Video Education on Hereditary Breast and Ovarian Cancer (HBOC) for Physicians: an Interventional Study.

The National Comprehensive Cancer Network (NCCN) guidelines are the gold standard in hereditary cancer risk assessment, screening, and treatment. A minority of physicians follow NCCN guidelines for BRCA1 or BRCA2 mutations. This study assesses the impact of an interventional educational program on HBOC in terms of knowledge. Physicians were sent an invite to join either an intervention survey (web-training offered prior to the knowledge survey) or control survey (web-training offered after the knowledge survey). Sixty-nine physicians in the intervention arm and 67 physicians in the control arm completed the survey. The interventional group regularly answered items correctly at a higher frequency than the control group. For example, 64.71% (n = 44) of physicians in the intervention group knew that multi-gene testing does not have to include only highly penetrant genes compared to 32.84% (n = 22) of the control group (p < 0.01). Similar results were seen with other specific survey items. The current study is important in that it shows web-based education to be a feasible and effective modality for training on hereditary breast cancer. This type of education may be incorporated into CME programs and can be used as a foundation for further studies as well.

Learning styles and the prospective ophthalmologist.

PURPOSE: Understanding the learning styles of individual trainees may enable trainers to tailor an educational program and optimise learning. Surgical trainees have previously been shown to demonstrate a tendency towards particular learning styles. We seek to clarify the relationship between learning style and learned surgical performance using a simulator, prior to surgical training. METHODS: The Kolb Learning Style Inventory was administered to a group of thirty junior doctors. Participants were then asked to perform a series of tasks using the EyeSi virtual reality cataract surgery simulator (VR Magic, Mannheim, Germany). All completed a standard introductory programme to eliminate learning curve. They then undertook four attempts of level 4 forceps module binocularly. Total score, odometer movement (mm), corneal area injured (mm(2)), lens area injured (mm(2)) and total time taken (seconds) recorded. RESULTS: Mean age was 31.6 years. No significant correlation was found between any learning style and any variable on the EyeSi cataract surgery simulator. CONCLUSION: There is a predominant learning style amongst surgical residents. There is however no demonstrable learning style that results in a better (or worse) performance on the EyeSi surgery simulator and hence in learning and performing cataract surgery.

Comparison of clinical characteristics and outcomes of critically ill adults with SARS-CoV-2 infection during Delta and Omicron variant predominance periods: a single-hospital retrospective cohort study.

INTRODUCTION: Initial reports suggest the B.1.1.529 (Omicron) variant of SARS-CoV-2 causes less severe disease compared with the B.1.617.2 (Delta) variant, though more widespread vaccination contributed to these findings. Little is known about clinical characteristics and outcomes of patients with SARS-CoV-2 infection requiring intensive care during periods of Delta and Omicron variant predominance. AIM: To examine and compare characteristics of critically ill adults with SARS-CoV-2 infection during periods of Delta and Omicron variant predominance. METHODS: We conducted a retrospective cohort study of critically ill adults with SARS-CoV-2 infection at one academic hospital in Los Angeles during Delta (15 July 2021-23 September 2021) and Omicron (21 December 2021-27 January 2022) predominance. Patient characteristics were compared between Delta-period and Omicron-period hospitalisations, overall and stratified by vaccination status. RESULTS: 79 adults required intensive care during the Delta predominance period and 116 during the Omicron predominance period. We found similar proportions of intensive care unit admissions occurring in fully vaccinated patients between the two periods, despite Los Angeles County data revealing an almost 60% increase in the proportion of SARS-CoV-2 hospitalisations occurring in fully vaccinated persons. There was no difference in the need for invasive mechanical ventilation (IMV). Among those who required IMV, the median duration of IMV was shorter overall (Delta=18 days; Omicron=8 days; p=0.006) and among unvaccinated persons (Delta=19 days; Omicron=8.5 days; p=0.018). Among unvaccinated persons, the median intensive care unit length of stay was shorter (Delta=12 days; Omicron=5 days; p=0.037) during Omicron predominance. There was no difference in the proportion of patients who died while hospitalised. CONCLUSIONS: In this single-hospital study, critically ill patients with SARS-CoV-2 infection experienced less severe respiratory disease during Omicron predominance, likely due to reduced variant-specific virulence. Vaccination likely reduced development of critical illness in adults with SARS-CoV-2 infection during Omicron predominance.

