Effect of a Template Case Report Based on Cognitive Task Analysis on Emergency Thinking Ability of Resident Doctors in Standardized Training.

OBJECTIVE: To explore the effect of a template case report based on cognitive task analysis on the emergency thinking ability of resident doctors in standardized training. METHODS: The doctors were split into two groups, according to the date they joined the emergency department (n = 40, each group): the observation and control groups. In the observation group, the resident doctors' teachers in standardized training adopted the cognitive task analysis method to determine the primary links of emergency thinking, made case templates, and carried out training based on the case template report. In the control group, traditional teaching methods were used by the teachers. RESULTS: In the observation and control groups, the scores at departure were 88.10 ± 3.88 and 75.23 ± 7.19, respectively (P < 0.05), and the student's ability improvement rates were 92.5% and 75.0% (P < 0.01). In addition, the awareness rate of "know how to study" and "know how to work in emergency" in the observation group was 90% and 90%, respectively. The rate of doctors that considered "missed diagnosis and misdiagnosis can be reduced" was 85%, and the rate of doctors that considered "help to learn in other departments in the future" was 80%. CONCLUSION: Template case reports based on the cognitive task analysis for emergency thinking training can help resident doctors in standardized training improve their emergency thinking ability.

One-year outcomes of intravitreal conbercept combined rescue therapy for polypoidal choroidal vasculopathy in a Chinese population: a real-life clinical data.

AIM: To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy (PCV). METHODS: This was an open label, single center, and interventional study. All enrolled patients were treated initially with three consecutive monthly intravitreal conbercept injections (0.5 mg). Additional conbercept injections were administered upon substantial polyp regression with improved visual acuity (VA). Eyes with partial or no polyp regression and poor VA were rescue treated with photodynamic therapy (PDT) for subfoveal polyps or thermal laser photocoagulation for extrafoveal polyps. Best-corrected visual acuity (BCVA), central foveal thickness (CFT) and polyp regression were observed as primary outcomes. Side effects were also collected during the follow-up period. RESULTS: A total of 56 eyes (56 patients) with PCV were included. BCVA increased significantly from the baseline of 43.52±24.21 letters to 55.88±21.94 letters (P<0.001) at 12mo, while CFT decreased significantly from 457.41±207.86 µm to 247.98±127.08 µm (P<0.001). All patients showed polyp regression. Twenty-three eyes achieved complete polyp regression after the three initial injections, which increased to 44 eyes at 12mo. Seventeen eyes underwent rescue therapy, among which 2 eyes treated with PDT and 15 eyes treated with laser photocoagulation. A mean of 4.30±1.43 injections were given per eye. No intraocular inflammation, retinal or vitreous hemorrhage, or systemic complication occurred. CONCLUSION: Conbercept is an effective and safe option for the treatment of PCV in Chinese population. The treatment regimen of three initial conbercept injections followed by additional injections or rescue therapies is efficacious for treating PCV.

Efficacy and safety of ranibizumab for wet age-related macular degeneration in Chinese patients.

AIM: To evaluate the clinical efficacy and safety of ranibizumab for wet age-related macular degeneration (wAMD) in Chinese patients and to determine the mean number of injections administered over one year of follow-up. METHODS: This single centre, retrospective observational case series study included data from 121 patients with wAMD (121 eyes) who were diagnosed by indirect ophthalmoscopy, fluorescence fundus angiography (FFA), indocyanine green angiography, and optical coherence tomography. Ranibizumab was injected into the vitreous cavities once per month for 3mo and as needed afterwards. Changes in visual acuity and central foveal thickness (CFT) during the follow-up period were compared, and the mean number of injections over the year was calculated. Patients with one or more adverse events related to the drugs and injections were recorded for further adverse events analysis. RESULTS: The study population included 70 males and 51 females aged between 50 and 87y (mean: 71.32±9.41y). The mean number of injections over the first year was 5±1 (range: 3-9). The mean best-corrected visual acuity by Early Treatment Diabetic Retinopathy Study increased from 43.2±19.3 (95%CI: 39.8-46.7) at baseline to 51.7±20.1 (95%CI: 48.1-55.3), and central foveal thickness (CFT) decreased from 526.5±277.0 µm (95%CI: 476.6-576.4) to 258.2±161.6 µm (95%CI: 229.2-287.3) at 12mo. The differences were statistically significant (P<0.001). Visual acuity significantly improved in 34.1% of the patients (38 eyes), stabilized in 66.1% of the patients (80 eyes), and significantly decreased in 2.5% of the patients (3 eyes). CFT at baseline was an independent risk factor of decreased CFT and increased visual acuity. None of the patients had severe adverse events during the follow-up period. CONCLUSION: Ranibizumab can effectively control disease progression and improve visual acuity in patients with wAMD. The disease conditions of most patients stabilized after a one-year treatment with an average of 5 injections.

