Topiramate is an antiepileptic drug effective for multiple types of seizure and is also used to prevent migraine attack. Several side effects have been reported, such as metabolic acidosis, nephrolithiasis, anorexia, weight reduction, drowsiness, glaucoma, hyperthermia, and cognitive dysfunction, whereas skin manifestationis were rarely reported. We report a case of a 12-year-old girl on medication of topiramate for 8 months due to focal epilepsy. She had fever, sore throat, burning sense in the vaginal area, and then flaccid bullae and erythematous patches proceeded to the whole bodyskin and mucosa including the conjunctiva, oral cavity, and genital areas. She was diagnosed with toxic epidermal necrolysis (TEN) and improved after the discontinuation of topiramate and with administration of high-dose intravenous steroid and immunoglobulin. We, herein, report a girl who developed severe side effects on the skin, TEN, due to topiramate.

PURPOSE: Mycoplasma pneumonia (MP) is a major cause of community-acquired pneumonia in children and young adults. We aimed to investigate the factors that may influence on the clinical manifestations of MP in children. METHODS: A total of 109 admitted children from October 2011 to February 2012 were prospectively enrolled with physical examination and laboratory tests (complete blood count, C-reactive protein [CRP], and particle agglutinin assay). The diagnosis of MP was made when there was an infiltration on the chest X-ray and the particle agglutination test was once over 1:640 or showed 4-fold increase in serial tests. They were grouped by age, fever duration after treatment, presence of pleural effusion and wheezing. RESULTS: Preschool children showed shorter duration of fever (P=0.001), more wheezing (P<0.001), lower segmented neutrophil (P<0.001), and lower CRP levels (P=0.004) compared to schoolchildren. Prolonged fever (>3 days) and pleural effusion were developed in children with higher CRP (P=0.018 and P=0.007). Wheezing has been developed in children with younger age (P=0.007). CONCLUSION: Younger age was a risk factor to develop wheezing in MP and prolonged fever and pleural effusion were more likely to develop in children with higher CRP.
Age Factors ; Agglutination Tests ; C-Reactive Protein ; Child* ; Child, Preschool ; Diagnosis ; Fever ; Humans ; Mycoplasma* ; Neutrophils ; Physical Examination ; Pleural Effusion ; Pneumonia ; Pneumonia, Mycoplasma* ; Prospective Studies ; Respiratory Sounds ; Risk Factors ; Thorax ; Young Adult

OBJECTIVE: The aim of our study is to describe the experience of delivery training for medical students by using a birth simulator as an educational tool during obstetrical clinical clerkship. METHODS: Study participants were 35 third year medical students of K medical school in Seoul. We have developed birth simulation courses using the robot birth simulator (S555 Noelle(TM). Maternal Neonatal Simulation System. Gaumard scientific, Coral Gables, FL.). During 4 weeks clinical clerkship, clinical teacher gave 90 minutes delivery practice session to students by one-to-one basis with birth simulator. After 4 weeks clinical experience, clinical teacher assessed students' delivery performance using birth simulator. Also students completed self-reported questionnaires to assess satisfaction with the teaching process and their perceptions of the effectiveness of simulation practice. RESULTS: Most students ranked delivery training with birth simulator as an interesting and useful way of understanding labor process and getting skills in obstetrics. And they assessed that they had more confidence to perform a vaginal delivery after the training. CONCLUSION: Simulation training with birth simulator during obstetrical clinical clerkship is an effective way to bridge the gap between the theory and the practice and augment clinical experience.
Anthozoa ; Clinical Clerkship ; Humans ; Obstetrics ; Parturition ; Surveys and Questionnaire ; Schools, Medical ; Students, Medical

The purpose of this article is to systematically review the literature that describes training and assessment that use an integrated patient simulator (IPS). We also tried to determine how to train learners with simulators, plan, and perform research on simulator-based education. Literature searches were conducted to identify articles from PubMed, EMBASE, and KMbase that were related to training and assessment that use an IPS, published from January 1999 to September 2008. Forty articles met the criteria and were analyzed. The results were as follows: Studies on IPS are the most common in graduate medical education (GME). The impact of IPS-based education is relatively greater in GME versus undergraduate medical education (UME) or continuing medical education (CME). IPS research in GME is characterized by addressing the effectiveness of clinical application, the training of procedures, and algorithms, rather than knowledge or simple skills. And research design is more elaborate in GME than UME or CME. IPS training in CME focuses mostly on specific clinical skills. Most training sessions in UME are offered to groups, but assessment is performed for a single student. Also, inter-rater reliability is checked unsatisfactorily in UME. IPS research in UME is characterized by limitations in design due to connections to the regular curriculum. According to findings above, we propose that: more detailed research design should be performed to overcome the limitations of UME research. For GME, increasing simulator-based training opportunities is desired, because its effectiveness and adaptability are relatively high.
Clinical Competence ; Computer Simulation ; Curriculum ; Education, Medical ; Education, Medical, Continuing ; Education, Medical, Graduate ; Education, Medical, Undergraduate ; Educational Measurement ; Humans ; Research Design ; Review Literature as Topic

