Communicating beyond the walls of academia

Tara Smith has a nice post discussing the methods for and importance of moving scientific discovery into the public sphere. She goes on to suggest that including additional funding for the purpose of outreach might be necessary because currently, only peer-reviewed communication with other scientists "counts" towards promotion and tenure.  She also recently gave a nice talk on Science Denial and the Internet; I've posted a link describing her talk below.  David Dobbs, a blogger at Wired had a recent post in the Guardian discussing similar issues, particularly why the scientific publication in the traditional sense is of little value or may actually be a cost.  It should be the data that counts, not the publication.

When I think about all of the wasted time we spend trying to format our papers for specific journals, then waiting 3-6 months to hear back from the journal, and then repeating the process until the paper is accepted, it makes me wonder how much more we could accomplish if we removed these hurdles.  This process enriches not scientists, but societies and others and serves as a method for "conflicted" direct-to-physician advertising. It's not like we find articles by reading the paper journals anymore.  Perhaps we could adopt a process where we publish a working paper online and then journals could compete for the rights to publish the data in their journal.  Wouldn't it be cool to turn a journal down?

Any other ideas for re-working the scientific communication system, both within the scientific community and creating incentives for outreach? We have to try harder to advance science against the pervasive pseudoscience that is forever expanding on the internet and within public policy. For example, if we could spend time communicating the benefits of vaccines instead of spending 15 months getting our vaccine paper accepted, we could serve the public more effectively and the public might actually see the value of science

Smith's Aetiology post: "Moving science communication into the public sphere"

Smith's recent talk on scientific communication, the internet and the anti-vaccine movement 

Dobb's Guardian Post: Publishing your science paper is only half the job

The white coat is back! (Sort of)

There's a new development in the UK with regards to doctor's attire. In 2008, white coats were banned as part of the bare below the elbow campaign. However, some hospitals in the UK are now mandating that doctors put the white coat back on, but there's a twist! The new coats have short sleeves. I wonder what the GQ Style Guy would say about this. I'm not a sartorial expert, but these coats sure look goofy to me. Click here if you want to order one.

Photo:   Internet Workwear Limited

Vancopime

A humorous video that makes a few serious points about antibiotic overuse (hat tip to Neil Fishman, antimicrobial steward par excellence, who forwarded it along)....

Creativity: Not always a good thing

There's a paper in this month's American Journal of Infection Control which looks at surveillance for CLABSI in pediatric ICUs. Surveys of personnel at 16 PICUs, mostly in academic medical centers, revealed that surveillance practices varied widely. Other practices which could affect the CLABSI rate also had great variability (e.g., blood culture practices--when they are drawn, how they are drawn, and how much blood volume is obtained). Interestingly, 100% of IPs surveyed reported that they applied the CDC CLABSI definition; however, when they were tested with clinical vignettes, none of the IPs applied the definition as written.

There really are no surprises here. This study confirms what many of us already knew--surveillance for HAIs is currently a mess, and little has been done to improve validity.

This week, through an informal email discussion with several hospital epidemiologists, I learned that the process of HAI case detection varies widely, with some hospitals involving front line providers in the decision as to whether an HAI exists. As the stakes associated with infections become greater, there is obviously a natural inclination to look hard at every potential case. But here's the real problem: whether the patient truly has an HAI or whether the patient meets the CDC definition of HAI are two different questions. At some hospitals, a strict black and white reading of the definition is applied. At others, clinical judgment is also considered, and in some cases, allowed to trump the definition.

Given the increasing practice of public reporting of HAI rates, improving the validity of data must become a priority. As a first step in this process, better definitions, with more specificity, would be of great help.

Importance of leadership in the public health response

The Republic of Turkey

We are all influenced by those around us.  On an individual level, this is particularly true if the person nearby is senior or has an elevated rank in comparison to those being influenced. For example, Mary Lankford and others from Chicago published in EID (Feb 2003) a study which aimed to determine if a new hospital design would improve hand hygiene compliance.  What they ultimately found was that health-care workers in a room with a senior (e.g., higher ranking) medical staff person who did not wash hands were much less likely to wash their own hands (OR = 0.2). Of course seniority in another more direct way, say a CEO who supports HAI prevention initiatives, can also influence a hospital's HAI response. Could others, such as political leaders,  also influence our HAI prevention behavior?

An interesting new study out of Turkey in BMC ID reports what factors most influenced HCW uptake of 2009 H1N1 influenza vaccine. In a two hospital survey of HCW, where the vaccination rate was only 12.7%, the factors that were associated with poor influenza vaccine uptake included the vaccine's perceived side effects, disbelief in the vaccine's protectiveness, negative news about the vaccine and the perceived negative attitude of the Prime Minister to the vaccine. Thus, our leaders can have a big impact on our public health response.  Perhaps this is something we should take into account when we vote this fall.

Lankford et al, EID, February 2003
Savas et al BMC ID, Sept 2010

Why coding matters or why we shouldn't use ICD-9 codes?

Marin Schweizer, our colleague at Iowa, has a nice post up on the Center for Disease Dynamics, Economics & Policy (CDDEP) blog concerning the downsides and difficulties of using ICD-9-CM codes for HAI research, surveillance or CMS's 'no pay rule'. It's definitely worth the trip over there for a read...

Marin Schweizer's CDDEP post

Staph: It's deeper than you think

For decades it's been known that the primary site of staphylococcal colonization is the anterior nares. Now there is a new, interesting paper in the Journal of Hospital Infection that provides a better understanding of colonization. Nasal swabs were performed on 37 cadavers and 9 were found to have colonization with S. aureus. The noses were then surgically removed and tissue sections taken. An antibody stain against S. aureus was applied to visualize the site of colonization. There were two important findings: (1) colonization only occurred distally in the stratified squamous epithelium (i.e., there was no colonization of the more proximal ciliated mucosa; and (2) in 6/9 cadavers, staph organisms were visualized in the hair follicle shaft, and in 2 the bacteria were visualized deep in the follicle. The presence of S. aureus deep in the hair follicle may explain why some patients do not decolonize or recolonize after decolonization with mupirocin since the drug may not be able to penetrate that deeply.