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    Maintenance of Certification: Focus Groups Provide Feedback

    JAMA Internal Medicine
    Published online Nov. 3, 2014

    Cook et al. conducted a study involving 11 focus groups totaling 50 primary care physicians to ascertain support for maintenance of certification (MOC) and concerns about its effectiveness, relevance, and value. They found that the participants viewed MOC as an unnecessarily complex process that is fundamentally out of alignment with its stated goals and purposes.

    For this focus group study, the researchers asked two questions: What are the barriers and enabling features associated with current MOC activities? How can these activities be changed to more effectively accomplish the intended purposes of MOC?

    The overarching response was that the purposes of MOC have not translated to the lives of individual physicians and their practice-specific needs. A number of participants noted that the primary reason they participated in MOC was to maintain needed professional standing. Moreover, they noted that both part 2 (self-assessment modules) and part 4 (practice performance projects) were largely irrelevant to their practice and an inefficient means of updating clinical knowledge and skills.

    Based on these and other findings, the researchers recommended six areas for improving the MOC process: 1) value for physicians and their patients, 2) integration with clinical practice, 3) effectiveness of instructional and assessment approaches, 4) relevance to individual needs, 5) coherence across MOC activities, and 6) support for physicians and simplification of actions.

    Autologous Serum Drops for Dry Eye Disease


    In this study, Hussain et al. evaluated whether 50 percent autologous serum eyedrops help alleviate dry eye disease after long-term use and found the drops to be both safe and effective. It is a valuable option in patients who have exhausted all other conventional forms of treatment.

    The researchers evaluated 63 patients (123 eyes) at the University of Michigan Health System who used autologous serum eyedrops. Mean follow-up was 12 months. Eleven of the patients had graft-vs.-host disease (GVHD), 11 had Sjögren syndrome, 38 had idiopathic dry eye, and the remainder had persistent epithelial defect or Stevens-Johnson syndrome.

    Schirmer scores and fluorescein staining improved during treatment for the patients with idiopathic dry eye and those with GVHD. By contrast, patients with Sjögren syndrome showed a significant improvement in fluorescein staining but no improvement in Schirmer scores. All patients reported subjective improvement with the use of the eyedrops, and no significant adverse effects were noted. A subset of 21 patients used the autologous serum drops in conjunction with the custom-designed scleral contact lens known as PROSE, applying the drops over the device and not within the tear reservoir.

    Despite the drops’ benefits, they do have several drawbacks, according to the researchers. These include an increased risk of infection, significant patient expense, the need for frequent blood draws, and the challenge of providing stable, temperature-controlled storage.

    Google Glass and Visual Function


    In the first evaluation of wearable electronics featuring head-mounted display systems, Ianchulev et al.compared the performance of Google Glass in perimetric visual field tests with that of regular eyewear. They found that the Google Glass device created a clinically meaningful visual field (VF) obstruction in the upper right quadrant.

    This small study involved three healthy individuals with 20/20 best-corrected visual acuity and normal baseline VFs. The patients wore Google Glass for a 60-minute acclimation period. They then underwent 30-2 and 60-4 threshold perimetric VF testing while wearing the device and again while wearing a regular control frame of similar color and temple width. The researchers also analyzed online images of people wearing Google Glass and assessed the images for prism position relative to the pupil.

    The results indicated a significant scotoma in each of the three participants during their use of Google Glass, with more than 10 degrees of VF in the horizontal axis subtended. The scotoma was absent during perimetry testing with the regular frame. Image analysis further demonstrated that most people wear the device near or overlapping the pupillary axis, which may induce scotoma and interfere with daily function.

    The researchers concluded that future studies should address issues such as contrast sensitivity and functional outcomes, notably driving ability in a simulated setting.


    Roundup of Other Journals is written by Jean Shaw and edited by Deepak P. Edward, MD.

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