Outcome of intravitreal bevacizumab for idiopathic choroidal neovascularization in the Chinese population.

OBJECTIVE: To assess the long-term visual and anatomical outcomes and safety of intravitreal injection of bevacizumab for idiopathic choroidal neovascularization (ICNV) in Chinese patients. DESIGN: Retrospective interventional case series. PARTICIPANTS: Seventy-seven eyes of 77 patients with ICNV. METHODS: Patients were given intravitreal injection of bevacizumab (1.25 mg/0.05 mL) for ICNV between March 2006 and May 2008. Main outcome measures were changes in best-corrected visual acuity (BCVA), central foveal thickness, which was measured by optical coherence tomography, and fluorescein angiography findings. RESULTS: Mean follow-up was 14.3 (SD 2.4, range 10-20) months. Mean BCVA improved from 0.66 (SD 0.36) logMAR at baseline to 0.25 (SD 0.28) logMAR at final follow-up (p < 0.001). Sixty-one patients (79%) gained BCVA of > or = 2 Snellen lines, and 1 eye (1%) lost BCVA of > or = 2 Snellen lines. Mean central foveal thickness decreased from 365 (SD 124) microm at baseline to 211 (SD 94) microm at final visit (p < 0.001). Sixty-two eyes (81%) needed reinjection. Both BCVA improvement and the change in central foveal thickness between the 1- time injection group and the multi-injections group were not statistically significant (p = 0.45 and p = 0.19, respectively). No significant ocular or systemic adverse effects were observed. CONCLUSIONS: The long-term results suggest an encouraging efficacy and safety of intravitreal bevacizumab for ICNV in Chinese patients.

Association of c3 gene polymorphisms with neovascular age-related macular degeneration in a chinese population.

PURPOSE: The purpose of this study was to determine whether the genetic polymorphisms of complement factor 3 (C3) are associated with neovascular age-related macular degeneration (AMD) in the Chinese population. METHODS: A total of 123 unrelated Chinese Han patients with neovascular AMD and 130 control subjects were recruited. Their six single-nucleotide polymorphisms (SNPs) in the C3 gene, one in the complement factor H (CFH) gene and two in the complement factor B (CFB) gene were characterized. Their genotypes, allele frequencies, and odds ratios were analyzed. RESULTS: The G allele of the C3 IVS2 rs2250656, but not other tested C3 SNPs of rs2230205, rs10411506, rs2230199, rs339392, and rs163913, was significantly associated with a reduced risk for AMD in the Chinese population (OR 0.605, 95% CI 0.39-0.93, p = 0.023), even after adjusting for age, gender, smoking status, CFH rs1061170, CFB rs4151667, and CFB rs641153 allele status (OR 0.58, 95% CI 0.35-0.96, p = 0.033). However, the C3 haplotype of A-A-C-A-T-T was identified as a statistically significant risk factor for neovascular AMD (OR 1.41, 95% CI 1.02-1.94). Furthermore, the C allele of the CFH rs1061170, but not the CFB rs4151667 and rs641153, was significnatly associated with increased risk for AMD (OR 3.09, 95% CI 1.55-6.15, p < 0.001). CONCLUSION: The G allele of C3 IVS2 rs2250656 may be a significantly protective factor for neovascular AMD in the Chinese population. This, together with low MAF of C3 R102G, may be partially responsible for the low prevalence of AMD in the Chinese population.