D.I.Y Science: Geek to Chic?

I have heard of D.I.Y. fashion, websites etc., but D.I.Y science? The epicenter of this nascent movement is in Brooklyn and was recently featured in the NY Times.

Quoting from the article, the goal “… is to promote science as a viable hobby for children and adults. ‘The more people get their hands dirty in a lab, the less likely they’ll be to have knee-jerk reactions to things like stem-cell research and genetically modified organisms’…..”

The movement is a motley group of amateur scientists who, empowered by internet based access to information, are performing research in their D.I.Y Labs. D.I.Y Science may be best represented by DIYbio.

What sort of long term impact this may have is largely unknown. Perhaps it can interest young students to pursue a career in medicine. The AAMC predicts a significant physician shortage in the USA, so any boost in interest is welcomed.

Architecture and Design: Agents of Change

I am going to tread beyond my comfort zone now with a new yet hopefully related topic.

In my public health seminar, the students read Dr. David Hilfiker’s book, Urban Injustice, How Ghettos Happen.  Dr. Hilfiker clearly articulates the complex history of urban poverty and explores the weaknesses and strengths of societal responses to poverty.  As a physician, he focuses on the need for access to healthcare as one of the essential ingredients for breaking the poverty trap.

While casually perusing Dwell magazine the other day, I came across a novel perspective on curbing urban blight. The article was about a young couple who focus their talent in design and architecture to affect sustainable social change in diverse and economically troubled areas. The result is the Detroit based Power House Project, which purchased a foreclosed home in a rough and tumble area of Detroit for $1900. The home serves now as the demonstration center and network for sustainable design and urban renovation, running through solar power and wind energy. It is a partnership of creative professionals, artists, architects, laborers, and social geographers interested in this neighborhood as an experiment in sustainable design, social change and urban rejuvenation. The project has now expanded to include 10 homes in the neighborhood.

This movement will likely not impact traditional health measures. However, thinking outside of the (public health) box, it may foster a greater sense of personal and community satisfaction in economically challenged neighborhoods, a precursor to healthy living.

Well done.

Military Recruitment in High Schools: A Public Health Controversy

Each spring I teach a seminar for the VCU Master in Public Health program title Contemporary Issues and Controversies in Public Health.  We cover issues such as obesity, poverty and health, gun control, down low behavior, and overtreatment in medicine. I recently came across a new (to me) public health controversy: military recruitment of high school students and its public health implications.

In a paper published in the American Journal of Public Health, the authors raise a seemingly valid concern about the effects of military recruitment in high schools. They chronicle the efforts to limit military recruitment of students by a PTA organization in Seattle, highlighting the aggressive measures used by recruiters, likened to predatory grooming, to gain access to students in high schools. Recruitment efforts are particularly aggressive in rural and low income urban areas. The authors cite several potential public health impacts such as studies demonstrating  the highest rates of all mental health disorders, including alcohol abuse, anxiety syndromes, depression, and posttraumatic stress disorder among the youngest cohort of military recruits, those aged 17-24 years. Youngest military recruits also have the highest rates of suicide and self inflicted injuries.

The Bush Administration’s No Child Left Behind Act, Section 9528,requires public schools to give military recruiters access to students at school and access to student’s contact information.

I remember recruiters in my high school in the mid-late 1980s. My Dad, a pediatrician, would half-jokingly provide me some wise advice when learning of their presence - "don't sign anything."

L.O.T

Labyrinth of Terror

What do you get when a world renowned epidemiologist and infectious diseases physician turns his efforts to writing fiction rather than science? The result is a unique combination of infection control, infectious diseases and bioterrorism played out in an international arena. No one other than our very own Dr. Richard Wenzel could weave the intricacies and challenges of infection prevention in a gripping and clever plot with engaging and creative characters.

The pages will turn themselves.

Who said that epidemiologists are boring?

Drs. Wenzel and Stevens at today's booksigning

Losing Touch, Sort of

Last week I promised to discuss glove use in clinical care.  So here it is.

