Tuesday, November 13, 2018

Here We Go Again, The Doctor's White Coat, But Wait,This is (Slightly) Nuanced.

Thomas Eakins- The Agnew Clinic, 1889
Here is an  article published in Pharos on the doctor's white coat.  The article explores the white coat as a symbol of the U.S. medical profession.  The historical context is neatly summarized.

But here is the most striking part:  In 1976 patient approval (Gallup Poll) of physicians (high or very high reported approval) was 56%.  In 2016, the reported approval was 65%, a modest gain.

In my opinion, public approval of the medical profession is less than optimal.  The white coat as a symbol of humanism and professionalism falls short.  Perhaps we would be better perceived if we relentlessly advocated for universal access to safe and reliable care.

As for my opinion on the white coat, it can be found in this comprehensive summary.

Saturday, November 10, 2018

IMED 2018: Workshop on the Guide to Infection Prevention in Healthcare Settings- Making Expert Content in Infection Prevention Available to All


Thank you the conference organizers and to the generous turnout for today's work shop on Guide to Infection Control in the Healthcare Setting.  The book is now in its 6th edition and transformed into a full content website.

In 2019, along with my co-editors and the support of the International Society for Infectious Diseases, we will transform the website into a WebApp- with interactive content, updates etc. 

The project will also be translated into Spanish.

The overarching goal is to make practical, hands on infection prevention expert knowledge available to all, for free.

The feedback from the audience was superb.

Friday, November 9, 2018

IMED 2018- Vienna, Austria: Opening Plenary of to a Strong Start





I am currently in Vienna, Austria, Attending the IMED 2018 (International Meeting on Emerging Diseases). 

The scientific program thus far has been superb with an engaging opening ceremony on the recent outbreaks including Ebola, Nipah Virus, Rift Valley fever, MERS CoV, Listeria and other pathogens, all by world experts.

Every outbreak is a wise teacher.

Tomorrow I have the honor of directing an IMED workshop on The Guide to Infection Control in the Healthcare Setting, on new directions and enhancements in our book turned open access website, accessible here.

Stay tuned.

Thursday, November 1, 2018

We Are Not As Good As We Think! Prevalence of Hospital Acquired Infections in the USA Remains High



Soource: Royal College of Nursing.org
We are not as good as we think.

The prevalence of hospital-acquired infections has decreased to 3.2% from 4% of hospitalized patients, as just reported here in the New England Journal of Medicine. No significant improvement in C. difficile infection was reported. 

This is a modest safety gain in my opinion. 

C difficile reduction has lagged because of ongoing antibiotic overuse, overly sensitive testing mechanisms (PCR) and less than optimal environmental disinfection. Probable diverse reservoirs for transmission, including the community, are also contributing factors.

To further improve the prevalence of hospital-acquired infections healthcare systems must vigorously focus on implementation science, with the specific use of pragmatic, real world interventions that reliably decrease risk.  This includes consistent mechanisms to ensure hand hygiene, patient chlorhexidene bathing, the use of safety checklists/safety time-outs and heighten environmental disinfection.  In addition, more strategies are needed to improve antibiotic use so as to minimize over treatment and selective pressure for drug resistant bacteria.

We can do better for the safety of our patients.

Monday, October 29, 2018

Do You Fancy Yourself an Agent of Change? If So, Read On

If you are attempting to make change within your organization, I would strongly suggest that you check out the book Switch by Chip and Dan Heath.

The three major elements for making significant organizational change:

  • 'Direct the Rider’- have a specific, rational argument  that avoids TBU (True But Useless) information
  •  “Motivate the Elephant”- call upon emotions so that people have a visceral motive for change
  • “Shape the Path” -explicitly and with the utmost simplicity show the critical steps to achieve the goals
Shaping the path requires the 4 Disciplines of Execution- setting wildly important goals, clearly identifying processes, measuring the processes with a scorecard and holding people accountable.

In other words, have a specific goal, provide a persuasive rational and emotional argument for change, then clearly plot out the steps.The simpler, the better.

Thursday, October 25, 2018

Money Talks! Industry and Public Health Don't Always Mix

Money talks and certainly buys influence.


This article published in the American Journal Public Health explores the influence of industry sponsorship on research agendas.  Credit to the authors for an extensive and informative review.

Bottom line: Industry sponsorship significantly influences research agendas, particularly in favor of pharmaceutical and device trials but also in the food and nutrition sector.  This results in publications that are generally favorable to industry positions.  

In addition, industry can disseminate research agendas by creating collaboration with prominent institutions and researchers. Prestige and legitimacy ensue.

This sort of bias in the research agenda can result in misaligned public health policies. 

Monday, October 22, 2018

Viral Spread of Medical Misinformation: A Major Public Health Threat

Misinformation going viral on vaccines and viral illnesses is ascendant and alarming, as neatly explored here in Nature.

The author, Professor Heidi Larson from the London School of Hygiene and Tropical Medicine and director of the Vaccine Confidence Project, argues that the next major outbreak will not be due to the lack of preventive technologies, but rather to vaccine preventable illnesses rendered moot by misinformation and erosion of public trust.

I have recently blogged about how false news spreads more efficiently than the truth, accessible here.

Bottom line, the viral spread of medical misinformation, particularly about vaccines, should now be recognized as a global public health threat.