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Karl C Golnik

Publications and source records attributed to Karl C Golnik.

16 recordsLinked to original sources
PubMed2006

Perceptions of recent ophthalmology residency graduates regarding preparation for practice.

OBJECTIVE: To evaluate young ophthalmologists' perceptions of how well residency training prepared them for various aspects of their clinical practice. DESIGN: Self-administered survey. PARTICIPANTS: Two hundred sixty-nine United States ophthalmologists who have been in practice for < or =5 years. METHODS: A 4-page questionnaire was mailed to a randomly selected sample of 900 U.S. members and fellows of the American Academy of Ophthalmology who had been in practice for < or =5 years. MAIN OUTCOME MEASURES: Comparison of perceived preparedness in clinical and nonclinical areas of ophthalmology practice. RESULTS: Two hundred sixty-nine surveys were completed and returned (margin of error, +/-5%). Analysis of tabulated results indicated that 86% said they were extremely or very well prepared to practice comprehensive ophthalmology after residency training. Even so, about half of those respondents also desired some additional clinical training, and two thirds felt the need for some additional training in surgical areas (refractive, oculoplastics/orbital, glaucoma, retina, and pediatric ophthalmic surgery). At least 60% reported being not very or not at all well prepared in 6 of the nonclinical areas explored (business operations and finance, personal financial management, practice management skills, coding and reimbursement, political advocacy, and exposure to practice setting models). With the exception of personal financial management, most ophthalmologists thought training in all of these nonclinical areas was the responsibility of the residency training program. CONCLUSION: The transition from residency training to successful, efficient, ethical, high-quality ophthalmic practice demands a number of skills in addition to diagnostic acumen and surgical ability. In general, the U.S. residency program graduates surveyed are comfortable with their clinical training, but less so with their training in nonclinical areas. Opportunities to help ophthalmologists prepare better for the transition to clinical practice after training appear to exist and might be addressed by training programs, professional organizations, informal physician networks, and other stakeholders.

Adult↗
PubMed2006

Structured journal club as a tool to teach and assess resident competence in practice-based learning and improvement.

PURPOSE: To describe the use of the journal club as a tool to teach and assess competency in practice-based learning (PBL) and improvement among residents in ophthalmology. DESIGN: Interventional case series. PARTICIPANTS: Ophthalmology residents. SETTING: Three academic ophthalmology residency programs in the United States. METHODS: A survey was performed of self-assessed skills in PBL among residents in ophthalmology training before and after the implementation of a structured review checklist during a traditional resident journal club. The survey had 5 domains, including (A) appraise and assimilate evidence, (B) read a journal article critically, (C) use a systematic and standardized checklist, (D) apply knowledge of study designs and statistical methods, and (E) maintain a self-documented written record of compliance. The respondents scored their ability (range, 1-5). RESULTS: The use of a structured journal club tool was associated with a statistically significant improvement in self-assessed ability in all 5 domains. CONCLUSIONS: Although validity, reliability, and long-term efficacy studies are necessary, the structured journal club is one method of teaching and assessing resident competency in PBL and improvement.

Clinical Competence↗
PubMed2006

The effect of decreased visual acuity on clinical color vision testing.

PURPOSE: Evaluate the effect of visual acuity on color vision testing. DESIGN: University based clinical experimental study. METHODS: Right eyes of 12 healthy subjects were fogged with plus lenses to logMAR 1.88 and assessed with D-15 panel, Ishihara, and Hardy-Rand-Rittler (HRR) plates. Subjects were tested at lesser degrees of fogging, 0.1 logMAR intervals. The acuity at which 5% of the population tests abnormally was estimated as follows. The average acuity at which a 10% reduction in correct responses occurred was determined. From this, two standard deviations were subtracted. Examination devices were compared using repeated measures analysis of variance. RESULTS: Color vision testing did not significantly differ from baseline up to logMAR 1.40 (D-15 panel), 1.10 (HRR plates), and 0.72 (Ishihara plates). Testing devices were significantly different (P < .005). CONCLUSIONS: Color vision testing is accurate up to logMAR 1.40 (20/501) with D-15 panel, 1.10 (20/252) with HRR plates, and 0.72 (20/106) with Ishihara plates.