There has been growing concern that donning gloves for patient care has led to a literal and figurative loss of touch between doctor and patient. In many ways, the gloved hands represent an artificial barrier to the healing touch. This was nicely explored by Dr. Pauline Chen in the following article. My quote in this article would suggest that glove use is a modern reality with little chance of reversal, especially given today’s emphasis on universal precautions and on controlling drug resistant bacteria.

Consider, however, the alternative. There are many advocates of aggressive screening of patients with implementation of contact isolation (precautions). I refer the reader to a spirited back and forth commentary on the expansion of contact precautions in the HAI Controversies blog. There is a growing body of literature highlighting the adverse effects of contact isolation in the hospital. For a nice review, click here. In brief, patients in contact isolation are visited less frequently by HCWs, have vital signs taken less often, have increased adverse events and experience symptoms of depression and dissatisfaction.

We favor the least restrictive approach. We aggressively promote broad based infection prevention efforts without hospital wide active detection and isolation. Hand hygiene and adherence to infection prevention best practice has allowed us to control drug resistant pathogens effectively in our ICUs. We published a manuscript documenting that universal gloving (without contact precautions) in a surgical ICU is as effective as the standard of care with contact precautions. This approach was well received by our HCWs, suggesting that it is sustainable.

So, gloving may result in a latex barrier, however, it is less restrictive and likely less damaging to the doctor-patient relationship than the barrier of isolation.

Healthcare Workers: Protect Yourselves!

Leading the Pack: VCU Internal Medicine Nurses Do it Safely!

There seems to be endless construction where I work. It is not uncommon for me to pass a construction site at the hospital and note that all workers are seemingly compliant with the use of personal protective equipment; gloves, goggles, hard hats and steel toed boots.

I am still bewildered why healthcare workers are so nonchalant in the use of protective measures, unnecessarily exposing themselves to potentially infectious agents through splashes in the eyes and mouth or through percutaneous injuries with sharp devices. This happens daily.

There is a growing body of literature detailing that personal protective measures result in a safer care. Use of goggle, gowns and gloves will limit the exposure to infectious agents. In the OR, protective eyewear, double gloving, use of hands free zones and blunt tip suture needles, as championed by the American College of Surgeons, will greatly enhance safety.

Sadly, there is a body of literature reporting that healthcare workers are uniformly poor in donning protective equipment at the point of care. Barriers include access to protective equipment, education and perception of risk. In some analyses, it seems that healthcare worker autonomy trumps safety. This is neatly explored in Dr. Atul Gawande’s book, the Checklist Manifesto. The translation of evidence into clinical practice is known as implementation science. For a relevant publication on implementing a safety culture change, I refer you to this article in the British Medical Journal.

Ironically, the same healthcare workers who refuse to wear protective equipment in the hospital will subsequently minimize risk on their drive home by wearing a seatbelt.

HCWs: Please practice safety at all times as you are invaluable to all of us.

Techno MDs: Leaders and Laggards

Although technology in medicine by no means equates to salvation, medical informatics can certainly make the transfer and sharing of patient information much easier in a complicated system. You would think that busy physicians would welcome medical information systems that would facilitate the transfer and hand off of patient histories, diagnostic tests and treatments between both providers and health care systems. Not true. 

I still get many referrals from community physicians and local hospitals with indecipherable chicken scratch for progress notes. I still must request faxes with labs and diagnostic test results.  Perhaps one day medical information systems will allow the secure electronic transfer of patient records between health care systems and providers. Based on recent publications, this will likely not occur soon.

Dr. Mike Edmond’s collaborative medical blog hyperlinks to an article by Megan Mcardle titled “Paging the Luddite”. Among other things, the article highlights how physicians have been slow to adopt medical informatics, partly because of cost and partly because of fear of oversight and loss of autonomy.

The WSJ recently reported the results of a CDC survey on the use of electronic medical records. The results are somewhat disappointing as only half of physicians reported using an electronic medical record, at least in some fashion.

We still have a long way to go.

My message to the other half: you are holding us back.