Variation in Entrustment When Sharing a Single Assessment System Between University- and Community-Based Residency Programs: A Comparison.

PURPOSE: Given resource constraints, many residency programs would consider adopting an entrustment-based assessment system from another program if given the opportunity. However, it is unclear if a system developed in one context would have similar or different results in another. This study sought to determine if entrustment varied between programs (community based and university based) when a single assessment system was deployed in different contexts. METHOD: The Good Samaritan Hospital (GSH) internal medicine residency program adopted the observable practice activity (OPA) workplace-based assessment system from the University of Cincinnati (UC). Comparisons for OPA-mapped subcompetency entrustment progression for programs and residents were made at specific timepoints over the course of 36 months of residency. Data collection occurred from August 2012 to June 2017 for UC and from September 2013 to June 2017 for GSH. RESULTS: GSH entrustment ratings were higher than UC for all but the 11th, 15th, and 36th months of residency (P < .0001) and were also higher for the majority of subcompetencies and competencies (P < .0001). The rate of change for average monthly entrustment was similar, with GSH having an increase of 0.041 each month versus 0.042 for UC (P = .73). Most residents progressed from lower to higher entrustment, but there was significant variation between residents in each program. CONCLUSIONS: Despite the deployment of a single entrustment-based assessment system, important outcomes may vary by context. Further research is needed to understand the contributions of tool, context, and other factors on the data these systems produce.

Impact of respiratory virus molecular testing on antibiotic utilization in community-acquired pneumonia.

We compared the clinical characteristics and antibiotic therapy of community-acquired pneumonia patients who were positive on a respiratory virus molecular test (polymerase chain reaction) with those who were negative. We found that respiratory virus molecular polymerase chain reaction testing has a minimal impact on reducing antibiotic utilization among viral pneumonia patients.

Probable Donor-Derived Cytomegalovirus Disease After Keratolimbal Allograft Transplantation.

PURPOSE: To report a case of probable donor-derived cytomegalovirus (CMV) infection after keratolimbal allograft (KLAL) transplantation. METHODS: Observational case report. RESULTS: A 41-year-old man with a history of aniridic keratopathy and limbal stem cell deficiency underwent KLAL in his right eye. Preoperatively, he was negative for CMV IgG and IgM. Postoperatively, he was maintained on tacrolimus and mycophenolate mofetil for systemic immunosuppression; he was also on prophylactic valganciclovir (for CMV) and trimethoprim/sulfamethoxazole (for pneumocystis pneumonia) for 1 month. Approximately 5 weeks postoperatively, he developed a nonproductive cough, rhinorrhea, and dyspnea. His condition did not improve with oral azithromycin or levofloxacin. He developed worsening symptoms over the next 2 weeks despite therapy. The serum CMV polymerase chain reaction was positive, and he was readministered valganciclovir with subsequent resolution of symptoms. CONCLUSIONS: We present the first case of CMV disease in a seronegative patient who received a presumed CMV-seropositive donor KLAL. Similar to solid organ transplantation, prophylactic and therapeutic management of CMV infection is necessary in the setting of systemic immunosuppression.