Division of Infectious Diseases

EMET Student Profile – Rohan Khazanchi, M1

Tell us about the position you are starting?
I will be joining the HIV Clinic over the next four years as a new HIV Enhanced Medical Education Track (EMET) student. Being in a longitudinal program like this means I will be returning to the HIV clinic throughout my medical training to learn about management of patients with HIV and work on an independent research project. I’m interested in health disparities and hope to conduct a public health study examining differences in the outcomes of our patients based on zip code, race/ethnicity, gender, socioeconomic status, and other social factors.

Background:
I was born in Cincinnati, OH, but grew up here in Omaha and graduated from Millard North High School in 2013. For the last four years, I attended Washington University in St. Louis where I studied Biology (Neuroscience concentration) with minors in Music and Psychological & Brain Sciences. I was involved in a variety of activities at WashU, but my experiences conducting neurobiology research and leading a songwriting program for children who had recently lost close members of their family particularly motivated me to pursue a medical career. I’m excited to be back in Omaha and studying at the College of Medicine for the next four years.

Why UNMC?
I am thrilled to be at an academic medical center that is both a leader in medical education and research. Both my parents are educators, which has contributed to my own interest in academics and medical education. In addition, conducting research has been integral to my development as a physician-in-training. Being at UNMC gives me ample opportunity to continue exploring these interests alongside my medical training.

Why did you choose to apply to the HIV EMET?
With our class being the first to enter a new curriculum, we were fortunate to be taught about HIV during our first months of medical school. I loved hearing from both patients and providers about the unique relationships formed between physicians and their patients with HIV. It is amazing to see how proper treatment can drastically improve quality of life for patients with HIV. In addition, I was drawn to the HIV clinic because of the large number of underserved patients they treat. I hope to continue combating social justice issues and working with underserved patient populations throughout my career.

Something interesting about me not related to medicine:
In college, I was fortunate to be part of an a cappella group (Mosaic Whispers) that ended up advancing to the finals of an international competition (ICCA — the same as Pitch Perfect!), and we performed on a Broadway stage in New York during the finals round. I think it would be fair to say I definitely peaked early…

We wish Rohan the best of luck over the next several years during his journey with us as part of the HIV EMET! More information about the EMET program can be found here.

New Faculty Spotlight – James Lawler, MD, MPH, FIDSA

Dr. Lawler recently joined UNMC and the ID Division serving as the Director of Clinical and Biodefense Research within the
National Strategic Research Institute and Director of International Programs and Innovation with Global Center for Health Security

On a more personal note, we asked Dr. Lawler a few questions: Why did you choose to come to UNMC? What excites you about Infectious Diseases? And we asked him to tell us something unrelated to medicine we may not know about him.

Here are his answers –

WHY UNMC: The people is what really attracted me to UNMC. There is an incredible sense of purpose and teamwork that is pervasive.

ID EXCITEMENT: I love the intellectual challenges of clinical ID emerging infectious disease research.

UNRELATED TO MEDICINE: I am a big college basketball fan.

Thank you Dr. Lawler! We are thrilled to welcome you and work with you going forward.

Learn more about the UNMC ID Division Faculty including Dr. Lawler here.

Faculty Research Presentation: Bacterial Iron Metabolism and Novel Antimicrobial Strategies

Every month, we have a faculty member presents their ongoing research. Last month we had the opportunity to learn from Dean Bradley Britigan about novel antimicrobial strategies involving disruption of bacterial iron metabolism. Microorganisms need iron for growth and metabolism; they need it for enzymes, gene regulation, and development of virulence factors. Most bacterial species requiring iron for metabolism secrete siderophores which are low molecular weight proteins that facilitate iron uptake into the cells.

Trojan Horse

Dr. Britigan shared that both Mycobacterium tuberculosis and Francisella tularensis are intracellular pathogens of macrophages that produce siderophores for iron-mediated pathogenesis. In the age of increasing antimicrobial resistance, Dr. Britigan’s work has been dedicated to investigating whether bacterial iron metabolism can be targeted as a novel antimicrobial approach to therapy. They have found some interesting results using gallium as a “Trojan horse”.

