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Division of Infectious Diseases

Last Words – by Graduating Fellow Dr. Bryan Walker

The following reflection was provided by graduating UNMC ID fellow, Dr. Bryan Walker.

Dr. Walker will be transferring to the University of Tennessee Medical Center where he will be practicing in general infectious diseases! Congrats Bryan!

Reflecting upon my time at UNMC as an infectious diseases fellow, I am struck by the amount of change experienced over the past two years.  I entered fellowship in the summer of 2021, amid the Covid-19 pandemic, and, like so many others, feeling a degree of fatigue. In addition, my wife and I moved from Tennessee expecting our first child. Although we knew we were going somewhere special for my training, uncertainty still loomed.

Thankfully, the life that my family and I were able to make in Omaha and the training I received at UNMC during these changes was remarkable. Upon our daughter’s birth on July 8th, we almost immediately felt the support and goodwill, not only of the fellowship, but of the entire division.  Faculty, staff, and co-fellows reached out to offer congratulations and support. Many of them I had not even met yet! My transition into my clinical rotations the following month was met similarly.  

Early on in my training I learned that the system of support I found at UNMC was not only integral to my thriving in fellowship but was also invaluable in my becoming a competent infectious diseases attending physician.  From the microbiology lab to the bedside, to working with some of the most amazing attendings, pharmacists, nurses, care technicians, medical students, and residents, I am leaving fellowship with a breadth of knowledge and experience, confident and comfortable practicing and teaching in most clinical settings across varying patient populations. I have additionally gained colleagues and collaborators that I know will be with me throughout my career. Further, my time working across disciplines with our pharmacy colleagues on anti-microbial stewardship has left me comfortable in taking on the responsibility of being an anti-microbial steward. Finally, my time spent conducting clinical research while at UNMC has been transformative, informing not only my future research interests but how I utilize the literature to better inform my clinical practice. I know all of this will pay dividends as I head off toward the start of my career.

So much of medical training comes down to putting some part of life on hold in hopes of obtaining the preparation needed to effectively care for those in need and, like good campers, leaving the profession better off than when we found it. I think a concern we all face in training is wondering, at times, if it will all be worth it. In other words, we occasionally question if gambling on our future selves, teachers, and colleagues will pay off. Reflecting on the uncertainty present prior to the start of my fellowship and threading that through my time as an ID fellow at UNMC, I am so grateful that the answer to my question is a resounding yes. 

– Dr. Bryan Walker, ID physician and graduating UNMC ID fellow, 2023

Today is National HIV Testing Day!

Each year, June 27th is observed as National HIV Testing Day (NHTD).  This year’s NHTD theme is “Take the Test & Take the Next Step.”  The act of getting tested is the first step in either treatment or prevention that leads to individuals being empowered to live long and healthy lives.  

 HIV testing is the pathway to engaging in care to keep yourself healthy, regardless of the test result. People who receive a negative test result can take advantage of HIV prevention tools such as pre-exposure prophylaxis (PrEP), condoms, and other sexual health services such as vaccines and testing for sexually transmitted infections. People who receive a positive test result can rapidly start HIV treatment (antiretroviral therapy, or ART) to stay healthy.

The Nebraska Medicine/UNMC Specialty Care Clinic specializes in the prevention and treatment of HIV.  Our clinic is staffed with doctors, nurse practitioners, pharmacists, nurses, social workers, and more!  We are all here to provide the highest level of care in a judgement-free atmosphere.  There is a wide range of prevention and treatment options available and we would be happy to review your best options with you.  If you or someone you know could potentially benefit from HIV testing, we invite you to our clinic, located at 804 South 52nd Street Omaha, NE 68106.  We can also be reached at 402-559-2666.  We look forward to serving you!

Content adapted from HIV.gov, visit the link for more information about National HIV Testing Day.

Last Words – by Graduating Fellow Dr. Mackenzie Keintz

The following reflection was provided by graduating UNMC ID fellow, Dr. Mackenzie Keintz.

Dr. Keintz will be transitioning to an infectious diseases faculty position here at UNMC ID! Congrats Mackenzie!

“My mentor, Dr. Jasmine Marcelin, likes to joke that I decided to go into infectious disease in-utero. While this is somewhat of an exaggeration, I did start this journey to become an infectious disease physician before I ever stepped foot into medical education. The journey was long, over a decade since I made the decision but now as I stand on the precipice of being an independent ID doctor, I feel significant gratitude for the road that has led me here. 

