The Association of Hearing Loss with Hospitalization.

BACKGROUND: Individuals with hearing loss (HL) are at higher risk for hospitalizations, and may be for readmissions, compared with their hearing peers. The objective of this prospective study was to confirm retrospective studies suggesting that HL increases hospital readmissions, and, if confirmed, possible causes for it. METHODS: A prospective cohort study of English-speaking patients >55 years old admitted to general medical and surgical floors at 2 large hospital systems in southeastern Michigan over a 2-year period was conducted. All patients underwent bedside audiometric testing. HL presence and severity were categorized using World Health Organization pure tone assessment parameters. Readmission rates, Charlson comorbidity index, socio-demographic and medical variables were obtained from Epic EMR databases. OUTCOMES: There were 1247 hospitalized patients enrolled. Of these, 76.8% had documented HL of which 50.5% (630) was mild HL and 26.3% (328) moderate or worse HL. Patients with any HL were older and more likely to be non-Hispanic, white, male, and had less education, lower health literacy, more comorbidities, and more difficulty communicating with their doctor. Readmission rates at 30 and 90-days were similar between HL and hearing groups, after adjusting for HL severity, Charlston index, and numerous potential confounders. CONCLUSION: Patients with HL do not seem to have higher rates of hospital readmissions. We did find high frequency of HL in hospitalized patients along with significant communication difficulties that patients had with their clinicians. These findings have implications for measures to improve patient-physician communication, potentially improving long-term health outcomes.

The Impact of Virtual Interviews on the Resident Candidate: A Before-and-After Comparison.

BACKGROUND AND OBJECTIVES: A significant impact of the COVID-19 pandemic on family medicine residency recruitment has been a requested transition to virtual interviewing by the Association of American Medical Colleges and the academic family medicine community. This has led to creative and adaptive approaches to virtual interviewing with little previous knowledge, experience, or processes. This work describes the impact of transitioning to virtual recruitment on applicants' reported experiences and factors influencing decision-making with family medicine at a large research university. METHODS: We made a comparison of 2 years of in-person interview day surveys with 2 years of virtual interview surveys following transition to virtual recruitment. We tested differences between in-person and virtual interviews for significance using χ2 tests. RESULTS: There were significant differences in factors influencing a candidate's decision to apply. Candidates who participated in virtual interviews were more interested in urban training settings, a community setting, and obstetrical training compared with the in-person interview cohort. Nearly 50% of virtual candidates reported preferring virtual interviews in the future. There were no significant differences in how candidates rated their experience of the interview process and they indicated adequate contact with resident personnel despite a transition to virtual interviews. CONCLUSIONS: The transition to virtual recruitment has been well received by candidates, as indicated by the high positive ratings of the cohorts. The transition has not resulted in a negative impact on the recruitment experience or the ability to meet with resident leadership.

Focus on Systems to Improve Morbidity and Mortality Conference Relevance.

BACKGROUND AND OBJECTIVES: Morbidity and mortality conference (MMC) is educationally important. However, resident physicians rate it less positively than faculty, citing focus on assigning blame rather than targeting change. Additionally, many MMC presentations are selected for clinical novelty instead of avoidable outcome. Despite significant time and resources routinely committed to MMC, its educational and clinical impact is generally limited. This warrants shifting focus toward quality improvement and systems-based care. METHODS: From July to December 2017, within a large, public academic center and medical school, the family medicine MMC became a quality conference (QC) focusing on thematically-linked, system-based errors. After case presentations, the audience split into small groups for targeted discussion then reconvened to identify specific interventions. We collected attitudinal data from faculty and resident physicians in attendance using real-time audience text polling, targeting case relevance and change impact. RESULTS: Compared to MMC, QC case relevance improved by 0.39 (P<.01) on a 5-point scale. Compared to MMC, QC cumulatively approached but did not meet statistical significance regarding changing clinical practice. Qualitative statements commented on increased multilevel engagement, dedicated follow up, and decreased didactic presentations. CONCLUSIONS: QC demonstrated statistically significant increased relevance compared to MMC, reflecting the benefit of systems-based, thematically-linked cases.

Chronic intestinal pseudo-obstruction due to Strongyloides stercoralis.

We report a case of chronic intestinal pseudo-obstruction due to a generalized visceral autonomic neuropathy in an immune-competent patient infected with Strongyloides stercoralis. The patient had immigrated to the United States from Sierra Leone in childhood but had not returned for decades. His symptoms resolved with ivermectin treatment. Clinicians should have a high index of suspicion for strongyloidiasis in any patient with abdominal complaints and a history of travel to endemic areas, even if the travel history is remote.