Assessment of a high-fidelity, virtual reality-based, manual small-incision cataract surgery simulator: A face and content validity study.

Purpose: To establish the face and content validity of the HelpMeSee Eye Surgery Simulator - a virtual reality-based cataract surgery simulator for manual small-incision cataract surgery (MSICS). Methods: The face and content validity were assessed on the sclero-corneal tunnel construction course. A questionnaire with 11 questions focused on the visual realism, with resemblance to real life surgery, and the training value of the simulator was developed. Thirty-five experienced MSICS surgeons participated in the study. Responses were recorded using a seven-point scoring system. Results: Overall, 74.3% (26/35) of the respondents agreed that the overall visual representation of the eye and the instruments in the simulator were realistic. The task of injecting a visco-elastic through the paracentesis was reported to be the most visually realistic task with a mean score of 5.78 (SD: 1.09; range: 2-7). With regard to content validity, 77.1% (27/35) of the subjects felt agreed that the errors and complications represented throughout the entire tunnel construction module were similar to those encountered in real life; the task of entering the anterior chamber with the keratome had a mean score of 5.54 (SD: 0.98; range 1-7), being rated the highest in that aspect. Overall, 94.3% (33/35) of the subjects agreed that the simulator would be useful in developing hand-eye co-ordination. A similar number of 94.3% (33/35) agreed that based on their experience, they would recommend cataract surgical training on this simulator. Conclusion: The results suggest that the HelpMeSee Eye Surgery Simulator appears to have sufficient face and content validity for cataract surgical training.

Effectiveness of simulation-based training for manual small incision cataract surgery among novice surgeons: a randomized controlled trial.

This study was designed to determine the effect of a novel simulation-based training curriculum for scleral tunnel construction in manual small incision cataract surgery (MSICS) compared with traditional training. In this multicenter, investigator-masked, randomized clinical trial, resident surgeons within 3 months of matriculation with minimal or no prior experience with MSICS were assigned either to simulation-based training, the Experimental Group (EG), or to conventional training, the Control Group (CG). EG residents were trained to perform scleral tunnel construction using a simulation-based curriculum (HelpMeSee Eye Surgery Simulator), while residents in the CG followed institution-specific curriculum before progressing to live surgery. Surgical videos of the first 20 attempts at tunnel construction were reviewed by masked video raters. The primary outcome was the total number of any of 9 pre-specified errors. On average, the total number of errors was 9.25 (95% CI 0-18.95) in the EG and 17.56 (95% CI 6.63-28.49) in the CG (P = 0.05); the number of major errors was 4.86 (95% CI 0.13-9.59) in the EG and 10.09 (95% CI 4.76-15.41) in the CG (P = 0.02); and the number of minor errors was 4.39 (95% CI 0-9.75) in the EG and 7.47 (95% CI 1.43-13.51) in the CG (P = 0.16). These results support that novice surgeons trained using the novel simulation-based curriculum performed fewer errors in their first 20 attempts at tunnel construction compared to those trained with a conventional curriculum.

Assessment of patient satisfaction, functionality, and quality of life after ultrasound-guided knee intervention: a prospective study.

OBJECTIVES: The use of ultrasound (US) guidance for the injection and aspiration of joints has improved accuracy. The aim of this study was to determine if differences exist in the level of patient satisfaction, functionality, and the quality of life in adult patients receiving US-guided (USG) versus landmark-guided (LMG) knee procedures. METHODS: This prospective, randomized study enrolled 41 patients undergoing knee procedures to USG or LMG groups. visual analogue scale (VAS) for pain, knee injury and osteoarthritis outcome score (KOOS), and patient satisfaction score on a 5-point Likert scale were measured pre-procedure, immediate (< 30 min) and late (4-6 weeks) post-procedure. RESULTS: Thirty-seven patients were included in the final analysis after exclusion of 4 dropouts (18 in LMG arm, 19 in USG arm). Compared with LMG group, patients in the USG group had significantly better improvement in pain immediately (VAS 1.63 ± 1.6 (95% CI 0.91, 2.35) vs 4.05 ± 2.5 (95% CI 2.90, 4.62), p = 0.001) and later post-procedure (VAS 2.68 ± 2.0 (95% CI 1.78, 3.58) vs 6.38 ± 3.8 (95% CI 4.62, 8.14) p = 0.004) and satisfaction scores immediately (4.89 ± 0.3 (95% CI 4.76, 5.02) vs 4.11 ± 1.0 (95% CI 3.65, 4.57), p = 0.002) as well as delayed post-procedure (4.52 ± 0.9 (95% CI 4.12, 4.92) vs 3.38 ± 1.6 (95% CI 2.64, 4.12), p = 0.028). CONCLUSION: USG knee procedures were associated with higher patient satisfaction, both immediately after the procedure and after 4-6 weeks compared with LMG knee procedures. Key Points •This prospective study is the first one to look at patient satisfaction as an outcome measure after intra-articular steroids knee injections. •USG (US-guided) knee procedures were associated with higher patient satisfaction compared with LMG (landmark-guided) knee procedures. •USG knee procedures resulted in greater improvement in symptoms, pain, and quality of life scales after 4-6 weeks compared with LMG knee procedures.

Rheumatic associations of autoimmune thyroid disease: a systematic review.

