Cyberchondria: Online Symptom Checking Won't Make You Feel Better

I recently came across this article published in Psychosomatics (from the Academy of Psychosomatic Medicine). Yes, there really is a peer-reviewed journal dedicated to psychosomatic disorders!

The article validates much of what I have observed in my practice of clinical infectious diseases.  Whether it is chronic fatigue, chronic Lyme disease etc, patients with already high levels of anxiety searching for medical information online felt worse after online symptom checking.  In fact, spending greater than 3 hours per day on the Internet for symptom searches resulted in heightened anxiety during the online search and worse anxiety afterwards.

Cyberchondria.

Perhaps we should now recommend that patients with illness anxiety avoid the Internet for illness related medical information.  

Easier said then done.

What Does Excellent Look Like? My (Very Brief) Perspective on Infection Prevention

This article in Academic Medicine caught my eye- What Would Excellence in Health Professions Education Mean if It Addressed our Most Pressing Health Problems?

The authors argue for metrics that assess key principles: matching the population health needs with the production of the right mix of health professionals, ones with the right set of skills so as to impact healthcare spending and quality.

This got me thinking, what does excellent look like for infection prevention?

I am not entirely sure how best to define excellence in infection prevention, however, I know where not to go with it.  Beware of illusory goals and unrealistic soundbites such zero healthcare associated infections.

Perhaps excellence in infection prevention is best described as the relentless implementation of evidence based risk reduction practices, with pragmatism and fidelity, so that they play out in the real world, for all at risk patients, in perpetuity (or until a better strategy arises). 

In other words, excellence in infection prevention is 'good practice' done consistently.

New Strategy: Boycott the Publisher!

University of California Los Angeles

Sometimes we need to think outside of the box.

This paper, published in the Chronicle of Higher Education, reports how the University of California Los Angeles has adopted a new strategy in its effort to negotiate with an academic publishing giant- Elsevier: boycott the publisher!  Consider publishing your papers elsewhere.

Specifically, campus officials have asked UCLA faculty members to consider declining to review and submit articles to Elsevier.

Why?  Money, of course.

The University California system's 5 year open access contract with Elsevier costs a whopping $50 million dollars.  The goal is to hit Elsevier were it hurts the most- its content.

As stated in the article: What they are selling is access to research. If they do not have the research, they have nothing to sell.

Touché

Of course, some argue that this could hurt the promotion and tenure of junior faculty.  There may be a grain of truth to this comment, however, people were previously promoted without open access publishing.

Kicking for a Cause: Richmond City FC 14th Annual Copa Navidad Charity Soccer Game

2018 Richmond City FC Copa Navidad

2018 Richmond City FC White

2018 Richmond City FC Blues

Richmond City FC Old Guard

Old footballers never die, they play in charity soccer games.

Today I was with Richmond City FC at the Annual Copa Navidad charity game. Another close match between Richmond City Blues versus Richmond City White. Later a photo opportunity with some of my old football palls. Unfortunately, due to an injury, I did not play in today’s match. 

More information at www.richmondcityfc.com

Hoy estuve con Richmond City FC en la Copa Navidad en un partido de fútbol benéfico. Fue otro partido peleado entre los blancos y los azules. Más tarde, me saqué una foto con la retaguardia del club. Lamentablemente, debido a una lesión, no pude jugar en el torneo de hoy.

Más información en www.richmondcityfc.com

ID Specialists See More Complex Patients and Now We Can Prove It!

Infectious diseases specialists see more complex patients. The difference is that now we can prove it!

This article published in JAMA Network Open is the 1st to report empiric evidence that the complexity of patients seen by infectious diseases specialists is greater than that of most other subspecialties.  Finally, something to back up our claim.

As the patient complex increases the time and resources required for care also increase.  This is no small detail. A good ID consult takes time and effort.

High complexity, high volume, low pay- modern day Infectious diseases in the current fee for service model. This will not make a good recruitment tool!

If compensation plans could only see things our way we would all be much happier.

Hot off the Press: SHEA Expert Guidance for Infection Prevention in the Operating Room Anesthesia Work Area

I am proud to announce that the SHEA Expert Guidance infection prevention in the anesthesia work area has published. This collaborative project was no small endeavor. Congratulations to all for their diligence and persistence in seeing the project completed.

The full manuscript is available here.

Although the extent to which surgical site and hospital acquired infections emanate from anesthesia interventions is likely low and poorly defined, the risk is not negligible. Along with our colleagues in anesthesia, we delved into controversial areas with the hope of providing sensible, expert guidance on how to minimize infection risk.

