Monday, February 8, 2016

The 80/20 Principle

Every now and then I go back to my bookshelf and dust off the book The 80/20 Principle- The Secret to Achieving More With Less Effort, by Richard Koch.

A free PDF copy is available here.

Based on an economic observation known as the Pareto Principle, the 80/20 Principle is an observation that 20% of inputs results in 80% of outputs or that 20% of your effort achieves 80% of your results. 

In more practical terms, much of the day is wasted and if you look around attentively, examples abound.  Much of what  we do during the workday has little meaning or real purpose- pointless meetings, shuffling papers, etc. Much of the issues that I deal with as an infectious diseases physician can be broken down in the 80/20 perspective: 80% of the infection prevention problems are caused by 20% of the units in the hospital.

By only recently recognizing this trend, I have learned to maximize my focus and productivity. Most importantly, I have learned to comfortably say 'no' to many unimportant requests. In doing so, things are clearer, more manageable and less stressful.  

This is achieved with personal awareness and self-discipline, there are no shortcuts.

Friday, February 5, 2016

The Annual Health Examination (Or Annual Check Up): Waste of Time and Money?

The time honored annual 'check-up' is traditionally viewed as sacrosanct in medical practice but what evidence exists to support it?

As it turns out, the evidence to support the periodic health examination is far less than robust and these visits are generally not recommended for asymptomatic adult patients. This does not mean that age and gender specific screening such as mammography and colon cancer screening should not be performed, rather, that an an annual 'check-up' is not necessary to achieve these targets.

For a very recent article on the matter, published in Annals of Internal Medicine, click here

New Perspectives on old paradigms, I love it.

Back on the VCU ID Consult Service tomorrow... 

Wednesday, February 3, 2016

Back in Honduras- February 2016: Random Images

Below are some random images from the last several days, many of them from my meanderings across the Catracho countryside.

Próxima parada...EEUU...bittersweet.













Tuesday, February 2, 2016

Back in Honduras-February 2016

Newspaper cover 2/1/16
I am back in Honduras, where Zika virus is alive and well. 

This week's objective is to plan and coordinate the June 2016 VCU Global Health and Health Disparities trip to rural, mountainous La Hicaca and environs. 

Highlights for the upcoming brigade include:
  • Reassessment of chlorine water sanitation project efficacy for sustainable potable water
  • Re-deployment of home water filters for improvement of water sanitation, as summarized here.
  • Ongoing implementation of new indoor cookstoves for improved indoor air quality, as previously summarized here.
  • Ongoing deworming and assessment of mass deworming efficacy, in collaboration with Dr. Ana Sanchez of Brock University, Ontario, Canada.
  • Ongoing installation of latrines to scale, in collaboration with the Pico Bonito Foundation, to minimize open defecation and the transmission of soil transmitted
    Mosquito control poster- Ministry of Health
    helminths
  • At the request of the local Ministry of Health, as part of the station based clinic process- targeted, formal educational messages will be delivered. This will include messages to prevent diarrheal illnesses, respiratory illnesses and mosquito,vector-borne diseases such as Dengue, Chikungunya and Zika virus.
  • Ongoing cervical pap smear assessments in collaboration with local public health authorities
  • For the first time, in collaboration with our colleagues from Brock University, we will formally assess and de-lice school aged children.
As always, plans are fluid and subject to the unexpected nature of things in Honduras. 

Things can go awry quickly.



Map of La Hicaca and environs


New Latrines- La Hicaca















Saturday, January 30, 2016

The Bedside Nurse, Antimicrobial Stewardship and Infection Prevention

This is an intriguing read in Clinical Infectious Diseases, one that recognizes the role of he staff nurse in antimicrobial stewardship. As stated in the paper, nurses are antibiotic first responders, central communicators, coordinators of care, as well as 24-hour monitors of patient status, safety, and response to antibiotic therapy-  their role as antimicrobial stewards seems self evident. 

Why stop there?

In essence, nursing staff are the champions of infection prevention. Nurses have the greatest contact with patients, almost uniformly wash their hands more than physicians and are major drivers of infection prevention best practices including central line checklists, urinary catheter discontinuation, head of bed elevation, and chlorhexidine patient bathing, to name a few.

Without nursing involvement, patient safety falters.

Sunday, January 24, 2016

Back in the United Kingdom

Back in the UK for the week where I was able to visit both London and Cardiff, Wales. Cardiff was particularly sentimental as I was a university exchange student there in 1992.

Old times revisited.


Grenadiers at the Tower of London

Tower Bridge

Tower of London

The London Eye

View of Parliament

Trafalgar Square

Regent Sounds Studio- where David Bowie and the Rolling Stones recorded some of their earliest music


Beau Brummell statue on Jermyn Street
View of the Thames from the Millennium Bridge

Globe Theatre

Norman Keep, Cardiff Castle

Cardiff Castle 

Norman Keep, Cardiff Castle

Cardiff Castle

View of Cardiff from atop Cardiff Castle


Cardiff University- University of Wales

Cardiff, Wales- Bay Area

Cardiff University- my old dormitory hall
Cardiff University grounds as seen from atop of the Student Union

Ramons- famous greasy spoon in Cardiff ,Wales- frequented by University students, also a site where Dr. Who was filmed

Cardiff University Student Union

Friday, January 15, 2016

The Votes are in and Sanitation is the Winner!

With Drs. Mason and Stevens in Honduras,
installing water filters for safe drinking water
The votes are in, as summarize in this BMJ Press release. Sanitation was voted the the greatest medical milestone since 1840, beating out other major achievements such as antibiotics, vaccines and anesthesia.

Here is a related article published recently in BMJ, a meta-analysis of water sanitation studies, confirming the impact  on decreasing protozoal diarrheal infections.

This is consistent with the ongoing, longitudinal public health sanitation works that we coordinate in rural Honduras, as summarized on our VCU Global Health and Health Disparities website.