A Review on the Use of the Educational Value Unit (EVU) among Teaching Hospitals.

(1) Background: In recent years, medical institutions across the U.S. have implemented a points system based on the Educational Value Unit (EVU) to assess and reward faculty for their educational efforts. The purpose of this narrative review is to summarize the current literature on EVU systems and to evaluate their utility in the U.S. healthcare system. (2) Methods: We searched the Ovid MEDLINE, Embase, Web of Science, and PubMed databases to identify literature describing the inception of EVU systems and current systems implemented by U.S. academic medical centers and medical schools. In total, a combined 48 studies and abstracts pertaining to EVU systems were reviewed, and a combined 26 published studies and abstracts from 1999 to 2022 pertaining to EVU systems were included. (3) Results: To our knowledge, at least 40 U.S. academic medical centers have used an educational metrics system, of which 21 institutions have published studies describing EVU systems in one or more of their medical departments. The outcomes associated with these self-described EVU systems are the focus of this study. EVU systems increase the number of faculty who meet baseline educational requirements, promote educational productivity, redistribute educational burden and funding among faculty members, and shift physician priorities towards education. The monetary reward associated with EVU systems is unlikely to be a significant factor contributing to these changes; instead, intrinsic motivation and a sense of academic responsibility play a larger role. (4) Conclusions: EVU systems are an effective way to evaluate and reward individual and departmental educational efforts in U.S. academic medical centers and medical schools. The adoption of EVUs will likely become more commonplace as U.S. academic medical centers and medical schools place additional emphasis on medical education.

Bilateral posterior capsule rupture and anterior vitreous prolapse from vigorous eye rubbing.

PURPOSE: We present the case of a 71-year-old male who developed decreased visual acuity eleven years after uncomplicated bilateral cataract extraction and in-the-bag IOL implantation following recent bouts of vigorous eye rubbing. OBSERVATIONS: On examination, the posterior capsules were ruptured centrally in both eyes, and there was anterior vitreous prolapse bilaterally. While both IOLs remained in the visual axis, there was mild bilateral decentration and resultant decreased vision. CONCLUSION AND IMPORTANCE: To the authors' knowledge, this is the first reported case of bilateral simultaneous posterior capsule rupture with anterior vitreous prolapse due to eye rubbing. Contrasting to previous case reports, this scenario demonstrates that severe eye rubbing can have variable severity and complications. Frequent and vigorous eye rubbing can be a precipitating cause of late postoperative posterior capsule rupture and should be avoided in pseudophakic patients, especially those with older IOL models.

Ophthalmic Virtual Visit Utilization and Patient Satisfaction During the COVID-19 Pandemic.

Background:Due to the COVID-19 pandemic, there was a surge in synchronous ophthalmic telehealth visits. The purpose of this study is to analyze the utilization and patient satisfaction of synchronous ophthalmic video visits over the course of the COVID-19 pandemic.Methods:In this retrospective, single-center cross-sectional study, 1,756 patients seen through synchronous video visits between March 1, 2020, and March 31, 2021, were identified using billing codes. E-mails containing a validated, 11-item, telehealth satisfaction scale were sent to patients who had at least one video visit within the study period. Questions were scored on a 1-4 scale, corresponding to poor, fair, good, and excellent. Main outcome measures included patient satisfaction scores, frequency of repeat video visits, and primary visit diagnoses.Results:The top 3 subspecialties by virtual visit volume were oculoplastic surgery (999 visits, 42.9%), neuro-ophthalmology (331 visits, 17.0%), and cornea (254 visits, 14.2%). The top 3 diagnoses seen were chalazion/hordeolum, dry eye, and meibomian gland dysfunction. The overall survey response rate was 14.3% (252 participants). The mean patient satisfaction score was 3.67 ± 0.63, with no significant difference in scores between specialties. A total of 380 (21%) patients had repeat virtual visits. Mean survey response scores were significantly higher for patients with repeat visits than those without (3.82 ± 0.42 vs. 3.62 ± 0.68, p = 0.03). Patients undergoing oculoplastic services were more likely to have repeat visits (odds ratio 2.58, 95% confidence interval 2.18-3.06, p < 0.001). Multivariate regression analysis found that provider thoroughness/skillfulness was the most predictive feature of the patient returning to a telehealth encounter (p = 0.01).Conclusions:Our study suggests that synchronous videoconferencing for ophthalmology is a highly satisfactory delivery method and will likely find continued success in select subspecialties as the pandemic fades.

Evaluation of the aerosol generating potential of endoscopic dacryocystorhinostomy.

PURPOSE: The COVID-19 pandemic gave rise to renewed concerns of the transmission risks posed by surgeries on sites of high viral colonization such as the nasopharynx. Endoscopic dacryocystorhinostomy (DCR) involves the creation of a new tear duct from the lacrimal sac to the nasal cavity. The purpose of this project is to determine if endoscopic DCR is an aerosol generating procedure (AGP). METHODS: An optical particle sizer (OPS) was used to intraoperatively quantify aerosol concentrations during four cases of endoscopic DCR. The OPS sampled the air once every 60 seconds throughout the operations. The time of important operative steps were documented and correlated with OPS readings. Particle concentrations during each major surgical step were compared to baseline readings by the Mann Whitney U Test. RESULTS: There were statistically significant increases in median particle concentrations during laryngeal mask airway intubations for both particles 0.3 to 5.0 µm and >5.0 µm (P < .001 and P = .023, respectively). Median particle concentrations during nasolacrimal duct probing, middle meatal debridement, drilling, balloon insertion, tube insertion, and Posisef insertion were not statistically different from baseline. CONCLUSIONS: Endoscopic DCR in itself does not appear to be an AGP. It is, however, associated with other aerosol generating events such as laryngeal mask intubation, and thus requires appropriate personal protective equipment. Cautious interpretation of the results is encouraged given the limitations of OPS. LEVEL OF EVIDENCE: 4.

