The Influence of Religious Belief on Burnout in Medical Students.

OBJECTIVE: Approximately half of all U.S. medical students are experiencing burnout. A previous study has demonstrated that higher levels of spirituality are associated with less burnout in medical students, yet no studies have examined the relationship between religious affiliation and burnout in medical students. The purpose of this study is to determine if specific religious affiliation and level of religious involvement is associated with less burnout in medical students. METHODS: A cross-sectional online survey was sent to all students attending five different osteopathic and allopathic medical schools in Kansas and Missouri. It contained a validated burnout measure, an item to identify religious affiliation, and items to quantify religious involvement. RESULTS: A response rate of 11.5% (495/4,300) was obtained. An ANOVA showed religious affiliations and burnout scores did not have any statistically significant relationships (F = 0.762, P = 0.619). Additionally, identification as an active participant within a religious affiliation had a statistically significant effect on burnout scores (F = 7.793, P = 0.005). CONCLUSIONS: This is the first study within the U.S. to show that religious affiliation is not associated with medical student burnout and that medical students who consider themselves to be active participants of their religion may be at lower risk of developing burnout, regardless of the faith they practice.

Ophthalmic manifestations of tetrasomy 18p.

PURPOSE: To characterize ophthalmic findings in patients with tetrasomy 18p, a rare chromosomal anomaly that has been previously associated with strabismus. METHODS: All subjects underwent a complete eye examination to screen for ocular pathology. RESULTS: A total of 25 subjects (13 female) were examined after they were diagnosed with tetrasomy 18p. The average age of subjects was 8.2 years (range, 13 months to 22 years). Of the 25 subjects, 18 (72% of examined subjects, 42% of the cohort) showed evidence of strabismus; 16 had esotropia (8 uncategorized, 5 infantile, and 3 accommodative), 1 had esophoria, and 1 was diagnosed with intermittent exotropia. CONCLUSIONS: The coincidence of esotropia with tetrasomy 18p indicates the need to routinely screen these patients for strabismus at the time of diagnosis.

Illustrations as a patient education tool to improve recall of postoperative cataract medication regimens in the developing world.

PURPOSE: To assess the impact of medication frequency illustrations in patient education for use in the developing world. METHODS: This was a randomized controlled trial of a study population of patients undergoing cataract surgery in St/Louis du Nord, Haiti. Patients and accompanying family members were randomized prior to surgery to receive either standard oral post/operative instructions or oral instructions with detailed illustrations regarding the morning, noon, evening, and bedtime use of topical antibiotic and steroid drops. On postoperative day 1, patients and enrolled family members were questioned regarding when and how often the patient was to use his or her eye drops by a blinded examiner, and results were compiled. RESULTS: Of the 65 patients enrolled in the study 32 patients were randomized to the oral group, 33 were randomized to the illustration group. The morning recall was 76% in the illustration group and 50% in the oral group without illustrations (p = 0.0259). Bedtime recall was 67% in the illustration group and 38% in the oral group (p = 0.0139). There was a statistically significant improvement in recall for the illustration group with the morning and bedtime doses. There was a trend in favor of the illustration group on the afternoon and evening doses; however this was not statistically significant. CONCLUSION: Illustrations appear to be a useful adjunct in explaining complex medication regimens to patients in the developing world where cultural and language barriers can be difficult to bridge. This better understanding could translate into improved medication compliance and outcomes.

Tetrasomy 18p: report of the molecular and clinical findings of 43 individuals.

Thus far, the phenotype of tetrasomy 18p has been primarily delineated by published case series and reports. Findings reported in more than 25% of these cases include neonatal feeding problems, growth retardation, microcephaly, strabismus, muscle tone abnormalities, scoliosis/kyphosis, and variants on brain MRI. Developmental delays and cognitive impairment are universally present. The purpose of this study was to more fully describe tetrasomy 18p at both the genotypic and the phenotypic levels. Array CGH was performed on 43 samples from individuals with tetrasomy 18p diagnosed via routine karyotype. The medical records of 42 of these 43 individuals were reviewed. In order to gain additional phenotypic data, 31 individuals with tetrasomy 18p underwent a series of clinical evaluations at the Chromosome 18 Clinical Research Center. Results from the molecular analysis indicated that 42 of 43 samples analyzed had 4 copies of the entire p arm of chromosome 18; one individual was also trisomic for a section of proximal 18q. The results of the medical records review and clinical evaluations expand the phenotypic description of tetrasomy 18p to include neonatal jaundice and respiratory distress; recurrent otitis media; hearing loss; seizures; refractive errors; constipation and gastroesophageal reflux; cryptorchidism; heart defects; and foot anomalies. Additional findings identified in a small number of individuals include hernias, myelomeningocele, kidney defects, short stature, and failure to respond to growth hormone stimulation testing. Additionally, a profile of dysmorphic features is described. Lastly, a series of clinical evaluations to be considered for individuals with tetrasomy 18p is suggested.

