Sustainable Curriculum to Increase Scholarly Activity in a Family Medicine Residency.

BACKGROUND AND OBJECTIVES: Scholarly activity (SA) is an Accreditation Council for Graduate Medical Education (ACGME) requirement for family medicine residency programs. Engaging residents in scholarly activity can be challenging. In 2010, the Naval Hospital Jacksonville Family Medicine Residency (NHJ FMR) program pioneered a research curriculum that dramatically increased resident SA output. The purpose of this study was to determine whether this output sustained over time. METHODS: A retrospective records review was performed on resident SA at the NHJ FMR program between academic years 2012-2013 to 2016-2017 (N=185). The following research curriculum interventions were implemented over academic years 2010-2012: a faculty research coordinator position, a scholarly activity point system, and a peer-driven resident research coordinator position. SA output was calculated based on total resident projects per year and "quality projects" or peer-reviewed projects per year. Regression analysis and Mann-Whitney U test tested nonparametric group comparisons. RESULTS: The number of quality projects per resident per year increased from 0.34 in 2012-2013 to 1.05 in the 2016-2017 academic year. The quality projects per resident per year demonstrated a statistically significant increase over time (F(1,9)-18.98, P<.005, R2 of 0.6784). When comparing preintervention years to postintervention years the average quality projects per resident was statistically significant (P<.005). CONCLUSIONS: This curriculum model emphasizes unique and reliably sustainable interventions to increase scholarly output that can be implemented at any residency program. SA volume and quality increased over 5 postintervention years despite annual resident research coordinator turnover. This research demonstrates a resident-driven culture change that warrants future research on adaptability to other programs.

Respiratory Syncytial Virus Bronchiolitis in Children.

Bronchiolitis is a common lower respiratory tract infection in infants and young children, and respiratory syncytial virus (RSV) is the most common cause of this infection. RSV is transmitted through contact with respiratory droplets either directly from an infected person or self-inoculation by contaminated secretions on surfaces. Patients with RSV bronchiolitis usually present with two to four days of upper respiratory tract symptoms such as fever, rhinorrhea, and congestion, followed by lower respiratory tract symptoms such as increasing cough, wheezing, and increased respiratory effort. In 2014, the American Academy of Pediatrics updated its clinical practice guideline for diagnosis and management of RSV bronchiolitis to minimize unnecessary diagnostic testing and interventions. Bronchiolitis remains a clinical diagnosis, and diagnostic testing is not routinely recommended. Treatment of RSV infection is mainly supportive, and modalities such as bronchodilators, epinephrine, corticosteroids, hypertonic saline, and antibiotics are generally not useful. Evidence supports using supplemental oxygen to maintain adequate oxygen saturation; however, continuous pulse oximetry is no longer required. The other mainstay of therapy is intravenous or nasogastric administration of fluids for infants who cannot maintain their hydration status with oral fluid intake. Educating parents on reducing the risk of infection is one of the most important things a physician can do to help prevent RSV infection, especially early in life. Children at risk of severe lower respiratory tract infection should receive immunoprophylaxis with palivizumab, a humanized monoclonal antibody, in up to five monthly doses. Prophylaxis guidelines are restricted to infants born before 29 weeks' gestation, infants with chronic lung disease of prematurity, and infants and children with hemodynamically significant heart disease.

Development of a pan-serotype reverse transcription loop-mediated isothermal amplification assay for the detection of dengue virus.

During dengue outbreaks, acute diagnosis at the patient's point of need followed by appropriate supportive therapy reduces morbidity and mortality. To facilitate needed diagnosis, we developed and optimized a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay that detects all 4 serotypes of dengue virus (DENV). We used a quencher to reduce nonspecific amplification. The assay does not require expensive thermocyclers, utilizing a simple water bath to maintain the reaction at 63 °C. Results can be visualized using UV fluorescence, handheld readers, or lateral flow immunochromatographic tests. We report a sensitivity of 86.3% (95% confidence interval [CI], 72.7-94.8%) and specificity of 93.0% (95% CI, 83.0-98.1%) using a panel of clinical specimens characterized by DENV quantitative reverse transcription-polymerase chain reaction. This pan-serotype DENV RT-LAMP can be adapted to field-expedient formats where it can provide actionable diagnosis near the patient's point of need.