As this month comes to a close, I want to share a brief look-back and a lot of gratitude to all those who have made this blog possible.
February 14, 2017 was our first UNMC ID blog post. It is amazing how much time has passed since then, and we are so grateful to all of our readers of our content, and for all of our UNMC colleagues and trainees who have contributed to this blog over the years. There are over 500 posts to-date filled with introductions, accolades, accomplishments and education! I encourage you to go back and review your favorite posts, those you may have missed, and please do continue to share the posts with others!
I want to specifically call out a special thanks to Dr. Rupp, our ID Division chief who has remained continually supportive of sharing the work, expertise and accomplishments of our Division through this platform. I would also like to thank my partner in crime in coordinating this blog, Dr. Marcelin, who has been a continued author, curator of content and social media disseminator and supporter of all these efforts. Finally, I also would like to thank our amazing student editor, Zachary VanRoy, who truly is invaluable in ensuring we have content to share.
Thank you again to everyone who has supported us, contributed to the blog, and who has read and shared our content. We are continually grateful!
The University of Nebraska Medical Center and College of Medicine is conducting a national search for a dynamic and accomplished individual to assume the role of Division Chief of Infectious Diseases. If you or someone you know may be ready for an exciting opportunity at UNMC ID, please see the contact information below, share this post within your network, and nominate yourself or others for this position!
UNMC ID Fast Facts:
The Division of Infectious Diseases supports all infection control activities at Nebraska Medicine and operates 5 inpatient teams including the vibrant General and Community ID services, as well as dedicated Orthopedic, Oncology, and Solid Organ Transplant ID consult teams. Existing areas of strength include: antimicrobial stewardship, global health security, biocontainment, HIV, infection prevention, oncology ID, solid organ transplant ID, and orthopedic ID. Of particular note at UNMC is the Global Center for Health Security. This nationally recognized center encompasses the Nebraska Biocontainment Unit, the Nebraska Quarantine Unit, Emerging Pathogens Lab and Deployable Teams. In addition, it is the home of the ASPR funded national Training, Simulation and Quarantine Center.
General Qualifications:
MD, MD/PhD or equivalent degree, with board certification in Infectious Diseases.
Eligibility for medical licensure in the State of Nebraska.
Scholarship, clinical and research accomplishments that would merit the rank of Associate Professor or Professor in the College of Medicine.
Demonstrated leadership experience in academic medicine, clinical practice, or professional societies.
National recognition in clinical, translational, and/or basic research.
Leadership qualities and experience to grow and sustain the division’s mission as well as foster a collaborative and collegial work environment.
Contact, Links and Resources:
Interested applicants should contact the Grant Cooper Team at rachel@grantcooper.com for inclusion in the ongoing application review.
Want to nominate a qualified candidate? Contact Rachel at the above email as well.
Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID. Today, we review three articles covering clinical trials that evaluate new drugs for the treatment of COVID-19, using three different approaches. As always, check out the linked full articles for more details.
Diana Florescu, MD, co-author of a recent reanalysis of a phase 3 COVID-19 clinical trial
In the first article, published in the journal Infection and co-authored by the late Dr. Diana Florescu, the authors examine the data from a phase 3 randomized and placebo-controlled trial of the antiviral medication molnupiravir specifically in immunocompromised patients. This medication works by inhibiting the ability of the virus to replicate and infect other cells. The study found a large reduction in hospitalization, death, and adverse events in immunocompromized patients who recieved treatment with molnupiravir, along with enhanced clearance of infectious virus. The authors conclude that, while this study had a small sample size, this evidence suggests that molnupiravir is a safe and efficacious treatment for mild-to-moderate COVID-19 in non-hospitalized immunocompromized patients.
Dr. Andre Kalil, co-author of a recent clinical trial exploring a new type of COVID-19 treatment
The second article, co-authored by Dr. Andre Kalil, takes a different approach by targeting the immune response to SARS-CoV-2 infection instead. Severe COVID-19 pneumonia can cause elevated production of a human protein called IL-33 by the immune system. While meant to enhance immune function, this exaggerated response instead causes excessive damage to the body during severe infection, contributing to the development of Acute Respiratory Distress Syndrome (ARDS). This study examined the efficacy and safety of new drugs aimed at interfering with the IL-33 pathway, among other approaches. While these new medications were not associated with safety concerns, the authors report that there was no improvement in time-to-recovery in patients with severe COVID-19 pneumonia.