The Effect of a Points System on Incentivizing Academic Behaviors of Attending Ophthalmologists.

(1) Background: Little is known regarding the best ways to promote academic throughput within the ranks of attending ophthalmology physicians. The purpose of this project is to evaluate the effect of a monetized points system on incentivizing research output and other academic activity in academic ophthalmology attendings. (2) Methods: This is a retrospective study of 15 academic ophthalmology attendings at a single academic teaching hospital from 1 July 2015 to 30 June 2020. A points system was implemented in the 2017 academic year (1 July 2016-30 June 2017), in which ophthalmology attendings accrued points for eight categories of academic achievement. We compared the overall number of publications, number of first/senior author publications, and corresponding impact factors of journals via the PubMed database in the two years of data before and after the points system was implemented. We analyzed points awarded for eight categories of academic achievement in the first, second, and third year of the program. (3) Results: There was no significant change in research productivity for attending ophthalmologists after institution of the points system. From 2017 to 2019, Mann-Whitney analysis revealed a significant increase in points awarded for mentorship per physician (p = 0.013). (4) Conclusions: Our data suggest that within the framework of the points system, attendings-rather than prioritizing publications-gravitated towards mentorship activities to accrue points.

Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement.

OBJECTIVE: To evaluate outcomes of cervical disc replacement (CDR) in patients with nonlordotic alignment. METHODS: Patients who underwent CDR were retrospectively reviewed and divided into 3 cohorts: (1) neutral/lordotic segmental and C2-7 Cobb angle (L), (2) nonlordotic segmental Cobb angle, lordotic C2-7 Cobb angle (NL-S), and (3) nonlordotic segmental and C2-7 Cobb angle (NL-SC). Radiographic and patient-reported outcomes (PROMs) were compared. RESULTS: One-hundred five patients were included (L: 37, NL-S: 30, NL-SC: 38). A significant gain in segmental lordosis was seen in all cohorts at < 6 months (L: -1.90° [p = 0.007]; NL-S: -5.16° [p < 0.0001]; NL-SC: -6.00° [p < 0.0001]) and ≥ 6 months (L: -2.07° [p = 0.031; NL-S: -6.04° [p < 0.0001]; NL-SC: -6.74° [p < 0.0001]), with greater lordosis generated in preoperatively nonlordotic cohorts (p < 0.0001). C2-7 lordosis improved in the preoperatively nonlordotic cohort (NL-SC: 8.04°) at follow-up of < 6 months (-4.15°, p = 0.003) and ≥ 6 months (-6.40°, p = 0.003), but not enough to create lordotic alignment (< 6 months: 3.89°; ≥ 6 months: 4.06°). All cohorts showed improvement in Neck Disability Index, visual analogue scale (VAS) neck, and VAS arm, without significant difference among groups in the amount of improvement ( ≥ 6-month PROMs follow-up = 69%). CONCLUSION: In patients without major kyphotic deformity, CDR has the potential to generate and maintain lordosis and improve PROMs in the short-term, and can be an effective treatment option for patients with nonlordotic alignment.

Patient Reported Outcomes in Patients Who Stop Following Up: Are They Doing Better or Worse Than the Patients That Come Back?

STUDY DESIGN: Follow-up study. OBJECTIVE: To determine whether minimally invasive lumbar spine surgery outcomes are different between those who are lost to follow-up and those who are not. SUMMARY OF BACKGROUND DATA: Lost to follow-up patients are a common source of selection bias for clinical outcomes research. Currently, there are no US based studies that evaluate the differences in outcomes of lost to follow-up patients after spine surgeries. METHODS: A retrospective review of prospectively collected data of 289 patients who underwent minimally invasive lumbar surgery and were at least 1 year postsurgery was performed. Patients were divided into two groups: (1) lost to follow-up (LTF), defined as patients who had missed more than two consecutive follow-up visits and had not attended their 1-year follow-up appointment; and (2) not lost to follow-up. For the not-LTF cohort, patient response outcome measures (PROMs) (oswestry disability index (ODI), visual analog scale (VAS) back/leg, Short Form-12 (SF-12) Physical/Mental, PROMIS) and return to activities data were collected prospectively at each follow-up. For LTF patients, data were collected through emailed surveys or telephone interviews. PROMs and return to activities data of the two groups were compared. Sub-group analysis by type of surgery (decompression or fusion) was also performed. RESULTS: For the entire cohort, independent t test analysis showed LTF patients had greater improvement in PROMIS Physical Function scores than those who were not-LTF (15.08 vs. 10.38, P = 0.026). For fusion surgeries, LTF patients showed a greater improvement in ODI (-30.94 vs. -16.23, P = 0.003) VAS back (-4.92 vs. -2.99, P = 0.044), and PROMIS-PF (16.09 vs. 10.38, P = 0.049). There were no significant differences in complication rates between LTF and not LTF patients. CONCLUSION: Patients undergoing minimally invasive lumbar surgery-in particular lumbar fusions-who are lost to follow-up and responded to subsequent email and phone interviews showed greater improvements in self-reported outcomes than those who continued to follow-up. Thus, our results suggest that a substantial subset of patients who are lost to follow-up do not fare worse than those who do follow-up. However, an opposite response cannot be excluded in those who did not respond to email and phone interviews. LEVEL OF EVIDENCE: 3.