Adult↗
PubMed2006

Changes in weight, papilledema, headache, visual field, and life status in response to diet and metformin in women with idiopathic intracranial hypertension with and without concurrent polycystic ovary syndrome or hyperinsulinemia.

The authors hypothesized that a metformin (MET)-diet would improve symptoms of idiopathic intracranial hypertension (IIH) in women who also had polycystic ovary syndrome (PCOS) or hyperinsulinemia without PCOS. Changes in weight, papilledema, headache, visual fields, and overall life status were prospectively assessed in response to 6 to 14 months on 2.25 g/day MET-diet or diet alone in 36 women with IIH, 23 with PCOS, selected by baseline body mass index (BMI) > or = 25, and no previous surgery for IIH. Overall life status was graded using a self-reported 1-5 scale (1 = well, normal activities; 2 = unwell, usual activities; 3 = poor, usual activities; 4 = poor, no usual activities; 5 = totally disabled). Conventional treatment for IIH was maintained unchanged during MET-diet intervention. The diet was hypocaloric (1500 calories/day), high protein (26% of calories), and low carbohydrate (44%). Of the 23 women with PCOS, 20 received MET-diet and 3 diet only (could not tolerate MET). Of the 13 women without PCOS, 7 were hyperinsulinemic and received MET-diet and 6 received diet alone. The 3 treatment groups (diet only [n = 9], PCOS-MET-diet [n = 20], and hyperinsulinemia-MET-diet [n = 7]) did not differ by median entry BMI (33.3, 37.6, and 35.7 kg/m(2)) or by duration of treatment (10.2, 11.4, and 10.9 months). Median percent weight loss was greatest in the PCOS-MET group (7.7%, P = 0.0015), was 3.3% in the diet only group, and 2.4% (P = 0.04) in the hyperinsulinemia-MET group. Papilledema significantly improved in the diet-alone group from 100% at baseline to 13% (P = 0.03), and in the PCOS-MET group from 95% to 30% (P = 0.002). If headache persisted on therapy, it was less intense-less frequent (P = 0.03) in the diet-only group and in the PCOS-MET group (P = 0.04). As many women with IIH have PCOS, and because weight loss is central to IIH treatment, diet-MET is a novel approach to treat IIH in women with concurrent PCOS or hyperinsulinemia without PCOS.

Adolescent↗
PubMed2005

Idiopathic intracranial hypertension, polycystic-ovary syndrome, and thrombophilia.

We studied thrombophilia, hypofibrinolysis, and polycystic-ovary syndrome (PCOS) in 65 women consecutively referred because of idiopathic intracranial hypertension (IIH) as a means of better understanding the origin of IIH, with the ultimate goal of developing novel medical therapies for IIH. Our hypothesis: IIH results in part from inadequate drainage of cerebrospinal fluid (CSF) resulting from thrombotic obstruction to CSF resorption-outflow, favored by thrombophilia-hypofibrinolysis. We conducted the polymerase chain reaction (PCR) and assessed serologic coagulation measures in 65 women (64 of them white) with IIH, PCR in 102 healthy white female controls (72 children, 30 age-matched adults), and serologic measures in the 30 adults. Of the 65 patients, 37 (57%) were found to have PCOS; 16 (43%) were obese (BMI > or = 30 to < 40), and 19 (51%) were extremely obese (BMI > or = 40). Of the 65 women with IIH, 25 (38%) were homozygous for the thrombophilic C677T MTHFR mutation, compared with 14% of controls (14/102) ( P = .0002). Thrombophilic high concentrations of factor VIII (>150%) were present in 9 of 65 (14%) IIH cases, compared with 0 of 30 controls (0%) (Fisher's p [p f ] = .053). An increased concentration of lipoprotein A (> or = 35 mg/dL), associated with hypofibrinolysis, was present in 19 of 65 IIH cases (29%), compared with 3 of 30 controls (10%) (p f = .039). IIH occurred in 18 of 65 IIH patients taking estrogen-progestin contraceptives (28%), in 6 patients taking hormone-replacement therapy (9%), and in 5 pregnant subjects (8%). We speculate that PCOS, associated with obesity and extreme obesity, is a treatable promoter of IIH. We also speculate that if thrombophilia-hypofibrinolysis and subsequent thrombosis are associated with reduced CSF resorption in the arachnoid villi of the brain, thrombophilia and hypofibrinolysis-often exacerbated by thrombophilic exogenous estrogens, pregnancy, or the paradoxical hyperestrogenemia of PCOS-are treatable promoters of IIH.