PURPOSE: Most medical schools have held clinical skills training programs recently. Despite these educational endeavors, few studies have attempted to address the effect of clinical skills assessments on clinical performance. This study investigated whether repeated experiences with the examination improved medical students' history-taking, physical exams, and patient-physician interactions (PPIs). METHODS: The subjects of the study were 101 4th-year medical students who participated in the clinical performance examination (CPX) 3 times. They completed their core clerkship before acquiring the first CPX scores; we tracked down the scores of three sets of CPX for 3 subdomains (history taking, physical exam, and patient-physician interaction) and investigated the changes in these scores. Additionally, we classified the research subjects into 3 groups by total CPX score-higher (upper 30%, n=30), intermediate (medium 40%, n=40), and lower (lower 30%, n=30)-and compared the curves for each group. RESULTS: Significant improvements were made on history taking and physical exam (F=130.786/237.358, p<0.01), while proficiency on the PPI declined (F=17.621, p<0.01). Additionally, scores in all levels improved continuously on history taking and physical exam, while students of the high and low levels experienced a sharp decline on the PPI (F=11.628, p<0.01). CONCLUSION: Improvement in the history-taking score reflects an accumulation of clinical knowledge and clinical exposure. Improvement on the physical exam score is affected by repeated practice on similar or identical cases and receipt of feedback. That PPI can deteriorate might be an effect of one's negative experience in a clinical clerkship.
Clinical Clerkship ; Clinical Competence ; Humans ; Research Subjects ; Schools, Medical ; Students, Medical ; Track and Field

The lung nodule is one of the pleuropulmonary menifestations in rheumatoid arthritis. We report here a case exhibiting hydropneumothorax due to a bronchoplerual fistula resulting from a ruptured rheumatoid lung nodule complicated with a aspergilloma in it. A 39 year-old man with rheumatoid arthritis was admitted because of cough for one month. Multiple subcutaneous nodules were noted and multiple lung nodules were seen on chest X-ray, Peripheral white cells were 9,600/mm3 with 1896 of eosinophils. The percutaneous needle aspiration biopsy of the largest lung nodule of right upper lobe showed massive necrosis without acid fast bacillus, fungus, or malignant cell. Three months after discharge, air-meniscus sign was seen on the biopsied lung nodule on X-ray. Five months later, the patient was readmitted due to dyspnea and chest pain and simple chest X-ray showed hydropneumothorax on the right side. The pneumothorax was not healed after closed thoracotomy and tube drainage, and high fever developed. The pleural fluid culture revealed Pseudomonas aeroginosa and Aspergillus fumigatus. Seventy days after admission, exploratory thoracotomy was done. Aspergilloma was found in the cavitated lung nodule which was ruptured into the pleural cavity through bronchopleural fistula.
Adult ; Arthritis, Rheumatoid* ; Aspergillus fumigatus ; Bacillus ; Biopsy, Needle ; Chest Pain ; Cough ; Drainage ; Dyspnea ; Eosinophilia* ; Eosinophils ; Fever ; Fistula* ; Fungi ; Humans ; Hydropneumothorax ; Lung* ; Necrosis ; Needles ; Pleural Cavity ; Pneumothorax ; Pseudomonas ; Thoracotomy ; Thorax

PURPOSE: Although standardized patients (SPs) have been used widely in medical education, there has been little research on SP trainers. The purpose of this study was to examine the roles SP trainers by establishing their job description and assessing the importance, frequency, and difficulty of each task element. METHODS: SP trainers' responsibilities were defined and their job descriptions were developed based on a focus group interview (FGI) of 6 panels. The validity of the duties, tasks, and task elements that were elicited from the FGI was examined by the 6 panels and a medical school professor. The data were collected using a questionnaire survey from 24 SP trainers in April 2011. The questionnaire pertained to the importance, frequency, and difficulty of the duties, tasks, and task elements that were identified in SP trainers' job descriptions. RESULTS: The job description of SP trainers consisted of 10 duties, 25 tasks, and 76 task elements. The average level of importance of the 10 duties was 4.29; "SP training" was identified as the most important duty (4.79+/-0.41). Of the 76 task elements, "providing training regarding the scoring criteria and standardizing the scoring system" had the highest levels of importance and frequency (4.83+/-0.48, 4.08+/-1.06). "Standardizing the acting abilities of SPs" was the most difficult task element (4.50+/-0.66). CONCLUSION: By analyzing the job description of SP trainers, this study is expected to help define the roles of SP trainers and facilitate their deployment.
Education, Medical ; Focus Groups ; Humans ; Job Description ; Schools, Medical ; Surveys and Questionnaires

