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Division of Infectious Diseases

Physician Assistant’s Week – Celebrating Our Colleagues!

As Physician Assistant’s Week draws to a close, the ID Division wants to recognize and extend our appreciation to our Physician Assistant’s that provide extraordinary care to our patients at Nebraska Medicine.

Kim Meyer

 

A graduate of the University of Nebraska Medical Center Physician Assistant Program, Kim has been a Physician Assistant for 15 years. Kim has served patients in both the inpatient and ambulatory environments. During her training, Kim had a deep interest in Microbiology. Had it not been for the influences of Drs. Pete Iwen, Mark Rupp, and Phil Smith during PA school, we would not have been lucky to have her a part of her our team. Whether she starts her day with a dog bite or with a potential exposure to Zika, Kim enjoys the challenges that provide care as part of the Infectious Diseases Team presents.

 

Erin Van Surksum

A graduate of Union College Physician Assistant program in Lincoln, NE, Erin has been a Physician Assistant for two years. Erin provides care for patients as part of the Transplant Infectious Diseases team in both the inpatient and ambulatory environment. Erin always knew she wanted to contribute in the healthcare field and was introduced to the Physician Assistant role by a family member. After shadowing a Physician Assistant, she knew this is how she wanted to contribute in the healthcare field. Erin enjoys the challenges that the unique patient population she serves presents, often researching unfamiliar infections, reviewing cultures, and adjusting antibiotic dosing to ensure the most appropriate plan of care is utilized. For Erin, one of the most rewarding aspects of being a Physician Assistant is the collaborative culture between the care teams she experiences while caring for our patients.

Content courtesy of Jonathan Nguyen.


 

Norovirus in Intestinal Transplant Recipients – A Different Presentation of Enteritis

Dr. Diana Florescu performed a large retrospective study, evaluating clinical presentation and outcomes of Norovirus infections in intestinal allograft compared to the native intestine. The study was done in collaboration with Dr. Pearlie Chong and included patients transplanted at UNMC and the University of North Carolina at Chapel Hill.

The study showed that intestinal transplant recipients tend to have more severe norovirus enteritis reflected in more frequent hospital admissions and requirement of prolonged intravenous hydration, but less likely to have nausea and vomiting at presentation compared with other allograft recipients. Understanding the differences in clinical course of norovirus enteritis between different allografts would help to understand who might require more aggressive intervention or might benefit from novel therapeutic agents. The findings suggest that the intestinal allograft might be infected earlier after transplantation than the native intestine.

This research collaboration led to the invitation to present our findings at the prestigious 26th International Congress of the Transplantation Society in Hong Kong. Our findings have been fully detailed in papers published Transplant Infectious Diseases in 2017.

https://www.ncbi.nlm.nih.gov/pubmed/28273399

Content courtesy of Dr. Florescu. 


 

IDWeek Continues with Great Sessions – Including One On Tele-Antimicrobial Stewardship

Whether ID physicians should help smaller hospitals develop their own program or should run the program for them was debated during discussions. Most likely the right approach will depend on the facility characteristics and their resources. During Question and Answer Session, Dr. Ashraf informed the speakers and the audience that Nebraska ASAP do work with small hospitals and long-term care facilities to help them develop their own program. The approach has its challenges but overall facilities learn over time and so do we. Nebraska ASAP has developed various tools for them to make their job easy and the best part is those tools are then available free of charge on Nebraska ASAP website (asap.nebraskamed.com) which can be used by facilities who are not directly involved in the educational intervention.

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Resistant CMV – Research Aimed at the Cure

 

Infections due to Cytomegalovirus(CMV) remain a significant problem for patients undergoing various types of transplants, including both hematopoietic stem cell transplants and solid organ transplant, particularly since these groups both require the use of potent immunosuppressive chemotherapy. Although the currently available systemic anti-cytomegalovirus agents are usually effective, their use is limited by their toxicities, especially in transplant recipients, who receive ongoing immunosuppressive medications to prevent organ rejection or graft-versus-host disease, and who receive other potential nephrotoxic therapies. The population of hematopoietic stem cell transplant and solid organ transplant recipients, whose CMV infections are increasingly refractory to available antiviral treatment, is an area of high unmet medical need as currently there are no approved treatment for resistant cytomegalovirus infections.

To help discover ways to meet this need, here at UNMC, Dr. Florescu and her research team are leading a study in transplant recipients of a drug for the treatment of CMV infections, including those resistant or refractory to standard of care.

Learn more about ID research at UNMC here.

Content courtesy of Dr. Diana Florescu. 


 

Dr. Rupp Setting the Record Straight on Transmission of Organisms via the Floor

Dr. Mark Rupp debated Curtis Donskey today regarding the role of the hospital floor in transmission of resistant pathogens. According to several in attendance, this was a great discussion! Key Point  Dr. Ashraf took away from this debate : Even though it is important to thoroughly clean floors, we need to remember that transmission of pathogens is more likely to happen due to lack of hand hygiene or not paying attention to high touch surfaces.

