Iberoamerican Ophthalmologists IOL Selection for Use on Themselves: Survey Results.

PURPOSE: To determine the preferred type of intraocular lens (IOL) that ophthalmologists would choose for themselves in case of cataract surgery. DESIGN: Prospective convenience questionnaire study. MATERIALS AND METHODS: We developed an electronic survey with seven (7) questions, combining multiple and open options. The following categories were established: monofocal (MonoIOL) without monovision (MonoIOL-SM) and with monovision (MonoIOL-CM) and multifocal (MultiIOL) that could be either a bifocal (MultiIOL-B), trifocal (MultiIOL-T) or extended focus (MultiIOL-E). The link for the survey was sent to ophthalmologists from Latin America and Spain through different ways. The 1209 responses were analyzed statistically. RESULTS: We received 1209 responses from 14 countries. The average age was 47.977 years (SD 11.711 years). Gender distribution was 839 males (72.8%) and 313 females (27.2%). Overall preference was MonoIOL-SM 23.90% (289), MonoIOL-CM 12.16% (147), MultiIOL-B 4.63% (56), MultiIOL-T 34.99% (423), MultiIOL-E 15.22% (110), and unsure 9.10% (110). Ophthalmologists that implant IOLs showed a greater preference for MultiIOL (64%) than those who did not implant IOLs (32.3%). Although all ophthalmologists preferred MultiIOL, anterior segment specialists chose them more frequently (59.1%) than posterior segment specialists (41%). CONCLUSION: Ophthalmologists would prefer to receive a multifocal IOL implantation despite the lower frequency of multifocal IOL implantation observed in the general population. The frequency was greater among ophthalmologists who implant IOLs compared to those who do not implant them. It was also greater among those who identified themselves as anterior segment specialists compared to posterior segment specialists.

The International Council of Ophthalmology Ophthalmic clinical evaluation exercise.

Purpose: Fifteen years after the publication of the Ophthalmic Clinical Evaluation Exercise (OCEX), it was deemed necessary to review and revise it, and to validate it for an international audience of ophthalmologists. This study to revise the OCEX and validate it for international use. Methods: The OCEX rubric was changed to a modified Dreyfus scale; a behavioral descriptor was created for each category. An international panel of ophthalmic educators reviewed the international applicability and appropriateness of the tool. Results: A tool for assessing and giving feedback on four aspects of clinical competence during the ophthalmic consultation (interview skills, examination, interpersonal and communication skills, and case presentation) was revised. The original scoring tool was improved to a new behavioral one, and relevant comments and suggestions from international reviewers were incorporated. The new tool has face and content validity for an international audience. Conclusion: The OCEX is the only tool for workplace assessment and feedback specifically for ophthalmology residents and the ophthalmic consultation. This improved and simplified version will facilitate its use and implementation to diverse programs around the world.

The International Council of Ophthalmology 360-degree assessment tool: development and validation.

BACKGROUND: The Accreditation Council for Graduate Medical Education and other organizations recommend 360-degree assessments for evaluation of interpersonal and communication skills, professional behaviours, and some aspects of patient care and system-based practice. No such tool has been developed for ophthalmology or received international content validation. OBJECTIVE: To develop a valid, internationally applicable, ophthalmology-specific 360-degree assessment tool. DESIGN: Exploratory study. METHODS: A literature review was conducted. Individual 360-degree evaluation items from several publications were catalogued and classified according to different groups of assessors. A panel of international authors reviewed the list and voted on items that were most appropriate for international use. The list was trimmed to reduce redundancy and to make it as brief as possible while still capturing the essential components for each category. A second panel of international ophthalmic educators reviewed the international applicability and appropriateness of this collated list; relevant comments and suggestions were incorporated. RESULTS: A tool for the evaluation of interpersonal and communication skills, professionalism, and system-based practice was developed. The tool has face and content validity. CONCLUSION: This assessment tool can be used internationally for giving formative feedback based on the opinions of the different groups of people who interact with residents.

One-Year Progress in Ophthalmic Education: Annual Review.