The role of high-resolution computed tomography and magnetic resonance imaging in the evaluation of isolated orbital neurofibromas.

PURPOSE: To analyze the imaging findings in patients diagnosed with isolated orbital neurofibromas. DESIGN: Retrospective observational case series. METHODS: Computed tomographic (CT) and magnetic resonance imaging (MRI) findings were reviewed in five patients with orbital neurofibromas in the absence of systemic neurofibromatosis in this multicenter study. The main outcome measures were bony and soft tissue abnormalities involving the orbit and surrounding anatomic spaces. RESULTS: Patient age ranged from 36 to 43 years (mean, 41 years); three patients were men and two were women. Duration of symptoms ranged from three to 20 years. Radiologic findings included intraconal and extraconal soft tissue masses in all patients, bony orbital abnormalities in three patients, and intracranial extension in two patients. In addition, MRI studies in one patient revealed the previously unreported presence of neurofibromas involving extraocular muscle. CONCLUSIONS: Isolated orbital neurofibromas may present with differing radiologic appearances. The combined use of high-resolution CT and MRI may be of benefit in the preoperative diagnosis of these uncommon orbital tumors.

Prevalence of floppy eyelid syndrome in obstructive sleep apnea-hypopnea syndrome.

OBJECTIVES: To determine the prevalence of floppy eyelid syndrome (FES) in obstructive sleep apnea-hypopnea syndrome (OSAHS) and to develop a method to measure eyelid laxity. DESIGN: Masked cross-sectional (prevalence) study examining patients referred to the Mayo Sleep Disorders Center. PARTICIPANTS AND/OR CONTROLS: Fifty-nine subjects were examined before undergoing polysomnography. Forty-four subjects had OSAHS, and 15 did not have it. TESTING: Subjects underwent slit-lamp examination and eyelid laxity measurements, followed by polysomnography. MAIN OUTCOME MEASURES: Presence of FES as defined by subjectively easy eyelid eversion, tarsal papillary conjunctivitis, and lash ptosis; force required to displace the upper lid 5 mm, as measured by a strain gauge device; number of apnea or hypopnea episodes per hour (apnea-hypopnea index [AHI]); presence of OSAHS, as defined by an AHI of > or =5; and abnormalities on electrocardiography. RESULTS: One patient with OSAHS was found to have FES, yielding a prevalence of 2.3% (95% confidence interval [CI]: 0.1%-12.0%). One patient was referred to the Sleep Disorders Center due to a diagnosis of FES; if this patient were included, the prevalence would be 4.5% (95% CI: 0.5%-15.1%). Subjectively easy lid eversion was more common in OSAHS patients than in non-OSAHS patients. When adjusted for age and body mass index, there was a trend for association between subjectively easy lid eversion and OSAHS, but this did not reach statistical significance. Subjectively easy lid eversion was associated with AHI. Force required to displace the upper lid 5 mm was lower in lids with subjectively easy eversion, but was not associated with OSAHS or AHI. Intraclass correlation among 3 strain gauge measurements was good for both right (82%) and left (83%) lids. There were no statistically significant differences in frequency of electrocardiographic abnormalities among the various groups. CONCLUSIONS: The prevalence of FES among OSAHS patients is low. Patients with subjectively easy upper lid eversion are at risk for OSAHS. By recognizing the potential for OSAHS in these patients, the ophthalmologist may play an important role in initiating their evaluation and treatment.

Combined endoscopic medial and inferior orbital decompression with transcutaneous lateral orbital decompression in Graves' orbitopathy.

PURPOSE: To determine the clinical efficacy and morbidity of combined endoscopic transnasal medial and inferior wall orbital decompression performed in conjunction with transcutaneous lateral orbital decompression. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirty-four subjects (64 orbits) underwent combined orbital decompression procedures for treatment of Graves' orbitopathy. INTERVENTION: Transnasal endoscopic medial wall and floor with simultaneous transcutaneous lateral orbital decompression. MAIN OUTCOME MEASUREMENTS: Ocular motility, visual acuity, and exophthalmometry. RESULTS: No new ocular motility disturbances occurred. There was a mean gain of 0.7 Snellen lines in acuity (range +9 to -10 lines). A mean proptosis reduction of 4.2 mm was observed (range 1-9 mm). CONCLUSIONS: Combined endoscopic transnasal medial and inferior orbital wall decompression done in conjunction with transcutaneous lateral orbital decompression carries a low risk of morbidity, including new onset motility disorders, and yields anatomic retropulsion of the globe that is comparable to other methods.