Content courtesy of the ID Division attendees at IDWeek. 

Follow IDWeek online via Twitter @UNMC_ID and #IDWeek2017

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IDWeek Pre-Meeting – Seminar on Best Practices in Antimicrobial Stewardship

Excellent pre-meeting Seminar on Best Practices in Antimicrobial Stewardship where numerous national experts presented.  The picture shows Dr.  Arjun Srinivasan from the CDC presenting on national compliance with Stewardship Core Measures. Dr. Trevor Van Schooneveld fromUNMC also presented during this session on Syndromic Stewardship: Combining Interventions to Improve Care.

Follow IDWeek events on Twitter @UNMC_ID and #IDWeek2017

Content courtesy of Dr. Van Schooneveld.

Do What You Do and Get Published, Too – Key Take Home Points!

 

This morning, a fantastic Faculty Development panel was held to a full house of attendees,  focused on how to maximize your productivity within your career and life. Our Division is incredibly productive and this is reflected in that two of the three panelists were from within our ranks: Dr. Hewlett and Dr. Scarsi were joined by Dr. Schenarts in providing insight and expertise in this area.

Missed the session? Here are a few of the key suggestions from that session:

  • Decide when and where you want to write – Where can you focus? What time of day are you productive?
  • Schedule the time – Block your calendar
  • Close the door
  • Find your team AND bring others up to your level when you can. Ask junior colleagues or trainees to work with you and delegate roles.
  • Set deadlines for when this will be done.
  • Do not forget downtime. It is critical to rest.
  • Write down possible research ideas to bring for possible future use.
  • Be an opportunist. When you have an experience that can teach others, capitalize on that.
    • Building a new clinical model? Write it up! If you do not, someone else will.
  • Sometimes the practical and simple clinical questions are well worth printing.
  • Choose a way to write and edit documents as a team IN ADVANCE so that roles are very clear.
  • Consider editing live together as opposed to constant track changes if possible as then your final draft will be done once and in real-time.
  • Not sure if you can publish your project because you hadn’t planned on it at the onset? Perhaps it was a quality improvement project? Call the IRB and ask. This is usually not an insurmountable situation.
  • Consider WHO you think will want to read this and submit to that journal.
    • “Not everything has to be a RCT published in The Lancet”
  • How do you get the expertise to do this?
    • Find a good mentor.
    • Reach out beyond your division.
    • Consider a national course or masters program for additional training.
    • Send your publication/grant/proposal to your WORST critic to focus on improvement.

 

Interested in learning more about faculty development opportunities at UNMC? Read more here.


 

IDWeek 2017 – The Official UNMC ID Guide of Where We Will Be!

IDWeek is upon us and we want to be sure YOU know where to find us! Below is the list of faculty presentations and posters from our Division. Please come visit us at IDWeek –  We would LOVE to meet you! 

Content courtesy of Sandy Nelson and the entire UNMC ID Division. 

 

Tuesday Oct 3

10:15-10:45 a.m.   Van Schooneveld TC.  Best Practices for Antimicrobial Stewardship Programs – Syndrome-specific interventions: Combining Interventions to Improve Care

4:10 p.m. Friefeld A. Transplant Infections. *at Vincent T. Andriole Board Review Course

Wednesday October 4

1:30-3:30 p.m.  Rupp ME. Controversies in Infection Prevention: Pro/Con

Thursday October 5

12:30-2:00 p.m.   Rupp ME, Olson C, Cavalieri RJ, Lyden E, Carling P. How Clean are the Clinics?

Assessment of Environmental Cleanliness in Ambulatory Care. Poster 481

12:30-2:00 p.m. Fitzgerald T, Nailon R, Tyner K, Beach S, Drake M, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Infection Control in Long-Term Care Facilities: Frequently Identified Gaps in Infrastructure, Surveillance and Safety. Poster 413

12:30-2:00 p.m. Tyner K, Nailon R, Beach S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Environmental Cleaning and Disinfection in Long-Term Care Facilities: Opportunities for Improvement. Poster 485

12:30-2:00 p.m. Chung P, Nailon R, Tyner K, Beach S, Bergman S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Van Schooneveld, T, Ashraf MS. Frequently Identified Gaps in Antimicrobial Stewardship Programs in Critical Access Hospitals. Poster 701

12:30-2:00 p.m. Chung P, Nailon R, Tyner K, Beach S, Bergman S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Van Schooneveld, T, Ashraf MS. Frequently Identified Gaps in Antimicrobial Stewardship Programs in Long-Term Care Facilities. Poster 702