Gallium is a trivalent cation with similar size, binding/affinity and molecular properties as a trivalent iron cation, however unlike iron, it cannot be reduced to a divalent state under physiologic conditions; therefore when gallium is substituted for iron in iron-containing enzymes they cease to function. If they saturate the bacterium’s environment with gallium, they can essentially “trick” it into believing it has iron, when it doesn’t. The ability of gallium to disrupt cancer cell iron metabolism via a similar mechanism of action in humans led to FDA approval of gallium nitrate for the treatment of hypercalcemia in malignancy. Early studies showed that gallium inhibited the growth of M. tuberculosis and F. tularensis in macrophages, and reduced the amount of intracellular iron within these bacteria in a concentration-dependent fashion. The inhibitory effect was found to be reversible when extracellular concentrations of iron were increased. In murine models infected with F. tularensis and M. tuberculosis, the overwhelming majority of mice survived infection when treated with gallium.

Cystic Fibrosis

This concept was then applied to Pseudomonas aeruginosa, with particular interest in the cystic fibrosis patient population due to growing antimicrobial resistance and biofilm production. Dr. Britigan’s team in collaboration with investigators at the University of Washington found that gallium also inhibited growth of P. aeruginosa in the murine models of pseudomonas infection, and most mice survived infection with this organism (unless there was significant iron levels in the environment). Remarkably, gallium also inhibited the formation of P. aeruginosa biofilm, with high concentrations killing bacteria within the interior of the biofilm. The mechanism of action for biofilm inhibition has not been fully determined, but they hypothesized that there may be multiple sites of action of the gallium. This hypothesis was tested in vitro with multiple iron-dependent bacterial enzymes including catalase, superoxide dismutase and ribonucleotide reductase, found to be inhibited by the presence of gallium in growth media.

This work has generated enough interest for clinical trials. In the phase 1 trial, the drug appeared to be well tolerated; the phase 2 trial results have not been released. Dr. Britigan’s lab is continuing to look at clinical isolates before and after treatment with gallium to evaluate for changes in resistance patterns as a result of this treatment, and studies are still ongoing. If applied to clinical practice, gallium would be given intravenously (FDA approved in this form). It’s half-life in the lung is approximately 48-72hrs, and in serum 24hrs, but is not a good candidate for oral formulation as it stands as it is not well absorbed from the gastrointestinal tract. In the cystic fibrosis population the inhaled formulation would be preferred, but studies of the drug in this form are ongoing.

Future Clinical Applications

The clinical application of gallium in bacterial infections would be complementary to the traditional antimicrobials. Gallium is bacteriostatic, which means it inhibits growth rather than kills bacteria. A theory of bacterial resistance mechanisms in biofilm-producing organisms is that the antibiotic cannot penetrate the biofilm adequately, therefore bacteria on inner layers can become resistant. Gallium synergy would be useful here, because its inhibitory effects extend to biofilm; it can help to penetrate biofilm, reduce bacterial burden and create an environment where bactericidal antibiotics can work more effectively to kill bacteria. Future directions and questions would be to define the forms of gallium that are most effective against target organisms, and expand to include evaluation of additional resistant organisms (e.g. M. abscessus), identify novel drug delivery options (e.g. nanoparticle aerosol delivery), or viral organisms (HIV/TB co-infections).

Teaching Old Drugs New Tricks

In an age where antimicrobial resistance is inevitable, it is a relief to hear about physician-scientists thinking outside the box when it comes to development of antimicrobial agents. Brand new drug development is important but can take up to 10 years along the continuum of drug idea to testing, to FDA approval, to clinical availability. For many of these resistant infections, we may not have 10 years to wait for this process, and this is where re-purposing “old” drugs can be helpful to bridge the gap.

Content Acknowledgement: Thanks to Dr. Bradley Britigan

ID Journal Club Presents…Antimicrobial Stewardship in Immunocompromised Patients with Febrile Neutropenia of Unknown Origin– Focusing on Early De-escalation

Targeted therapy and antimicrobial stewardship in patients with febrile neutropenia is difficult because in the vast majority of cases, an organism is not identified, and patients are known to be high risk for serious infections. Antibiotic de-escalation in patients with neutropenic fever varies, with European guidelines recommending 72hr de-escalation and North American guidelines recommending continuation of broad spectrum therapy until neutrophil engraftment. Dr. Jasmine Marcelin presented a study in ID Journal Club recently that applied an antimicrobial stewardship intervention to this patient population.

