Thursday, July 11, 2019

Play it Safe! Fake Kiss the Pope's Ring

Now this article is intriguing. 

Should the Pope continue to allow his followers to kiss the Piscatory ring? The practice, albeit ritualized, is far from hygienic, as summarized in this brief manuscript.

But how real is the risk of infection? Probably small and the risk of an outbreak from the Pope's ring is even smaller.

The practical solution, if so sought: adopt a fake kiss of the ring.

As for rings at the bedside in healthcare, they should be banned as the bacterial burden is significant. Rings also cannot be effectively cleaned in between patients.

Time for a practice change.

Saturday, July 6, 2019

Checklist for Anthrax Mass Exposure Event: Hopefully We Will Never Need to Use It

I was pleased to see this paper on a checklist for anthrax mass exposure published in the Annals of Internal Medicine. The paper was written by my Cornell University colleague, Dr. Nathaniel Hupert.

Dr. Hupert and I previously published a protocol for anthrax screening in 2003, also in Annals of Internal Medicine. That paper is available here.

In the unlikely case of an anthrax mass exposure event, in the face of fear and chaos, a sensitive and reliable checklist to distinguish anthrax signs and symptoms from other conditions would be a hugely valuable triage tool.

Let's hope we never have to use it.

Tuesday, July 2, 2019

The Catalogue of Shipwrecked Books: The Amazing Quest for All Books in All Languages

Source: The Vintage News

Everyone knows of Christopher Columbus but what about his youngest son Hernando Columbus? After accompanying his explorer father to the New World (on the 3rd and 4th voyages) Hernando become a different sort of conquistador back in Europe. A conqueror of books.

Hernando  amassed on of the largest private libraries ever known, with the deliberate goal  of collecting widely (all books in all languages), beyond what was considered acceptable or of value by the Catholic church. His collection spanned between 15,000-20,000 books. Hernando was obsessed with collecting, mapping, and cataloging a wide view of then contemporary affairs. 

His ambition and stamina in this singular quest was amazing.

The collection, known as the Colombine Library, is housed in Seville, Spain.

Herando's bibiomaniacal quest is deftly recounted in The Catalogue of Shipwrecked Books, by Edward Wilson-Lee, which is, incidentally, a book worth collecting.

Thursday, June 27, 2019

One Time Chlorhexidine Wipe for CAUTI Reduction! Too Good to be True?

One percent chlorhexidine for meatal cleaning prior to urinary catheter insertion significantly reduces(by 74%) the risk of catheter associated urinary tract infection. The study was a multi-center, stepped-wedged randomized controlled trial recently published in Lancet Infectious Diseases, available here.


Now the hard part will be getting nursing staff to reliably use chlorhexidine for meatal cleaning prior to  urinary catheter insertion.  This will require education, human factors engineering (i.e. making chlorhexidine the default product in the catheter insertion kit), audits and feedback.

Too good to be true? 

Perhaps not.

Monday, June 24, 2019

White Coat Effects! The More Senior the Rank the Lighter the Coat

Source: BMJ

Here is a witty article that only the British Medical Journal would publish, straight from the archives and available to all in open access format.  I actually read this paper as a 3rd year medical student at the University of Buffalo in 1995.

White Coat Effects. A study of medical rank and weight of the white coat. The more senior the rank, the lighter the coat.

Cool, although we no longer wear white coats (!), as published here.

Tuesday, June 18, 2019

Misinformation During A Public Health Crisis

Misinformation during a public health crisis is a significant threat.

Check out this essay titled Civil Society's Role in a Public Health Crisis, available here.

The potential impact of uncensored backchannel data, by way of Twitter, text messages, emails, blogs, photos and videos, could result in devastating and misleading information. The consequences would include panic, drug shortages, supply hording and misguided quarantine, diagnostic and treatment efforts . This threat could be as impactful as the actual pandemic itself.

A misinformation containment communication strategy is urgently needed- one with truthful, purposeful information that serves as a ' communication inoculation"- which is nicely explored in the essay.

The time to plan is now, post event is too late.

For a previous blog post and Facebook Lie video on Pandemic Richmond, follow this link.

Friday, June 14, 2019

Ode to Famed Infectious Diseases and Park Avenue Physician: Benjamin H Kean, MD

When I completed my infectious diseases training at New York Hospital-Cornell University the name Benjamin Kean was legendary.  Unfortunately, I arrived nearly 7 years after his death. Dr. Kean's New York Times (1993) obituary is found here.

I recently discovered Dr. Kean's memoir, in the form of a dusty library book titled M.D.: One Doctor's Adventures Among the Famous and Infamous from the Jungles of Panama to a Park Avenue Practice. A damn good read!

A proper dedication to Dr. Kean was published in ID Clinics of North America, available here.