Alexis Reedy-Cooper

Introduction: Inadequate scholarship is a common concern in graduate medical education. Many barriers to scholarship have been identified, but there are limited data on which are most important. A rank-order of barriers from learners’ perspectives would better enable programs to address perceived barriers. Methods: Given that learners are experts in their own perceptions, we applied the Delphi method of generating consensus expert opinion to construct ranked lists of physician-perceived barriers to scholarly activity at various sites. The survey was conducted within three separate health systems. Respondents were asked to identify their perceived barriers via free text and the listed barriers were consolidated by the research team. In the second round, respondents were presented with the consolidated lists and asked to rank them. In the third and final round, each respondent was shown a comparison of their own rankings to that of their peers and given an opportunity to make changes. Ranking differences between programs were compared using Rank Biased Overlap (RBO). Results: The Delphi method is a straightforward method to obtain a ranked list of perceived learner barriers to scholarly activity; its primary limitation is learner engagement and, of note in our study, high dropout rates. RBO is an effective method of ranking differences between programs and specialties. Top barriers across programs included time, overwhelm with the research process, and lack of interest or energy. Discussion: Several of the identified barriers may be addressed with enthusiastic mentors, streamlined administrative processes, and education. This could be done within a hospital system or on a national level through specialty organizations.

Approximately 7% of children in the United States younger than 18 years have a diagnosed eye disorder, and 1 in 4 children between two and 17 years of age wears glasses. Routine eye examinations during childhood can identify abnormalities necessitating referral to ophthalmology, which optimizes children's vision through the early diagnosis and treatment of abnormalities. The U.S. Preventive Services Task Force recommends vision screening at least once in children three to five years of age to detect amblyopia or its risk factors to improve visual acuity. The American Academy of Family Physicians supports this recommendation. The American Academy of Pediatrics recommends screening starting at three years of age and at regular intervals in childhood, and that instrument-based screening (e.g., photoscreening, autorefraction) is an alternative to vision charts for testing visual acuity in patients three to five years of age. Eye examinations include visual acuity testing, external examinations, assessing ocular alignment and pupillary response, and assessing for opacities with the red reflex examination. Common abnormalities include refractive errors, amblyopia (reduction in visual acuity in one eye not attributable to structural abnormality), and strabismus (misalignment of the eye). Rare diagnoses include retinoblastoma (often detectable through loss of red reflex), cataracts (detectable by an abnormal red reflex), and glaucoma (often manifests as light sensitivity with corneal cloudiness and enlargement).

Patients who are admitted to the hospital frequently (>3 admissions in a 6-month period) are a large driver of health care costs. Recently, research has focused on these groups of super-utilizing patients to try to find ways to meet their care needs in the outpatient setting. However, most research so far has focused on the urban underserved population who do not have a usual source of care. The goal of this study is to identify a group of patients from a suburban academic family medicine practice who have been admitted to the hospital frequently over a 6-month period and interview them to identify patient-perceived barriers to care in the outpatient setting. Nine of the 176 patients identified as frequently hospitalized were interviewed. Interpretive phenomenology analysis was used to identify perceived barriers and facilitators to care. Although some identified barriers were similar to those noted in groups of the urban underserved, including chronic disease and polypharmacy, other barriers were uniquely identified in the nonurban population, including transportation and support at home. Transportation issues, lack of support at home, and poor interdisciplinary communication were found to increase risk for readmission. Conversely, good interdisciplinary communication and ample support from family, including support services at home, were viewed as facilitators to outpatient care.

Objectives Despite its importance for patient safety, there have been few studies of medication reconciliation in primary care. Our goal was to identify potential patient, physician, medical assistant (MA), and office visit factors associated with accurate medication lists in Cleveland Clinic primary care practices. Methods Physician and MA medication reconciliation activities were directly observed during office visits. The primary outcome was agreement between the electronic medical record medication list at the conclusion of the office visit and what the patients said they were actually taking, assessed by structured telephone interview within 2 weeks of the office visit. Medication list agreement was defined as the absence of any discrepancies in name, dose, frequency, route, and as-needed status. Associations between patient, physician, MA, and office visit factors and medication list accuracy were assessed using χ² tests and logistic regression. Results Twenty-four physicians and 33 MAs were observed during 231 patient encounters. Nineteen patients (8%) could not be contacted for the telephone interview and were excluded from the analysis. Thirty-two patients (15%) had perfect medication list agreement for prescription and nonprescription medications, and 66 patients (31%) had medication list agreement for prescription medications only. Of the 14 patient, physician, and MA medication reconciliation behaviors examined, only 1, in which the MA begins the medication review with an open-ended question, was significantly associated with a medication list in agreement (odds ratio, 2.96; confidence interval, 1.43–6.09) for prescription and nonprescription medications. This association was not significant when only prescription medications were included (odds ratio, 0.90; confidence interval, 0.43–1.91). No behaviors we observed significantly influenced prescription medication list agreement. Conclusions Having MAs begin their medication review with an open-ended question may be a simple, inexpensive, and easily implemented process to increase accuracy of medication lists for prescription and nonprescription medications.

The interface between intersecting microfluidic multicomponent flow is investigated experimentally. The system studied has a main channel and an intersecting (at 90 degrees) daughter channel and the fluid is a water-microsphere mixture. Flow visualization is achieved using confocal fluorescence microscopy. Microsphere solutions of 2% and 4% spheres (by weight) are investigated and compared to each other as well as all water flows. A three-dimensional rendering of the location and shape of the interface at the junction for different flow ratios (daughter flow to total) is examined for a combined flow Reynolds number of approximately one. The interface downstream of the junction is reasonably planer (two-dimensional) and the presence of microspheres does not appear to strongly influence the location of the flow interface.