Pharmacist-Physician Collaboration at a Family Medicine Residency Program: A Focus Group Study

Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR), family medicine faculty (FMF), and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice. Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice. Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1) roles of pharmacists recognized by physicians in different settings, 2) benefits to collaboration, and 3) keys to successful pharmacist-physician collaboration which include a) developing the relationship, b) optimizing communication, c) creating beneficial clinical workflow, d) clarifying roles and responsibilities, and e) increasing opportunities for meaningful interactions. Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the physicians understand the abilities of pharmacists, and help the pharmacists articulate to the physicians the value of what they provide to patients. The five keys identified in this study are building blocks to advance a successful collaborative working relationship that positively benefits patient care and achieves the Quadruple Aim. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties Treatment of Human Subjects: IRB exemption granted   Type: Original Researc

Pharmacist-Physician Collaboration at a Family Medicine Residency Program: A Focus Group Study

Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR), family medicine faculty (FMF), and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice. Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice. Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1) roles of pharmacists recognized by physicians in different settings, 2) benefits to collaboration, and 3) keys to successful pharmacist-physician collaboration which include a) developing the relationship, b) optimizing communication, c) creating beneficial clinical workflow, d) clarifying roles and responsibilities, and e) increasing opportunities for meaningful interactions. Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the physicians understand the abilities of pharmacists, and help the pharmacists articulate to the physicians the value of what they provide to patients. The five keys identified in this study are building blocks to advance a successful collaborative working relationship that positively benefits patient care and achieves the Quadruple Aim. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties Treatment of Human Subjects: IRB exemption granted   Type: Original Researc

Experiential Learning Programs for the Future of Engineering Education

The need for 21st century engineers to be educated as creative innovators is discussed. Three complementary experiential learning programs that help engineering students learn to stretch beyond their comfort zones are described: a multidisciplinary design program; an entrepreneurship program; and an international engineering program. These three interdisciplinary programs each address common educational needs: to create flexible, creative, self-actualized change agents. The approaches we are taking to implement and institutionalize these in a large, comprehensive, research oriented university are described.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86757/1/Sick5.pd

The Big Ten IPE Academic Alliance: A regional approach to developing Interprofessional Education and practice

Interprofessional practice and education (IPE) efforts has greatly increased in the past few years, primarily through the leadership of several national and international organizations. These organizations have sponsored forums for information exchange and best practices, which has significantly influenced the development of programs across various educational institutions and practice environments. Several regional groups have emerged, organized around a common purpose and geographic proximity, to share ideas and implement new IPE programs across the cooperating organizations. This article describes the history and growth of one of the newer regional groups, the Big Ten IPE Academic Alliance. Included in this discussion is how the group was created, its governing structure and the various results of its efforts. The intent is to provide expanded guidance how to develop regional groups that are effective vehicles for the successful implementation of IPE within educational and health settings

Initial Efforts to Manage IPE during the COVID-19 Pandemic: Reports from the Big Ten Academic Alliance

Purpose: The COVID-19 pandemic required higher education institutions to quickly transition to a virtual platform. This was challenging for those involved in interprofessional education (IPE), given the goal that students from two or more professions learn about, from, and with one another. The Big Ten IPE Alliance is a subgroup of the larger Big Ten Academic Alliance. The purpose of this paper is to share the collective experiences of multiple large, research intensive universities in addressing the challenge of implementing IPE programs under the conditions established by the COVID-19 pandemic. Methods: To better understand how the Big Ten schools dealt with the transition to virtual learning for didactic and clinical IPE given the COVID-19 pandemic, a subset of representatives from the Big Ten IPE Alliance met to discuss best practices for virtual learning in the IPE realm. Each participating university completed an electronic 14 question survey related to their IPE curriculum during the COVID-19 pandemic from March 2020 thru August 2020 and the responses were analyzed. Results: Four categories were identified as needing to be addressed to develop and implement successful interprofessional didactic and clinical experiences. The categories identified included content/assessment, virtual technologies, faculty and facilitators, and learners. Conclusions/Recommendations: Consider including authentic and innovative mechanisms to deliver IPE experiences that meet the learning needs and accreditation requirements. Interinstitutional collaborations such as within the Big Ten IPE Alliance can be beneficial in assessing current and future best practices in IPE