Dr. Hewlitt, a member of the ACTT-4 Study Group which investigated this new approach to immunomodulation during COVID-19
The last article, published in The Lancet: Respiratory Medicine also co-authored by Dr. Kalil along with LuAnn Larson, RN, and Dr. Angela Hewlitt, explores the efficacy of adjunct therapy with baricitinib or dexamethasone in addition to a standard COVID-19 medication, remdesivir. Both baricitinib and dexamethasone calm an overactive immune response, though through different means, and have evidence supporting their use during COVID-19. However, a study comparing their efficacy in conjunction with antiviral therapy has not previously been performed. To explore this regimen, the authors conducted a randomized, double-blind, double placebo-controlled trial with patients enrolled at 67 trial sites across the globe. The study found that the addition of baricitinib or dexamethasone to remdesivir resulted in similar rates of mechanical ventilation-free survival by the end of the study period. However, patients administered dexamethasone experienced significantly more adverse events, treatment-related adverse events, and severe or life-threatening adverse events than those taking baricitinib. The authors conclude, “a more individually tailored choice of immunomodulation now appears possible, where side-effect profile, ease of administration, cost, and patient comorbidities can all be considered”.
This post highlights an upcoming event that is a part of UNMC’s celebration of Black History Month. For a complete list of the month’s celebrations and educational events, see this UNMC Newsroom article.
What: Come join us for an educational evening to learn about HIV & AIDS in the black community. This event, sponsored by the UNMC/Nebraska Medicine Community Wellness Collaborative, Office of Inclusion, and the Nebraska AIDS Project, will feature wisdom from Dr. Precious Davis, director of the community collaborative academy, and Darryl Brown Jr., senior director of programs and advocacy at Black & Pink National and a board member at the Nebraska AIDS Project. Food, beverages, and light music with a live DJ will complement this evening of education.
When:Friday, February 16th, from 6pm-8pm
Where: The UNMC and Nebraska Medicine Community Wellness Collaborative
(2120 N. 29th St., Suite 200)
Note: Registration for this event is preferred (link, proceed to ‘View All Events’ or use the QR code to the left), but walk-ins are also welcome!
More info about the Community Wellness Collaborative at UNMC: The Community Wellness Collaborative is a nonclinical, educational and community-serving space created in partnership with Nebraska Medicine and UNMC, located in Omaha’s Highlander development. The Community Wellness Collaborative is dedicated to engaging individuals and groups and connecting them with health resources.
The Collaborative offers:
Health resources
Space for collaboration
Education programming around health and wellness
Guidance for people interested in careers in health care
Congratulations to Dr. Nicolás Cortés-Penfield, who was recently invited to join the Open Forum Infectious Diseases editorial advisory board.
Editorial advisory boards are composed of influential individuals in a journal’s field who are tasked with guiding the direction and progress of a journal. This is accomplished in many ways but often involves reviewing potential manuscripts for scientific integrity and rigor before publication. Additionally, members provide input and knowledge to guide the development of a journal and, by extension, the academic field at large.
An invitation to a journal’s editorial advisory board is a recognition of expertise and quality contributions to a field’s scientific literature. Congratulations, Dr. Cortés-Penfield, on an honor well deserved!
This just in! A new article published last month by Dr. Andre Kalil outlines an effective measure to treat COVID-19 in immunocompromised individuals at elevated risk of serious disease from this infection. See below for a quick digest of the article, and read the full story here.
Why is it essential to research COVID-19 treatment specifically in the immunocompromised population?
Dr. Andre Kalil, author of a new study assessing the efficacy of antiviral medication in immunocompromised COVID-19 patients.
This population is at elevated risk of severe disease and death resulting from infection. This is due to an increased susceptibility to the virus and the reduced efficacy of preventative measures, such as vaccines. Therefore, these patients have been largely excluded from clinical trials centered around COVID-19 for ethical and logistical reasons. This means there are comparatively few evidence-backed medical standards for treating COVID-19 infection in this population, leaving medical professionals with insufficient standardized guidance on which regimens are safe and effective.
How does the study address this gap in evidence-based medicine?
This study focused specifically on immunocompromised COVID-19 patients and retrospectively assessed whether or not they were administered remdesivir, a common COVID-19 treatment, during their hospital stay, calculating all-cause mortality rates for each population. More than 50,000 patients from 48 US states were assessed in this study.
What is remdesivir?
Remdesivir is an anti-viral medication that has been shown to be very effective in reducing death, disease severity (including the need for assisted ventilation), and hospitalization rates among infected individuals. It works by interfering with the ability of the virus to replicate itself and infect other cells.