I started at UNMC in 2018 as an internal medicine resident. I quickly found a home in the division of infectious disease. The mentorship that followed affirmed my decision to pursue ID and eventually persuaded me to stay here at UNMC for my fellowship training. 

Although I could spend hours telling you about the wonderful training I received during fellowship about all manners of infectious disease, the thing that has meant the most to me has been the relationships I have built with both faculty and my co-fellows. It has been a wonderful experience learning from some of the best clinical and research clinicians and pharmacists in the field. My practice style has been influenced by each one of you throughout the years, and the combination has made me a better physician. The mentorship I have received has prepared me to excel in the field and I cannot thank you all enough. 

As I transition to the faculty, I aspire to embody the compassion of Dr. Marcelin, the stewardship of Dr. Van Schooneveld, the leadership skills of Dr. Rupp, the thoroughness of Dr. Schnaubelt, the educational aptitude of Dr. Cortes, the kindness of Dr. Walker and many other skills imparted by the faculty I have had the privilege to work alongside. The lessons I have learned from each of you are endless, and I am immensely grateful for the profound influence you’ve had on me. I am so excited to join this exceptional division for another year and I hope I can make even a fraction of the impact you have all given me to the next class of fellows, residents, and students. Thank you all!”

– Dr. Mackenzie Keintz, ID physician and graduating UNMC ID fellow, 2023

UNMC ID Launches Program to Improve Health Equity

The UNMC ID Division is launching Achieving Equitable Health Outcomes in Nebraska, a program to support Nebraska-based organizations in improving health equity in alignment with the Joint Commission’s new priority. See the flyer below and check out this linked website for more information.

Interested in learning more? The first meeting is TODAY, June 21st, at 12pm.

For more information, see https://www.unmc.edu/intmed/divisions/id/echo/health-equity/phase2.html.

Research Digest: Ventilator-Associated Events

Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID. This week, we feature three articles exploring infectious complications associated with ventilator use. As always, be sure to check out the linked full articles for more details.

The first article, co-authored by Dr. Kelly Cawcutt and Dr. Trevor Van Schooneveld (pictured right), provides commentary on the usefulness of risk factors and outcome research on ventilator-associated events (VAE), which include pneumonia as well as a diverse set of additional disorders such as pulmonary edema and mucus plugging among many others. They review multiple previous studies which have attempted to characterize the impact of adverse ventilator-associated events and further distinguish them from specifically ventilatory-associated pneumonia (VAP). The authors conclude that risk factors and outcome research which identify ways to prevent VAE may not be applicable to improvement in the smaller subcategory of VAP. Read the full details here.

In the second article, also co-authored by Dr. Cawcutt (pictured left), ID experts offer guidance on strategies to prevent VAP and VAE as well as non-ventilator hospital-acquired pneumonia. These recommendations are stratified by patient population, offering specific guidance for neonates, pediatric patients, and adults. Cumulating in an extensive update guided by expert testimony and reviewed and approved by a panel of ID specialists, this article provides the medical community with essential tips to avoid common yet life-threatening adverse events. Read the full recommendations at this link.

Dr. Jonathan Ryder, 2nd year UNMC ID fellow

The last article, authored by Dr. Jonathan Ryer (pictured left) and Dr. Andre Kalil (pictured right), explores the association between COVID-19 and VAP. This patient population has been noted to experience VAP at a much higher rate than patients infected with other viruses. Adding to this, there is also an increased risk of shock and bloodstream infections in COVID-19 patients. This article comments on the questions that still exist surrounding this trend and what may be behind it. While a clear cause remains elusive, as the authors note, “[there is]…one thing we can say with certainty: patients hospitalized with COVID-19 are undoubtedly requiring longer hospital/ICU stay and prolonged mechanical ventilation duration, are more frequently proned, and are receiving more immunosuppressive drugs than any other respiratory viral infection ever before.” These factors provide clues to the potential cause of the increased risk of VAP. Read the whole commentary here.

Meeting Recap: Nebraska HIV Prevention & Care Update

The 2023 Nebraska HIV Prevention & Care Update was a great success on 5/18/23 at UNO Barbara Weitz Center for Community Engagement. Hosted by the Nebraska Dept of Health and Human Services and KS/NE AIDS Education and Training Center, the program featured presenters and panelists representing the health department, Nebraska Medicine/UNMC Specialty Care Center, community-based organizations, and consumers of HIV care. Over 100 participants joined in person and virtually from across the region.

