Characteristics and trends in publications of abstracts presented at the Canadian Ophthalmological Society Annual Meetings: 2010-2015.

OBJECTIVE: To evaluate the publication rate of abstracts presented at the Canadian Ophthalmological Society (COS) Annual Meetings from 2010 to 2015. DESIGN: A retrospective review and literature search of abstracts presented at the COS Annual Meetings from 2010 to 2015. METHODS: Abstracts were obtained from the scientific programs for the 2010-2015 COS meetings, excluding 2014 (data unavailable). Title, author number, presentation type, subspecialty, institution, and study design were collected. MEDLINE and PubMed were searched in duplicate using abstract title, key words, and authors. Publication date, journal, impact factor, and citation score were recorded for each publication. Publication rates were determined by year of abstract presentation, presentation type, study type, subspecialty, author number, institution, and time to publication. RESULTS: 876 abstracts were presented, of which 326 (37.3%) were posters and 548 (62.7%) were oral presentations. The publication rate was 42.9% (375 publications) with a 16-month median time to publication. The publication rate did not vary significantly by presentation type or year. Publication rates were highest among vision rehabilitation (75.0%) and glaucoma (52.0%) subspecialties; basic science research (65.0%) and systematic reviews/meta analyses (62.0%) study designs had the highest representation. Most presentations were published in the Canadian Journal of Ophthalmology (117 presentations, 31.2%). The mean impact factor and citation score for published abstracts were 2.39 ± 2.3 and 1.70 ± 1.16, respectively. CONCLUSIONS: The publication rate of abstracts presented at the COS Annual Meetings has remained stable across this 5-year analysis. Publication rates are comparable to those of other specialty conferences.

Ophthalmology referrals from optometry: a comparative study (the R.O.C.S study).

OBJECTIVE: To characterize emergency optometrist referrals triaged at a tertiary ophthalmology care centre by physical examination findings and provisional diagnosis accuracy. DESIGN: Prospective case review. PARTICIPANTS: Consecutive patients referred to a tertiary eye care clinic for an after-hours ocular consult. METHODS: Variables extracted from the patient charts included date of referral, age, sex, eye(s) under examination, referral visual acuity (VA), referral intraocular pressure (IOP), the referring optometrist's provisional diagnosis, VA at the time of the ophthalmologist consultation, IOP at the time of the ophthalmologist consultation, number of days between referral and ophthalmic consultation, and the ophthalmologist's diagnosis. Optometrist VA measures were correlated against ophthalmologist measures for left eye, right eye, diseased eye, and nondiseased eye. The independent t test was used to compare IOP measures between clinicians, and the absolute frequency of agreement between localization of eye pathology was reported. RESULTS: After categorizing disease by anatomic location, absolute agreement between optometrist provisional diagnosis and ophthalmologist diagnosis was 60.0%. Strong correlations were found between optometrist and ophthalmologist VA measurements. IOP measurements were reported less frequently by optometrists. In cases in which referral IOP was documented, no significant difference was observed between clinician measures. CONCLUSIONS: VA and IOP measurements by optometrists are reliable, although IOP measurements were included less frequently in optometrist referrals. Optometrist referrals correctly localized eye pathology in 60.0% of cases. Two cases of retinal tear and 2 cases of retinal detachment, for which a precise reason for referral is ideal, were referred for other reasons.

Patient satisfaction with wait times at an emergency ophthalmology on-call service.

OBJECTIVE: To assess patient satisfaction with emergency ophthalmology care and determine the effect provision of anticipated appointment wait time has on scores. DESIGN: Single-centre, randomized control trial. PARTICIPANTS: Fifty patients triaged at the Hamilton Regional Eye Institute (HREI) from November 2015 to July 2016. METHODS: Fifty patients triaged for next-day appointments at the HREI were randomly assigned to receive standard-of-care preappointment information or standard-of-care information in addition to an estimated appointment wait time. Patient satisfaction with care was assessed postvisit using the modified Judgements of Hospital Quality Questionnaire (JHQQ). In determining how informing patients of typical wait times influenced satisfaction, the Mann-Whitney U test was performed. As secondary study outcomes, we sought to determine patient satisfaction with the intervention material using the Fisher exact test and the effect that wait time, age, sex, education, mobility, and number of health care providers seen had on satisfaction scores using logistic regression analysis. RESULTS: The median JHQQ response was "very good" (4/5) and between "very good" and "excellent" (4.5/5) in the intervention and control arms, respectively. There was no difference in patient satisfaction between the cohorts (Mann-Whitney U = 297.00, p = 0.964). Logistic regression analysis demonstrated that wait times influenced patient satisfaction (OR = 0.919, 95% CI 0.864-0.978, p = 0.008). Of the intervention arm patients, 92.0% (N = 23) found the preappointment information useful, whereas only 12.5% (N = 3) of the control cohort patients noted the same (p < 0.001). CONCLUSION: Provision of anticipated wait time information to patients in an emergency on-call ophthalmology clinic did not influence satisfaction with care as captured by the JHQQ.