We hope that our recommendations will resonate and positively influence our anesthesia colleagues.

The Evolution of the Clinician Educator: All Great But Let's Call it Like it is!

I have hired multiple clinician educators in my institution, all of whom are doing wonderful clinical and academic work.  The academic output by my team is remarkable given the competing priorities of clinical expectations.

I refer you to this recent article on the evolution of the the clinician educator published in Academic Medicine.

The article is insightful and neatly summarizes the role of clinician educators in academic medical centers, particularly the critical role that these faculty play in the dedicated teaching of students and residents.  The clinician educator role has evolved through formal faculty development, educational scholarship in dedicated journals (e.g.  Academic Medicine) and through the appearance of professional societies (e.g. Academic Alliance of Internal Medicine).

I agree with all the above but lets call like it is.

The major and present obstacle to academic success as a clinician educator is the current primacy of clinical RVUs. Until we carve out dedicated time and funding for academic roles such as teaching, education will always be second fiddle.

Budgets and compensation are a reflection of priorities and values- simple as that.

Somen Debnath Visit to VCU: Around the World On Bicycle Tour for HIV / AIDS Awareness!

This visit was truly special.

Today we had the great honor of hosting Mr. Somen Debnath  who is on a personal and spiritual mission to raise HIV awareness.  He is on a 200,000 km, 191 country around the world bicycle tour.  His visit to Richmond, Virginia and the VCU HIV Center marks 155,000 kilometers and 150 countries into the journey.

During his odyssey Mr. Debnath was captured by the Taliban and held for 24 days, was robbed six times, beaten eight times, went through 280+ tires and had his bicycle stolen thrice.  

Along the way he also met thousands and thousands of wonderful people and raised awareness for HIV/AIDS. Somen has not yet lost his enthusiasm. 

Inspirational.

Images from the event are below.

Visit is Somen's website and stunning visual travelogue here.

Start With Why if You Seek to Lead and Inspire

I recently read the book Start With Why by Simon Sinek. The book explores how leaders inspire.  

I have seen many executives who focus on what we do and how we do it (execution).  They do not clearly communicate the "why"-the inspirational core mission.

Effective leaders personify the "why", they talk about it, embody it, preach it and inspire those around them.

The same applies to healthcare.  

Leaders who inspire us to better and safer care, rather than RVUs and patient throughput, will almost certainly have positive outcomes on patients, physicians, nurses and staff. 

So, seek to inspire first. The outcomes will then follow.

Sepsis Editorial:Thank You For A More Comprehensive (and Concise) Perspective

Source: American Nurse Today

This article on sepsis published in Clinical Infectious Diseases provides a much needed public health perspective on a serious issue.

We focus on the early diagnosis and management of sepsis through protocolized mechanisms in acute care settings.  I have nothing against standardizing care for severe conditions. However, sepsis is a greater problem than just timely diagnosis and management.

In this editorial a more comprehensive view of sepsis is considered, this includes a focus on surveillance, antimicrobial stewardship, pathogens (vaccines), health behaviors (smoking), management of chronic conditions (preferable prior to hospitalization), demographics, microbiome, infection prevention and minimizing invasive devices. 

Comprehensive and concise. Thank you!

Instead of stopping the leaks in the dam, build a better dam.

Infection Prevention Shortcomings: A Betrayal of Trust?

All serious endeavors must begin with answering the question 'why?'  

We have a paper currently in press titled Infection Prevention in the Hospital: How Much Can We Prevent and How Hard Should We Try? The paper will be published in January 2019, Current Infectious Diseases Reports.

We estimate that 50%-70% of hospital-acquired infections are potentially preventable.

So how hard should we try and why?

In the book Betrayal of Trust: The Collapse of Global Public Health, Laurie Garrett writes that “public health is an essential trust, between government and its people, in a pursuit of health for all…” This includes “...a healthcare system that follows the primary maxim of medicine- do no harm.”

In my opinion, healthcare systems that fail to prioritize and relentlessly pursue infection prevention betray the maxim of medicine, primum non nocere.  This is a betrayal of the public's trust. 

Our safety mandate is clear.

Spoiler! Thanksgiving Dinner, Salmonellosis and Other Infections of Leisure

If you are germaphobe read no further.

This MMWR report gingerly reminds us of the dangers of salmonellosis from poultry, specifically a salmonella outbreak from a Thanksgiving dinner.  

In truth, the biggest risk at Thanksgiving is overeating and not salmonella.

But why stop there? 

Check out the book titled Infections of Leisure. 