Here is a quick summary of what was discussed:

  • New developments in HIV care in 2023
  • Patient perspectives on aging with HIV
  • Barriers to HIV prevention and PrEP for cisgender Black women
  • HIV prevention and care needs for incarcerated and system-impacted people
  • Updates in oral health access and correlations of health for people with HIV
  • Best practices regarding PrEP uptake in disproportionally impacted communities of color in Nebraska
  • HIV prevention and PrEP disparities for people who are Transgender
  • Socioeconomic barriers to engaging patients in HIV care
  • Lessons learned with long-acting antiretroviral therapy

For more information about this year’s conference, or if you are interested in getting involved in future Nebraska HIV Update conferences, please contact Nichole Regan at nregan@nebraskamed.com.

Improving HIV Care: UNMC ID’s Telehealth Intervention Receives National Recognition

Earlier this month, the Specialty Care Clinic’s telehealth intervention plan was recognized and published as a ‘Best Practice’ on TargetHIV.org. This achievement follows from extensive research into existing patients utilizing the telehealth platform and confirmed that HIV care delivered via phone or video chat can be just as effective as care provided in a clinic for patients who prefer it. Read on for the details about Target HIV, best practices, and how the COVID-19 pandemic changed how effective HIV care could be offered at Nebraska Medicine.

What is TargetHIV?

From their webpage, “The TargetHIV website is the one-stop shop for technical assistance and training resources for HRSA’s Ryan White HIV/AIDS Program (RWHAP), the federal program that funds local and state agencies to deliver HIV care for people with HIV who are uninsured or underinsured.“

Essentially, TargetHIV is a nationally recognized resource for clinics looking to improve care of patients living with HIV.

What are Best Practices?

In short, ‘Best Practices’ are exactly that: documented successes in HIV care which are published on the TargetHIV webpage so others can learn from and implement similar interventions. This section gathers and shares what works in RWHAP-funded settings to improve outcomes for people with HIV and to support replication by others.

Why did the Specialty Care Clinic start to trial telehealth care?

During the COVID-19 pandemic, HIV clinics had to transform care delivery for people with HIV, with many clinics transitioning rapidly to alternative methods such as telehealth. In March 2020, SCC recognized the need to adjust its clinic operations to promote patient and staff safety during the pandemic. This adjustment, limiting in-person interactions, conflicted with the clinic’s usual approach to promoting retention in care and viral suppression, which relied on patients making frequent visits to the clinic not only for clinical care but also for ongoing medication adherence and case management support. Prior to March 2020, SCC did not offer telehealth services.

How did it go?

Great! Analysis of the first six months of telehealth offerings (around the beginning of the COVID-19 pandemic) revealed that 35% of visits utilized telehealth technology. In all patients, viral suppression rates were high, but telehealth patients actually maintained a higher rate of viral suppression than patients who visited the clinic in-person during the same time period. This indicates that telehealth HIV care can be highly effective for those patients who choose it.

What else can I find on the Specialty Care Clinic Telehealth Best Practices webpage?

The SCC published all the information that another clinic might find useful when implementing telehealth for their patients, including planning and implementation tips for setting up telehealth, lessons learned during this trial phase, and additional resources for those looking to get started. Check it out here for more information

UNMC ID in the Community: HIV Awareness and Education

The following content was provided by Valentina Orduna, a medical case manager at the Specialty Care Clinic. She joined the HIV/Infectious Diseases team in May 2017 after already working for Nebraska Medicine for 16 years. At Nebraska Medicine, she started as a Pharmacy Technician for 10 years, three years as a Pharmacy Financial Counselor, and three years at the Peggy Cowdery Clinic as a New Patient Coordinator. Valentina is bilingual in Spanish and English. She is devoted and passionate about assisting in the medical field and helping the community.

Earlier this month, UNMC ID’s Specialty Care Clinic participated in the annual Cinco De Mayo festivities, using this opportunity to spread awareness and education about HIV. Read on for Valentina’s report from this great community outreach event.

