Randomized Controlled Study of a Remote Flipped Classroom Neuro-otology Curriculum

CONTEXT: Medical Education can be delivered in the traditional classroom or via novel technology including an online classroom. OBJECTIVE: To test the hypothesis that learning in an online classroom would result in similar outcomes as learning in the traditional classroom when using a flipped classroom pedagogy. DESIGN: Randomized controlled trial. A total of 274 subjects enrolled in a Neuro-otology training program for non-Neuro-otologists of 25 h held over a 3-day period. Subjects were randomized into a control group attending a traditional classroom and a trial group of equal numbers participating in an online synchronous Internet streaming classroom using the Adobe Connect e-learning platform. INTERVENTIONS: Subjects were randomized into a control group attending a traditional classroom and a treatment group of equal numbers participating in an online synchronous Internet streaming classroom. MAIN OUTCOME MEASURES: Pre- and post-multiple choice examinations of VOR, Movement, Head Turns, Head Tremor, Neurodegeneration, Inferior Olivary Complex, Collateral Projections, Eye Movement Training, Visual Saccades, Head Saccades, Visual Impairment, Walking Speed, Neuroprotection, Autophagy, Hyperkinetic Movement, Eye and Head Stability, Oscilllatory Head Movements, Gaze Stability, Leaky Neural Integrator, Cervical Dystonia, INC and Head Tilts, Visual Pursuits, Optokinetic Stimulation, and Vestibular Rehabilitation. METHODS: All candidates took a pretest examination of the subject material. The 2-9 h and 1-8 h sessions over three consecutive days were given live in the classroom and synchronously in the online classroom using the Adobe Connect e-learning platform. Subjects randomized to the online classroom attended the lectures in a location of their choice and viewed the sessions live on the Internet. A posttest examination was given to all candidates after completion of the course. Two sample unpaired t tests with equal variances were calculated for all pretests and posttests for all groups including gender differences. RESULTS: All 274 subjects demonstrated statistically significant learning by comparison of their pre- and posttest scores. There were no statistically significant differences in the test scores between the two groups of 137 subjects each (0.8%, 95% CI 85.45917-86.67952; P = 0.9195). A total of 101 males in the traditional classroom arm had statistically significant lower scores than 72 females (0.8%, 95% CI 84.65716-86.53096; P = 0.0377) but not in the online arm (0.8%, 95% CI 85.46172-87.23135; P = 0.2176) with a moderate effect size (Cohen\u27s d = -0.407). CONCLUSION: The use of a synchronous online classroom in neuro-otology clinical training has demonstrated similar outcomes to the traditional classroom. The online classroom is a low cost and effective complement to medical specialty training in Neuro-Otology. The significant difference in outcomes between males and females who attended the traditional classroom suggests that women may do better than males in this learning environment, although the effect size is moderate. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, identifier NCT03079349

Randomized Controlled Study of a Remote Flipped Classroom Neuro-otology Curriculum

ContextMedical Education can be delivered in the traditional classroom or via novel technology including an online classroom.ObjectiveTo test the hypothesis that learning in an online classroom would result in similar outcomes as learning in the traditional classroom when using a flipped classroom pedagogy.DesignRandomized controlled trial. A total of 274 subjects enrolled in a Neuro-otology training program for non-Neuro-otologists of 25 h held over a 3-day period. Subjects were randomized into a “control” group attending a traditional classroom and a “trial” group of equal numbers participating in an online synchronous Internet streaming classroom using the Adobe Connect e-learning platform.InterventionsSubjects were randomized into a “control” group attending a traditional classroom and a “treatment” group of equal numbers participating in an online synchronous Internet streaming classroom.Main outcome measuresPre- and post-multiple choice examinations of VOR, Movement, Head Turns, Head Tremor, Neurodegeneration, Inferior Olivary Complex, Collateral Projections, Eye Movement Training, Visual Saccades, Head Saccades, Visual Impairment, Walking Speed, Neuroprotection, Autophagy, Hyperkinetic Movement, Eye and Head Stability, Oscilllatory Head Movements, Gaze Stability, Leaky Neural Integrator, Cervical Dystonia, INC and Head Tilts, Visual Pursuits, Optokinetic Stimulation, and Vestibular Rehabilitation.MethodsAll candidates took a pretest examination of the subject material. The 2–9 h and 1–8 h sessions over three consecutive days were given live in the classroom and synchronously in the online classroom using the Adobe Connect e-learning platform. Subjects randomized to the online classroom attended the lectures in a location of their choice and viewed the sessions live on the Internet. A posttest examination was given to all candidates after completion of the course. Two sample unpaired t tests with equal variances were calculated for all pretests and posttests for all groups including gender differences.ResultsAll 274 subjects demonstrated statistically significant learning by comparison of their pre- and posttest scores. There were no statistically significant differences in the test scores between the two groups of 137 subjects each (0.8%, 95% CI 85.45917–86.67952; P = 0.9195). A total of 101 males in the traditional classroom arm had statistically significant lower scores than 72 females (0.8%, 95% CI 84.65716–86.53096; P = 0.0377) but not in the online arm (0.8%, 95% CI 85.46172–87.23135; P = 0.2176) with a moderate effect size (Cohen’s d = −0.407).ConclusionThe use of a synchronous online classroom in neuro-otology clinical training has demonstrated similar outcomes to the traditional classroom. The online classroom is a low cost and effective complement to medical specialty training in Neuro-Otology. The significant difference in outcomes between males and females who attended the traditional classroom suggests that women may do better than males in this learning environment, although the effect size is moderate.Clinical Trial RegistrationClinicaltrials.gov, identifier NCT03079349