Plain Language Summary: The study found that in patients whose blood counts had dropped due to chemotherapy that developed fevers with no identifiable cause, stopping antibiotics 5 days after fevers resolved did not lead to worse outcomes (as compared to continuing antibiotics until blood counts recovered).

Snyder et al; Early Antimicrobial De-escalation and Stewardship in Adult Hematopoietic Stem Cell Transplantation Recipients: Retrospective Review, Open Forum Infectious Diseases. https://doi.org/10.1093/ofid/ofx226

The authors of this study sought to provide a middle ground by assessing whether or not patients who were de-escalated after 5 days of therapy (but before engraftment) would have worse outcomes.

This was a single-center retrospective cohort study looking at allogeneic hematopoietic stem cell transplant (HSCT) patients with febrile neutropenia (who had defervesced and were clinically stable) who were de-escalated to neutropenic prophylaxis after 5 days (cohort 1) vs those who were continued on broad-spectrum therapy until engraftment (cohort 2). The study included 120 patients, with 46 in cohort 1 and 74 in cohort 2. The question: if patients are de-escalated after 5 days, are they more likely to have recurrent fever?

In the assessment of recurrent fever, early de-escalation was non-inferior to prolonged broad spectrum antibiotics (15% vs 19%, 90% CI -0.09 to 0.16, p 0.026). There was no difference in the occurrence or time to re-escalation/re-initiation of broad spectrum antibiotics. Additionally, there were no differences in down-stream effects such as length of stay, ICU admissions, Clostridium difficile infections or in-hospital mortality, and notably, no patients developed bloodstream infection after de-escalation, regardless of recurrent fever. Finally, in the early de-escalation group there were 0.6 days of gram-positive antimicrobial agents per patient compared to 1.7 days per patient in the group that received prolonged broad spectrum antibiotics (p=0.001).

While it certainly does NOT demonstrate that de-escalating after 5 days is better than continuing antibiotics until engraftment, there was no difference in clinical outcomes in patients who were de-escalated early compared with those continued on prolonged antibiotics, with added benefits of reduction of cost and antimicrobial utilization. The authors added that the results of this study have already led to changes in clinical practice at their institution.

The biggest limitation of this study was that it was retrospective: missing data is always a concern. How can we be sure that there were no uncontrolled variables that impacted duration of empiric antimicrobial therapy?

This article led to great discussion among the group, and fortunately our entire Oncology ID group was in attendance, including Dr. Alison Freifeld, first author of the 2011 IDSA Neutropenic Fever Guidelines and Director of our Oncology Infectious Disease Program here at UNMC ID. Dr. Freifeld commented that “we have been interested in early de-escalation for a while now“, and shared that their group have been even more aggressive than what is described here for early de-escalation. Dr. Andrea Zimmer added that while difficult to quantify, anecdotally there have not been high rates of post-de-escalation febrile illnesses even with aggressive de-escalation.

The Journal Club group also briefly discussed a related study, a recent randomized controlled trial, the “How Long Study” (Aguilar-Guisado, Manuela et al. The Lancet Haematology , Volume 4 , Issue 12 , e573 – e583). In this study, the authors found that in similar high-risk patients with hematologic malignancies or HSCT and febrile neutropenia, empiric therapy could be safely discontinued without neutropenic prophylaxis after 72hrs of being afebrile. Like the study by Synder et al., this RCT noted no difference in rate of recurrent fever, mortality, or other adverse events in the group with antibiotics discontinued compared with continuing empiric antibiotics until neutrophil engraftment.

While it remains to be seen whether early de-escalation or complete discontinuation is the best recommendation, both these studies demonstrate the value of antimicrobial stewardship in the immunocompromised population with febrile neutropenia.

UNMC ID Welcomes New M1 Enhanced Medical Education Track Students

The UNMC College of Medicine offers a unique Enhanced Medical Education Track (EMET) program which provides an opportunity for medical students to delve into particular disciplines of interest in the field of medicine throughout their four year degree program. Track students attend seminars, preceptorships and complete a research project culminating in a poster or conference presentation. More information about the EMET program can be found here.

One of these tracks is HIV medicine, and we are always excited to have track students come through our HIV clinic. Our track students have participated in many research projects, with over 20 publications and presentations. This year, we are pleased to welcome two M1 students who will be joining our track: Rohan Khazanchi and Kevin Hanna. They are both very passionate about HIV care. In upcoming posts, we will introduce them separately.