Adolescent↗
PubMed2005

The diagnostic yield of the evaluation for isolated unexplained optic atrophy.

PURPOSE: To report the diagnostic yield for the evaluation of isolated and unexplained optic atrophy. SETTING: Two tertiary care academic neuroophthalmology clinics. DESIGN: Retrospective case series. PARTICIPANTS: Patients with optic atrophy. METHODS: Retrospective review of all charts with the diagnosis of optic atrophy. Included patients were adults with isolated, but unexplained, optic atrophy. Patients were excluded if they were children, had incomplete or inadequate documentation of the findings, had nonneurologically isolated optic atrophy (e.g., other localizing findings), or had a history (e.g., prior neuroimaging study showed a compressive lesion, prior ischemic optic neuropathy) or examination (e.g., central retinal artery occlusion) evidence for an etiology for the optic atrophy. MAIN OUTCOME MEASURE: Results of diagnostic evaluation. RESULTS: A total of 1110 charts with the diagnosis of optic atrophy were reviewed from the 2 participating institutions (368 from the University of Cincinnati and 742 from the University of Iowa). Of these 1110 charts, 91 (8%) with isolated unexplained optic atrophy were included, and 1019 charts (92%) were excluded. Of 91 included patients, 18 (20%) had a compressive lesion causing optic atrophy, and 73 (80%) cases had no etiology for the optic atrophy on neuroimaging. Of the 18 patients with abnormal imaging (e.g., meningioma, pituitary adenoma, craniopharyngioma) studies, 11 had bilateral and 7 had unilateral optic atrophy. Five of the 18 patients had progressive visual loss, 3 had hemianopic visual field loss, and 11 were younger than 50 years old. CONCLUSIONS: Patients with optic atrophy in our study typically had historical or examination findings that led to an etiologic diagnosis. Neuroimaging showed an etiology in 20% of patients. Other laboratory testing did not produce an etiologic diagnosis in the absence of a suggestive history or examination. On the basis of our results, we recommend neuroimaging for all patients with unexplained optic atrophy and consideration for directed laboratory studies only.

Brain Neoplasms↗
PubMed2005

Assessment of ophthalmology resident on-call performance.

PURPOSE: To design and implement a valid tool for assessment of ophthalmology resident on-call performance. DESIGN: Retrospective chart audit. SETTING: Tertiary care academic ophthalmology programs. PARTICIPANTS: Ophthalmology faculty and residents at the University of Cincinnati and the University of Iowa. METHODS: A 1-page on-call assessment tool (OCAT) and scoring rubric were developed to evaluate ophthalmology resident on-call performance. A retrospective chart audit of consecutive resident on-call charts was performed at the University of Cincinnati and the University of Iowa, and resident performance was scored using the OCAT. RESULTS: A consensus of faculty comments established the face and content validity of the OCAT. One hundred ninety-one on-call consultations were assessed. Timeliness of consultation was the most common category receiving a borderline or unsatisfactory rating. Borderline ratings in knowledge-based categories (history, examination, assessment and plan, urgency rating) occurred more often for postgraduate year 2 (PGY2) residents than for PGY3 residents (P = 0.05, chi-square test). Incomplete differential diagnosis (n = 6) and lack of follow-up instruction (n = 5) were the most common deficiencies observed. CONCLUSIONS: The OCAT has face, content, and discriminative validity. It can be used to assess resident competence in patient care, professionalism, and medical knowledge. Interrater and intrarater reliability still need to be determined. The OCAT may prove to be an additional assessment tool for meeting the Accreditation Council for Graduate Medical Education competencies mandate.