Factors Influencing the Underreporting of Concussion in Sports: A Qualitative Study of Minor Hockey Participants.

OBJECTIVE: The present study is to identify factors contributing to underreporting of concussion in adolescent athletes. DESIGN: Qualitative interviews. SETTING: Participants were interviewed in an office environment. PARTICIPANTS: Interviews were conducted with 31 minor hockey players, 10 parents, 6 coaches, 4 trainers, 2 managers, and one game official. Players were 13 to 15 year old. With selective sampling, an inductive approach of analyzing the interviews was undertaken and themes were identified and analyzed. ASSESSMENT OF RISK FACTORS: Underreporting is a complex phenomenon. A number of risk factors related to hockey culture, players, reference others, and rules of play were assessed. MAIN OUTCOME MEASURES: Reasons not reporting concussion is accepted in minor hockey. RESULTS: Aspects of hockey culture such as an overemphasis on winning games and upheld misperceptions about the risks associated with concussion were identified as relevant to the underreporting of concussions. Various factors relevant to the underreporting of concussions include player's motivation to win, group membership dynamics such as a player's role as the team's "enforcer," coaches' own motivation to win to further their own opportunities in the sport, and parents' personal financial interest or alternative agenda in terms of time commitments and their child's future career prospects. CONCLUSIONS: Our findings indicate that underreporting of concussion among those players interviewed appears to be prevalent and associated with misconceptions about injury risk, and a culture that both reinforces and encourages underreporting with tacit or overt complicity of parents and coaches. Our findings support the need to alter the culture of violence and tough play in hockey by education, rule changes, economic measures, and changes in governance of the sport. Interviewing more stakeholders and policy makers would shed light on such potential interventions.

Ophthalmic referrals from emergency wards-a study of cases referred for urgent eye care (The R.E.S.C.U.E Study).

OBJECTIVE: To characterize emergency department (ED) referrals in order to identify the most common pathologies, compare accuracy of diagnosis, and measure correlation of visual acuity (VA) and intraocular pressure (IOP) measurements between the ED and ophthalmology setting. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review of consecutive patients referred for an ocular emergency after hours to a tertiary care emergency eye clinic in Hamilton, Ontario, between February 17, 2015, and May 3, 2015 (n = 288). METHODS: Variables extracted from the patients' charts included date of referral, age, sex, eye(s) under examination, VA at the time of referral, IOP at the time of the referral, site of referral, the referring physician's provisional diagnosis, VA at the time of the ophthalmologist consultation, IOP at the time of the ophthalmologist consultation, number of days between referral and ophthalmic consultation, and the ophthalmologist's diagnosis. RESULTS: Agreement between ED provisional diagnosis and ophthalmology was good at 79.4% when classified according to anatomic location of pathology. A strong correlation was found between VA measurements in the ED and ophthalmology setting (p < 0.001). IOP measurement was infrequently checked in ED and a significant difference existed between ER physician and ophthalmologist measurements (p = 0.010) where ophthalmology reported lower IOP. CONCLUSIONS: The 5 highest volume diagnoses in descending order were posterior vitreous detachment/vitreous syneresis, corneal abrasion, keratitis, anterior uveitis, and retinal tear/detachment. Visual acuity measurements in ED are reliable. IOP is infrequently checked in the ED and more unreliable when measured over 20 mm Hg.

Role of journal club in Canadian ophthalmology residency training: a national survey of program directors.