The intersection of Interprofessional Education and One Health: A qualitative study in human and veterinary medical institutions

Interprofessional Education (IPE) and One Health are two common and overlapping frameworks for teaching collaborative practice. IPE is common at human medical institutions, while One Health is more common in graduate and veterinary programs. The connection between IPE and One Health is still being explored both in scholarship and in real-world professional settings. This prospective, qualitative research study examines the intersection of IPE and One Health at institutions that are members of the Clinical and Translational Science Award (CTSA) One Health Alliance (COHA). COHA consists of veterinary schools partnered with medical institutions through the National Institutes of Health CTSA funding mechanism with the specific goal of advancing the understanding of diseases shared by humans and animals. Twenty-four interviews were conducted with professionals across eight professions. Subjects noted that some of the biggest barriers to IPE education were awareness, accessibility, efficacy, and implementation beyond the classroom. Competency across multiple institutions and a consistent, validated evaluation tool were noted to be lacking. Interviews highlighted a lack of a shared mental model for IPE and One Health across the medical professions, major hurdles for implementation in professional curricula, and a disconnection between bridging IPE and One Health to the workforce and global challenges. Future work in this area may be focused on assessing the IPE and One Health offerings beyond COHA institutions, giving a more holistic understanding on how IPE and One Health are being deployed. One Health can be operationalized through the adoption of IPE principles and practices into curriculum. This research is critical to educate others on current applications, role, and definitions of One Health and IPE. The ultimate goal of this work is to help cultivate transdisciplinary leaders in the human and animal medicine who will have the skills to solve systemic problems

LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie

Unsupervised assessment of microarray data quality using a Gaussian mixture model

<p>Abstract</p> <p>Background</p> <p>Quality assessment of microarray data is an important and often challenging aspect of gene expression analysis. This task frequently involves the examination of a variety of summary statistics and diagnostic plots. The interpretation of these diagnostics is often subjective, and generally requires careful expert scrutiny.</p> <p>Results</p> <p>We show how an unsupervised classification technique based on the Expectation-Maximization (EM) algorithm and the naïve Bayes model can be used to automate microarray quality assessment. The method is flexible and can be easily adapted to accommodate alternate quality statistics and platforms. We evaluate our approach using Affymetrix 3' gene expression and exon arrays and compare the performance of this method to a similar supervised approach.</p> <p>Conclusion</p> <p>This research illustrates the efficacy of an unsupervised classification approach for the purpose of automated microarray data quality assessment. Since our approach requires only unannotated training data, it is easy to customize and to keep up-to-date as technology evolves. In contrast to other "black box" classification systems, this method also allows for intuitive explanations.</p

Proyecto I: Fundamentos de educación interprofesional

Sin financiaciónNo data (2018)UE

Defining and Characterizing Frequent Attenders: Systematic Literature Review and Recommendations

Purpose: To decrease cost and improve efficiency, health care organizations have focused on frequent attenders — patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance. Methods: This systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent attendance. Results: Most studies defined frequent attenders by number of health care visits within a set time period (n = 115) and top percentile cutoff (n = 42). Based on averages across studies, we propose the following frequent attender definitions: for primary care, either the top 10th percentile or at least 10 visits in 12 months; for emergency room, at least 5 visits in 12 months; and for inpatient hospitalization, at least 4 admissions in 12 months. Common factors correlated with frequent attendance were mental health and chronic disease. Conclusions: We propose definitions of frequent attenders for three common health care settings: primary care, emergency room, and inpatient. Future studies should include mental health and chronic disease, among other factors, when studying this population. Adoption of these recommendations will allow comparisons across studies such that meta-analyses may better determine interventions for more appropriate health care utilization