Family Medicine Clerkship Students’ Experiences With Team-Based Care

Interprofessional team-based care has the potential to improve patient outcomes, improve access to care, decrease costs, and improve team satisfaction. In recent years, efforts to implement team-based care have grown with the adoption of the Patient-Centered Medical Home (PCMH) and an increasing focus on value-based payment models. To better prepare our learners for this future, we introduced a formal team-based care curriculum in our three family medicine residency programs and one pediatric program. In addition to curricula for residents, we developed a team-based care didactic for family medicine clerkship students, presented by an interprofessional team of faculty. This session will describe our curricular efforts, team-based didactic for students, and outcomes related to students’ experiences with and knowledge of team-based care

VERIFICATION OF THE DEFENSE WASTE PROCESSING FACILITY'S (DWPF) PROCESS DIGESTION METHOD FOR THE SLUDGE BATCH 7A QUALIFICATION SAMPLE

For each sludge batch that is processed in the Defense Waste Processing Facility (DWPF), the Savannah River National Laboratory (SRNL) performs confirmation of the applicability of the digestion method to be used by the DWPF lab for elemental analysis of Sludge Receipt and Adjustment Tank (SRAT) receipt samples and SRAT product process control samples. DWPF SRAT samples are typically dissolved using a room temperature HF-HNO{sub 3} acid dissolution (i.e., DWPF Cold Chem Method, see DWPF Procedure SW4-15.201) and then analyzed by inductively coupled plasma - atomic emission spectroscopy (ICP-AES). This report contains the results and comparison of data generated from performing the Aqua Regia (AR), Sodium peroxide/Hydroxide Fusion (PF) and DWPF Cold Chem (CC) method digestions of Sludge Batch 7a (SB7a) SRAT Receipt and SB7a SRAT Product samples. The SB7a SRAT Receipt and SB7a SRAT Product samples were prepared in the SRNL Shielded Cells, and the SRAT Receipt material is representative of the sludge that constituates the SB7a Batch or qualification composition. This is the sludge in Tank 51 that is to be transferred into Tank 40, which will contain the heel of Sludge Batch 6 (SB6), to form the Sb7a Blend composition

Pericardial Thickness Measured With Transesophageal Echocardiography: Feasibility and Potential Clinical Usefulness

AbstractObjectives. This study assessed the reliability of transesophageal echocardiographic measurements of pericardial thickness and the potential diagnostic usefulness of this technique.Background. Transthoracic echocardiography cannot reliably detect thickened pericardium. The superior resolution achieved with transesophageal echocardiography should allow better pericardial definition.Methods. Pericardial thickness measured at 26 locations in 11 patients with constrictive pericarditis who underwent intraoperative transesophageal echocardiography was compared with pericardial thickness measured with electron beam computed tomography. Intraobserver and interobserver variabilities were determined. Pericardial thickness was then measured in 21 normal subjects. With these values as a guide, two observers reviewed 37 transesophageal echocardiographic studies to determine whether echocardiographic measurement of pericardial thickness could be used to distinguish diseased from normal pericardium.Results. The correlation between echocardiographic and computed tomographic measurements (r ≥ 0.95, SE ≤ 0.06 mm, p < 0.0001) was excellent. The ±2 SD limits of agreement were ±1.0 mm or less for pericardial thickness <5.5 mm and ±2.0 mm or less for the entire range of thicknesses. Intraobserver and interobserver agreements were good. Mean normal pericardial thickness was 1.2 ± 0.8 mm (±2 SD) and did not exceed 2.5 mm. Pericardial thickness ≥3 mm on transesophageal echocardiography was 95% sensitive and 86% specific for the detection of thickened pericardium.Conclusions. Measurement of pericardial thickness with transesophageal echocardiography is reproducible and should be a valuable adjunct in assessing constrictive pericarditis.(J Am Coll Cardiol 1997;29:1317–23

Development Of Ion Chromatography Methods To Support Testing Of The Glycolic Acid Reductant Flowsheet In The Defense Waste Processing Facility

