RESUMO
PURPOSE: To assess the accuracy and performance of the Butterfly IQ+ handheld ultrasound (HHUS) in detecting retinal detachments (RDs). METHODS: A cross-sectional observational study of eyes with (n = 20) and without (n = 20) RD imaged using a conventional B-scan ophthalmic ultrasound device Ellex Eye Cubed by Clarion Medical Technologies (Cambridge, ON, CA) and a portable HHUS (Butterfly IQ+). Images were compared between the modalities for qualitative differences. Agreement between the HHUS and standard ultrasonography equipment and with clinical examination was quantified using Cohen's kappa coefficient. RESULTS: Forty eyes of 33 patients were included in the study. Twenty eyes of 18 patients had RDs, and 20 eyes of 18 patients did not. The observed agreement in RD diagnosis between the Butterfly and the Ellex Eye Cubed was 97.5%., and the Cohen's Kappa was 0.950 (95% CI: 0.85-1.00). The observed agreement in RD diagnosis between the Butterfly IQ+ and diagnosis confirmed by the gold standard of clinical exam was 92.5%, and Cohen's Kappa was 0.850 (95% CI: 0.69-1.00). The sensitivity and specificity of the Butterfly ultrasound in RD diagnosis were 90% (95% CI: 68.3-98.8%) and 95% (95% CI: 83.2-100), respectively. CONCLUSION: There was a high degree of agreement between the systems for the identification of RD. The Butterfly IQ's extreme portability and ease of use make it a viable option to screen for RDs in hospital-based consults, emergency departments, or low-resource settings.
RESUMO
PURPOSE: To quantify the resident learning curve for cataract surgery using operative time as an indicator of surgical competency, to identify the case threshold at which marginal additional educational benefit became equivocal, and to characterize heterogeneity in residents' pathways to surgical competency. SETTING: Academic medical center. DESIGN: Large-scale retrospective consecutive case series. METHODS: All cataract surgery cases performed by resident physicians as primary surgeon at Massachusetts Eye and Ear from July 1, 2010, through June 30, 2015, were reviewed. Data were abstracted from Accreditation Council for Graduate Medical Education case logs and operative time measurements. A linear mixed-methods analysis was conducted to model changes in residents' cataract surgery operative times as a function of sequential case number, with resident identity included as a random effect in the model to normalize between-resident variability. RESULTS: A total of 2096 cases were analyzed. A marked progressive decrease in operative time was noted for resident cases 1 to 39 (mean change -0.17 minutes per additional case, 95% CI, -0.21 to -0.12; P < .001). A modest, steady reduction in operative time was subsequently noted for case numbers 40 to 149 (mean change -0.05 minutes per additional case, 95% CI, -0.07 to -0.04; P < .001). No statistically significant improvement was found in operative times beyond the 150th case. CONCLUSIONS: Residents derived educational benefit from performing a greater number of cataract procedures than current minimum requirements. However, cases far in excess of this threshold might have diminishing educational return in residency. Educational resources currently used for these cases might be more appropriately devoted to other training priorities.