PURPOSE: The aim of this study was to update the practicing ophthalmologist on the English language literature about medical education from the prior year. DESIGN: A search of English language literature was performed on PubMed from January 1, 2014, to December 31, 2014. METHODS: Because the search using the main topic of the review "medical education" came up with 7394 citations, authors finally decided to narrow the search to 3 topics of their interest:1. Current state of competency-based education and teaching methods of competencies. This section included ophthalmic/ophthalmology education, core competencies, competency-based education, teaching strategies, tools and methods in medical education.2. E-learning. This section included e-learning, online learning, online teaching, Web-based teaching, Web-based learning, and flipped classroom.3. ASSESSMENTS: This section included assessment of medical students, residents, fellows, faculty, attending physicians, and medical teachers, assessment of medical student ophthalmology programs, ophthalmology residency programs, residency programs, and fellowship programs. RESULTS: The authors reviewed and summarized articles published in 2014 examining or describing the 3 main areas of the review described previously. CONCLUSIONS: This review updates the comprehensive ophthalmologist on advances in ophthalmic medical education. Ophthalmic educators could apply the ideas presented in this review according to their possibilities in their own settings and programs.

Webinar software: a tool for developing more effective lectures (online or in-person).

PURPOSE: To describe the use of online seminars (webinars) to improve learning experience for medical residents and fostering critical thinking. MATERIALS AND METHODS: Sixty-one online seminars (webinars) for residents were developed from April 2012 to February 2013. Residents attended the lectures in the same room as the presenter or from distant locations. Residents interacted with the presenter using their personal computers, tablets, or smartphones. They were able to ask questions and answer the instructor's multiple choice or open-ended questions. The lecture dynamics consisted of: (1) The presentation of a clinical case by an expert on the clinical topic; (2) the instructor asked open-ended and multiple-choice questions about the problem-resolution process; (3) participants responded questions individually; (4) participants received feedback on their answers; (5) a brief conference was given on the learning objectives and the content, also fostering interactive participation; (6) lectures were complemented with work documents. RESULTS: This method allowed for exploration of learning of scientific knowledge and the acquisition of other medical competences (such as patient care, interpersonal and communication skills, and professionalism). The question-and-answer activity and immediate feedback gave attendees the chance to participate actively in the conference, reflect on the topic, correct conceptual errors, and exercise critical thinking. All these factors are necessary for learning. CONCLUSIONS: This modality, which facilitates interaction, active participation, and immediate feedback, could allow learners to acquire knowledge more effectively.

Development of a new valid, reliable, and internationally applicable assessment tool of residents' competence in ophthalmic surgery (an American Ophthalmological Society thesis).

PURPOSE: To test the validity and reliability of a new tool for assessing residents' competence in ophthalmic surgery. Changing paradigms of ophthalmic education in the United States have influenced worldwide ophthalmic education and necessitated new methods of assessing resident competence. Accordingly, a new tool for assessing residents' competence in ophthalmic surgery (phacoemulsification) that could be applicable internationally was developed. We hypothesize that this instrument is valid and reliable. METHODS: A panel of six international content experts adapted a previously published tool for assessing phacoemulsification. The tool (called the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric, or ICO-OSCAR:phaco) was reviewed by 12 international content experts for their constructive comments, which were incorporated to ensure content validity. Ten expert cataract surgery teachers then graded six recorded phacoemulsification surgeries with the ICO-OSCAR:phaco to investigate inter-rater reliability. RESULTS: The coefficient alpha statistic (a measure of reliability/internal consistency) for the ICO-OSCAR:phaco as a whole was 0.92, and 17 of its 20 dimensions had alpha coefficients greater than 0.70. CONCLUSIONS: The ICO-OSCAR:phaco is a valid and reliable assessment tool that could be applied internationally to satisfy the global need of new instruments to comply with emerging trends in ophthalmic education. A toolbox of similar surgical competency assessment tools is being developed.

International Council of Ophthalmology: Refocusing Ophthalmic Education in the Asia-Pacific Region and Beyond.

