Michael N. Wiggins

Effects of presentation method on the understanding of informed consent

Background/aim: Knowledge of which presentation methods impart the most information to patients can improve the informed consent discussion. The purpose of this study was to determine if the comprehension and recall of the informed consent discussion varied with presentation method. Methods: Randomised, prospective study at the University of Arkansas for Medical Sciences. 90 freshmen medical students were randomly assigned to one of three groups and separately went through an informed consent on cataract surgery. Group A heard an informed consent presentation. Group B was shown diagrams while hearing the same presentation. Group C heard the consent and then watched an informational video on cataract surgery. A 10 point multiple choice quiz was administered after the presentation and repeated again 1 week later. Results: Scores from each group were averaged as number correct out of 10 questions. For same day scores, group C scores (7.70 (SD 1.24)) were significantly higher than group A (6.39 (1.63)). One week testing revealed that group C (6.96 (1.62)) recalled more between the two time periods and scored significantly higher than groups A (5.15 (2.11)) and B (5.54 (1.64)). Conclusions: This study found differences in the participants’ ability to recall facts based on the manner in which the material was presented. It clearly demonstrated that the use of visual aids improved the ability to remember facts and risks associated with cataract surgery beyond a verbal presentation alone. It also showed a benefit of the repetition of information as provided by audiovisual presentations that can be used in conjunction with the physician-patient discussion.

Patient perceptions of professionalism: implications for residency education

Objectives  The purpose of this study was three‐fold: to identify which behavioural, communicative and personal presentation characteristics most closely represent patients’ views of professionalism; to determine whether patients perceive resident doctors as displaying these characteristics, and to explore whether or not resident doctor professional behaviour creates an impression of clinical competence to the degree where patients perceive a decreased need for Attending Physician involvement.

The use of topical honey in the treatment of corneal abrasions and endotoxin-induced keratitis in an animal model.

Purpose: To investigate the effect of topically applied honey on intact corneas, surgically induced corneal abrasions and endotoxin induced keratitis. Materials and Methods: The effect of honey on the cornea was investigated by application of honey on intact corneas, wounded corneas and endotoxin-induced keratitis in Lewis rats. The corneas were wounded by creating an epithelial defect using a surgical blade, and the keratitis was induced by topically applying Pseudomonas aeruginosa endotoxin to scarified corneas. After treatment rats were sacrificed and cornea harvested in each case. Corneas were processed for paraffin embedding for histological and immuno-fluorescence staining. Corneas were also harvested and processed for total ribonucleic acid (RNA) isolation for reverse transcriptase-polymerase chain reaction (RT-PCR) analysis for various growth factors and inflammatory chemokines/cytokines). Results: Histological analysis revealed that no inflammation or morphological changes occurred after honey treatment in naive intact corneas. Vascular endothelial growth factor (VEGF) levels were also not altered after honey treatment. Topical application of honey to injured corneas resulted in faster epithelial healing and decreased expression of VEGF, transforming growth factor beta (TGF-β), interferon gamma (IFN-γ), interleukin 12 (IL-12) and tumor necrosis factor alpha (TNF-α) in injured corneas. Our results also established that honey treatment reduced the inflammation in endotoxin-induced keratitis by reducing the levels of angiogenic factors (VEGF and TGF-β), inflammatory cytokines (IL-12) and chemokines (CC chemokine receptor 5(CCR-5)). Conclusion: Short term use of honey on intact corneas can be safe. Honey has anti-angiogenic and anti-inflammatory properties that can be explored in several corneal inflammatory and infectious conditions.

Defining the core competency of professionalism based on the patient's perception.

Background:  To better define professionalism using a 10‐question multiple‐choice survey of patient preferences.

Diphenhydramine as a topical ocular anesthetic

OBJECTIVE To determine whether 5% diphenhydramine solution has an anesthetic effect when administered topically to rabbit corneas. DESIGN Experimental study. PARTICIPANTS Twenty white New Zealand rabbits. METHODS Twenty rabbits at the University of Arkansas for Medical Sciences received 1 drop of 5% diphenhydramine solution in the left eye and 1 drop of balanced salt solution in the right eye. Corneal sensation was then measured with a Cochet-Bonnet esthesiometer at 30-, 60-, and 90-minute intervals. Rabbits were observed for conjunctival reaction. Follow-up fluorescein and Rose Bengal slit-lamp examinations were then performed to assess toxicity. RESULTS Diphenhydramine solution at a 5% concentration demonstrated a significant anesthetic effect 30, 60, and 90 minutes after instillation (p < 0.0001, p = 0.0001, p = 0.0164, respectively). Mild conjunctival injection occurred in all diphenhydramine-treated eyes. No toxic effects on the corneal epithelium were observed. CONCLUSIONS When applied topically to rabbit corneas, 5% diphenhydramine solution has a significant anesthetizing effect compared with salt solution (control eyes). Topical diphenhydramine may be a safe alternative in patients requiring topical anesthesia who have multiple allergies to topical anesthetics. Additional studies are needed to determine a dose-response curve and to further evaluate corneal toxicity prior to use in humans.

