Purpose: To report a biopsy-proven case of granulomatosis with polyangiitis (GPA) who visited for red eye and discomfort. We detected papillary thyroid cancer by a whole-body scan.Case summary: A 56-year-old female presented to our clinic with hyperemia and discomfort in the right eye for the past 1 month. The visual acuity was 0.9 in the right eye. Congestion and chemosis of the right conjunctiva were observed by slit-lamp microscopy. There was a firm, erythematous, tender mass near the right nasolacrimal duct. Impairment of adduction and infraduction and proptosis were observed. Radiologically, a 3.6 × 2.6 × 1.2 cm right orbital mass was seen in the intraorbital extraconal space, invading the right nasolacrimal duct and nasal cavity. Pathologic and supplementary investigations showed granulomatous, c-anti-neutrophil cytoplasmic antibodies (ANCA)-positive inflammation in the mass. The patient was diagnosed with GPA. Whole-body computed tomography and positron emission tomography-computed tomography revealed multiple lesions in the right orbit, nasal cavity, mediastinum, retropubic area, and left thyroid gland. Thyroid ultrasonography and biopsy led to a diagnosis of papillary carcinoma with lymph node metastasis. Topical and systemic steroids and rituximab injection were administered, and total thyroidectomy with bilateral central lymph node dissection was performed. This led to improvements in proptosis and limitation of extraocular movement. Conclusions GPA is a rare disease that may initially present with ocular symptoms. It can be associated with malignancies even in the absence of immunosuppression. Patients with ocular problems suspected of having GPA should undergo autoimmune antibody testing, including ANCA and tissue biopsy.

PURPOSE: The purpose of this study was to identify the correlation of critical thinking disposition and problem solving process, and the simulation-based assessment of clinical competence based on a survey of college nursing students. METHODS: In this descriptive correlation study, data for 214 nursing students were analyzed using t-test and Pearson correlation coefficients. RESULTS: Critical thinking disposition, problem solving process, and simulation-based assessment of clinical competence averaged 3.76+/-0.46 (out of 5), 3.67+/-0.47 (5), and 1.51+/-0.17 (2), respectively. A significant difference in scores for simulation-based assessment of clinical competence was found between the high-scoring group and low-scoring group in critical thinking disposition. A significant positive correlation was found between critical thinking disposition and nursing assessment, a sub-domain of clinical competence. CONCLUSION: The results suggest that success in simulation-based learning requires critical thinking disposition in the nursing students, and their critical thinking disposition plays a positive role in nursing assessment, which evaluates the patient's status in a complex situation. Simulation-based learning programs help assess the students' levels in their clinical judgement and performance, and identify their strengths and weaknesses so that the instructor can evaluate and improve the current teaching method.
Clinical Competence* ; Humans ; Learning ; Nursing Assessment ; Pediatric Nursing* ; Problem Solving* ; Statistics as Topic ; Students, Nursing* ; Teaching ; Thinking*

Purpose: To evaluate the reliability, validity, and usability of a mobile phone app that captures facial images to identify strabismus. Methods: We enrolled patients who visited our pediatric strabismus clinic and provided consent for participation in the study. The facial photographs of the patients were automatically captured by the app. The app used the photographs to identify ocular misalignment based on the comparison of the positions of the corneal reflex and limbus of both eyes. The results from the app were compared to the physician’s diagnosis. Intraclass correlation coefficients were used to assess the test-retest and interrater reliability of the app. Additionally, the guardians captured photographs of the patients through this app for 1 month at home to evaluate the frequency of manifest exotropia at home. And the results were compared to those of other strabismus control scales. Results: A total of 103 patients were enrolled and 10 patients were enrolled for the home control test. Based on the physician’s diagnosis, the sensitivity, specificity, positive predictive value, and negative predictive value of the app were 74.6%, 87.5%, 90.4%, and 68.6%, respectively. The interclass correlation coefficients for inter-rater and test-retest reliability were 0.801 (p = 0.011) and 0.828 (p < 0.001), respectively. The frequency of intermittent exotropia recorded by the app at home showed a strong positive correlation with other control scales (rho > 0.770, p = 0.009). Conclusions This mobile phone app is easily accessible and useful for the rapid determination and recording of strabismus, particularly in uncooperative patients. Also, this app may be used as a reliable indicator of the frequency of manifest strabismus at home.

