Dr. Zimmer on “Why I Love ID”: I love the diversity and complexity of the field and especially enjoy working with immunocompromised populations. Seeing a variety of challenging cases and working with multiple different teams makes every day interesting.
Learn more about Dr. Zimmer and the UNMC ID Division here.
I was given the rare opportunity to share my story via the AAMC of how I came to be both a physician and Infectious Diseases/Critical Care subspecialist. Everyone has an amazing story to tell full of both successes and failures, lessons learned and lessons yet to come. Here at UNMC I am honored to be surrounded my amazing, inspiring faculty members within my Division, Department and University as a whole.
There are new generations of students – aspiring physicians, nurses, respiratory therapists, scientists, nurse practitioners, physician assistants, scientists and so many others – preparing to step forward into careers in healthcare. By sharing our stories we remind students of our vulnerability, humanity and persistence in improving the lives of those around us.
At the encouragement of a friend and co-faculty member, I am sharing my story with you in hopes to encourage others to do the same.
Who will you share your story with?
– Post and content are the personal opinion of Dr. Kelly Cawcutt and may not reflect the opinions of the Division of Infectious Diseases or UNMC as a whole.
Two medical students working with UNMC ID Division faculty were recognized by the Department of Internal Medicine for excellence and will receive the 2017 Medical Student Research Award at Grand Rounds on June 2.
Jordan Broekhuis, a fourth year student working with Dr. Sara Bares in the HIV Enhanced Medical Education Track (EMET), conducted a survey of pharmacists in Nebraska and Iowa and found that although many respondents had limited knowledge and experience with HIV pre-exposure prophylaxis (PrEP), most indicated a willingness to provide PrEP after additional training. The results of the study were presented in Seattle at the Conference on Retroviruses and Opportunistic Infections (CROI).
Logan Jones, a fourth year medical student working with Dr. Mark Rupp, conducted a study examining blood culture practices at Nebraska Medicine. In a retrospective review using a conditional hierarchical linear model, Logan noted that blood cultures obtained through a central venous catheter contained a significantly greater volume of blood than cultures obtained via peripheral venipuncture. This observation has clinically significant implications regarding the diagnostic yield of blood cultures and the accuracy of the differential time to positivity assessment. Logan presented his findings at the annual ID Week meeting in New Orleans in October 2016.
Jordan Broekhuis will start Surgery Residency training in July at Beth Israel Deaconess Medical Center, Boston, MA, and Logan Jones will enter Internal Medicine residency training at the University Health Science Center in Portland, OR.
Congratulations to Jordan Broekhuis and Logan Jones!
-Content courtesy of Dr. Mark Rupp
Work hard, play hard.
Medicine is a hard job AND a team sport. We must take time out to celebrate our colleagues work and accomplishments!
This week is Medical Laboratory Professionals Week, which is held the last full week of April each year. Events are held to celebrate the critical work that clinical laboratory scientists perform on a daily basis. This week our Microbiology teams celebrated with a night of bowling and had two teams, the Honey Bowlers and the Gippidy doo doos.
Thank you for all of your efforts to provide amazing patient care!
– Post content courtesy of Dr. Paul Fey.
A prospective controlled trial conducted by Rupp and colleagues in the UNMC ID Division demonstrates a significant 87.6% decrease in blood culture contamination. Results were recently published in Clinical Infectious Diseases and are available on open access at: https://academic.oup.com/cid/article/3099374/Reduction-in-Blood-Culture-Contamination-Through
The study was conducted in the Nebraska Medicine Emergency Department and involved 971 patients and 1,942 blood cultures. Patients needing blood cultures who granted informed consent had one culture obtained in the standard fashion and the other obtained using an innovative device that diverts and sequesters the first 1.5-2.0 mL of blood. It is thought that the first portion of blood carries contaminating skin cells and microbes. Blood culture contamination was significantly reduced through use of the initial specimen diversion device (ISDD) compared to standard procedures: (2/904 (0.22%) ISDD vs 16/904 (1.78%) standard practice, P=0.001). Sensitivity was not compromised: true bacteremia was noted in 65/904 (7.2%) ISDD vs 69/904 (7.6%) standard procedure, P=0.41. No needle stick injuries or potential blood borne pathogen exposures were reported. Seventy-three percent of phlebotomists completed a post-study anonymous survey and widespread user satisfaction was noted.
Blood culture contamination is a common and clinically significant problem. False positive blood cultures increase laboratory costs by approximately 20%, are associated with nearly 40% increase in antibiotic charges, are treated with antimicrobials up to one-half of the time, extend the length of hospital stay up to five days and subject patients to the real harms associated with antibiotic exposures such as toxicity, side effects, interactions and emergence of resistance. It is estimated that a contaminated blood culture costs somewhere between $1,000 (1998) and $8,700 (2009) per case. Approximately 30,000,000 blood cultures are performed in the United States each year. If our findings were extended to all blood cultures in the United States, and a midpoint cost of $4,850 was applied, it would result in approximately 467,000 fewer contaminated blood cultures and a cost saving of $2,270,000,000-that’s real money!