12:30-2:00 p.m. Uriel Sandkovsky, Michelle Schwedhelm, Shonelle Grayer, Emily Adelgren, and Mark E. Rupp. Small Changes Make a Big Difference in the Fit of N95 Respirators. Poster 435

 

Friday, October 6

12:30-2:00 p.m.  Green Hines A, Zwiener J, Stec R, Heybrock B, Hegemann L, Simonsen K. Cost Analysis of an Antimicrobial Stewardship Program (ASP) Protocol for Adherence to the 2014 American Academy of Pediatrics (AAP) Palivizumab Prophylaxis Recommendations in a Freestanding Children’s Hospital. Poster 1608

12:30-2:00 p.m. Bares SH and Sandkovsky U. Development and Assessment of an HIV-focused E-learning Flipped Classroom Curriculum in an Infectious Diseases Fellowship Program. Poster 1446

12:30-2:00 p.m. Tyner K, Nailon R, Beach S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Frequently Identified Infection Control Gaps Related to Hand Hygiene in Long-Term Care Facilities. Poster 1322

 

Saturday October 7

12:30-2:00 p.m.  Rupp ME, Tandon HK, Danielson PW, Cavalieri RJ, Sayles H. Peripheral Intravenous Catheters – “They Don’t Get No Respect”. Poster 2160

12:30 -2:00 p.m.  Uriel Sandkovsky, Fang Qiu, Andre C. Kalil, Ada Florescu, Natasha Wilson, Christa Manning, and Diana F. Florescu. Risk factors for development of cytomegalovirus resistance in solid organ transplantation: a retrospective nested case control study. Poster 2448

12:30 -2:00 p.m.  Uriel Sandkovsky, Fang Qiu, Andre C. Kalil, Adriana Weinfeld-Massaia, Joong Kwon, Cynthia Schmidt, and Diana F. Florescu. Epidemiology of Bloodstream Infections in Kidney Transplant Recipients: A Systematic Review and Meta-analysis. Poster 2375

12:30 -2:00 p.m.  Signorelli J, Liewer S, Zimmer A, Freifeld AG Incidence of Febrile Neutropenia in Autologous Hematopoietic Stem Cell Transplant (HSCT) Recipients on Levofloxacin Prophylaxis at a Single Center Midwest Cancer Center Poster 2390

12:30 -2:00 p.m.  Richard Hankins, Denisa Majorant, , R Jennifer Cavalieri, , Elizabeth Lyden, Paul D. Fey, Mark E. Rupp,  and Kelly Cawcutt, Microbial Colonization of Intravenous Luer Lock Connector During Active Infusions Among Hospitalized Patients Poster 2155

 

Find us on Twitter @UNMC_ID; #UNMCID


 

Twitter Here We Come!!

Thank you for ALL of the AMAZING support for our blog! We are thrilled to continue our venture into social media to provide more content, and commentary, on what is happening in the world of Infectious Diseases – particularly here at UNMC. With that goal in mind, we have officially launched our Twitter account @UNMC_ID. We encourage you to join us on Twitter and engage in the conversations, particularly given the increasing utilization of Twitter for academic medicine,  faculty development, promotion of publications, access to journal articles via links and Twitter chats and the opportunity to engage in conversations with colleagues both near and far. IDWeek is almost here(October 4-8th) and is a great time to get involved! Tag #IDWeek2017 AND #UNMCID to follow the conference virtually.

See you on Twitter!


 

 

Welcoming Our New Fellows – Focus on Dr. Hankins

Tell us about the position you are starting?

I think it’s a little difficult to fully describe the position that I am starting.  I don’t fully know all the ins and outs of what the Infectious Disease fellow does, but I’m excited to get into the position and learn.

Tell us about your background?

When people ask me where I’m from, I always find that to be a difficult question to answer.  I was born in the south, where most of my family is from, and my extended family still lives, but grew up in Omaha, so I usually answer that partly from Nebraska and partly from Mississippi.  After finishing high school in Nebraska I went to Ole Miss for undergrad, before returning to Nebraska for medical school.

Why UNMC?

I have ended up staying at UNMC for both internal medicine residency and infectious disease fellowship.  When ever I have thought about leaving UNMC, I seem to be drawn back to how much I enjoy working with the people here.

What about ID makes you excited?

I’m excited to be able to start focusing on just treating infections.  I noticed as I was going through residency that it always seemed the patient’s that had infections were the most interesting to me.  I was always astounded how quickly and much people can improve from getting anti-microbial therapy. I’m also excited about the interesting differentials that occurs in patients being seen by the infectious disease service, and the history and clues that contribute to the infectious disease work up.

Tell us something about yourself UNRELATED to medicine? 

Outside of medicine, I have found that I really enjoyed Mock Trial, an activity that I was able to compete in during high school and college, and that since I have been in Omaha have been able to coach a collegiate team.

Learn more about the UNMC Division of Infectious Diseases and ID fellowship here.


 

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