What did they find?
Graphical abstract from Mozaffari et al.
The authors found that patients who were administered remdesivir had a much lower mortality rate than those who did not receive the medication. This trend was consistent across multiple different SARS-CoV-2 variants, including pre-Delta, Delta, and Omicron viruses. The authors concluded, “Remdesivir, with its established efficacy and safety profile and widespread availability, is an important therapeutic option for treatment of COVID-19 in immunocompromised patients“.
Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID.Today, we review three articles covering the efforts to utilize research to improve the way we practice medicine, from optimizing the work environment to making it easier to find the most up-to-date recommendations. As always, check out the linked full articles for more details.
Dr. Hewitt, co-author of an article examining the effect of PPE on providers
The first article, co-authored by our own Dr. Angela Hewitt and Dr. James Lawler of the UNMC Global Center for Health Security, discussed the impact of heat strain and dehydration on healthcare workers who must wear personal protective equipment (PPE) as they care for patients with high-consequence infectious diseases. The authors conducted a literature review of 30 articles that analyzed the effect of PPE on providers and concluded that there is much benefit to be gained from the development of cooler and more comfortable PPE materials. Such developments could slow the rate of dehydration and reduce heat strain on front-line workers caring for those with serious infectious diseases. Read the full details here.
Drs. Broadhurst (left) and Brett-Major (right), co-authors of this study assessing the success of the ISTARI system
The next article, authored by many UNMC faculty members, including Dr. Jana Broadhurst and Dr. David Brett-Major, explored the use of a new generation of cost-effective biocontainment units called ISTARI (Isolation System for Treatment and Agile Response for High-Risk Infections). Designed to provide negative-pressure rooms in low-resource areas and decrease PPE use in the setting of highly infectious diseases, each unit is designed to perform ~20 air exchanges/hour with HEPA filters and multiple access points for providers to perform patient care without entering the unit, decreasing overall PPE usage. While some limitations were noted, providers rated their ability to perform their job roughly equivalent to the standard care scenario. 100% of teams met critical actions for patient management, including intubation, cardioversion, and CPR! This establishes the ISTARI unit as a cost-effective isolation unit, maximizing provider safety in managing patients with highly infectious diseases, particularly in low-resource settings. Read the full story here.
Dr. Cawcutt, co-author of this report on the rapid dissemination of COVID-19 best practices
The last article, co-authored by Dr. Kelly Cawcutt, outlines ways to improve the dissemination of new medical information, such as that which changes rapidly (i.e., COVID-19 best practices). The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative is a 6-month project that trains volunteer interprofessional teams on the Checklist for Early Recognition and Treatment of Acute Illness and Injury approach, a structured and systematic method for delivering evidence-based critical care. The included weekly 1-hour videoconference sessions on high-impact topics, monthly quality improvement coaching sessions, and extensive additional resources for asynchronous learning. The program was well-received by participants and led to the initiation of several quality improvement projects. Read the paper here.
As we enter the holiday season and approach the coming new year, it is appropriate to reflect on 2023 –what a year!
Unfortunately, 2023 started with the tragic death of Dr. Diana Florescu, a cherished ID faculty member. Prior to her death, Diana was recognized as the 2022 UNMC Scientist Laureate. To preserve her memory and sustain her legacy, the Diana Florescu Clinical Research and Education Fund was established, to be used to support ID clinical research and education – activities to which Diana dedicated her career.
Although we continue to greatly miss Dr. Florescu, 2023 also brought incredible joy with 2 births in the division – Charles Alexander Rehm and Sophia Victoria Grimon. In addition, we added 6 new physician faculty members: Dan Cybulski, Jenn Davis, McKenzie Keintz, Jon Ryder, Sias Scherger, and Juan Teran; as well as new staff members: Fantasia Blackson, Lance Burwell, Lexi Hilkemeier, Agustin Delgado Jimenez, Travis Mach, Emmanuel Nazaire Essam Nkodo, Anna Nordhagen, McKenzie Rehm, Elizabeth (Lizzy) Sawka, Kerry Stevens, and Eva Williams.
To hit just a few highlights of our research, education and clinical missions:
In 2023, the ID Division continued to hum with clinical activity. On any given day, 5 teams of ID clinicians provided expert inpatient consultative care on the Community, General, Oncology, Orthopedic, and Solid Organ Transplant services. Ambulatory clinics were offered in each of the service areas as well as at our comprehensive program for persons with HIV at the SCC. Ambulatory ID services were initiated at the Village Pointe location and innovations were offered in the Travel Medicine Clinic, Nontuberculous Mycobacterium Clinic, and Long-acting Injectable Antiretroviral Clinic. Ryan Ross was distinguished with the Nebraska Medicine ITEACH Award for Excellence in Clinical Care.