Rohan Khazanchi, M1

Kevin Hanna

Ryan Ross, RN on Why I Love ID

Why I Love ID:

“Why I love ID? I love ID because it brought me many new challenges as a nurse. I’ve been able to learn in depth about infections ranging from Tuberculosis to prosthetic joint infections. I love being part of a team that has the knowledge and expertise to be able to diagnose infections that others could not find. It’s very rewarding to see these infections with a cure. And mostly importantly I love ID because I have been fortunate enough to work with such an amazing group of staff who have been willing to mentor me along the way!”

– Ryan Ross

See more about the UNMC ID Division here.

Pharm to Exam Table: Meet Biktarvy, the Newest of the Antiretroviral Family!

Pharm to Exam Table: Clinical Pharmacology/Antimicrobial Updates – Biktarvy, a new co-formulated integrase inhibitor-based treatment approved for HIV

On February 7th 2018, the Food and Drug Administration approved a new combination antiretroviral drug called Biktarvy®(1). Biktarvy® (B/F/TAF) is a single-tablet, once daily regimen containing the novel integrase strand transfer inhibitor bictegravir coformulated with emtricitabine and tenofovir alafenamide (1). Current HIV guidelines recommend integrase strand transfer inhibitor (INSTI)-based regimens as initial therapy for HIV patients due to their high potency and a favorable side effect profile. Consequently, the introduction of a new integrase inhibitor underscores the importance of integrase strand transfer inhibitors in treating HIV infections.

B/F/TAF is a small, once-daily, single tablet regimen that offers several advantages over existing antiretroviral regimens. No HLA-B*5701 testing (abacavir hypersensitivity) is required prior to initiation, no food intake requirements, and it has a lower potential for drug-drug interactions with its lack of a pharmacokinetic booster within the formulation1. A number of randomized controlled phase III trials were instrumental in assessing the efficacy and safety of B/F/TAF. Study 1489 was a randomized, non-inferiority, trial comparing B/F/TAF to dolutegravir, abacavir, and lamivudine (3). 92·4% of treatment naive subjects in the B/F/TAF arm achieved viral suppression at 48 weeks compared to 93% in the dolutegravir, abacavir, and lamivudine arm (3).

Study 1490 was a randomized, non-inferiority, phase III trial comparing B/F/TAF to dolutegravir, emtricitabine and tenofovir alafenamide. 89.4% of treatment naive subjects in the B/F/TAF arm achieved viral suppression at 48 weeks compared to 92.9% in the dolutegravir, emtricitabine and tenofovir alafenamide arm (4). Study 1878 was an open label, randomized study comparing subjects who were virologically suppressed on a boosted protease inhibitor plus a dual nucleoside inhibitor containing regimen and then switched to B/F/TAF2. 92.1% of subjects who switched to B/F/TAF were virologically suppressed after 48 weeks compared to 88.9 % in the boosted protease inhibitor arm (2).

Notably, no treatment-emergent resistance to bictegravir was identified in any of the aforementioned studies. B/F/TAF was well tolerated with nausea, vomiting and diarrhea as the most common side effects reported. Given its unique properties, potency, and tolerable safety profile, B/F/TAF provides offers another viable option as initial therapy or as an alternative antiretroviral therapy for the treatment of HIV infection.

References
1 Biktarvy® [package insert].Foster City, Gilead Sciences Pharmaceuticals Incorporated; 2018
2 Gilead. Safety and Efficacy of Switching From Regimens Consisting of Boosted Atazanavir or Darunavir Plus Either Emtricitabine/Tenofovir or Abacavir/Lamivudine to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Virologically Suppressed HIV-1 Infected Adults. Available from: https://clinicaltrials.gov/ct2/show/NCT02603107
3 Gallant J et al. (2017). Bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir, abacavir, and lamivudine for initial treatment of HIV-1 infection (GS-US-380-1489): a double-blind, multicentre, phase 3, randomised controlled non-inferiority trial. Lancet. 390(10107); 2063-2072
4 Sax PE et al. Coformulated bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir with emtricitabine and tenofovir alafenamide, for initial treatment of HIV-1 infection (GS-US-380-1490): a randomised, double-blind, multicentre, phase 3, non-inferiority trial. Lancet. 2017; 390(10107):2073-2082.

