Learning Collaboratives in Medical Education: Exploring the Impact of Collaboratives' Structure and Resources and Teams' Experience.

The Alliance of Independent Academic Medical Centers (AIAMC) organized and coordinated a multicenter learning collaborative, National Initiative V (NI V), focused on community health and health inequity. A pre-post descriptive study was designed to examine the outcomes of the AIAMC NI V. Data were collected from pre- and post-assessment surveys as well as a project milestone self-assessment survey.

Statewide Antibiotic Stewardship: : An eBrightHealth Choosing Wisely Initiative.

Objective: To implement a collaborative statewide antibiotic stewardship initiative in both the ambulatory and inpatient settings.

Methods: Five participating Delaware health systems each convened internal team(s) to translate the vision set forth by the eBrightHealth LLC Choosing Wisely Work Group into clinical action through process improvement efforts at their institutions. The teams focused on implementing antibiotic time-outs, and on improving antibiotic prescribing for upper respiratory infections in ambulatory settings.

Value of prior imaging review before ordering renal sonography in the evaluation of abnormal renal function.

Background: To determine the prognostic relevance of prior imaging studies in the evaluation of patients referred for renal ultrasound (US) examination to investigate abnormal renal function tests.

Methods: We conducted a retrospective study of 208 consecutive renal US examinations performed for abnormal renal function tests.

Results: 68% (142/208) of patients reviewed for the study had prior abdominal imaging with 15% (21/142) receiving that imaging within 1 month prior to the renal US study and 56% (80/142) within the prior year.

Improving Infusion Pump Safety Through Usability Testing.

With the recognition that the introduction of new technology causes changes in workflow and may introduce new errors to the system, usability testing was performed to provide data on nursing practice and interaction with infusion pump technology. Usability testing provides the opportunity to detect and analyze potentially dangerous problems with the design of infusion pumps that could cause or allow avoidable errors. This work will reduce preventable harm through the optimization of health care delivery.

An Interdepartmental Care Model to Expedite Admission from the Emergency Department to the Medical ICU.

Background: Early evidence suggests that multidisciplinary programs designed to expedite transfer from the emergency department (ED) may decrease boarding times. However, few models exist that provide effective ways to improve the ED- to-ICU transition process. In 2012 Christiana Care Health System (Newark, Delaware) created and implemented an interdepartmental program designed to expedite the transition of care from the ED to the medical ICU (MICU).

Barriers to and facilitators of interprofessional-interdepartmental interventions: unearthing departmental culture.

This study evaluates how emergency department (ED) and medical intensive care unit (MICU) providers interact in the setting of a quality improvement project designed to enhance transport/care for patients from the ED to the MICU. Focus groups were conducted with nurses, residents, physician assistants, and physicians from the ED and MICU at baseline and 6 months regarding their thoughts on and perspectives of the intervention and working with colleagues from another department. Data were then analyzed utilizing a multistep coding scheme that identified key barriers to and facilitators of the interprofessional-interdepartmental intervention.

A phylogenetic study of Laeliinae (Orchidaceae) based on combined nuclear and plastid DNA sequences.

Background And Aims: Laeliinae are a neotropical orchid subtribe with approx. 1500 species in 50 genera. In this study, an attempt is made to assess generic alliances based on molecular phylogenetic analysis of DNA sequence data.

Necrotizing and crescentic lupus nephritis with antineutrophil cytoplasmic antibody seropositivity.

Background And Objectives: Lupus nephritis is a classic immune complex glomerulonephritis. In contrast, antineutrophil cytoplasmic antibodies are associated with necrotizing and crescentic glomerulonephritis, in the absence of significant immune deposits. Antineutrophil cytoplasmic antibodies are detected by indirect immunofluorescence in 20% of patients with systemic lupus erythematosus.

Sulfadiazine-induced nephrolithiasis detected by spiral CT scan.

Nephrolithiasis is a known complication of the use of sulfadiazine in the treatment of cerebral toxoplasmosis. Radiographic diagnosis of this complication has historically been challenging. Between March 1999 and June 2002, 11 patients were treated for cerebral toxoplasmosis with sulfadiazine-containing therapy.