Practice Patterns Among Eye Care Providers at US Teaching Hospitals With Regard to Assessing and Educating Patients About Smoking.

PURPOSE: To investigate practice patterns of eye care providers at academic medical centers in the United States (US) with regard to assessing patients' smoking status and exposure, educating patients regarding ocular risks of smoking, and counseling patients about smoking cessation. DESIGN: Cross-sectional survey. METHODS: An anonymous survey including multiple choice and Likert-style questions was constructed on http://www.surveymonkey.com and emailed to the coordinators of all 113 US ophthalmology residency programs, with a request to forward to all faculty, fellows, residents, and optometrists at their institution. Main outcome measures include proportion of eye care providers who assess patients' smoking status, educate patients regarding ocular risks of smoking, and discuss with patients smoking cessation options. RESULTS: Of the 292 respondents, 229 (78%) "always" or "periodically" ask patients about their smoking status, 251 (86%) "seldom" or "never" ask patients about secondhand smoke exposure, 245 (84%) "always" or "periodically" educate patients about ocular diseases associated with smoking, 142 (49%) "seldom" or "never" ask patients who smoke about their willingness to quit smoking, and 249 (85%) "seldom" or "never" discuss potential methods and resources to assist with smoking cessation. CONCLUSIONS: Most eye care providers assess patients' smoking status and educate patients regarding ocular risks of smoking. However, approximately half do not ask, or seldom ask, about patients' willingness to quit smoking, and most do not discuss smoking cessation options.

Trends in cataract surgery training curricula.

PURPOSE: To evaluate trends in cataract surgery training curricula and factors affecting timing of resident participation as a primary surgeon. SETTING: Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA. DESIGN: Cross-sectional study of anonymous survey results. METHODS: A description of the study and link to an online survey was e-mailed to program directors of each ophthalmology residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME). RESULTS: Fifty-one (44%) of the 116 program directors completed the survey. First-year, second-year, and third-year residents performed a mean of 2, 25, and 155 phacoemulsification surgeries, respectively, as a primary surgeon. Only 1 program (2%) required residents to perform extracapsular cataract extraction (ECCE) before performing phacoemulsification. Clear corneal phacoemulsification was the first technique taught to trainees at 91% of programs. More than two thirds (71%) of program directors indicated that their program had a cataract surgery training curriculum designed to transition residents gradually to the operating room. These curricula included structured wet laboratory (92%) and lecture (89%) components. Inadequate resident knowledge and surgical skill base (57%) and anticipation of increased surgical complication risk (37%) were the most commonly reported factors impeding earlier exposure to phacoemulsification in residency. CONCLUSIONS: Results show that residents today begin surgical training with phacoemulsification rather than ECCE, perform a higher number of phacoemulsification surgeries than is required by the ACGME, and begin performing phacoemulsification as early as their first or second year of residency. Despite these evolutions, 29% of respondent ACGME-accredited ophthalmology residency programs reported not having a formal cataract surgery training curriculum.

Inhibition of calpain but not caspase activity by spectrin fragments.

Calpains and caspases are ubiquitous cysteine proteases that are associated with a variety of cellular pathways. Calpains are involved in processes such as long term potentiation, cell motility and apoptosis, and have been shown to cleave non-erythroid (brain) alpha- and beta-spectrin and erythroid beta-spectrin. The cleavage of erythroid alpha-spectrin by calpain has not been reported. Caspases play an important role in the initiation and execution of apoptosis, and have been shown to cleave non-erythroid but not erythroid spectrin. We have studied the effect of spectrin fragments on calpain and caspase activities. The erythroid and non-erythroid spectrin fragments used were from the N-terminal region of alpha-spectrin, and C-terminal region of beta-spectrin, both consisting of regions involved in spectrin tetramer formation. We observed that the all spectrin fragments exhibited a concentration-dependent inhibitory effect on calpain, but not caspase activity. It is clear that additional studies are warranted to determine the physiological significance of calpain inhibition by spectrin fragments. Our findings suggest that calpain activity is modulated by the presence of spectrin partial domains at the tetramerization site. It is not clear whether the inhibitory effect is substrate specific or is a general effect. Further studies of this inhibitory effect may lead to the identification and development of new therapeutic agents specifically for calpains, but not for caspases. Proteins/peptides with a coiled coil helical conformation should be studied for potential inhibitory effects on calpain activity.

Association studies of erythroid alpha-spectrin at the tetramerization site.

The functional roles of residues 21-43 and 55-59 in the alpha-spectrin N-terminal region in forming tetramers were determined by the introduction of mutations at each of these positions. We measured association affinities for tetramer formation (K(d)), which can be used to predict clinical severity, of these mutants. A total of nine residues critical for association with beta-spectrin were found. The mutations of six of these residues have already been known to cause hereditary elliptocytosis or hereditary pyropoikilocytosis. Clinical symptoms associated with three mutations of residues 23, 57 and 58 have not yet been reported. We suggest that these mutations may also introduce abnormalities to erythrocytes.