Assessment of fatigue in intraocular surgery: analysis using a virtual reality simulator.

AIM: To determine the effect of fatigue on intraocular surgical performance using a virtual reality simulator. METHODS: Seven experienced ophthalmic surgeons were recruited. The first set of data collection was immediately before a live theatre session. Each surgeon received a standardized orientation to a virtual reality cataract surgery simulator (Eyesi©, VRmagic, Mannheim, Germany). All surgeons then completed ten attempts on level-four forceps module. The parameters recorded were total score, total time, total time score, corneal injury score, lens injury score, odometer score, and operating without red reflex score. To reduce the effect of the learning curve, each surgeon had a "plateau" score calculated for every parameter, which was the average of their final four attempts. The surgeons then returned immediately after their scheduled theatre lists to complete a further ten attempts on the same module and similar parameters were recorded. RESULTS: Following routine theatre lists, simulator parameters slightly improved, with only the total score (97.28 to 98.57, p = 0.028) and total time (44 s to 35 s, p = 0.033) being statistically significant. The mean theatre list operating time was 197 min (SD ± 23.60). CONCLUSIONS: No detrimental effect of fatigue was demonstrated following a routine operating list. The study provides a template for further assessments of fatigue in high-volume cataract surgery lists.

Genotype analysis of polymorphisms in autoimmune susceptibility genes, CTLA-4 and PTPN22, in an acute anterior uveitis cohort.

PURPOSE: Acute anterior uveitis (AAU) is the most common form of uveitis and is thought to be autoimmune in nature. Recent studies have described genes that act as master controllers of autoimmunity. Protein tyrosine phosphatase type 22 (PTPN22) and Cytotoxic T lymphocyte antigen-4 (CTLA-4) are two of these genes, and single nucleotide polymorphisms (SNPs) in the genes encoding these molecules have been associated with several autoimmune diseases. In this study we have analyzed SNPs in PTPN22 and CTLA-4 in patients with AAU. METHODS: The functional protein tyrosine phosphatase type 22 (PTPN22) SNP (R620W rs2476601, 1858C/T), and two CTLA-4 SNPs (rs5742909, -318C/T and rs231775, 49A/G) were analyzed in 140 patients with AAU and 92 healthy controls by sequence-specific primer -polymerase chain reaction (SSP-PCR). Data was analyzed by chi(2) analysis and Fisher's exact test. RESULTS: There was no significant association between PTPN22 620W, CTLA-4 -318C/T, or CTLA-4 49A/G and AAU. Similarly, there was no association with the three SNPs when patients were classified by race or gender. Finally, there was no association with the presence of ankylosing spondylitis in the patient cohort. CONCLUSIONS: The data do not support an association between SNPs in PTPN22 and CTLA-4, genes regarded as genetic master switches of autoimmunity. This raises the issue of the etiology of AAU and the possibility that it should be regarded as an autoinflammatory rather than an autoimmune condition.

Safety of nondominant-hand ophthalmic surgery.

PURPOSE: To establish the safety of nondominant-hand simulated intraocular surgery. SETTING: Horizon Suite Simulation Centre, South Devon Foundation NHS Trust, Devon, United Kingdom. DESIGN: Cohort study. METHODS: Physicians with no previous ophthalmic surgical experience completed an introductory program on the EyeSi ophthalmic surgical simulator to eliminate the learning curve. They then completed the validated level-4 forceps module 4 times with their dominant hand and then 4 times with their nondominant hand. Simulator total score, odometer movement, corneal injury, lens injury, and total time were recorded. Acuity (Snellen near) and stereoacuity (Frisby) were also recorded. RESULTS: All 30 physicians showed good acuity (6/6 and N6 or better) and stereopsis (mean 35 seconds of arc). The total score was lower (mean 60.8 versus 65.6; P=.019), operating times were longer (mean 71.6 versus 70.0; P=.026), and lens injury was greater (mean 0.93 versus 0.79, P=.021) when operating with the nondominant hand than with operating with the dominant hand. Those with higher scores with the dominant hand had higher scores with their nondominant hand. CONCLUSIONS: Simulated nondominant-hand ophthalmic surgery resulted in less efficient, less safe, and slower surgery. This observation was more marked in those with less skill with their dominant hand. This has practical implications for trainee and trainer if 1 surgeon is left handed and 1 right handed. It also suggests that a higher degree of competence with the dominant hand is required before performing nondominant-hand surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Can virtual reality simulation help to determine the importance of stereopsis in intraocular surgery?