Content provided courtesy Allan O. Osiemo, UNMC Pharm.D. Candidate 2018

Celebrating Doctor’s Day

March 30th will pass by for some as any other day. However, it should not. It is a day for us to celebrate and recognize American physicians for their ongoing work to improve the health of our communities, country and world. As we have said before, in the end, we are all patients. Doctors will impact the lives of most, if not all, American’s at some point. Today, we urge you to recognize this service and say Thank You.

National Doctors’ Day has a date rich with history. March 30th is the anniversary of the first use of general anesthesia in surgery by Dr. Crawford Long in 1842 when he used ether in Jefferson, Georgia for the excision of a neck tumor. In 1933, Eudora Brown Almond (wife of Dr. Charles B. Almond), and the Barrow County Medical Auxiliary Society in Georgia commemorated this date by mailing cards to physicians and their families along with placing flowers on graves of deceased doctors.

In 1958, The US House of Representatives adopted a resolution to formally commemorate Doctors’ Day and on February 21, 1991 President George Bush proclaimed March 30th as National Doctors’ Day to recognize American physicians working to improve the health of this country through patient care, research, education and more.

The proclamation reminds us of both the honor and the cost of following the professional calling of being physician.

“More than the application of science and technology, medicine is a special calling, and those who have chosen this vocation in order to serve their fellowman understand the tremendous responsibility it entails…Accordingly, reverence for human life and individual dignity is both the hallmark of a good physician and the key to truly beneficial advances in medicine.

However, in addition to the doctors whose name we easily recognize, there are countless others who carry on the quiet work of healing each day in communities throughout the United States — indeed, throughout the world. Common to the experience of each of them, from the specialist in research to the general practitioner, are hard work, stress, and sacrifice. All those Americans who serve as licensed physicians have engaged in years of study and training, often at great financial cost. Most endure long and unpredictable hours, and many must cope with the conflicting demands of work and family life.”

Here at UNMC we are grateful for all of our physician colleagues who strive to always provide the best care for the patient and we recognize the sacrifices each has had to make in the process. The institution will be celebrating Doctors’ Day in honor of this.

But, we are also specifically grateful for our ID Division physicians who provide excellent care for patients, but also, who make sure to care for each other by stepping up to help a colleague in need, covering a shift, mentoring and sponsoring colleagues, and who truly appreciate the unique expertise of each of our faculty members.

To all physicians reading this – THANK YOU and please do thank a colleague.

If are not a physician, but you know one, say thank you today. Those two words carry phenomenal value to each and every physician.

Happy Doctors’ Day!

Breakfast with IDSA CEO Chris Busky, CAE

This morning members of our UNMC ID division had the opportunity to have breakfast with the CEO of the Infectious Diseases Society of America (IDSA), Chris Busky, CAE. Though it was early in the morning, our fellows and several faculty made an appearance at the breakfast, where we listened to a short presentation by Mr. Busky, followed by an informal question-and-answer session discussing issues that affect us all as Infectious Diseases physicians. Below is an account of our discussions.

In his presentation, Mr. Busky discussed the strategic priorities of IDSA:

Strategic Priority 1: Promote the value of the Infectious Diseases Physician/HIV Specialist

IDSA is committed to spending time and resources to communicate the value of our specialty, and help ID physicians communicate this value to the key stakeholders, including hospital administrators, payers and policy makers. This involves a strategic redefining of our brand and their messaging campaign. They have created a “Value of Infectious Diseases Specialists” toolkit which includes resources for leading Antimicrobial Stewardship Programs. Additionally, they recently produced the largest Infectious Diseases Compensation survey in history with a record 2500 responses (compared to other surveys that only included a paltry single digit percentage of ID physicians) to provide better compensation data for IDSA members. One of our fellows brought up a great point: can we add value to the Infectious Diseases Physician by including access to training for minimally invasive procedures, through point-of-care ultrasound? Think – abscess drainage, paracentesis, thoracentesis, line placement etc… Many non-proceduralists perform these kinds of tests in community hospitals, why not ID physicians? Could this be an opportunity for diagnostic stewardship? The answer to this is unclear, but there may be interest in this as many ID fellow candidates are considering ID-Critical care for this reason.