I just blew the dust off of it when removing it from my bookshelf.  The book beautifully highlights the microbes that await us during our most carefree moments-at the shore, in fresh water, with our pets, during sporting activities and with our exotic trendy cuisine. Riveting.

Happy Turkey Day.

2018 New Jersey APIC / ID Society Lecture: What an Amazing Line-Up!

Dr. Michael Osterholm

Thank you to the New Jersey APIC (Association of Professionals in Infection Control) Chapter and to the NJ ID Society for inviting me to speak at their annual infectious diseases conference. The meeting theme was The Changing Paradigm of Infectious Disease Prevention.

It was a particular honor to share the podium with Professor Michael Osterholm of the University of Minnesota and author of Deadliest Enemy, Our War Against Killer Germs. Other esteemed colleagues included Drs. David Calfee (Cornell University), Bill Rutala (UNC Chapel Hill) and Thomas Kirn (Rutgers Robert Wood Johnson Medical School).

I was both humbled and honored to be a part of the conference.

The turnout was superb.

As always, I learn more than I teach at these events.

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.

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.

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.

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.

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.

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. 

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.

Open Access to All: The Guide to Infection Control in the Healthcare Setting

Our book, The Guide to Infection Control in the Healthcare Setting (6th Edition) is fully updated and available, in a web-based format, open access to all, here.

The Spanish language translation is in process. 

Further plans for the Guide (development of an App and additional content) are to be discussed at IMED 2018, with the publisher, The International Society for Infectious Diseases .

Stay tuned.

Super-Book! Super-Bugs: An Arms Race Against Bacteria

The book Super-Bugs: An Arms Race Against Bacteria is a stellar read on the looming antimicrobial resistance crisis.
Kudos to the authors on this super book, the best that I have read on the topic 

The writers take a complicated subject and neatly break it down into its component parts with clear and direct writing.  

Antibiotic resistance is not seen as an immediate urgency as it is a slow moving issue that on a day-to-day basis people do not experience or see.  This poses a massive challenge for policy makers. Couple this with antibiotic overuse (both in humans and in animals) and the financial disincentives for pharmaceutical companies to developed and market new drugs and a crisis awaits.

Realistic solutions are offered and include public-private partnerships for drug development, antimicrobial stewardship (both in humans and in agriculture) and heightened infection prevention.

Complicated problems need sensible, multi-modal approaches, as expertly argued. This is no dry, academic tome.

Here is a well written commentary in The Telegraph (UK) exploring the above in greater detail.

Read on.

Social Media Decorum for Medical Professionals: The Crowded Elevator Rule

Source: The Writing Cooperative

Social media blurs the barriers between professional and personal lives.

How should healthcare professionals maintain a social media presence without compromising professional appearance?

This manuscript published in the Journal of the American College of Surgeons is a timely best practices guidance for social media use by surgeons, applicable to all healthcare professionals.

Some of the recommendations are both straightforward and commonsense such as not using social media as a tool for patient-physician communication and always protecting patient confidentiality.  Also, avoid posting content that may have negative or unintended consequences in the workplace. Last, the article recommends that surgeons should actively maintain a professional online profile.

I agree with all of the above.

Personally, I try to follow one inviolate rule: never post anything online that I would not be comfortable saying in a crowded elevator.  

It works for me. 

Personal Protective Equipment Coverall! The Way To Go?

Source: Johns Hopkins Center for Bioengineering Innovation and Design

We have previously argued (here) that healthcare workers need training in personal protective equipment (PPE) doffing, especially given the high risk of self contamination.

I read with great interest this article in American Journal of Infection Control, where a novel PPE coverall (for Ebola) was assessed in stimulated scenarios.

This new PPE suit has a rear entry and exit seem, covered zippers and over the shoulder pull tabs which simplify donning and doffing. In a simulated scenario, this new design was comfortable and well received by healthcare workers.

The next critical step, in my opinion, is formally assessing self contamination at the time of doffing. 

If the newly designed PPE coverall suit decreases self contamination (vs the traditional PPE suit), this may be the way to go.

Bowler Men And Beyond: Rene Magritte at the SF MoMA

Adjacent to the Moscone Convention Center is the San Francisco Museum of Modern Art (SF MoMA), currently housing an excellent exhibit titled Rene Magritte, The Fifth Season.

A perfect respite from long days of conferencing at ID Week 2018.

Magritte was a provocateur in a well cut suit and a notable surrealist artist.

The (iconic) man in the bowler hat! 

Belgian artist Rene Magritte

Iconic work- The Birth of Man by Rene Magritte

The Blogger within an interactive exhibit at the Magritte exhibit