การใช้สมุดบันทึกการปฏิบัติงานทางคลินิกเพื่อประเมินการเรียนรู้ทางสูติศาสตร์นรีเวชวิทยา ( Assessment of student’s clinical skill in Obstetrics and Gynecology: logbook versus Objective Structure Clinical Examination.)

     While the training of clinical skills is a requirement for medical study, it is necessary to evaluate whether a student receives enough learning experience. Besides a standard test, the objective structure clinical examination (OSCE), another way to assess the clinical experience of student is the evaluation of the number of patients whom the medical student has take care, which is recorded in a logbook. In this study, the Department of Obstetrics and Gynecology , Faculty of Medicine, Srinakharinwirot University aimed to examine the relationship between the number of studied cases as shown in the student’s logbook and the score that the student got from OSCE. The data of number of patients were collected from 106 logbooks of 4th year medical students that were handed in the department after the 8-week training session in 2008. It was shown that the average number of cases of low risk pregnancy and high risk pregnancy that were taken care per a student were 9.0±3.4 and 5.7±3.7, respectively. The average number of labor cases that were attended by a student was 10.4±3.0. The average number of operative obstetric cases that were attended by a student was 16.7±4.3. The average number of obstetric cases that were attended by a student in obstetric operative room was 5.9±2.3. The average number of obstetric inpatient cases that were taken care per a student was 8.9±2.7. The average number of gynecologic outpatient cases that were taken care per a student was 11.8±11.5. The average number of obstetric cases that were attended by a student in gynecologic operative room was 5.5±2.4. The average number of gynecologic inpatient cases that were taken care per a student was 5.8±1.9. The average number of frequency of evening on-duty was 8.5±0.9. These data revealed that the students should practice the clinical skills from enough number of patients. However, the average score of total students from OSCE was only 53.4±9.7 percent. The statistical tests also showed that there was no relation between the numbers of studies cases and the scores taken by OSCE. Therefore, the criteria for checking the student’s logbook should be evaluated and adjusted for better assessment of clinical training in the department.

Low cost combination of DCIP and MCV was better than that of DCIP and OF in the screening for hemoglobin E.

OBJECTIVE: To evaluate hemoglobin E screening tests in a large scale of cases. MATERIAL AND METHOD: A cross-sectional descriptive study was conducted Whole blood obtained from subjects was evaluated for CBC, OF, DCIP, and hemoglobin typing. RESULTS: Five hundred twenty seven hemoglobin E and 280 reference subjects participated. DCIP's sensitivity, specificity, positive predictive value, and negative predictive value were 97.16%, 98.93%, 99.42%, and 95.19%, respectively. These values of OF were 69.12%, 80.00%, 86.67%, and 57.88%, respectively. In the combination of DCIP and OF gave rise to these values of 99.43%, 79.29%, 90.03%, and 96.67%, respectively. Finally the combination of DCIP and MCV < 80 fL resulted in these values to be 99.43%, 98.93%, 99.43%, and 98.93%, respectively. False positive and false negative rate were 1.07% and 0.57%, respectively. CONCLUSION: Combination of DCIP and MCVwas better than that of DCIP and OF in hemoglobin E screening.

Correlation of uterine cervical length measurement from transabdominal, transperineal and transvaginal ultrasonography.

OBJECTIVE: To investigate the feasibility of transperineal ultrasonography for uterine cervical assessment by determining the correlation of uterine cervical length measurement from transabdominal, transperineal and transvaginal ultrasonography and comparing discomfort arising from each technique. MATERIAL AND METHOD: Fifty pregnant women of 37 weeks' gestation or later who gave consent participated in this research. They had no exclusion criteria, which were listed as the following: preterm premature rupture of membranes, previous cervical surgery, undiagnosed vaginal bleeding, and true labor pain. They all underwent transabdominal (3.5-MHz curvilinear transducer), transperineal (3.5-MHz curvilinear transducer) and transvaginal ultrasonography (7.5-MHz curvilinear endovaginal transducer). The uterine cervical length was measured from the straight line between the external and internal os. If either of the external or internal os was not clearly demonstrated, the authors would justify the cervical length as non-measurable. Measurement in each technique was performed twice and the mean cervical length was used for data analysis. Discomfort arising from each technique was evaluated by visual analog scale. RESULTS: Uterine cervical length was measurable in 23 (46%), 49 (98%) and in all cases by transabdominal, transperineal and transvaginal ultrasonography respectively. In the transabdominal technique, no significant differences in woman's age, weight, body-mass index and parity were observed between measurable and non-measurable cases. Significant correlation was demonstrated between transperineal and transvaginal ultrasound (r = 0.73, p < 0.01). A significantly higher discomfort score was demonstrated in transvaginal ultrasonography, but no significant difference in discomfort score was found between transabdominal and transperineal ultrasonography. CONCLUSION: Transperineal ultrasonography is feasible for acceptable uterine cervical visualization with only slight discomfort to the patients.