Class of 2013 Abstract / Specific Aims: The objective of this study was to compare the use of amikacin 1 year before the national drug shortage and 1 year during drug shortage in order to evaluate the impact of the drug shortage on prescribing amikacin at an academic medical center. Methods: All patients admitted to an academic medical center between January 1, 2008 to December 31, 2008 before the shortage and January 1, 2011 to December 1, 2011 during the shortage who were prescribed amikacin were evaluated. Data collected included demographic information, type of infection, aminoglycoside therapy prescribed, laboratory data, culture and susceptibility data, therapy outcomes, and potential complications of aminoglycoside therapy. Appropriateness of amikacin therapy was based on each subject’s clinical condition, culture and susceptibility results, and availability of an alternative antibiotic agent. The use of amikacin was considered inappropriate in subjects with Gram-negative organisms that had either tobramycin or gentamicin minimum inhibitory concentrations of less than or equal to 2 mcg/mL. Main Results: A total of 11 subjects in 2008 and 17 subjects in 2011 who were prescribed amikacin were evaluated. The median and range duration of amikacin therapy was 2.2 days and 0-17 days in 2008. In 2011, the median and range duration of amikacin therapy was 4.6 days and 0-38 days. In 2008 and 2011, 27% and 47% were subjects with cystic fibrosis and/or a history of solid organ transplant, respectively. In 2008 73% of amikacin orders were classified as appropriate while 59% of amikacin orders were classified as appropriate in 2011. Ototoxicity was reported in one subject who received amikacin in both 2008 and 2011. Conclusion: Despite restrictions for ordering amikacin implemented during a nationwide shortage, the percentage of appropriate orders for amikacin was lower during the shortage compared to before the shortage at an academic medical center.

Global health initiatives from academic medical centers have rapidly proliferated over the last decade. This paper endeavors to describe our 5-year experience as an academic medical collaborative supporting healthcare delivery, medical training, and research at Hôpital Saint Damien-Nos Petits Frères et Soeurs, the only freestanding children's hospital in Haiti. Descriptions of the history and current activities of our academic medical collaborative, its partnership and communication structure, its evolution to fill the expressed needs of our host site, its funding mechanisms, and its challenges and opportunities for the future are included.

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The debate about healthcare reform revolves around a triple aim of improving the health of populations, improving the patient experience, and reducing the cost of care. A major tool discussed in this debate has been the adoption of electronic health record (EHR) systems to record and guide care delivery. Due to low adoption rates and limited examples of success, the problem was a lack of understanding by healthcare organizations of how the EHR fundamentally changes an organization through the interactions of people, processes, and technology over time. The purpose of this case study was to explore the people, processes, and technology factors that change as a result of an EHR implementation. Complexity theory was used as the lens to evaluate the effects of the EHR on the holistic system of healthcare. Data were collected using semistructured interviews and observations of physicians, nurses, and administrators, as well as document reviews of organizational documents related to the EHR. Data were analyzed using open coding to identify themes and patterns of usage that redesign or restructure institutional resources. The results of this study demonstrated positive changes in the interactions of healthcare providers with increasing collaboration on process changes and reliance on EHR for communication. These findings may positively affect government policy and the organizational approach to adoption and ongoing use of EHRs to create organizational change beyond the implementation of such systems, thus benefiting both health care employees and patients.

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