Strategic Priority 2: Attract the Best and Brightest to ID/HIV

Acknowledging that (a) medical students start to decide on broad scope of specialty (Internal Medicine vs non-Internal Medicine) by their second year of medical school, and (b) Internal Medicine residents decide on subspecialty fellowship interests by their second year of residency, IDSA is increasing efforts to attract medical students and residents to our field. The society now has over 1000 resident/medical student members, and several ID interest groups directly affiliated with IDSA. The society acknowledges the need to continually engage these students/residents well into their training, so that they remain interested in Infectious Diseases when the time comes to pick their specialty. Additionally, IDSA will be piloting a new leadership institute program in 2019. This program will provide an opportunity to create a blended curriculum involving professionals to describe leadership/business core competencies tailored specifically to infectious diseases as a specialty, to promote advancement of ID physicians in leadership positions throughout their careers.

Strategic Priority 3: Promote Leadership in Antimicrobial Resistance and Stewardship

Society journals have recently released several publications outlining the need for Infectious Disease Leadership in Antimicrobial Stewardship Programs (which ties into the priority of promoting ID Physician value). Acknowledging that these programs are needed (perhaps even more critically so) in smaller communities with limited resources and worldwide, IDSA is actively exploring how to utilize Tele-Stewardship programs nationally and internationally in combination with appropriate compensation models. This tele-health program for Antimicrobial Stewardship is also applicable for long-term health care facilities. Our own Dr. M Salman Ashraf is also exploring this in Nebraska and has collaborated with the CDC and Nebraska Department of Health to create the Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP). Additionally, IDSA has piloted the Antimicrobial Stewardship Centers of Excellence Program to”promote excellence in optimizing antimicrobial use and combating antimicrobial resistance (AMR) by identifying institutions that effectively demonstrate these activities“. Finally, as part of promoting leadership in this area, IDSA is developing an Antimicrobial Stewardship curriculum for fellowship programs, including basic and advanced curricula that should be available for free to ID program directors and fellows later this year.

Strategic Priority 4: Produce Relevant Guidelines

IDSA is committed to producing high-quality guidelines, using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to standardize and improve quality of guidelines. Guideline committees will work with an ID physician guideline specialist and methodologist to have more streamlined and consistent development guidelines that address relevant clinical needs. They have also committed to rapid turn-around, high-level updates of guidelines and better coordination with international society guidelines.

Strategic Priorities 5 & 6: Promote ID/HIV Research, and Advocate for Public Health Funding in ID/HIV

IDSA has been a strong funding advocate. They advocate for funds through the National Institute of Allergy and Infectious Diseases (NIAID), Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA). Additionally, they advocate for Global Health through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and United States Agency for International Development (USAID). IDSA has several ID/HIV funding programs for which members are eligible. Tied to the priority of attracting the Best and Brightest, to promote research in HIV/ID, IDSA has been funding the Medical Scholars Program. Finally, membership to the HIV Medicine Association is included in IDSA membership, and this sub-society is dedicated to promoting quality in HIV care, directing major HIV-related policies and guidelines.

Member Engagement

IDSA has >11,000 members in 100+ countries across 6 continents, and the society is constantly working on transforming their brand. They will be moving towards more personalized engagement, featuring stories of physician members, fellows, resident/students interested in ID. The annual conference has been improving in popularity each year,largely due to improved content, more opportunities for interaction and new features (ID Bug Bowl was a blast!). IDSA is being more deliberate about creating personal connections, engaging dynamics, relevant content and opportunities for networking with smaller, more interactive sessions to transform the conference.

IDWeek 2018 will be in San Francisco October 3-7 (UNMC_ID will be there!). There are also additional opportunities for fellows to get involved, and Open Forum Infectious Diseases is an opportunity for ID fellows to submit their work for publication. There are clinical and research meetings for fellows occurring in April and June 2018 respectively. IDSA encourages active membership engagement, and the society is committed to providing volunteering roles for all who want to be involved-advocacy, website content, media core (be a content expert), journal club, education, mentorship etc. Regarding engagement in political advocacy, the society had record engagement (>4000) from members in 2017 with face to face meetings, action alerts, member visits in local communities. Mr. Busky emphasized that the society’s role in advocacy is never complete – engagement with congress is ongoing, building and strengthening relationships on Capitol Hill to advance the priorities of the society representing its individual physician members. He encouraged physician members to be a consistent voice reaching out to Congressional representatives with the message to prioritize ID/HIV concerns.

