Tuesday, July 26, 2016

Good Read! The Fantastic Laboratory of Dr. Weigl

Dr. Rudolf Weigl was an eccentric and accomplished Polish zoologist, infectious diseases specialist and immunologist who developed a typhus vaccine. Dr. Ludwik Fleck was an assistant of Weigl. Both worked independently, under duress (Fleck in Buchenwald concentration camp), to produce typhus vaccines for the Nazi cause. 

The Fantastic Laboratory of Dr. Weigl explores typhus from a sociopolitical perspective and chronicles the horrors of the Nazi medical corps and war machine. 

However, the story has a fantastic twist: 

Dr. Weigl is the medical version of Oskar Schindler. He hid the Polish intelligentsia from the Gestapo by hiring them to work in his laboratory. Dr. Fleck duped the Nazis by producing bogus vaccines for their troops and the SS. Both survived the Nazi regime.

Brilliance in the face of horrific adversity.

Friday, July 22, 2016

The Medical Literary Messenger Spring/Summer 2016 Issue Published!

As Editor in Chief of the Medical Literary Messenger, I am proud to announce the publication of the Spring/Summer 2016 issue. 

The free PDF download is available here

All content, present and archived, is available in PDF, MOBI and EPUB format.

Special kudos to Brie Dubinsky, Rachel Van Hart and Dr. Megan Lemay for their invaluable coordination and work on this issue. 

The content is truly superb.

Wednesday, July 20, 2016

The Collateral (Horizontal) Benefits of a Vertical Infection Prevention Intervention

Horizontal infection control programs, as summarized here, employ evidence based strategies (hand hygiene, CHG bathing, checklists etc) to decrease the risk of infection from all pathogens transmitted by the same and most common mechanism: contact. This is the backbone of our very successful hospital infection prevention program at VCU Health.

Here is an article in National Geographic summarizing an MRSA infection prevention initiative at Veterans Affairs (VA) hospitals featuring my esteemed colleague Eli Perencevich.

The goal was to reduce MRSA, but 'collateral benefit' on other pathogens was observed. Kudos to them.

The interventions were multiple, including MRSA screening/isolation, emphasis on HH and expansion of the infection control staff.  Although MRSA was the target, investments made in the infection prevention platform resembled a horizontal infection prevention program.

In the case of the VA, much of the control MRSA initiative was from a top-down mandate.

In most cases, however, why not start with the horizontal approach first, then target problem pathogens afterwards? 

Reducing infections, broadly, is the overarching goal.

Tuesday, July 19, 2016

Animals in Healthcare Facilities: If Done Right, The Infection Prevention Risk is Minimal

Here the clip from a video interview that was done at the SHEA 2016 Spring Conference

In my opinion, if done properly, as summarized in this SHEA publication , the infection control risk of animal assisted therapy in the hospital is very, very small. 

The benefits outweigh the risks.

Vibrio vulnificus- Back in the News

In June I wrote a brief blog post about Vibrio vulnifucus infections, about having seen two cases in one week. By no means do I feel that there is a heightened incidence, particularly in the Tidewater area of Virginia, however, there appears to be some concern.

Here is a recent television appearance related to Vibrio infections in Virginia.

Of note, the serious Vibrio vulnifucus generally occur in people with underlying chronic diseases, such as liver disease or diabetes, not healthy folks enjoying a day at the beach or river.

Wednesday, July 13, 2016

VCU News- Medicine on a Mission: VCU Global Health and Health Disparities Program Honduras 2016 News Highlight and Video

Here is the VCU News highlight about our 2016 VCU Global Health and Health Disparities Program Honduras trip.

Thank you to Leha Byrd, from VCU News, for joining us in country and producing the news report.

The video is below.

Ignore Your Front Office Staff at Your Own Peril...

L-R: Krystle Shaw, Peggy Andrews, the Blogger, Nadia Masroor,
Missing : Lisa Hassmer
The start of a new academic year (July) is an opportune time to pause and acknowledge the phenomenal work done by my staff so that the VCU Division of Infectious Diseases and Hospital Infection Prevention Program can succeed.

In the last two years both services have been resuscitated and revamped. 

The hiring of multiple new physicians, personnel and expansion of fellowship, clinic schedules, research, education and infection prevention initiatives would simply not be possible without Nadia Masroor (Research/Program Coordinator), Peggy Andrews (Executive Assistant), Krystle Shaw (Administrative Assistant) and Lisa Hassmer (Executive Secretary Hospital Infection Prevention Program).

