Resident operative time as an independent predictor of early post-operative cataract surgery outcomes and supervising attending surgeon impact: a retrospective case series.

BACKGROUND: The authors sought to determine if resident operative time in cataract extraction and intraocular lens insertion (CE/IOL) affects early visual outcomes and post-operative recovery. They further sought to investigate if attending surgeons can reduce resident operative time. METHODS: This retrospective, chart-review, case series at single Veterans Affairs Hospital (VA Tennessee Valley Healthcare System) studied resident cataract surgeries between March 1, 2018 and March 31, 2020. Following power analysis, 420 eyes of 400 patients from all resident cataract surgeries were included. Eyes with attending as primary surgeon, laser-assisted cataract surgery, or concurrent secondary procedures were excluded. Linear mixed effect models were used to study the association between operative time and visual outcomes while adjusting for covariates including cumulative dissipated energy, preoperative factors, and intraoperative complications. RESULTS: Longer operative time was statistically associated with worse post-operative-day 1 (POD1) pinhole visual acuity (PH-VA) adjusting for cumulative dissipated energy and other operative factors (p = 0.049). Although resident physicians were the primary surgeons, the operative times were different between the ten supervising attending surgeons in the study (p < 0.001). CONCLUSION: The results suggest that increased resident operative time is a significant, independent risk factor for decreased POD1 PH-VA. Increased resident operative time is not associated with worsened long term visual outcomes. Attending surgeons may be able to reduce resident operative time, which is associated with improved early visual outcomes.

Content and Readability of US Procedure Consent Forms.

This qualitative study uses data from the American Hospital Association National Survey Database to analyze the content and readability of a sample of US procedures consent forms.

Talking with Patients about Surgical Trainees.

AbstractTraining of resident physicians is essential for the care of future patients. While surgical trainee involvement is necessary, its disclosure to patients can often be omitted or underplayed by surgeons. The informed consent process and the underlying ethical principles make evident that patients should be informed of trainee involvement. In this review we explore the importance of disclosure, current themes in practice, and the optimal discussion for which we should strive.

SARS-CoV-2 Nasopharyngeal Swab as a Foreign Body: A Case Report.

The SARS-CoV-2 pandemic response utilizes nasopharyngeal swabbing as a prolific testing method for presence of viral RNA. The depth of the swab to the nasopharynx coupled with breakpoints along the shaft leads to a risk for foreign body retention. Here, we present a case of a nasopharyngeal swab that became a retained foreign body during routine swabbing to test for the SARS-CoV-2 virus. Bedside flexible fiberoptic endoscopy was performed and did not reveal a foreign body in the nasopharynx or larynx. Subsequent computed tomography (CT) scan demonstrated the radiopaque retained foreign body at the distal gastroesophageal junction. The patient remained asymptomatic and did not have any upper airway or gastrointestinal symptoms. This unique case demonstrates a potential risk associated with SARS-CoV-2 nasopharyngeal swab testing and highlights management strategies that serve the patient while adequately protecting health care providers. A standardized approach to evaluation optimally includes bedside flexible endoscopy with appropriate personal protective equipment, prompt airway evaluation if aspiration is suspected, and noncontrasted CT imaging if the known foreign body is not identified via other modalities.

Medical phenome of musicians: an investigation of health records collected on 9803 musically active individuals.

Previous studies suggest that musicians may be at higher risk for a set of medical problems; however, this literature has been limited by relatively small sample sizes, self-reports, and lack of controls. To address such limitations, we examined trends in the medical care of musicians in an Electronic Health Record database. On the basis of a collection of keywords and regular expressions in the patients' clinical notes, we identified 9803 "musicians" that we matched for sex, median age (across the medical record), ethnicity, race, the length of record, and the number of visits with 49,015 controls. We fitted 1263 logistic regression models to determine whether the phenotype was correlated with musicianship. Two hundred fifty-seven phenotypes were more prevalent in musicians than controls after Bonferroni adjustment (P < 7.6 × 10-6 ), including diseases of the larynx and vocal cords (OR = 2.32 (95% CI: 2.25-2.40)), and hearing loss (OR = 1.36 (95% CI: 1.32-1.39)). Fifteen phenotypes were significantly more prevalent in controls than musicians, including coronary atherosclerosis (OR = 0.91 (95% CI: 0.89-0.94)). Although being a musician was related to many occupational health problems, we identified protective effects of musicianship in which certain disorders were less common in musicians than in controls, indicating that active musical engagement could have health benefits analogous to athletic engagement.