Burnout/Stress

Mr. Busky wanted to know what we are doing to address stress/burnout here. Our general ID service is our busiest clinical inpatient service. Acknowledging this, our Division Chief Dr. Mark Rupp has already made plans to split this service into two. This will significantly reduce the patient census and make a difference in reducing stress. Of course, time spent documenting in the EMR (universal problem for all medical specialties) contributes to stress/burnout, when physicians are spending 2-3 hrs after care is provided to document in EMR. The group felt that one of the biggest contributors to burnout/stress in our specialty is the struggle with with communicating value of ID outside our division – many ID physicians find themselves engaged in several different activities to “prove their worth”, compared to some proceduralist specialties which may be able to focus more on what they actually trained to do for the same (but usually higher) compensation. In the same thread, we discussed how to communicate the value of ID sub specialties such as Oncology-ID, Ortho-ID, or Transplant-ID to the related medical specialties in promoting this niche care. Mr. Busky shared that IDSA is part of the “Cognitive Care Alliance” of specialties, collectively working towards advocating for value of these cognitive specialties.

Diversity

IDSA acknowledges there are gender and racial disparities within our ID workforce. Their first goal was to evaluate it to see what the gaps are as described in this publication. Now that the extent of the gap has been identified, IDSA has committed to integrating principles of Diversity, Inclusion & Equity into the core values of the society. The IDSA board will go through training to define these principles and model to the society, with the goal of not only recruiting more women and under-represented minorities, but improving visibility this commitment to membership by ensuring that women and People of Color are represented on leadership committees, award recipients, ID week speakers and society representatives. Additionally, the society aims to diversify the membership and leadership geographically, to ensure that there is representation of more individuals from Midwest/mountain regions. Finally, they recognize that there is a need for more clinical representation on leadership committees and are working to diversify their boards in this way also.

Today, Mr. Busky came to us and by just having a conversation with us, showed us that IDSA is working for us, dedicated to personalizing its connection with members and pursuing our common interests. Thank you for sharing!

Congratulations to UNMC ID Faculty designated as Top Teachers for 2017!

After every rotation, medical students and Internal Medicine Residents at UNMC submit evaluations on their faculty members. The Department of Internal Medicine pools all of the evaluation data and designates the faculty with the top 33% of evaluation scores as “Top Teachers”. For the year 2017, four of our Infectious Disease faculty members who attend on the General ID Service and participate in Medical Student Education were awarded this honor.

Meet our Internal Medicine 2017 Top Teachers from UNMC ID!

Dr. Sara Bares, MD Assistant Professor of Medicine; Associate Director of the Specialty Care Clinic; Director of the UNMC COM HIV Enhanced Medical Education Track; Co-Director of UNMC COM Defenses & Invaders Microbiology Course

Dr. Angela Hewlett, MD, MS Associate Professor of Medicine; Medical Director, Nebraska Biocontainment Unit; Associate Medical Director, Nebraska Medicine Infection Control & Epidemiology; Director, Infectious Diseases Outpatient Clinics; Faculty Adviser, Medical Student Infectious Disease Interest Group

Dr. Mark Rupp, MD Professor of Medicine; Chief, Division of Infectious Diseases; Medical Director, Nebraska Medicine Department of Infection Control & Epidemiology

Dr. Trevor Van Schooneveld, MD Associate Professor of Medicine; Medical Director, Nebraska Medicine Antimicrobial Stewardship Program; Program Director, UNMC Infectious Disease Fellowship; Associate Medical Director, Nebraska Medicine Infection Control & Epidemiology

The UNMC ID Division would like to congratulate Drs. Sara Bares, Angela Hewlett, Mark Rupp and Trevor Van Schooneveld for being awarded Top Teachers in 2017. All four of them have been awarded this honor in the past – this is the 3rd for Dr. Bares, 8th for Dr. Hewlett and 9th for Drs. Rupp and Van Schooneveld.

Drs. Sara Bares and Angela Hewlett were among only 19 faculty members in the Department of Internal Medicine who were designated 2017 Top Teachers by both medical students and residents.

This is yet another testament to our Division’s commitment to Medical Education and growing the next generation of Infectious Disease Doctors!