They fuel the locomotive.

Thank you-

Tuesday, July 12, 2016

Should We Be Shocked By Congress's Impasse on Zika Funding?

Should we be shocked by Congress's impasse on funding of Zika virus preparedness?

I personally do not think that this is surprising. Yes, there is heightened partisan bickering over seemingly everything at the moment so politics may play a role. 

However, in an interview for the National Journal, published here, I express my concern that the perception of risk may be driving (or stalling) the process. Despite the potential for significant public health consequences (children born with microcephaly), Zika does not pose the risk of a highly lethal and contagious viral hemorrhagic fever such as Ebola.

Absent that risk, and until there is significant autochthonous transmission of Zika in the USA, funding and awareness may be relegated to the proverbial back burner. 

Paul Bearman, Photographer- VCU Global Health and Health Disparities Honduras Trip, June 2016

Paul Bearman, my nephew, was in Honduras with the VCU Global Health and Health Disparities Program this past June.

As he is bilingual, he interviewed nearly 400 patients for our research protocols and served as an interpreter in the clinics.

Paul also has a growing interest in photography and captured the images below on the trip.

Sunday, July 10, 2016

Procalcitonin for Antibiotic De-Escalation in the ICU. Ready for Prime Time?

With the heightened interest given to antibiotic stewardship and de-escalation, I read with great interest this article published in the Lancet Infectious Diseases.

The study was a pragmatic trial, a study design which I fancy, as summarized here. The investigators protocolized the use of procalcitonin levels to aid in antibiotic de-escalation in ICU patients. They reported a 20% reduction in antibiotic use with an unexpected improvement in mortality, something which has yet to be reported.  There are limitations such as the study groups were not blinded and compliance with per protocol antibiotic de-escalation was not super tight. The study is laudable yet not a slam dunk.

Whether interventions such as this can impact antibiotic susceptibility across a healthcare system or even decrease the risk of C. difficile diarrhea is unknown. I would argue that this is the ultimate goal of antibiotic stewardship.

Are we ready to move forward with procalcitonin to guide antibiotic de-escalation? Not yet.

The results are tantalizing but need to be replicated. More pragmatic studies to assess the impact of this strategy for antibiotic stewardship, and, if the results are positive, it would be time to mobilize an effort for changing antibiotic use with protocols utilizing procalcitonin levels. 

Changing physician behavior is challenging enough. To do so with less than truly solid data makes it even that much more difficult, almost impossible.

Wednesday, July 6, 2016

Virginia Public Radio Interview - Zika Virus Awareness with Senator Tim Kaine

For those who may have an interest in Zika virus awareness, here is a brief radio interview that I did for Virginia Public Radio in Richmond, VA.

It is short, thankfully.

Tuesday, July 5, 2016

Zika Virus, The Next Epidemic, Infectious Diseases Emergency Preparedness and Why We Are Not Ready

I spent the morning at the Virginia Department of Health at Zika virus briefing and roundtable discussion with US Senator Tim Kaine of Virginia. I shared the table with Dr. Marissa Levine, Commissioner of the Virginia Department of Health and colleagues from maternal-fetal medicine and the Red Cross. 

The topic was Zika virus and infectious diseases emergency preparedness. The process is complex and involves education, vector (mosquito) control, vaccine development, rapid diagnosis and case management. A common theme was the lack of dedicated, consistent funding for infectious diseases emergency preparedness in the USA. 

We have FEMA for natural disasters but no equivalence for emerging infectious disease threats.

On a global scale, no coordinated, organized and well funded emergency response is available for looming threats, as summarized in this TED talk below by Bill Gates.

We are simply not prepared for the coming plague.

Friday, July 1, 2016

Back at Work- Pondering the Last 2 weeks

Since returning from Honduras 5 days ago,  I have spent most of the week back on the consult service. 

In certain ways, I enjoyed enjoyed medicine in the 3rd world more. No electronic medical record, dictation and billing!

Without a doubt, medical care is infinitely more sophisticated in the USA than in rural, mountainous Honduras. The clinical environment is more advance as are the diagnostic and therapeutic interventions. Cost is largely unchecked and out of control here too.

Regardless of the setting, whether remote and primitive or high tech and modern, the doctor-patient relationship has felt the same. 

If we lose sight of this goal then we have lost our purpose in medicine.

Happy 4th of July weekend for those who are stateside.