Anesthesiology Residency Training and the Anesthesia Toolbox: Five Years of Experience With a Collaboratively Developed Peer-Reviewed e-Learning System.

The Internet is a source of professional self-education for medical students and residents. Unfortunately, much of the content discovered through search engines is of insufficient quality for professional education. The Anesthesia Toolbox (AT) was developed to provide online peer-reviewed educational resources for anesthesiology trainees and faculty. Since 2014, AT has developed 24 curricula, 822 content items, and 3238 quiz questions. As of March 2020, 64 anesthesiology residency programs in the United States subscribed to the AT (41% of total). Since the onset of the pandemic in March, AT has added 25 programs (28% increase) and gained 1156 users (26% increase).

Electron Beam Irradiated Corneal Versus Gamma-Irradiated Scleral Patch Graft Erosion Rates in Glaucoma Drainage Device Surgery.

INTRODUCTION: Patch graft erosion and implant exposure is a known complication of glaucoma drainage device (GDD) surgery. Recently, electron beam (e-beam) irradiated corneal tissue ha s become available; however, limited data exist on the rates of erosion for e-beam irradiated corneal grafts compared to traditional scleral grafts after GDD surgery. METHODS: This retrospective study examines the records of 253 eyes from 225 adult subjects who underwent GDD surgery with either e-beam irradiated corneal or scleral grafts at the Casey Eye Institute by five surgeons between April 22, 2014 and October 11, 2017. Surgical procedures and the occurrence of graft erosion were determined using billing codes and verified by manual review of electronic health records. RESULTS: The average age at the time of surgery was 61.3 ± 17.5 years (n = 200) and 60.8 ± 16.8 years (n = 53) for the e-beam irradiated cornea and sclera groups, respectively. The average follow-up time post-surgery was 416 ± 345 days and 495 ± 343 days for the e-beam irradiated cornea and sclera groups, respectively. There were no statistically significant differences in sex, age, follow-up time, and glaucoma diagnosis between the groups; however, the e-beam irradiated cornea group was statistically more likely to have an Ahmed implant as compared to the sclera group. No erosion events were noted in either group. CONCLUSION: e-Beam irradiated corneal grafts were used 3.8 times more frequently relative to scleral grafts, yet there were no cases of graft erosion in either group during the follow-up period.

A Large-Scale Examination of Veterans with Normal Pure-Tone Hearing Thresholds within the Department of Veterans Affairs.

BACKGROUND: Department of Veterans Affairs (VA) audiologists have anecdotally reported examining numerous Veterans with normal pure-tone thresholds; however, the prevalence of these patients within the VA is unknown. The VA audiological data repository provides an ideal dataset to examine this group of Veterans. Knowing the prevalence of normal-hearing Veterans within the VA system is the first step to understanding the underlying referral patterns and clinical complaints of Veterans. Data repositories which capture data from both normal and impaired populations provide an indispensable view into hearing health care which can help to improve diagnosis and treatment of Veterans' hearing difficulties. PURPOSE: Using the VA audiological data repository, this study aimed to (1) determine the prevalence of normal hearing thresholds among Veterans seeking hearing health care within the VA health care system and (2) determine the prevalence of abnormal clinical audiology test results among Veterans with normal hearing thresholds. RESEARCH DESIGN: This study was a large-scale retrospective, descriptive observational analysis of uploaded audiological records from the VA Denver Acquisition and Logistics Center audiological data repository encompassing visits that took place between April 1991 and June 2015. STUDY SAMPLE: At the time of data extraction, there were 3,641,326 audiological records in the repository, with 2,322,771 unique individual records. The study sample was further restricted to include only individuals with normal hearing (n = 235,091), which was defined as pure-tone thresholds better than, or equal to, 25 dB HL at octave frequencies from 250 to 8000 Hz, bilaterally. Patients ranged from 19 to 90+ years of age. DATA COLLECTION AND ANALYSIS: We describe the data using frequencies and percentages for categorical variables and means and standard deviations for continuous variables. In addition to hearing thresholds, the occurrence of abnormal results on other tests in the audiological test battery is also reported. We estimate the prevalence of normal hearing among all Veterans with records in the VA audiological data repository. RESULTS: Veterans with normal hearing were on average 37 yr old. The prevalence of Veterans with normal hearing thresholds visiting VA audiology clinics in the current hearing repository dataset was 10.12%. Overall, 41% of Veterans with normal pure-tone thresholds had other clinically abnormal audiological test results; for example, contralateral acoustic reflex thresholds (31.7%) and tympanometry (21.5%) had the highest rate of abnormal test results. CONCLUSIONS: Approximately one in ten Veterans seeking care within the VA healthcare system, and reported to the VA audiological data repository, has normal pure-tone hearing thresholds. This may be an underestimate of the true underlying prevalence of normal-hearing Veterans seeking audiology services at the VA because records with normal results were not consistently submitted to the repository. In addition, 41% of Veterans with normal pure-tone thresholds nonetheless presented with other audiological abnormalities. This study suggests that future work directed toward understanding referral patterns and clinical complaints of individuals who present to VA audiology clinics with normal hearing thresholds may be fruitful in the cause of improving diagnosis and treatment of Veterans' hearing difficulties.