The International Council of Ophthalmology (ICO) is a global organization with a regional focus. Working in partnership with supranational and ICO member societies, the ICO is building a "World Alliance for Sight" to improve access to the highest-quality eye care worldwide. Designed to preserve and restore vision on an international scale, the ICO initiative, "Refocusing Ophthalmic Education," enhances ophthalmic education of residents, subspecialists, medical students, and allied eye care personnel by redefining the most effective ways to teach and in creating beneficial educational opportunities. The "Teaching the Teachers" program helps ophthalmic educators incorporate more effective methods of training and continuing professional development to meet societal needs, achieved in part through regional courses for residency program directors; symposia, and keynote talks presented by ICO's World Ophthalmology Educational Colloquium, Conferences for Ophthalmic Educators, and ophthalmic surgical competency rubrics. Recognizing that standardized curricula are essential for consistent ophthalmic education, the ICO has developed a curricular framework whereby goals, expectations, knowledge base, competencies, and technical training are delineated. The ICO is defining worldwide models of team training and compiling best practice, which will include training-program accreditation to ensure improvement in the education of ophthalmologists. International Council of Ophthalmology Web-based teaching courses, a Webinar Network, and a technology blog further support information and communication technologies for teaching and learning. At the ICO's Center for Ophthalmic Educators (educators.icoph.org), trainers will find valuable teaching resources in multiple languages as well as ways to share ideas and collaborate with peers and other ophthalmic educators.

Respuesta hemodinámica a medios de contraste en pacientes sometidos a cateterismo cardíaco con pobre función ventricular

Realizamos en el Hospital Militar Central de Bogotá una observación prospectiva en pacientes con pobre función ventricular, donde comparamos el comportamiento hemodinámico y clínico luego de la administración de una dosis usual de medio de contraste iónico y no iónico, durante un cateterismo cardíaco diagnóstico. Estudiamos 60 pacientes, 37 recibieron diatrizoato de metilglucamina y 23 lopamidol. No encontramos diferencias significativas en la tolerancia clínica (náuseas, vómito y reacciones alérgicas) ni en los parámetros hemodinámicos (frecuencia cardíaca, presión de fin de diástole del ventriculo izquierdo, presión aórtica y presión pulmonar) en los pacientes sometidos a medios de contraste iónico y no iónico. realizamos una revisión de la literartura y damos pautas para el uso de los medios de contraste en catetrismos cardíacos

Insulinemia y resistencia a la insulina: factores de riesgo independiente para restenosis luego de angioplastia coronaria?

La angioplastia coronaria y trasluminal percutánea (ACTP) es un procedimiento aceptado para la revascularización miocárdica en pacientes seleccionados. Sin embargo, la restenosis coronaria (RC) se presenta entre 30-55 por ciento en los primeros seis meses luego del procedimiento. Han sido descritos muchos fenómenos en la fisiopatología de la RC y el resultado final es una proliferación y migración de células de músculo liso vascular (CMLV) con síntesis de matriz extracelular. La insulina y la hiperinsulinemia han sido consideradas por algunas observaciones como factores de riesgo en el desarrollo de l aterosclerosis por sus efectos como factor de crecimiento de CMLV. No conocemos la relación entre la insulina y el desarrollo de RC. Realizamos un estudio clínico prospectivo y correlacional en 27 pacientes sometidos a ACTP en forma exitosa, con factores de riesgo mayores controlados, a los cuales se les realizó un control angiográfico y una prueba de supresión de insulina con octreótido (somatostatina) para valorar la resistencia a la insulina en un período de 4-6 meses post-t ACTP. Seis mujeres y 21 hombres. Edad de 61+-2.83 años. Fracción de eyección de 0.59+-0.014. Se presentó RC (lesión >50 por ciento) en el 48.1 por ciento. No se evidenció diferencias significativas entre los pacientes con RC y sin RC en cuanto al índice de masa corporal, glicemias, colesterol total, triglicéridos, c-HDL, c-LDL, ácido úrico y lesión residual. Los niveles de insulina en ayunas (p=0.120), insulina pico (p=0.159), insulina a las 2 hrs postprandial (p=0.369) y elpromedio de glicemia en el clamp de insulina (GPFE) (p=0.922) tampoco evidenciaron diferencias estadísticas. Nuestros resultados en la población estudiada no mostraron correlación entre las cifras de insulina con el porcentaje de obstrucción coronaria post ACTP. Esperamos contar con una mayor población y otros estudios en esta área

Estudo experimental da reaçäo tecidual à liga de titânio Ti6A14V (ELI): uma análise qualitativa / Experimental study of tissue reaction to titanium alloy Ti6A14V (ELI): a qualitative analysis