Citation:
Rupp ME, Cavalieri RJ, Marolf C, Lyden E. Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device. Clinical Infectious Diseases. Electronic ahead of print April3, 2017. https://academic.oup.com/cid/article/3099374/Reduction-in-Blood-Culture-Contamination-Through
– Content courtesy of Dr. Mark Rupp
Dr. Sandkovsky on “Why I Love ID”: I love ID because we tend to deal with the unknown, and even when we think we might know there is this intriguing relationship between clinical medicine, basic science and pathophysiology, combined with the social aspects provided by our patients, who make this such a personalized and unique specialty.
See more about Dr. Sandkovsky and the rest of the UNMC ID Division here.
Nebraska is a midwest state with those innate values that, in my limited experience thus far, tends to be against boasting and toward humility. Characteristics often to be proud of, but at times, humbleness verges on being a fault.
The Ebola experience highlights the experience here – UNMC and NMC were ready for Ebola – for a LONG time. Preparedness, drills and money spent “just in case” we ever needed those skills. Guess what? We did. And we were ready.
These experiences have prompted an amazing documentary that you should both watch and share. Infectious diseases are among the most terrifying and deadly diseases known to man. Help us, and the world, be prepared.
The link below connects to the full-length version of the documentary created by NET called “After Ebola: Nebraska and the Next Pandemic”, which chronicles the Nebraska Biocontainment Unit and Nebraska preparedness. It will also air on NET at the following times:
Wednesday, April 19 at 9pm on NET
Friday, April 21 at 7pm on NET World
Saturday, April 22 at 12am on NET
Saturday, April 22 at 7pm on NET
Sunday, April 23 at 8am on NET World
Sunday, April 23 at 12pm on NET
Monday, April 24 at 7pm on NET World
Wednesday, April 26 at 8am on NET World
Friday, April 28 at 11:30 1pm on NET World
Saturday, April 29 at 12am on NET World
Saturday, April 29 at 7pm on NET World
Wednesday, May 24 at 8pm on NET
http://netnebraska.org/interactive-multimedia/news/net-news-after-ebola-nebraska-and-next-pandemic
This post represents personal opinion and was written by Kelly Cawcutt, MD, MS. It does not necessarily represent the opinions of the entire Division of Infections Diseases, UNMC, NMC or NET as a whole.
Credit given to: Angela Hewlett, MD and Phil Smith, MD along with the entire Nebraska Biocontainment Unit for their amazing leadership and efforts throughout this ongoing experience.
Our Division is committed to improving the care of our patient through scholarly activities including clinical research. Here is one of our teams out on the patient floors collecting data related to improve the technology we use for intravenous (IV) lines in our patients. We presented our first phase of this project at IDWeek last year (see poster below) and have just finished collecting data on phase 2 using our updated technology. One part of this team to highlight is that research is not just for our faculty! We have Richard Hankins (internal medicine resident), Jen Cavalieri (research coordinator extraordinaire), Denisa Majorant, MD (ID fellow) and Dr. Kelly Cawcutt (Faculty). Not pictured are Dr. Paul Fey (Microbiology), Elizabeth Lyden(Biostatistician) and Dr. Mark Rupp (Faculty).
Read the published abstract here.
Dr. Florescu on “Why I Love ID”: In infectious diseases, the process of diagnosis is like detective work, a real challenge of the clinical ability. I also feel that I have a significant impact on the life of my patients – infections can make people incredibly sick very fast, and I can get them back to where they were.
See more about Dr. Florescu and the UNMC ID Division here.
Last week, our Infectious Diseases Interest Group held a multidisciplinary panel surrounding careers in Infectious Diseases. Students from medicine, pharmacy, nursing, graduate studies and public health were all in attendance!
There are broad career opportunities within Infectious Diseases and this area always evolving. Teams are multidisciplinary and truly collaborate together regarding patient care, education and scholarly activities. To highlight the different avenues of career paths, the panelists discussed their role on the ID team and the path that led each one of them to a career within Infectious Diseases along with their current carrier and what each panelist finds rewarding about ID.
The student panel included:
Nursing: Ryan Ross from Nebraska Medicine; Kallie Hannam and Marilyn Van Gestel from Children’s
Nurse Practitioner: Whitney Knuth from Nebraska Medicine
Physician Assistants: Maggie Krejci from Children’s; Kim Meyer from Nebraska Medicine
Pharmacy: Dr. Philip Chung from Nebraska Medicine
MD: Dr. Andrea Green
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