There are way too many individual honors to list but a few more highlights of 2023 include promotion to the rank of Associate Professor for Dr. Andrea Zimmer and Dr. Elizabeth Schnaubelt rising to the rank of Colonel in the USAF. Dr. Jasmine Marcelin took on new duties as the Vice Chair for Equity and Inclusion in the Department of Internal Medicine, Dr. Nada Fadul was named to the Board of Directors of HIVMA, and Jessica Quick was recognized as a Fellow of FACMPE.
It is abundantly evident the UNMC ID Division is full of amazingly bright, talented, and dedicated clinicians, researchers, and educators and a terrifically effective support staff.
In closing, after nearly 32 years as a faculty member at UNMC, with the last 13 years as the ID Division Chief, and with such an incredibly accomplished and successful Division, it is a perfect time for me to step aside and watch as a new chief is chosen to lead the Division to even greater heights. A search firm has been hired and a search committee has been named and 2024 should usher in a leadership transition. It has been my life’s honor to help lead the ID Division and I look forward to staying on as a faculty member for several more years.
I hope the “UNMC ID family” and all the readers of the UNMC ID blog have a joyous holiday season and that 2024 is happy, healthy, and prosperous!
Every fall, the UNMC student-led organization Fostering the Future sponsors a project to create blankets for foster children, women and children at shelters, refugee families, children undergoing long-term medical treatments, and adults undergoing chemotherapy. This year, the UNMC ID Specialty Care Clinic decided to get into the holiday spirit and join the fun by cutting and tying fleece blankets for donation to youth in foster care with help from Project Everlast, Project Harmony, Partnership 4 Kids, and the Omaha Police Department. The SCC Client Services Team tied the blankets (pictured right).
Fostering the Future is a student-led, interprofessional service-learning initiative dedicated to promoting resources and solutions to address the health challenges at-risk youth face in the Omaha metropolitan area. Their mission is to improve the quality of life for at-risk youth and the overall health of our community by providing a continuum of resources, education, leadership opportunities and impactful personal experience to create healthy, positive, sustainable futures for children.
The annual blanket project is just one of several ways to get involved. The group also holds educational health workshops with individuals in foster care with mentorship opportunities, panel discussions and programs to educate health professionals on foster care, and a youth health fair covering topics like exercise, nutrition, healthy relationships, CPR and first aid, substance abuse, and personal and professional development.
Thank you, SCC, for donating your time to this great project!
If you are interested in learning more about Fostering the Future or would like to get involved, contact the Office of Community Engagement at the following link.
In academic medicine, and especially in ID, we pay great attention to evidence-based practices. And rightfully so, instituting treatments and procedures that are supported by data improves the practice of medicine and the quality of life for patients. Sometimes absent from this data are the stories behind it, and the personal interactions that define what it means to be an ID professional.
Providing a space for these stories is the purpose of a recurring section in the journal Clinical Infectious Diseases. According to the journal, these articles feature narrative stories from members of the infectious diseases community that focus on how a career in ID affects the provider. The goal is for Voices of ID to highlight personal stories told in authors’ personal voices in order to help the ID community process the impacts of COVID-19, and life in medicine in general. The journal explains, “These moving accounts provide a mosaic of the different ways we experienced the pandemic and remind us why so many of us have made a home within the ID community—a group full of thoughtful and brilliant people who are passionate about making this world a better place“. Notably, our own Dr. Sara Bares is the assistant editor of this collection.
Nikki Regan, author of a narrative at the intersection of patient and practitioner during the COVID-19 pandemic, now published in Clinical Infectious Diseases.
Today, we want to feature the work of Nikki Regan who recently authored an article in this collection entitled “Just Breathe: My First 12 Hours as a Clinician Patient With COVID-19“. In it, she explores the very human side of contracting COVID-19, complete with the anxieties and responsibilities that come with being an ID medical professional afflicted with COVID-19 during the height of the pandemic. It is a personal narrative with themes and experiences that will resonate with the experiences of many healthcare professionals, as we try to come to grips with the disruption of the COVID-19 pandemic.
You can read “Just Breathe: My First 12 Hours as a Clinician Patient With COVID-19” at this link, and check out the entire Voices of ID collection here.
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