Ion Chromatography (IC) is the principal analytical method used to support studies of Sludge Reciept and Adjustment Tank (SRAT) chemistry at DWPF. A series of prior analytical ''Round Robin'' (RR) studies included both supernate and sludge samples from SRAT simulant, previously reported as memos, are tabulated in this report.2,3 From these studies it was determined to standardize IC column size to 4 mm diameter, eliminating the capillary column from use. As a follow on test, the DWPF laboratory, the PSAL laboratory, and the AD laboratory participated in the current analytical RR to determine a suite of anions in SRAT simulant by IC, results also are tabulated in this report. The particular goal was to confirm the laboratories ability to measure and quantitate glycolate ion. The target was + or - 20% inter-lab agreement of the analyte averages for the RR. Each of the three laboratories analyzed a batch of 12 samples. For each laboratory, the percent relative standard deviation (%RSD) of the averages on nitrate, glycolate, and oxalate, was 10% or less. The three laboratories all met the goal of 20% relative agreement for nitrate and glycolate. For oxalate, the PSAL laboratory reported an average value that was 20% higher than the average values reported by the DWPF laboratory and the AD laboratory. Because of this wider window of agreement, it was concluded to continue the practice of an additional acid digestion for total oxalate measurement. It should also be noted that large amounts of glycolate in the SRAT samples will have an impact on detection limits of near eluting peaks, namely Fluoride and Formate. A suite of scoping experiments are presented in the report to identify and isolate other potential interlaboratory disceprancies. Specific ion chromatography inter-laboratory method conditions and differences are tabulated. Most differences were minor but there are some temperature control equipment differences that are significant leading to a recommendation of a heated jacket for analytical columns that are remoted for use in radiohoods. A suggested method improvement would be to implement column temperture control at a temperature slightly above ambient to avoid peak shifting due to temperature fluctuations. Temperature control in this manner would improve short and longer term peak retention time stability. An unknown peak was observed during the analysis of glycolic acid and SRAT simulant. The unknown peak was determined to best match diglycolic acid. The development of a method for acetate is summaraized, and no significant amount of acetate was observed in the SRAT products tested. In addition, an alternative Gas Chromatograph (GC) method for glycolate is summarized

SLUDGE WASHING AND DEMONSTRATION OF THE DWPF FLOWSHEET IN THE SRNL SHIELDED CELLS FOR SLUDGE BATCH 5 QUALIFICATION

Sludge Batch 5 (SB5) is predominantly a combination of H-modified (HM) sludge from Tank 11 that underwent aluminum dissolution in late 2007 to reduce the total mass of sludge solids and aluminum being fed to the Defense Waste Processing Facility (DWPF) and Purex sludge transferred from Tank 7. Following aluminum dissolution, the addition of Tank 7 sludge and excess Pu to Tank 51, Liquid Waste Operations (LWO) provided the Savannah River National Laboratory (SRNL) a 3-L sample of Tank 51 sludge for SB5 qualification. SB5 qualification included washing the sample per LWO plans/projections (including the addition of a Pu/Be stream from H Canyon), DWPF Chemical Process Cell (CPC) simulations, waste glass fabrication (vitrification), and waste glass chemical durability evaluation. This report documents: (1) The washing (addition of water to dilute the sludge supernatant) and concentration (decanting of supernatant) of the Tank 51 qualification sample to adjust sodium content and weight percent insoluble solids to Tank Farm projections. (2) The performance of a DWPF CPC simulation using the washed Tank 51 sample. This includes a Sludge Receipt and Adjustment Tank (SRAT) cycle, where acid is added to the sludge to destroy nitrite and remove mercury, and a Slurry Mix Evaporator (SME) cycle, where glass frit is added to the sludge in preparation for vitrification. The SME cycle also included replication of five canister decontamination additions and concentrations. Processing parameters for the CPC processing were based on work with a non radioactive simulant. (3) Vitrification of a portion of the SME product and Product Consistency Test (PCT) evaluation of the resulting glass. (4) Rheology measurements of the initial slurry samples and samples after each phase of CPC processing. This work is controlled by a Task Technical and Quality Assurance Plan (TTQAP) , and analyses are guided by an Analytical Study Plan. This work is Technical Baseline Research and Development (R&amp;D) for the DWPF