To investigate specific disease patterns in the rheumatic manifestations associated with autoimmune thyroid disease (AITD) through a systematic literature review. We performed a systematic review using the Medline OVID, PubMed, EMBASE, and Web of Science databases through May 2018 for experimental and observational studies that explored the association of AITD with degenerative joint disease (DJD), osteoarthritis (OA), chronic widespread pain (CWP) and fibromyalgia syndrome (FMS), and seronegative inflammatory arthritis (IA). A total of 2132 articles were identified. After title and abstract screening and removal of duplicates, 66 articles were retrieved for full text review. Eighteen studies were deemed eligible for inclusion. Six observational studies reported up to 45% prevalence of DJD in AITD. Hand and spinal DJD were reportedly associated with higher odds of AITD. Twelve observational studies were retrieved reporting up to 62% prevalence of FMS in AITD patients. Four studies described the occurrence of seronegative IA in AITD patients. The rheumatic associations of AITD may manifest specific patterns of disease distinct from those of other well-defined autoimmune syndromes and contribute significantly to disease burden.

Third-Trimester Fetal Biometry and Neonatal Outcomes in Term and Preterm Deliveries.

OBJECTIVES: To determine whether specific biometric thresholds for head circumference, abdominal circumference, femur length, and estimated fetal weight can identify neonates at risk for adverse outcomes. METHODS: We conducted a retrospective analysis of women with sonographic biometry after 26 weeks' gestational age (GA) followed by delivery of term and preterm neonates from 2007 through 2011. The head circumference, abdominal circumference, femur length, and estimated fetal weight were obtained. Sonographic data were merged with birth certificate and neonatal data. Biometry and estimated fetal weight were divided into percentile thresholds: 10th and above (reference), below 10th, below 5th, and below 3rd. Neonatal outcomes included neonatal intensive care unit admission, 5-minute Apgar score less than 7, and a composite of any morbidity/mortality (hypoxic-ischemic encephalopathy, periventricular leukomalacia, necrotizing enterocolitis, sepsis, renal failure, or death). Logistic regression yielded odds ratios and 95% confidence intervals for biometry and outcome, then adjusted for GA at delivery. RESULTS: A total of 2237 patients delivered at term, and 455 delivered before term. Neonatal intensive care unit admission was not associated with any biometric threshold in the term and preterm groups. Five-minute Apgar score less than 7 was associated with head circumference below 10th, abdominal circumference below 3rd, and estimated fetal weight below 5th percentiles in the term group and head circumference below 10th, abdominal circumference below 10th, and femur length below 10th percentiles in the preterm group (P < .05). Composite morbidity/mortality was associated with abdominal circumference below 5th, femur length below 10th, and femur length below 3rd percentiles in the term group and head circumference below 5th, abdominal circumference below 10th, and femur length below 5th percentiles in the preterm group (P< .05). Adjustment for GA did not affect outcomes for term deliveries but did affect nearly all outcomes for preterm deliveries. CONCLUSIONS: Irrespective of GA, no one biometric threshold can accurately predict adverse neonatal outcomes.

Management of Musculoskeletal Manifestations in Inflammatory Bowel Disease.

Musculoskeletal manifestations are the most common extraintestinal manifestations in inflammatory bowel diseases. Some appendicular manifestations are independent of gut inflammation and are treated with standard anti-inflammatory strategies. On the other hand, axial involvement is linked to gut inflammatory activity; hence, there is a considerable amount of treatment overlap. Biological therapies have revolutionized management of inflammatory bowel diseases as well as of associated articular manifestations. Newer mechanisms driving gut associated arthropathy have surfaced in the past decade and have enhanced our interests in novel treatment targets. Introduction of biosimilar molecules is expected in the US market in the near future and will provide an opportunity for considerable cost savings on healthcare. A multidisciplinary approach involving a gastroenterologist, rheumatologist, and physical therapist is ideal for these patients.

Musculoskeletal manifestations in inflammatory bowel disease: a revisit in search of immunopathophysiological mechanisms.

Inflammatory bowel diseases are chronic inflammatory disorders of multiple organ systems, primarily involving the gut, with chronic relapsing and remitting course. Musculoskeletal involvement is the most common extraintestinal manifestation. Distinct cell-mediated and humoral immunopathophysiological mechanisms have been identified underlying gut and joint inflammation in patients with inflammatory bowel disease and arthritis. Genetic polymorphisms in genes coding for NOD2 and IL12/IL23 complex lead to impaired antigenic handling in the gut and local immune dysregulation. The gut-synovial axis hypothesis implicates both environmental and host factors acting as triggers to initiate inflammation in genetically predisposed individuals, leading to priming of Th1 and Th17 lymphocytes in the gut and subsequent homing to the synovial tissue. Similar to gut, antibody-dependent cell-mediated cytotoxicity and complement-mediated cell lysis may also contribute to the joint damage. Involvement of peripheral joints occurs in 2 distinct manners, one being oligoarticular asymmetric arthritis associated with active disease and the other being polyarticular symmetric involvement of small joints. The axial involvement may include asymptomatic sacroiliitis, inflammatory back pain, and ankylosing spondylitis, running an independent clinical course. Noninflammatory involvement of the musculoskeletal system may present as osteopenia, osteonecrosis, fibromyalgia, or myopathies, leading to significant impact on quality of life.