“Earlier this month we celebrated Cinco De Mayo in South Omaha.  Brief information about Cinco De Mayo: this event is NOT Mexican Independence Day. Cinco de Mayo celebrates the date of the Mexican army’s May 5th, 1862 victory over France at the Battle of Puebla during the Franco-Mexican War.  Although this event is not celebrated much in Mexico (except in Puebla), in the United States, Cinco de Mayo is a big celebration. 

In Omaha, the event runs for three days and attracts about 200,000 people to South Omaha. Each year the Specialty Care Center (SCC) tries to participate in either the health fair or the parade. This year we participated in the parade to bring HIV awareness and education to the community. From my experience working with mainly Hispanic patients, there is still a lot of stigma about HIV and how it is transmitted.  We wanted to bring basic information about how HIV is transmitted and how it is not transmitted.  I’m thankful for the support of everyone at the SCC who helped me make the participation in this event a success and I’m looking forward to future participation in different events in the Hispanic community. “

– Valentina Orduna, bilingual medical case manager, Specialty Care Clinic – Nebraska Medicine

UNMC ID Celebrates ID Pharmacist Day

The third annual Infectious Diseases (ID) Pharmacists Day is today, Monday, May 22, 2023. This day recognizes the importance of ID pharmacists and the contributions they make to patient care. Here at UNMC ID, we are lucky to have a team of highly talented and dedicated ID pharmacists working to help patients and fight infectious diseases every day. In celebration of this day, read on below for a quick introduction to some of our fantastic ID pharmacists.

Bryan Alexander, PharmD, BCIDP, BCPS, AAHIVP

Clinical Pharmacist and Pharmacy Program Coordinator for Outpatient Parenteral Antimicrobial Therapy

Brief Biography: After having been raised in the suburbs outside Cleveland, my training and professional life have taken me to stops living in Chicago, Baltimore, Saint Louis, central Virginia, and now Omaha. My family is now happily settled here – my wife is a university professor and we have two elementary-age children.

I love being an ID Pharmacist because the profession is so wide-ranging in scope and impact, and pharmacotherapy remains central to the range of countermeasures that we employ. Also, infectious disease attracts the most collaborative, brilliant, and compassionate people, such that the teams I get to work with and the problems we work on are constantly edifying.

I love being an ID Pharmacist because ID is so complex and interesting; there is always a new problem to solve or a drug regimen to optimize to try to ensure the best care for patients. I work with the absolute best people who make my job so much fun.

Brief Biography: Grew up in rural Nebraska and attended the University of Nebraska-Lincoln (Go Huskers!) for undergrad prior to obtaining my PharmD from the University of Nebraska Medical Center. I then completed my PGY1 pharmacy residency and PGY2 ID pharmacy residency at Nebraska Medicine prior to accepting my current position.

Molly Miller, PharmD, BCIDP

Clinical Pharmacist Practitioner practicing in Infectious Diseases, Antimicrobial Stewardship, and Outpatient Parenteral Antimicrobial Therapy

Jeremy Tigh, PharmD

Infectious Diseases/Antimicrobial Stewardship Outreach Pharmacist.

Brief Biography: I am from a small town in Northern Nevada originally and went to undergrad and pharmacy school in Utah, where I graduated in 2020. I then came to NMC for residency, and stayed on for my career! 

I love being an ID Pharmacist because… Too many reasons to just pick one. For starters, I love the impactful work that I get to do day in and day out. Making a positive impact on patients’ lives and public health is very rewarding and fulfilling. This area of medicine also appeals to my natural curiosity and need for life-long learning as the field is rapidly evolving with new drugs, pathogens, emerging infections, and evolving resistance patterns.

I love being an ID Pharmacist because it keeps me on my toes! There is always something new to learn and new ways to solve problems. The ID group at Nebraska Medicine is extraordinarily collaborative and knowledgeable and I am lucky to be able to work with them on a daily basis.

Brief Biography: I was born and raised in Omaha, received my PharmD from the University of Nebraska Medical Center in 2012, and started at Nebraska Medicine Bellevue. I became the Antimicrobial Stewardship Pharmacist at Nebraska Medicine Bellevue in 2017.

