VCU Investure Dinner: Richard P Wenzel Endowed Professorship of Internal Medicine

VCU in 2004: With Mike Edmond (Left) and Richard Wenzel (Right)

Last night I attended the VCU Investure dinner for endowed professorships.

Although I have held the title for several years, It was an absolute honor to formally receive the Richard P. Wenzel Endowed Professorship in Internal Medicine from the Virginia Commonwealth University.

Due the massive influence, mentorship and friendship, both personally and professionally, from Drs. Richard Wenzel (now Professor Emeritus) and Michael Edmond (now at University of Iowa), I have succeeded at VCU. 

Gratus semper.

AO Trauma Clinical Priority Program Forum on Bone Infections: It's Good To Explore Beyond Your Comfort Zone

Perhaps I have been consorting too much with infectious diseases specialists and hospital epidemiologists. My academic focus may be too narrow.

I spent the weekend, as an invited participant, at the AO Trauma / AO Foundation 7th Annual Meeting-Clinical Priority Program (CPP) forum on bone infections. The meeting was held in Washington, DC.

The small, international group of participants (USA, England, Wales, Ireland, Belgium, Switzerland, Germany, and Japan) included orthopedic surgeons, basic scientists, immunologists, an electron microscopist and one infectious diseases specialist (the Blogger).

The discussions focused on leading translational research, to better understand the pathophysiology and further the diagnosis and treatment of complicated bone infections. New perspectives, deeper awareness and novel concepts are best found out of one's typical comfort zone.

Along with VCU Orthopedic Chairman and AO Trauma CPP Chair, Dr. Stephen Kates, I am a co-investigator on a multi-center, international protocol to standardize and implement a surgical site infection risk reduction bundle for open fractures. The study has launched and is collecting data.

More to come.

The Great Influenza and Author John M. Barry at The Virginia Museum of History and Culture

Last evening I had the pleasure of attending The Great Influenza event at the Virginia Museum of History and Culture. The guest of honor was celebrated writer John M. Barry, author of The Great Influenza. The near capacity crowd greeted the honored guest with enthusiasm.

Following the keynote address by Mr. Barry, where he discussed the history of the 1918 influenza pandemic, lessons learned and looming concerns, I had the honor of being a panel member participant, on a discussion of influenza, pandemics and unique pathogens. Panel members included Dr. Peter Buckley (Dean VCU School  of Medicine) and Dr. Michael Donnenberg (Infectious Diseases and Senior Associate Dean for Research VCU School of Medicine)

Images from the event are below.

Left to right: Drs. Donnenberg, Buckley, John M. Barry, the Blogger

Once Again, Untested Assumptions: Microbiota, Probiotics and Patient Harm

This article is a fresh reminder of an untested assumption, something not uncommon in medicine.

Probiotics, to restore the microflora and prevent antibiotic associated diarrhea and Clostridium difficile infections, how could these be unsafe?

Probiotics are presumed low risk but we simply don't know the potential harms because adverse events are not rigorously assessed in related clinical trials.

Now when asked about the safety of probiotics,  I am obligated to modify my answer: 

Probiotics are likely safe but we simply don't know for sure.

Hand Hygiene: How Much is Enough?

I am back in the USA, back at work, preparing slides for my ID Week 2018 pro/con debate on hand hygiene tracking and monitoring.

We hold hand hygiene sacrosanct in infection prevention.  Some would argue that hand hygiene does not prevent infections, rather, it reduces the transmission of multi-drug resistant organisms, as explored here. 

Regardless, it is safe to say that hand hygiene is potentially one of the most important infection prevention interventions and that compliance is generally suboptimal. A good systematic review and meta-analysis of interventions to promote hand hygiene can be accessed here.

Beyond that, things become contentious.

The proportionate impact of hand hygiene on infection prevention outcomes is debatable, there are no head to head trials comparing one multi-modal hand hygiene tracking strategy to another and certainly none comparing multi-modal strategies to the emerging hand hygiene electronic monitoring systems on the market.  

What is the optimal level of hand hygiene compliance?  At what point is there a diminishing return with improved hand hygiene and infection prevention outcomes?  Which hand hygiene interventions are most reasonable and sustainable, so that they play out in the real world?

Simply put, our science (hospital infection prevention) lacks specificity. 

So how much hand hygiene is enough?  No one really knows but more is probably better.

Vexing.

Budapest: Hospital in the Rock

A a less known destination in Budapest is the Hospital in the Rock.

This medical bunker built within the caves of Castle Hill served as a World War II Red Cross hospital during the siege of Budapest. During most dire times, capacity soared to 600 patients! Not unexpectedly, infections were an issue with such overcrowding.

In 1956, the facility served a similar war-time hospital purpose during 1956 Hungarian revolution.

Under the Soviets, the facility was used as a nuclear bunker.

Fascinating.

Parting Images of Budapest

I am still writing a travelblogue.

Parting images include night scenes, below, from my meanderings through Budapest.

A storied city with eclectic influences from the Ottomans, the Habsburgs and the Soviets. The Széchenyi Thermal Bath was particularly unique.

Other highlights include a visit to Castle Hill, the Hospital in the Rock (blog post here), the Hungarian Parliament Palace, the Great Market Hall, the sober Shoes on the Danube Monument (to jews executed by Nazis on the Danube riverbank) and a Barons of Budapest walk through former palaces, museums and libraries in Budapest.