/tratamiento farmacológico , Presión Intraocular/fisiología , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Estudios Transversales , Monitoreo de Drogas , Femenino , Glaucoma/epidemiología , Glaucoma/fisiopatología , Humanos , Presión Intraocular/efectos de los fármacos , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas/administración & dosificación , Proyectos Piloto , Estudios Prospectivos , Encuestas y Cuestionarios
14.
Clin Exp Ophthalmol ; 46(9): 984-993, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29927020

RESUMEN

IMPORTANCE: Worldwide, ophthalmology teaching is being reduced or eliminated from medical school curricula. The current state of ophthalmic teaching in Australia is unknown. BACKGROUND: To evaluate the perceptions of junior medical officers (JMOs) and medical students on ophthalmology teaching in Australian medical schools. DESIGN: Survey-based cross-sectional study. PARTICIPANTS: A total of 838 JMOs and medical students from across Australia. METHODS: Fifty-six hospitals and 20 medical schools across Australia were contacted. Hardcopy and online surveys were distributed to participants at consenting institutions, evaluating the characteristics of ophthalmology teaching received during medical school and participant confidence in basic ophthalmological clinical skills and knowledge. Factor analysis was performed on confidence scores. MAIN OUTCOME MEASURES: Likert scale confidence ratings, teaching methods encountered versus preferred. RESULTS: Four hundred and thirty-two (51.6%) surveys were received from JMOs and 406 (48.4%) from medical students. The most common form of teaching received were lectures (71.3% JMOs, 65.5% medical students), while the most preferred type were hospital tutorials (37.7% JMOs, 61.6% medical students). Mean confidence in ophthalmology-specific skills and knowledge topics were not high for medical students (skills: 2.66/5, 95% confidence interval [CI] = 2.55-2.76; knowledge: 2.88/5, 95% CI = 2.80-2.96) and JMOs (skills: 2.52/5, 95% CI = 2.43-2.60; knowledge: 2.84/5, 95% CI = 2.77-2.91). Many participants voiced the need for more ophthalmology teaching, particularly clinically oriented opportunities. CONCLUSIONS AND RELEVANCE: JMOs and medical students do not show high levels of confidence in basic ophthalmological clinical skills and knowledge, and report inadequate emphasis on ophthalmology during medical school.


Asunto(s)
Competencia Clínica , Educación de Pregrado en Medicina/métodos , Cuerpo Médico de Hospitales/psicología , Oftalmología/educación , Estudiantes de Medicina/psicología , Enseñanza/normas , Estudios Transversales , Femenino , Humanos , Masculino
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