PURPOSE: In this study, we compared the effects of constructivist and traditional teaching strategies in teaching advanced cardiac life support (ACLS) skills during simulation-based training (SBT). METHODS: A randomized, pre- and post-test control group study was designed to examine this issue in 29 third-year emergency medical technician (EMT) students. Participants received SBT through constructivist SBT (CSBT) or traditional lecture-based SBT (TSBT) teaching strategies. We evaluated the effects of the simulation training on ACLS knowledge, and performance immediately after practice and at retention. RESULTS: The knowledge and performance of the CSBT group were higher than compared with the TSBT group (mean knowledge 33.3+/-5.03 vs. 29.5+/-5.33, p=0.36; and mean performance 12.20+/-1.85 vs. 8.85+/-3.54, p=0.010). However, there was no difference between two groups in retention between groups 1 month later (mean knowledge 31.86+/-4.45 vs. 31.50+/-4.65, p=0.825; and mean performance 12.13+/-0.99 vs. 12.57+/-1.78, p=0.283). CONCLUSION: CSBT is more effective with regard to knowledge acquisition and performance than TSBT. Further studies are needed to explore ways of improving retention and transfer of knowledge from simulated to real situations with SBT.
Advanced Cardiac Life Support ; Emergency Medical Technicians ; Humans ; Retention (Psychology)

OBJECTIVE: To determine the prevalence and phases of dysphagia in inflammatory myositis. METHOD: We surveyed 106 patients diagnosed with inflammatory myositis by rheumatologist. After applying exclusion criteria, 64 patients were studied. We performed chart review and questionnaire survey for current feeding status, underlying diseases, the prevalence and phases of dysphagia. Questionnaire was composed of 11 different questions, 7 for the evaluation of oral phase and 4 for pharyngeal phase. RESULTS: There were 25 males and 39 females, and the average age was 45.1+/-15.9 years. The average age when diagnosed was 41.4+/-14.8 years. The proportion of dysphagia at onset was 50%; 34.4% in oral phase and 43.8% in pharyngeal phase. There was no significant difference between dermatomyositis and polymyositis regarding the proportion. The most common cause of dysphagia in oral phase was dry mouth (28.1%), and the second common causes were opening of mouth (12.5%), chewing (12.5%), and residual material in mouth (12.5%). The most common cause in pharyngeal phase was pharyngeal muscle weakness (35.9%), and the second common cause was choking sign indicating aspiration (29.7%). CONCLUSION: With the high proportion of dysphagia in inflammatory myositis, we should pay more attention to dysphagia, because we need to do swallowing training in these patients.
Airway Obstruction ; Deglutition ; Deglutition Disorders* ; Dermatomyositis ; Epidemiology ; Female ; Humans ; Male ; Mastication ; Mouth ; Myositis* ; Pharyngeal Muscles ; Polymyositis ; Prevalence ; Surveys and Questionnaires

Field efficacy of enterotoxigenic Escherichia coli-specific phage (PhiCJ19) as a feed additive was evaluated in weaning piglets. Fifty-four piglets at 3~4 weeks old were allocated in three different groups and two of them were fed with bacteriophage at different concentrations (10(6) PFU/kg feed and 10(8) PFU/kg feed, respectively) for 30 days. Body weight and feed intake were measured at 10 days interval and body condition and fecal score were inspected every day. Based on the measurement, feed conversion rate (FCR) and average daily gain (ADG) of each group during 30 days were analyzed. The analysis suggests that the bacteriophage may help the improvement of FCR and ADG at 10(8) PFU/kg of bacteriophage feeding group in 30 days. A result from analysis of fecal score indicates that the bacteriophage also may help to relieve the intermittent diarrhea in post-weaning stage. Those results suggest that bacteriophage might help the growth of piglets in post-weaning stage.
Bacteriophages ; Body Weight ; Diarrhea ; Enterotoxigenic Escherichia coli ; Escherichia ; Weaning