Diplopic Uveitis - Presentation PPT

33 year-old man presented with 3 days of binocular diplopia. Visual acuity was 20/30 OU and pupillary exam was normal. Motility testing demonstrated right partial 3rd nerve palsy (no adduction and limited supraduction with complete ptosis). There were +1/2 anterior chamber cells and few vitreous cells bilaterally. Fundoscopy was normal with mild bilateral cystoid macular edema on OCT. Of note, the patient was diagnosed with bilateral panuveitis six years ago for which no identifiable cause was found. He was treated with several topical and systemic immunosuppressants, but was receiving only adalimumab injections regularly for past two years; he continued to demonstrate low-grade panuveitis while on treatment. He recalled having three previous episodes of intermittent diplopia with right ptosis during last three years which spontaneously resolved. Urgent MRI/MRA revealed densely enhancing osteodestructive lesion around right sphenoid sinus, extending into adjacent meninges, right cavernous sinus and right superior orbital fissure; associated soft tissue thickening had low signal on T2. Radiological differential was between inflammatory or neoplastic entities. After short course of oral prednisone, motility deficits and ptosis resolved. One month later, diplopia recurred; right 6th nerve palsy was diagnosed. At the same time, central vision deteriorated to counting fingers with right RAPD. CT chest, abdomen and pelvis were normal. Extensive serological testing was unrevealing. Transphenoidal biopsy of skull base mass demonstrated inflammatory infiltrate with lymphocytes and slight increase in B cells, but was otherwise unrevealing. Bone marrow biopsy was normal. Adalimumab was discontinued and, two weeks after biopsy, acuity had improved to 20/40 OD; motility deficits had resolved. There were still +1/2 cells in AC bilaterally. CT brain and orbits demonstrated destructive changes in left sphenoid sinus and thickening of left cavernous sinus and orbital apex. Radiological differential was unchanged. A diagnostic procedure was performed

Diplopic Uveitis - Video

33 year-old man presented with 3 days of binocular diplopia. Visual acuity was 20/30 OU and pupillary exam was normal. Motility testing demonstrated right partial 3rd nerve palsy (no adduction and limited supraduction with complete ptosis). There were +1/2 anterior chamber cells and few vitreous cells bilaterally. Fundoscopy was normal with mild bilateral cystoid macular edema on OCT. Of note, the patient was diagnosed with bilateral panuveitis six years ago for which no identifiable cause was found. He was treated with several topical and systemic immunosuppressants, but was receiving only adalimumab injections regularly for past two years; he continued to demonstrate low-grade panuveitis while on treatment. He recalled having three previous episodes of intermittent diplopia with right ptosis during last three years which spontaneously resolved. Urgent MRI/MRA revealed densely enhancing osteodestructive lesion around right sphenoid sinus, extending into adjacent meninges, right cavernous sinus and right superior orbital fissure; associated soft tissue thickening had low signal on T2. Radiological differential was between inflammatory or neoplastic entities. After short course of oral prednisone, motility deficits and ptosis resolved. One month later, diplopia recurred; right 6th nerve palsy was diagnosed. At the same time, central vision deteriorated to counting fingers with right RAPD. CT chest, abdomen and pelvis were normal. Extensive serological testing was unrevealing. Transphenoidal biopsy of skull base mass demonstrated inflammatory infiltrate with lymphocytes and slight increase in B cells, but was otherwise unrevealing. Bone marrow biopsy was normal. Adalimumab was discontinued and, two weeks after biopsy, acuity had improved to 20/40 OD; motility deficits had resolved. There were still +1/2 cells in AC bilaterally. CT brain and orbits demonstrated destructive changes in left sphenoid sinus and thickening of left cavernous sinus and orbital apex. Radiological differential was unchanged. A diagnostic procedure was performed

Is Ishihara Color Plate Testing As Reliable On IPod-IPhone and IPad as on paper format

"Ishihara testing is frequently used to evaluate dyschromatopsia in patients with optic nerve disease. Several electronic versions are available nowadays. We compared results on the electronic versus paper formats in patients with dyschromatopsia.