Os autores, através de um trabalho experimental, estudam qualitativamente a reaçäo tecidual à liga de titâno Ti6A14V (ELI) no osso e na musculatura de 24 ratos, divididos em seis grupos de quatro animais, utilizando uma análise histológica e radiológica, em relaçäo à variante tempo (2, 7, 15, 30, 60 e 90 dias). Näo encontraram qualquer reaçäo histológica em partes moles ou alteraçöes radiológicas entre dois e 90 dias após o implante. O achado histológico no osso traduz-se, nas primeira 48 horas, por uma reaçäo inflamatória aguda inespecífica, seguida da formaçäo de uma pseudomembrana ao redor do implante, constituida por fibroblastos, até 30 dias. Entre 60 e 90 dias, constatam osso primário totalmente mineralizado ao redor do implante de liga de titâno. Também näo verificam qualquer reaçäo de toxicidade, hipersensibilidade, ou soltura de fragmento metálicos do implante de liga de titânio no rato entre dois e 90 dias de seguimento

Valvotomía mitral percutánea: valor pronóstico de la evaluación ecocardiográfica

Se informan los resultados inmediatos, el seguimiento clínico y ecocardiográfico a 16 ñ ocho meses de 21 pacientes consecutivos con valvulotomía mitral percutánea. Los pacientes se dividieron en dos grupos de acuerdo con el índice ecocardiográfico: Grupo I (Indice = 8): 16 pacientes. Grupo II (Indice = 8): 6 pacientes. El éxito inicial (Area valvular = 1.5 cm²) fue: Grupo I 100 por ciento. Grupo II: 87 por ciento. En el grupo I todos los pacientes se encontraban en clase funcional II-III antes del procedimeinto; en el seguimiento, 93 por ciento esntan en clase I. El área valvular mitral aumentó de 1.03ñ0.16 cm² a 2.42ñ0.45 cm² (p<0.01), disminuyendo a 1.64ñ0.38 cm² en el seguimiento (p=NS). El gradiente dsiminuyó de 17ñ4.5 a 4.4ñ2.9 mmHg (p<0.001), aumentando a 6.4ñ2.6 en el seguimiento (p=NS). Se documentó reestenosis en dos pacientes (13 por ciento). En el grupo II, 100 por ciento se encontraban en clase III-IV, mejorando 80 por ciento a clase I y 20 por ciento a clase II. En el seguimiento, 80 por ciento regresó a clase III-IV. El área valvular aumentó de 1.27ñ0.19 cm² a 2.57ñ0.59 cm² (p=0.01), regresando a 1.25ñ0.04 cm² en el seguimiento. El gradiente disminuyó de 14ñ3.8 a 4.3ñ4 mmHg (p<0.001), aumentando a 10ñ4.8 mmHg en el seguimiento. Se documentó reestenosis en el 100 por ciento. Se concluye que los resultados inmediatos son buenos en todos los pacientes con estenosis mitral. La selección adecuada utilizando el ecocardiograma es fundamental para mantener el éxito inicial a largo plazo

Validación clínica y estadística de cuatro métodos de mediación de gasto cardíaco y Qp/Qs por Doppler en niños

Se midieron por Ecocardiografía Doppler los gastos sistémicos y pulmonar en 31 pacientes sanos y 26 pacientes conocidos por tener C.I.A ó C.I.V. La obtención de los gastos sistémico y pulmonar se realizó con cuatro métodos diferentes, ya validados y presentados en la literatura. Se partió de la premisa que los pacientes sanos no deben tener cortocircuito, por lo que, el Qp/Qs debe ser cercano a uno. Se realiza un análisis estadístico enfrentando cada uno de los cocientes obtenidos por los métodos a evaluar, entre ellos mismos y contra el cociente teórico ideal. Además se analizan Sensibilidad, Especificidad, Valor Predictivo positivo y negativo con el grupo de pacientes enfermos. Se obtienen los siguientes resultados: que los cuatro métodos son diferentes entre sí, que el más confiable desde todo punto de vista es el método Distancia latido por Planimetría, con menor variabilidad al compararlo con normales y mejor Sensibilidad, Especificidad y Valores Predictivos al compararlo con pacientes enfermos. El método Convencional (usado rutinariamente) no cumple parámetros estadísticamente aceptables para su uso, según el presente estudio