AIM: To establish the effect of acute loss of stereopsis on simulated intraocular surgical performance. METHODS: This study was performed using the EYESi ophthalmic surgical simulator. Thirty junior doctors with no previous ophthalmic surgical experience were enrolled and distance visual acuity (Snellen), near visual acuity and stereoacuity (Frisby) were recorded. All participants completed a standard introductory programme on the forceps module to eliminate the learning curve. They then undertook four attempts of level 4 forceps module binocularly and another four monocularly to simulate an acute loss of stereopsis. Total score, odometer movement, corneal area injured, lens area injured and total time taken were recorded. RESULTS: Mean age was 31 years (SD±9). None had amblyopia, with all demonstrating distance visual acuity of 6/6 or better and N6 for near. Mean stereopsis was 35 s of arc (SD±18). Average total score decreased from 60 while operating binocularly to 47 monocularly (p<0.05). Average corneal area injured increased from 0.95 mm(2) to 2.30 mm(2) (p<0.05), average lens area injured increased from 1.76 mm(2) to 3.53 mm(2) (p<0.05) and average time taken increased from 69.6 s to 77.4 s (p<0.05). CONCLUSION: The importance of stereopsis for intraocular surgery is difficult to establish in a live theatre setting without compromising patient safety. Virtual reality simulators provide a safe alternative. This study demonstrates a statistically significant decrease in simulated intraocular surgical performance with acute loss of stereopsis in potential ophthalmic training applicants. Caution is recommend in using these results to advocate stereopsis testing as a screening tool in interviews because some participants performed well despite an absence of stereopsis.

Glaucoma surgery.

Glaucoma is a potentially blinding condition that cannot be easily defined. There are various types of glaucoma which may vary in symptoms from none at all to sudden pain and redness. There is a characteristic optic neuropathy, or damage to the optic nerve, which results in progressive loss of visual field. The most important risk factor is an increase in the intraocular pressure (IOP) secondary to a reduction in the drainage of aqueous fluid from the drainage pathways in the eye, the filtration angle (Kanski 2007, Allingham et al 2011).

Effect of distraction on simulated anterior segment surgical performance.

PURPOSE: To determine the effect of distraction on anterior segment surgical performance using a virtual reality simulator in expert and novice surgeons. SETTING: Horizon Suite Simulation Centre, South Devon Foundation NHS Trust, Devon, England. DESIGN: Cohort study. METHODS: Expert and novice ophthalmic surgeons completed a standardized and validated surgical task 10 times on a virtual reality simulator (EyeSi). They then completed a cognitive task (arithmetic questions), after which they completed 10 attempts on the simulator module while also completing the cognitive task. RESULTS: For experts (n = 7), the distracting cognitive task had no statistically significant effect on operating scores. The rate of correctly answered questions decreased from 12.3 per minute ± 2.1 (SD) while single tasking to 8.6 ± 3.1 per minute while dual tasking (P=.018). For novices (n = 14), the distracting cognitive task had no effect on any operating score except a small reduction in the penalty odometer score. The rate of correctly answered questions decreased from 11.5 ± 4.1 per minute while single tasking to 7.0 ± 3.2 per minute while dual tasking (P=.001). CONCLUSION: A distractive cognitive task reduced the ability of novice surgeons and expert surgeons to deal with that cognitive task, although their simulated surgical performance was not overtly compromised. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Strabismus: background and surgical techniques.

Through the process of evolution, the position of the eyes within the head has moved from lateral to frontal. Although reducing the panoramic view afforded by the lateral positioning, this new arrangement allowed stereopsis (depth perception) (Hubel and Wiesel 1965).

Local anaesthetic cataract surgery: factors influencing perception of pain, anxiety and overall satisfaction.

To assess factors influencing perception of pain, anxiety and overall satisfaction during local anaesthetic cataract surgery an audit was carried out at the West of England Eye Unit. Patients receiving sub-Tenons after previous peribulbar anaesthesia had significantly higher pain scores. Patient satisfaction was significantly higher when a handholder was present in theatre. Finally, no difference was found in the three variables whether anaesthesia was administered by an anaesthetic practitioner or an anaesthetist.