These results demonstrate that the general safety of zoster vaccine in older persons is not altered by a recent history of documented HZ, supporting the safety aspect of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommendation to administer zoster vaccine to all persons ≥ 60 years of age with no contraindications, regardless of a prior history of HZ.

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In this article, the authors reexamine the Ambulatory Diagnostic and Treatment Center (ADTC) model, which uniquely combines the education of trainees with the care of referred patients at one Veterans Affairs medical center. As an ambulatory clinic with an inpatient mind-set, the ADTC uses a series of closely spaced outpatient appointments that are longer than typical ambulatory visits, offering a VIP-level of evaluation with the patient-centered goal of expedited diagnosis and treatment. Faculty triage patients by weighing factors such as urgency, educational value, complexity, and instability of diseases in conjunction with the resources, availability, and appropriateness of other services within the medical center.The ADTC's unique focus on the education of trainees in comparison with other clinical rotations is evident in the ratio of learning to patient care. This intensive training environment expects postgraduate year 2 and 3 internal medicine residents and fourth-year medical students to read, reflect, and review literature daily. This mix of education and care delivery is ripe for reexploration in light of recent calls for curriculum reform amidst headlines exposing delays in veterans' access to care.A low-volume, high-intensity clinic like the ADTC can augment the clinical services provided by a busy primary care and subspecialty workforce without losing its emphasis on education. Other academic health centers can learn from this model and adapt its structure in settings where accountable care organizations and education meet.

We present a case of a 77-year-old male with persistent gram-positive nonYspore-forming bacillus bacteremia that developed several months after a right femoral-popliteal bypass for critical limb ischemia and a nonhealing toe amputation site. He required an implantable cardioverter defibrillator concomitantly for secondary prevention of ventricular fibrillation. Initially suspected to be a contaminant and subsequently growing from the implantable cardioverter defibrillator leads, all isolates were identified as Corynebacterium striatum. The patient was successfully treated with a prolonged course of antibiotics and explantation of the defibrillator. This represents the first case reported in the literature of Corynebacterium striatum cardiovascular implantable electronic device infection from an apparent noncontiguous source. Multiple isolates of indistinguishable diphtheroids from multiple blood cultures in patients with implantable devices should be considered clinically significant.