Purpose: Approximately 90% of the medical institutions in Korea are located in cities, so there is a disparity in medical resource distribution between urban and rural areas. In order to establish an equal healthcare system, it is necessary to understand the distribution and treatments offered by medical institutions and to investigate access to these facilities. In the present study, we investigated medical institutions offering ophthalmic examinations for children in Korea. Methods: The presence or absence of regional eye clinics and ophthalmologists in public health centers, public health offices, and military medical facilities were investigated in different cities and counties. In addition, the population status and ophthalmic facilities in vulnerable areas were investigated. Results: In the second quarter of 2021, there were 1,658 regional eye clinics in Korea located in Seoul, Gyeonggi, Busan, and Daegu, respectively. There were a total of 3,610 ophthalmologists in Seoul, Gyeonggi, Busan, and Daegu, respectively. Among the 250 counties, 20 did not have eye clinics while 13 did not have an ophthalmologist. The average time required to reach the closest eye examination center was 48.0 ± 38.1 minutes by car and 75.1 ± 40.0 minutes by public transportation. The total population in vulnerable areas was 558,336, including 28,358 children under the age of 10 years. Conclusions The present study identified vulnerable areas for eye examinations. Based on the findings, it is necessary to establish a healthcare system with improved accessibility, equity, and efficiency considering the importance of ophthalmic examinations in children and the elderly.

Purpose: To investigate the status of low-vision care in Korea and the needs of ophthalmologists, and to define future directions for the diagnosis and treatment of low-vision patients. Methods: Twenty survey questions exploring low-vision knowledge were emailed to members of the Korean Ophthalmological Society, and the responses were analyzed. Results: In total, 158 responses were collected from ophthalmologists working in different institutions, including 62 (45.6%) at university hospitals. Many respondents (91, 57.6%) reported knowing the criteria for low vision, but approximately half (74, 46.9%) reported that they had little or no knowledge of low vision in general. More than half of the respondents (87, 55.1%) had never written a prescription for a visual aid, and only 32 (20.2%) were able to prescribe such aids. The principal reasons for hesitation in the treatment of low-vision patients were lack of knowledge (117, 74.5%) and poor medical reimbursement (41, 26.1%). Many respondents (152, 96.2%) wanted to learn more about low vision, and approximately half (71, 45.5%; 74, 47.4%) felt that the current low-vision care environment in Korea requires improvement. Conclusions Despite the increasing need for low-vision care in South Korea, the number of ophthalmologists who can provide such care (including prescriptions for visual aids) is insufficient. Lack of education and poor medical reimbursement are important problems. Low-vision clinics must promote outreach activities, and institutions should develop programs to educate ophthalmologists.

Purpose: We report a case of regressed retinal astrocytic hamartomas (RAHs) in tuberous sclerosis complex (TSC) patients by mammalian target of rapamycin inhibitor (everolimus) treatment. Case summary: A 12-year-old girl diagnosed with TSC visited for regular checkups. The patient had undergone regular fundus examinations every year after the finding of multiple RAHs in both eyes in the initial screening at 3 months of age. There was no change in the size or thickness of the lesions until she reached 10 years of age. Two months later, the patient started systemic everolimus (5 mg, AFINITOR®, Novartis, Basel, Switzerland) treatment for 17 months under the care of a pediatric neurologist for seizure control. Subsequent fundus examination and measurements by optical coherence tomography showed improvement in the maximal thickness of all lesions, specifically, a reduction of 25%. Conclusions mTOR inhibitors are targeted agents that regress systemic hamartomas and control convulsions without serious side effects in TSC patients. The particular one used in this study, Afinitor everolimus, reduced the RAH size in our patient. Thus, in cases where an RAH affects vision due to its location, everolimus can considered as a therapeutic option.

