Preparing Academic Medical Centers for the Clinical Learning Environment Review: Alliance of Independent Academic Medical Centers National Initiative IV Outcomes and Evaluation.

BACKGROUND: Driven by changes to improve quality in patient care and population health while reducing costs, evolvement of the health system calls for restructuring health professionals' education and aligning it with the healthcare delivery system. In response to these changes, the Accreditation Council for Graduate Medical Education's Clinical Learning Environment Review (CLER) encourages the integration of health system leadership, faculty, and residents in restructuring graduate medical education (GME). Innovative approaches to achieving this restructuring and the CLER objectives are essential. METHODS: The Alliance of Independent Academic Medical Centers National Initiative (NI) IV provided a multiinstitutional learning collaborative focused on supporting GME redesign. From October 2013 through March 2015, participants conducted relevant projects, attended onsite meetings, and participated in teleconferences and webinars addressing the CLER areas. Participants shared best practices, resources, and experiences. We designed a pre/post descriptive study to examine outcomes. RESULTS: Thirty-three institutions completed NI IV, and at its conclusion, the majority reported greater CLER readiness compared with baseline. Twenty-two (88.0%) institutions reported that NI IV had a great impact on advancing their efforts in the CLER area of their project focus, and 15 (62.5%) reported a great impact in other CLER focus areas. Opportunities to share progress with other teams and the national group meetings were reported to contribute to teams' success. CONCLUSION: The NI IV learning collaborative prepared institutions for CLER, suggesting successful integration of the clinical and educational enterprises. We propose that national learning collaboratives of GME-sponsoring health systems enable advancement of their education mission, leading ultimately to better healthcare outcomes. This learning model may be generalizable to newfound programs for academic medical centers.

Yoga in Pregnancy: An Examination of Maternal and Fetal Responses to 26 Yoga Postures.

OBJECTIVE: To examine the acute maternal and fetal effects of yoga postures and suspected contraindicated postures in a prospective cohort of healthy pregnant women in the third trimester. METHODS: This was a prospective study that evaluated pregnant women between 35 0/7 and 37 6/7 weeks of gestation in a one-on-one yoga session. A baseline nonstress test, vital signs, and pulse oximetry were performed. Participants then assumed 26 yoga postures. Vital signs, pulse oximetry, tocometry, and continuous fetal heart rate monitoring were obtained in each posture. Postsession nonstress test, vital signs, and pulse oximetry were obtained. Participants were contacted 24 hours postsession. RESULTS: Twenty-five healthy pregnant women were evaluated. Ten reported regular yoga practice, eight were familiar with yoga, and seven had no yoga experience. Yoga groups were similar in age, race, body mass index, gestational age, and parity. Presession and postsession nonstress tests were reactive. Presession and postsession data showed no change in maternal heart rate, temperature, pulse oximetry, or fetal heart rate. During the 26 yoga postures, vital signs, pulse oximetry, and uterine tocometry remained normal in all women and in all postures. The fetal heart rate across all 26 postures was normal. There were no falls or injuries during the total cumulative 650 poses. No participants reported decreased fetal movement, contractions, leakage of fluid, or vaginal bleeding in the 24-hour follow-up. CONCLUSION: All 26 yoga postures were well-tolerated with no acute adverse maternal physiologic or fetal heart rate changes. LEVEL OF EVIDENCE: III.

Idiopathic granulomatous mastitis with erythema nodosum simulating breast abscess in pregnancy: A case report.

Granulomatous mastitis is a rare benign inflammatory condition of the breast and is known to be associated with pregnancy. A 25-year-old Hispanic G2P1 at 17 weeks gestation presented to the emergency department with findings consistent of a breast abscess. The abscess failed to resolve with incision and drainage followed by multiple courses of antibiotic therapy. A biopsy was then obtained and yielded a diagnosis of granulomatous lobulitis. The patient was treated with steroids and her symptoms resolved. Granulomatous lobulitis may present with characteristics of various clinical entities including neoplasm or, as in this case, abscess. Clinicians should consider a diagnosis of granulomatous mastitis in cases of recalcitrant breast abscess.