Clinical Competence↗
PubMed2005

The ophthalmic clinical evaluation exercise: reliability determination.

PURPOSE: Reliable and valid tools must be developed to assess the core residency competencies identified by the Accreditation Council for Graduate Medical Education. The Ophthalmic Clinical Evaluation Exercise (OCEX) is a tool designed to assess the ophthalmology resident's competence in patient care. The OCEX has been shown to have face and content validity. This study will determine the degree to which the OCEX is reliable and has construct validity. PARTICIPANTS: Ninety-four academic ophthalmology teaching faculty from ophthalmology residency programs across the country. METHODS: Participants reviewed a video compact disc of the same resident and new patient encounter and then completed the OCEX. A scoring rubric was provided. RESULTS: Results indicate that the OCEX is a reliable tool for faculty to use to assess residency competency. The coefficient alpha statistic (a measure of reliability/internal consistency) for the OCEX as a whole was 0.81. The alpha statistics for 3 of 4 subscales that comprise the OCEX (i.e., interviewing skills = 0.65, interpersonal skills/professionalism = 0.73, case presentation = 0.70) were lower than the OCEX as a whole, but were acceptable for new scales. However, the alpha for the examination subscale (i.e., 0.27) was extremely low. Interrater reliability assessment shows that of 33 individual OCEX items, 31 (94%) had at least 85% of the raters rating the student in 1 of 2 consecutive rating categories. CONCLUSIONS: The OCEX shows both reliability and validity and, therefore, meets the Accreditation Council for Graduate Medical Education criteria for an acceptable assessment tool.

Accreditation↗
PubMed2005

Diagnostic yield for neuroimaging in patients with unilateral eye or facial pain.

BACKGROUND: The neuroimaging evaluation of isolated pain in or around the eye has not been studied previously. We report the low diagnostic yield of neuroimaging in patients who have a normal ocular examination and unilateral eye pain or facial pain predominantly affecting the eye. METHODS: Retrospective review of patients referred to 3 neuro-ophthalmology practices for unexplained pain in or around the eye. Inclusion criteria were adults with isolated unilateral eye/facial pain, neuroimaging, and a normal eye exam. Ex-clusion criteria were symptoms typical of a defined pain syndrome (e.g., trigeminal neuralgia or giant cell arteritis), and exam findings that would account for the pain. RESULTS: One hundred and twenty-seven (127) of the 760 reviewed patients met study criteria, and underwent MRI (75) or CT (34) scans, or both (18). Imaging was normal in 106 (83%). Abnormalities (n = 21) on imaging (17%) included nonspecific T2-weighted hyperintensities (10), sinusitis (5), superior ophthalmic vein enlargement (1), pontine lacunar infarct (1), Chiari malformation (1), thalamic mass (1), old occipital stroke (1), and focal enlargement of the third cranial nerve (1). INTERPRETATION: Although imaging showed abnormalities in 17% of cases of isolated pain in or around the eye, only 2 abnormalities were believed to be possibly related to the pain and only 1 case was probably related. The diagnostic yield of neuroimaging in patients with a normal examination and isolated, unilateral eye/facial pain referred to a neuro-ophthalmologist is low.

Adult↗
PubMed2004

Neuro-ophthalmologic manifestations of systemic disease: rheumatologic/Inflammatory.