Daniel Schroeder, PharmD, BCPS

Clinical Pharmacist Practitioner and Antimicrobial Stewardship Pharmacist at Nebraska Medicine Bellevue and Nebraska Antimicrobial Stewardship Assessment and Promotion Program

Jenna Pruesker, PharmD, BCPS

Nebraska Antimicrobial Stewardship Assessment and Promotion Program Pharmacy Coordinator at Nebraska Medicine and Nebraska DHHS Pharmacist

Brief Biography: Doctor of Pharmacy; University of Nebraska Medical Center, College of Pharmacy 2013, PGY1. Residency: CHI Health Saint Elizabeth, Lincoln, Nebraska.

Before joining Nebraska Medicine in 2022, I spent 9 years at Faith Regional Health Services in Norfolk, Nebraska as the Antimicrobial Stewardship Program Director. 

I love being an ID Pharmacist because it involves so much critical thinking and problem-solving. My work is primarily outreach to rural, resource-limited settings, so helping facilities solve antibiotic-related problems challenges me to think outside the box every day. 

I love being an ID Pharmacist because the field is constantly evolving which provides plenty of challenging clinical situations to work through and endless research opportunities.  

Brief Biography: I graduated from the University of Nebraska College of Pharmacy in 2007 and joined the HIV/Infectious Diseases group in 2015 and the Department of Pharmacy Practice in 2019. As a pharmacy clinician at the Specialty Care Center, I provide care for people living with HIV including antiretroviral therapy initiation and revision as well as various other management services together with primary care services.

Josh Havens, PharmD, BCPS

Specialty Care Center, HIV Program

Shawna Sunagawa, PharmD

PGY2 ID Resident

Brief Biography: I am originally from Hawaii but completed my undergrad and pharmacy degree at Creighton University, #RollJays! I matched for PGY1 residency at Nebraska Medicine and was fortunate enough to stay on for a PGY2 ID!

I love being an ID Pharmacist because of the interprofessional nature of the field! Not only am I working with phenomenal ID providers, pharmacists, microbiologists, and other healthcare professionals but I also get to “work with” some pretty cool bugs/drugs!

Brief Biography: I currently work as the Antimicrobial Stewardship Coordinator for Nebraska Medicine and as a Clinical Professor at the Department of Pharmacy Practice at the University of Nebraska Medical Center. I am also the Program Director for the PGY2 Infectious Diseases Pharmacy Residency and conduct research in infectious diseases pharmacotherapy. My group’s current project is optimizing anti-infective use inside and outside of hospitals.

Scott Bergman, PharmD, FCCP, FIDSA, BCIDP

Pharmacist Coordinator, Antimicrobial Stewardship Program (ASP) – Nebraska Medicine

In Case You Missed It: Nebraska ASAP to Host Upcoming Antimicrobial Stewardship Summit

In case you missed it, there is still time to register online for the 2023 Antimicrobial Stewardship Summit. Registration closes this upcoming Tuesday, May 23rd. Read below for information regarding this great opportunity!

The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) will be hosting its annual Nebraska Antimicrobial Stewardship Summit in person on Friday, June 2, 2023, at the Embassy Suites LaVista Hotel and Conference Center. There will be a combined morning session followed by afternoon breakout sessions with targeted presentations in long-term care and acute care/outpatient settings tracks. Registration for the Summit is $99 per attendee, which includes parking, food, and CE credits for physicians, nurses, pharmacists, and medical laboratory scientists. Read on below for more information and to register!

Register now! Go to www.unmc.edu/cce/asap2023

Detailed information:

JOIN US.  Friday, June 2nd from 7:30 a.m. – 4 p.m.
The 2023 Antimicrobial Stewardship Summit: Saving Antibiotics So Antibiotics Can Save Lives will highlight the importance of antimicrobial stewardship and focus on implementation strategies that will promote facility-wide incorporation and improve antimicrobial use and patient outcomes.
TARGET AUDIENCE
This accredited continuing education activity is designed for:

– Post-acute and long-term facilities: Long-term care providers, medical directors, infection preventionists, nurses, consultant pharmacists, directors of nursing, quality program leaders, and other health care providers interested in improving the management of common infections through the incorporation of antimicrobial stewardship principles.

– Outpatient facilities and acute care hospitals: Family medicine providers, internal medicine providers, ambulatory care providers, pharmacists, nurses, medical directors, quality program leaders, and other health care providers interested in improving the management of common infections through the incorporation of antimicrobial stewardship principles.
SUMMIT LOCATION
Embassy Suites by Hilton Omaha La Vista Hotel & Conference Center
12520 Westport Parkway, La Vista, NE 68128

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