Effects of repeated oral examinations on ophthalmology residents

Background/aim: Oral examinations are required for board certification in Ophthalmology in the USA. The current literature offers no recommendation on the number of administrations during residency. The purpose of this study was to determine how often oral examinations (OEs) should be administered and what effects repeated OEs might have on residents’ comfort level with OEs and confidence level in their knowledge base. Methods: From 2004 to 2006, a structured oral examination was administered every 4 months to ophthalmology residents at the University of Arkansas for Medical Sciences. A survey was administered just prior to each oral examination. Results: After two oral examinations, self-confidence and ability to self-assess one’s knowledge increased and anxiety decreased in the residents. Residents’ belief that they could pass an oral examination for board certification statistically improved after the third oral examination. Conclusions: To achieve the full benefits of oral examination training, the exam should be taken at least three times during residency. Formal, structured oral examinations, repeated over time, seem to reduce resident anxiety and improve the residents’ ability to realistically assess their level of preparation for an OE.

Primary care physicians’ knowledge of the ophthalmic effects of diabetes

OBJECTIVE Previous studies suggest that many patients with diabetes do not receive an annual dilated eye examination because of a lack of referrals from primary care physicians (PCPs). This study aims to determine the depth of knowledge of PCPs regarding diabetic eye disease. DESIGN Cross-sectional assessment. PARTICIPANTS Ninety-seven PCPs. METHODS An 8-question, multiple-choice assessment was administered over a 3-month period to 208 PCPs in attendance at continuing medical education conferences. RESULTS Ninety-seven PCPs completed the assessment. Participants had a mean total score of 5.9 of 8 possible (73.8%). Questions regarding screening, clinical findings, and prevention were answered correctly by ≥81% of the respondents. However, questions regarding risk factors and complications were answered correctly by less than 35% of the respondents. No difference in scores was found based on the type of residency training received or the number of years in practice. CONCLUSIONS Although PCPs may require greater education in the complications and risk factors of diabetic eye disease, study participants demonstrated a good overall depth of knowledge regarding diabetic eye disease. Thus, previous reports of only 35% to 55% of patients with diabetes receiving an annual dilated fundus examination are likely not due to a lack of physician education.

Implementing a structured oral examination into a residency program: getting started.

BACKGROUND AND OBJECTIVE To describe the steps involved in implementing a structured oral examination into a residency program PATIENTS AND METHODS Existing oral examination format was evaluated and deficiencies addressed by creating a structured examination and increasing the frequency of administration to ophthalmology residents at the University of Arkansas for Medical Sciences. RESULTS A structured oral examination was implemented. It provided both a realistic simulation of the board certification examination and a process that was a useful teaching method and assessment tool. It was valuable in addressing the Accreditation Council for Graduate Medical Education (ACGME) competencies. CONCLUSIONS Oral examinations can be a versatile means of teaching and assessing resident physicians. Although the implementation process can be onerous, once in place, it can become an efficient tool for assessing all categories of the ACGME competencies and can provide valuable training in oral examination performance.

Microbial contamination of ophthalmic operating microscopes

Brachytherapy is the most common method for treating uveal melanoma. However, complications that include inter alia, radiation retinopathy and radiation optic neuropathy have been described. Such complications have been treated by various methods, including laser photocoagulation, systemic corticosteroids and recently, intravitreal injections of triamcinolone acetonide. HBOT has been suggested in the treatment of various retinal pathological conditions, and optic neuropathies, including radiation-induced optic neuropathy. In our present case, we report the response of irradiation retinopathy and optic neuropathy to HBOT with marked improvement in the clinical appearance of the fundus and the visual field.

Reprint of: Primary care physicians’ knowledge of the ophthalmic effects of diabetes

OBJECTIVE Previous studies suggest that many patients with diabetes do not receive an annual dilated eye examination because of a lack of referrals from primary care physicians (PCPs). This study aims to determine the depth of knowledge of PCPs regarding diabetic eye disease. DESIGN Cross-sectional assessment. PARTICIPANTS Ninety-seven PCPs. METHODS An 8-question, multiple-choice assessment was administered over a 3-month period to 208 PCPs in attendance at continuing medical education conferences. RESULTS Ninety-seven PCPs completed the assessment. Participants had a mean total score of 5.9 of 8 possible (73.8%). Questions regarding screening, clinical findings, and prevention were answered correctly by ≥ 81% of the respondents. However, questions regarding risk factors and complications were answered correctly by less than 35% of the respondents. No difference in scores was found based on the type of residency training received or the number of years in practice. CONCLUSIONS Although PCPs may require greater education in the complications and risk factors of diabetic eye disease, study participants demonstrated a good overall depth of knowledge regarding diabetic eye disease. Thus, previous reports of only 35% to 55% of patients with diabetes receiving an annual dilated fundus examination are likely not due to a lack of physician education.