Rheumatologic and inflammatory systemic diseases often cause similar neurologic and neuro-ophthalmologic manifestations. A wide variety of conditions can be included in these categories. This article summarizes the most common of these conditions, including sarcoidosis, idiopathic orbital inflammation, inflammatory bowel disease, Wegener's granulomatosis, polyarteritis nodosa, Churg-Strauss syndrome, Behcet's disease, systemic lupus erythematosis, scleroderma, Sjogren's syndrome, and rheumatoid arthritis.

Eye Diseases↗
PubMed2004

The Ophthalmic Clinical Evaluation Exercise (OCEX).

PURPOSE: New concise tools must be developed to assess reliably and validly the core residency competencies identified by the Accreditation Council for Graduate Medical Education. PARTICIPANTS: Eighteen content experts (residency program directors). METHODS: A 1-page Ophthalmic Clinical Exercise Examination (OCEX) checklist, for use during observed resident-patient interactions, was developed by an American Board of Ophthalmology taskforce. The OCEX checklist was sent to 18 content experts for their review and constructive comments. RESULTS: Experts' comments were incorporated, establishing face and content validity. CONCLUSIONS: The OCEX has face and content validity. It can be used to assess a resident's patient care skills, medical knowledge, and interpersonal skills. Reliability and predictive validity still need to be determined.

Accreditation↗
PubMed2004

The monocular vertical prism dissociation test.

PURPOSE: To determine if the monocular vertical prism dissociation test can differentiate between organic and nonorganic visual loss. DESIGN: A prospective, single-masked observational study. METHODS: Three institutional neuro-ophthalmology practices. Group 1 consisted of 30 normal controls. Group 2 included 30 patients with known organic visual loss. Group 3 contained 35 patients with suspected nonorganic monocular visual loss. Participants were asked to describe what they saw while viewing a single Snellen letter when a 4-prism diopter base-down prism was placed in front of their better eye. Outcome was measured by whether the participant sees one or two letters with the prism in place. RESULTS: Vision-appropriate results were given by all members of Group 1 (two images) and by all members of Group 2 (one image). Two images were seen by 31 of 35 members of Group 3, indicating nonorganic visual loss. The other 4 subjects in Group 3 saw one image; each was subsequently found to have occult pathology. CONCLUSION: The vertical prism test quickly differentiates organic from nonorganic monocular visual acuity loss.

Adolescent↗
PubMed2002

Infectious optic neuropathy.

A wide variety of infectious agents are known to cause optic neuropathy. This article will consider the bacteria, spirochetes, fungi, and viruses that most commonly affect the optic nerve. Clinical presentation is variable, but some pathogens often produce a characteristic funduscopic pattern. Diagnosis is usually made on the basis of clinical suspicion and serologic testing. Polymerase chain reaction is also increasingly utilized. Most infectious agents can be effectively treated but visual recovery is highly variable.

Anti-Infective Agents↗
PubMedDate not supplied

Using the Journal Club to teach and assess competence in practice-based learning and improvement: a literature review and recommendation for implementation.

The traditional journal club has historically been used to teach residents about critically reading and reviewing the literature in order to improve patient care. The Accreditation Council for Graduate Medical Education competencies mandate requires that ophthalmology residency programs both teach and assess practice-based learning and improvement. A systematically conducted review of the literature regarding the use of the journal club in resident medical education was performed to define specific recommendations for implementation of a journal club tool. Selected best practices for a successful journal club were gleaned from the existing medical literature. These include the following: 1) the use of a structured review checklist, 2) explicit written learning objectives, and 3) a formalized meeting structure and process. The journal club might prove to be an excellent tool for the assessment of competencies like practice-based learning which may be difficult to assess by other means. Future study is necessary to determine if journal club can improve educational outcomes and promote lifelong competence in practice-based learning.

Clinical Competence↗