OBJECTIVE: To conduct a national survey of journal club curricula in Canadian ophthalmology residency programs. DESIGN: Cross-sectional web-based survey. PARTICIPANTS: Fifteen Royal College of Physicians and Surgeons of Canada (RCPSC) ophthalmology residency program directors. METHODS: The 15 RCPSC ophthalmology residency program directors were invited to participate in a 31-item online survey. The survey inquired about the purpose, educational goals, and structure of journal club. Basic statistics were performed to compare responses across institutions. RESULTS: Thirteen of the 15 program directors replied, representing an 87% response rate. Twelve (92%) institutions maintained a journal club. All of the program directors surveyed felt that journal club had educational value. Resident attendance was typically mandatory (75%) and correspondingly high across programs. There was 100% agreement that randomized controlled trials were most often selected for review. The primary journal club objectives were for residents to develop critical appraisal skills and to conduct a literature search (67%). Formal teaching and evaluation of these skills were not prioritized by any program. Seventeen percent felt the most important objective was to impact clinical practice. CONCLUSIONS: Canadian ophthalmology program directors expressed high levels of satisfaction that journal club was effective in meeting its stated objectives. This indicates that the teaching model promoted resident critical appraisal skills; however, objective evaluation methods to assess resident competence in evidence-based medicine were not described by any respondents. As RCSPC ophthalmology programs transition to competency-based medical education, program directors may consider modifying journal club curriculum, broadening its utility toward a means of outcome assessment.

Aggression, Violence and Injury in Minor League Ice Hockey: Avenues for Prevention of Injury.

BACKGROUND: In North America, more than 800,000 youth are registered in organized ice hockey leagues. Despite the many benefits of involvement, young players are at significant risk for injury. Body-checking and aggressive play are associated with high frequency of game-related injury including concussion. We conducted a qualitative study to understand why youth ice hockey players engage in aggressive, injury-prone behaviours on the ice. METHODS: Semi-structured interviews were conducted with 61 minor ice hockey participants, including male and female players, parents, coaches, trainers, managers and a game official. Players were aged 13-15 playing on competitive body checking teams or on non-body checking teams. Interviews were manually transcribed, coded and analyzed for themes relating to aggressive play in minor ice hockey. RESULTS: Parents, coaches, teammates and the media exert a large influence on player behavior. Aggressive behavior is often reinforced by the player's social environment and justified by players to demonstrate loyalty to teammates and especially injured teammates by seeking revenge particularly in competitive, body-checking leagues. Among female and male players in non-body checking organizations, aggressive play is not reinforced by the social environment. These findings are discussed within the framework of social identity theory and social learning theory, in order to understand players' need to seek revenge and how the social environment reinforces aggressive behaviors. CONCLUSION: This study provides a better understanding of the players' motivations and environmental influences around aggressive and violent play which may be conducive to injury. The findings can be used to help design interventions aimed at reducing aggression and related injuries sustained during ice hockey and sports with similar cultures and rules.

Saccadic eye movements in mild traumatic brain injury: a pilot study.

OBJECTIVE: To investigate whether repeat saccadic reaction time (SRT) measurements using a portable saccadometer is useful to monitor patients with mild traumatic brain injury (mTBI). METHODS: Seven patients with newly-diagnosed mTBI and five agematched controls were prospectively recruited from an emergency Department. Saccadic eye movements, symptom self-reporting and neuropsychological tests were performed within one week of injury and again at follow-up three weeks post-injury. Control patients underwent saccade recordings at similar intervals. RESULTS: Median saccade reaction times were significantly prolonged within one week post-injury in mTBI compared to controls. At follow-up assessment there was no significant between-groups difference. Changes in median SRT between the two assessments were not statistically significant. Four of the seven mTBI patients showed significantly increased SRT at follow-up; three of the mTBI patients and all controls showed no significant change. Among the three mTBI patients with persistent decreased SRT, two experienced loss of consciousness and reported the greatest symptoms, while the third was the only subject with significant decrease in neuropsychological testing scores at both assessments. CONCLUSION: In three of seven mTBI patients, saccadic eye movements remained delayed within three weeks post-injury. These three patients also showed persistent symptoms or no improvement on neuropsychological testing. This pilot study using a portable saccadometer suggests that comparing SRT from three weeks post-injury to that within one week of injury may be useful for early detection of a subpopulation at risk of persistent disability from mTBI. This finding suggests that further investigation in a large study population is warranted.Les saccades oculaires dans le traumatisme cérébral léger : une étude pilote.