Purpose: To evaluate the usefulness of video-oculographic waveform analysis in nystagmus patients. Methods: We carried out an observational case study in 18 patients (age, 7-32 years) with nystagmus who visited our clinic regularly for more than 1 year. Video-oculography (VOG) recording was performed (SLVNG®; SLMED, Seoul, Korea/3D Video-Oculography®; SMI, Teltow, Germany), and the velocity, peak velocity, and frequency of ocular movement were evaluated. The results of VOG analysis were compared to the diagnosis based on clinical examination and video recording. Results: Eleven patients showed corresponding results, while the results differed between presumed diagnosis by VOG waveform analysis and clinical diagnosis in seven patients. Two of the discordant group showed additional waveforms that were not found on clinical examination. In addition, the number of inverse cases was two. The VOG waveform results corresponded to the diagnosis based on video recording in 16 patients. Conclusions Video-oculography is useful for diagnosis and management of nystagmus patients as it is noninvasive, comfortable, and can be performed in patients with difficulties with electronystagmography, such as pediatric patients. In addition, its waveform analysis and quantification are reliable taking into consideration diagnosis based on clinical examination and video recording.

Purpose: We report a case of regressed retinal astrocytic hamartomas (RAHs) in tuberous sclerosis complex (TSC) patients by mammalian target of rapamycin inhibitor (everolimus) treatment. Case summary: A 12-year-old girl diagnosed with TSC visited for regular checkups. The patient had undergone regular fundus examinations every year after the finding of multiple RAHs in both eyes in the initial screening at 3 months of age. There was no change in the size or thickness of the lesions until she reached 10 years of age. Two months later, the patient started systemic everolimus (5 mg, AFINITOR®, Novartis, Basel, Switzerland) treatment for 17 months under the care of a pediatric neurologist for seizure control. Subsequent fundus examination and measurements by optical coherence tomography showed improvement in the maximal thickness of all lesions, specifically, a reduction of 25%. Conclusions mTOR inhibitors are targeted agents that regress systemic hamartomas and control convulsions without serious side effects in TSC patients. The particular one used in this study, Afinitor everolimus, reduced the RAH size in our patient. Thus, in cases where an RAH affects vision due to its location, everolimus can considered as a therapeutic option.

Purpose: To evaluate the usefulness of video-oculographic waveform analysis in nystagmus patients. Methods: We carried out an observational case study in 18 patients (age, 7-32 years) with nystagmus who visited our clinic regularly for more than 1 year. Video-oculography (VOG) recording was performed (SLVNG®; SLMED, Seoul, Korea/3D Video-Oculography®; SMI, Teltow, Germany), and the velocity, peak velocity, and frequency of ocular movement were evaluated. The results of VOG analysis were compared to the diagnosis based on clinical examination and video recording. Results: Eleven patients showed corresponding results, while the results differed between presumed diagnosis by VOG waveform analysis and clinical diagnosis in seven patients. Two of the discordant group showed additional waveforms that were not found on clinical examination. In addition, the number of inverse cases was two. The VOG waveform results corresponded to the diagnosis based on video recording in 16 patients. Conclusions Video-oculography is useful for diagnosis and management of nystagmus patients as it is noninvasive, comfortable, and can be performed in patients with difficulties with electronystagmography, such as pediatric patients. In addition, its waveform analysis and quantification are reliable taking into consideration diagnosis based on clinical examination and video recording.

BACKGROUND: We describe the characteristics of malpractice claims related to central venous catheterization and identify causes and potential preventability of such claims. METHODS: A retrospective study was performed by reviewing records at Lawnb and Lx CD-rom. The records on closed malpractice claim related to central venous catheterization were abstracted from the files available for analysis. The records were reviewed and were analysed to determine the factors associated with a successful defense. RESULTS: Twelve closed claim cases, related to central venous cathetertization were reviewed in the data for malpractice. Catheter-related complications were pneumothorax, hemothorax, cardiac tamponade, pyothorax, hematoma due to arterial puncture, pseudoaneurysm. Almost cases resulted in indemnity payment and verdict for patient. CONCLUSIONS: Although malpractice claims related to central venous catheterization were uncommon, they resulted in high rate and amount of indemnity payments. In pediatric patient, catheterization should be performed with attention. Clinicians should consider the underlying disease of patients and do any pretreatment if needed. Post-procedural radiologic confirmation can improve patient outcome and is also associated with decreased indemnity risk. Informed consent is also important.
Aneurysm, False ; Cardiac Tamponade ; Catheterization ; Catheterization, Central Venous* ; Catheters ; CD-ROM ; Central Venous Catheters* ; Empyema, Pleural ; Hematoma ; Hemothorax ; Humans ; Informed Consent ; Malpractice ; Pneumothorax ; Punctures ; Retrospective Studies