Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training.

BACKGROUND: Laparoscopic simulator training translates into improved operative performance. Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual; however, because rates of skill acquisition vary widely, such curricula may be difficult to implement. We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum. METHODS: Residents (R1, n = 20) were enrolled in an IRB-approved prospective study at the beginning of the academic year. All completed the following: a background information survey, a battery of 12 innate ability measures (5 motor, and 7 visual-spatial), and baseline testing on 3 validated simulators (5 videotrainer [VT] tasks, 12 virtual reality [minimally invasive surgical trainer-virtual reality, MIST-VR] tasks, and 2 laparoscopic camera navigation [LCN] tasks). Participants trained to proficiency, and training duration and number of repetitions were recorded. Baseline test scores were correlated to skill acquisition rate. Cutoff scores for each predictive test were calculated based on a receiver operator curve, and their sensitivity and specificity were determined in identifying slow learners. RESULTS: Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN. Curriculum implementation required 347 man-hours (6-person team) and 795,000 dollars of capital equipment. With an attendance rate of 75%, 19 of 20 residents (95%) completed the curriculum by the end of the academic year. To complete training, a median of 12 hours (range, 5.5-21), and 325 repetitions (range, 171-782) were required. Simulator score improvement was 50%. Training duration and repetitions correlated with prior video game and billiard exposure, grooved pegboard, finger tap, map planning, Rey Figure Immediate Recall score, and baseline performance on VT and LCN. The map planning cutoff score proved most specific in identifying slow learners. CONCLUSIONS: Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education, but may require significant resources. Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance, its importance may lie in the prediction of the rapidity of skill acquisition. These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs.

Correction of astigmatism with rigid gas permeable lenses.

Comparison of the results of keratometry and refraction usually suggests the appropriate contact lens for a patient's eye. Specialized rigid toric contact lenses include bitoric and back toric RGP lenses, front toric RGP lenses, and bitoric RGP lenses with prism ballast. Each lens has specific indications.

Health-related quality of life of cataract patients: cross-cultural comparisons of utility and psychometric measures.

BACKGROUND: This study was conducted to assess the presence and/or absence of cross-cultural differences or similarities between Korean and United States cataract patients. A systematic assessment was performed using utility and psychometric measures in the study population. RESEARCH DESIGN: A cross-sectional study design was used to examine the comparison of preoperative outcomes measures in cataract patients in Korea and the United States. Study subjects were selected using non-probabilistic methods and included 132 patients scheduled for cataract surgery in one eye. PARTICIPANTS: Subjects were adult cataract patients at Samsung and Kunyang General Hospital in Seoul, Korea, and Tulane University Hospital and Clinics in New Orleans, Louisiana. MEASUREMENTS: Preoperative utility was assessed using the verbal rating scale and standard reference gamble techniques. Current preoperative health status was assessed using the SF-36 and VF-14 surveys. Current preoperative Snellen visual acuity was used as a clinical measure of vision status. RESULTS: Korean patients were more likely to be younger (p = 0.001), less educated (p = 0.001), and to have worse Snellen visual acuity (p = 0.002) than United States patients. Multivariate analysis of variance (MANOVA) revealed that in contrast to Korean patients, United States patients were assessed to have higher scoring in general health, vitality, VF-14, and verbal rating for visual health. This higher scoring trend persisted after controlling for age, gender, education and Snellen visual acuity. The difference in health-related quality of life (HRQOL) between the two countries was quite clear, especially in the older age and highly educated group. CONCLUSIONS: Subjects in Korea and the United States were significantly different in quality of life, functional status and clinical outcomes. Subjects in the United States had more favorable health outcomes than those in Korea. These differences may be caused by multiple factors, including country-specific differences in economic status, health care system, cultural value system, and health policy. Cross-cultural differences should be considered when making international comparisons of quality of life.

Quantifying Pseudomonas aeruginosa adhesion to contact lenses.

PURPOSE: Pseudomonal keratitis can occur in soft contact lens wearers following compromise of the corneal epithelium and exposure to pathogens. This study was initiated to determine if Pseudomonas aeruginosa has the ability to adhere preferentially to unused contact lenses made from different FDA group polymers. METHODS: Pseudomonas aeruginosa (strain PA01) was grown to its early stationary phase and diluted into phosphate-buffered saline to a concentration of 12000 to 16000 cells/mL. Samples from each of the four FDA-designated polymer classes used for the manufacture of soft lenses were incubated in pseudomonal inoculant for 4 hours. The lenses were removed and the number of bacteria bound was quantified using electrical impedance particle counting. RESULTS: A lens constructed from a group I polymer (nonionic polymer with <50% water) bound the fewest bacteria (7.2% of total cells +/- 1.0 SD) whereas a lens made from group II polymers (nonionic polymer with >50% water) showed the highest level of bacterial binding (42% of total cells +/- 4.5 SD). Lenses constructed from group III and IV polymers showed intermediate levels of bacterial binding (28.4% +/- 1.8 SD and 29.3% +/- 1.7 SD, respectively). CONCLUSIONS: The polymer type used to construct the contact lens may influence subsequent bacterial adhesion events. Contact lenses made from nonionic polymers with high water content may carry higher risks of bacterial contamination.