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The coronavirus disease 2019 (COVID-19) pandemic thrust health care professionals around the globe to the frontlines to care for those affected by this medical crisis. While many surgical and procedural medical subspecialties experienced drastic declines in patient visits during this time, the demand for psychiatric services was more stable. In response to statewide stay at home orders, third-year residents in the psychiatry outpatient clinic described in this article quickly transitioned to telepsychiatry to continue providing care to their patients. While providing care from home, these residents experienced a number of challenges that serve as important lessons for enhancing competence in telepsychiatry services.

Purpose In this pilot study, we aimed to investigate the efficacy of an electronic medical record (EMR) order set for lubricating ointment (four times daily) in the prevention of exposure keratopathy in ventilated patients in the intensive care unit (ICU) at the University of Utah. We attempted to capture the magnitude of morbidity, cost, and care burden in ventilated patients, as well as the utility of a systematic EMR-based preventative lubrication protocol in the ICU setting. Methods After implementation of the order set, a retrospective chart review was performed to capture all ventilated ICU patients pre- and postintervention. Three separate study periods were used: (1) Six months prior to coronavirus disease 2019 (COVID-19) and prior to the ocular lubrication intervention; (2) the subsequent 6-month period including COVID-19 patients but prior to any intervention; and (3) the subsequent 6-month period postintervention, including COVID-19 patients. The primary endpoint of ointment use per day was analyzed with a Poisson regression model. Secondary endpoints including rates of ophthalmologic consultation and exposure keratopathy were compared with Fisher's exact test. A poststudy survey of ICU nurses was included. Results A total of 974 ventilated patients were included in the analysis. Ointment use per day increased by 155% (95% confidence interval [CI] 132–183%, p < 0.001) following the intervention. Rates also increased 80% (95% CI 63–99%, p < 0.001) during the COVID-19 study period but prior to intervention. The percentage of ventilated patients requiring a dilated eye exam for any indication was 3.2, 4, and 3.7% in each of the study periods, respectively. There was an overall down trend in the rate of exposure keratopathy which was diagnosed in 33.3, 20, and 8.3% of those receiving ophthalmologic consultation, though these rates were not statistically significant. Conclusion These preliminary data show a statistically significant increase in the rates of lubrication in mechanically ventilated patients using an EMR-based order set in the ICU setting. There was no statistically significant decrease in the rates of exposure keratopathy. Our preventative protocol with lubrication ointment was of minimal cost burden to the ICU. Further longitudinal and multicenter studies are needed to better assess the efficacy of such a protocol.

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Purpose We investigate trends in cornea fellowship positions filled over time and applicant characteristics associated with matching into cornea fellowship. Methods Characteristics of cornea fellowship applicants were assessed using deidentified 2010 to 2017 San Francisco (SF) Match data. Publicly available SF Match cornea fellowship data including the number of participating programs, number of positions offered, number of positions filled, percentage of positions filled, and number of vacancies from 2014 to 2019 were also analyzed as data from 2010 to 2013 were unavailable. Results From 2014 to 2019, the number of cornea fellowship programs increased by 11.3% (mean 2.3% per year, p = 0.006) and the number of positions offered increased by 7.7% (mean 1.4% per year, p = 0.065). Of 1,390 applicants from 2010 to 2017, 589 (42.4%) matched into cornea. After controlling for potential covariates, graduation from a U.S residency program (odds ratio [OR]: 6.15, 95% confidence interval [CI]: 4.05–9.35, p < 0.001) and a greater number of interviews completed (OR: 1.35, 95% CI: 1.29–1.42, p < 0.001) were associated with increased odds of cornea fellowship match. A greater number of applied programs (OR: 0.97, 95% CI: 0.95–0.98, p < 0.001) was associated with decreased odds of matching into cornea fellowship. The proportion of applicants matching into cornea fellowship increased until 30 applications. Conclusions The number of cornea fellowship programs and positions increased from 2014 to 2019. Graduation from a U.S residency program and a greater number of interviews completed were associated with an increased likelihood of cornea fellowship match. Unlike applying to any ophthalmology subspecialty fellowship, applying to greater than 30 cornea fellowship programs was associated with decreased odds of matching.