Diplopic Uveitis - Abstract

33 year-old man presented with 3 days of binocular diplopia. Visual acuity was 20/30 OU and pupillary exam was normal. Motility testing demonstrated right partial 3rd nerve palsy (no adduction and limited supraduction with complete ptosis). There were +1/2 anterior chamber cells and few vitreous cells bilaterally. Fundoscopy was normal with mild bilateral cystoid macular edema on OCT. Of note, the patient was diagnosed with bilateral panuveitis six years ago for which no identifiable cause was found. He was treated with several topical and systemic immunosuppressants, but was receiving only adalimumab injections regularly for past two years; he continued to demonstrate low-grade panuveitis while on treatment. He recalled having three previous episodes of intermittent diplopia with right ptosis during last three years which spontaneously resolved. Urgent MRI/MRA revealed densely enhancing osteodestructive lesion around right sphenoid sinus, extending into adjacent meninges, right cavernous sinus and right superior orbital fissure; associated soft tissue thickening had low signal on T2. Radiological differential was between inflammatory or neoplastic entities. After short course of oral prednisone, motility deficits and ptosis resolved. One month later, diplopia recurred; right 6th nerve palsy was diagnosed. At the same time, central vision deteriorated to counting fingers with right RAPD. CT chest, abdomen and pelvis were normal. Extensive serological testing was unrevealing. Transphenoidal biopsy of skull base mass demonstrated inflammatory infiltrate with lymphocytes and slight increase in B cells, but was otherwise unrevealing. Bone marrow biopsy was normal. Adalimumab was discontinued and, two weeks after biopsy, acuity had improved to 20/40 OD; motility deficits had resolved. There were still +1/2 cells in AC bilaterally. CT brain and orbits demonstrated destructive changes in left sphenoid sinus and thickening of left cavernous sinus and orbital apex. Radiological differential was unchanged. A diagnostic procedure was performed

Syphilitic Perineuritis with Preserved Visual Function (.pdf)

Syphilis has reemerged since the past 20 years. Designated as great masquerader, it can have multiple clinical manifestations in the eye: anterior uveitis, chorioretinitis, exudative retinal detachments and papillitis, to name a few. We report a case of syphilitic optic perineuritis, rare presentation of the disease

Diplopic Uveitis - Path PPT

33 year-old man presented with 3 days of binocular diplopia. Visual acuity was 20/30 OU and pupillary exam was normal. Motility testing demonstrated right partial 3rd nerve palsy (no adduction and limited supraduction with complete ptosis). There were +1/2 anterior chamber cells and few vitreous cells bilaterally. Fundoscopy was normal with mild bilateral cystoid macular edema on OCT. Of note, the patient was diagnosed with bilateral panuveitis six years ago for which no identifiable cause was found. He was treated with several topical and systemic immunosuppressants, but was receiving only adalimumab injections regularly for past two years; he continued to demonstrate low-grade panuveitis while on treatment. He recalled having three previous episodes of intermittent diplopia with right ptosis during last three years which spontaneously resolved. Urgent MRI/MRA revealed densely enhancing osteodestructive lesion around right sphenoid sinus, extending into adjacent meninges, right cavernous sinus and right superior orbital fissure; associated soft tissue thickening had low signal on T2. Radiological differential was between inflammatory or neoplastic entities. After short course of oral prednisone, motility deficits and ptosis resolved. One month later, diplopia recurred; right 6th nerve palsy was diagnosed. At the same time, central vision deteriorated to counting fingers with right RAPD. CT chest, abdomen and pelvis were normal. Extensive serological testing was unrevealing. Transphenoidal biopsy of skull base mass demonstrated inflammatory infiltrate with lymphocytes and slight increase in B cells, but was otherwise unrevealing. Bone marrow biopsy was normal. Adalimumab was discontinued and, two weeks after biopsy, acuity had improved to 20/40 OD; motility deficits had resolved. There were still +1/2 cells in AC bilaterally. CT brain and orbits demonstrated destructive changes in left sphenoid sinus and thickening of left cavernous sinus and orbital apex. Radiological differential was unchanged. A diagnostic procedure was performed

IgG4-related disease presenting as panuveitis without scleral involvement

Abstract Background The following case emphasizes the importance of including IgG4-related disease (RD) in the differential diagnosis of intraocular inflammation and multiple cranial nerve palsies. Results A 33-year-old man, with a history of idiopathic bilateral panuveitis, presented with a new right pupillary-sparing partial third nerve palsy, which spontaneously resolved in 2 weeks, but was followed 1 month later, by a right sixth nerve palsy, which also resolved within a few weeks. Motility disturbance was accompanied by a decrease in the central acuity in the right eye. Magnetic resonance imaging/angiography (MRI/MRA) demonstrated a densely enhancing osteodestructive skull base process extending through the cavernous sinus and into the right superior orbital fissure. Biopsy of the lesion was consistent with IgG4-related disease (RD). Conclusions This is the first reported case of IgG4-RD associated panuveitis without scleral involvement, expanding the list of clinical manifestations of the IgG4-RD