New tools for shoe-leather epidemiologists

Here's an interesting article in Salon on the use of social media to identify people at risk of STDs. The article contains an interview with Peter Leone, an Infectious Diseases physician at UNC, who discusses exploring social networks to expand the circle of at-risk persons instead of just relying on conventional  methods for contact tracing.

Graphic: Salon

The utility of medical meetings

There's a provocative commentary in this week's JAMA by John Ioannidis on medical conferences. His argument is that "medical congresses may serve a specific system of questionable values that may be harmful to medicine and health care." Some of the issues he notes include:

• The huge carbon footprint generated by attendees' travel
• The dissemination of misinformation due to abstracts that are not well reviewed, sometimes inaccurate, and many of which are never ultimately published as full-length articles
• Giving opinion leaders disproportionate influence
• Over-the-top exhibit halls
• Industry sponsored satellite meetings

He concludes by calling for research on the best ways to disseminate information and educate physicians. I have to admit that I usually don't learn a great deal at meetings, but it sure is fun to catch up with old friends! 

Photo: The Serra Group

800,000 Reasons to Market Your Science

800,000  That's the number of manuscripts in science and engineering published each year.  If you read a paper a day, a noble goal, you could read 0.05% of the published papers.  Imagine if you are a primary care doc who had to keep up in multiple clinical areas or worse yet, a science journalist.  How could you manage?

JournalWatch from qfever.com

Now let's turn that around.  Let's say you're a scientist who has important data you want to share.  How can you make your one very very important manuscript stand out among the 800,000? Your magnum opus represents a mere 0.000125% of all papers published in the last 365 days.  To make you feel better, we could assume equal likelihood that a paper is published on any given day and find that only 2192 papers are published per day. So your paper would represent 0.05% of papers published on the day it appears.  Better act fast since things get worse if you consider a whole week. You get my point.

So why should anyone read your paper? More accurately, how can you convince me to read your paper if I don't even know it exists?  Answer: You have to market it.  Some authors at some institutions who publish in some journals (AJIC not ICHE) are lucky, since someone does the marketing for them.  If you're not so lucky, you and your colleagues have to do the marketing.  If you're looking for the how and why we should market our science, look no further than this month's issue of Nature Materials. It includes an editorial, commentary and interview of Marc Kuchner, astrophysicist and author of a new book titled Marketing for Scientists, each discussing the importance of science marketing.

This isn't just about selling your paper or raising your profile, nor is it limited to increasing your chances of NIH funding, but rather it has very large public health implications.  We have spent years in infection prevention quietly studying methods to prevent the spread of resistant bacterial pathogens and reducing surgical infections with very little notice and certainly very little funding.  By nature we are type-A, quiet and hard working folk, who don't want to rock the boat.  Well, guess what?  It ain't working.

To emphasize our lack of voice...Q: Who are the two most prominent public voices in quality improvement / infection prevention?  A: Peter Pronovost (critical care) and Atul Gawande (surgery).  Thank goodness someone is speaking up!

So what can we do?

1) When you publish a paper on antibacterial resistance or infection prevention, advertise it.  Get on twitter or Facebook. Call your local paper's science reporter if they still have one, work with your hospital or university to do a press release, and demand the journal do a press release (see point #2)

2) Call ICHE and SHEA and insist on a press releases for your paper, even if it's not published in ICHE (joking on that last part). Currently, ICHE does a little monthly email thingy on 1-2 papers - not going to work!  Ask them to emulate what APIC and AJIC do - much better!

3) Call your representative and ask why no one is doing anything about new antibiotics and why there are all these infections without treatment.  Ask them why there is no direct funding from CMS for infection prevention services for acute and long-term care facilities. Use your science to start the conversation - say - "look what I just found!"

4) Start a local chapter of ID physicians, ICPs, microbiologists and others that focus on raising awareness for antibacterial resistance.  Work together to communicate resistance trends in your locality and the findings of your research. (I know I'm dreaming)

5) Get your state and local health departments involved - send them your papers. I bet they know a way to get newspapers interested in resistance.

We aren't just scientists, we are stewards of our science. If you care enough to do the study and publish the paper, you should care 10x more that someone reads and uses your science!

...that's all I got for now, see you on twitter...

(live) image source: http://www.qfever.com/journalwatch.html

TB: "In some areas we have probably already lost the battle"

A recent article in the British newspaper, The Observer, reports on the disturbing situation with multi-drug resistant tuberculosis. The article points out the current situation of increasing MDR cases is a result of loss of funding for TB, mismangement of infected patients, and the terrible situation of so few effective antibiotics.

Photo: Alexander Joe/AFP

Sorry guys! Not wearing a white coat makes us more stupider

My new favorite study.  Researchers at Northwestern University explored the impact that clothes have on our thinking processes. Specifically, they looked at the impact that wearing a lab coat has on attention-related tasks.  While it is well documented that what one wears impacts the perceptions and reactions of others (See Molloy's new Dress for Success), less research has been completed on the impact clothes have on the wearers themselves.

In three related randomized trials, Adam and Galinsky explored the science of "enclothed cognition" which suggests that people are influenced by (a) physically wearing specific clothes and (b) the symbolic meaning of the clothes.

In the first study they randomized 58 students to randomly wear a lab coat or their street clothes.  Subjects were then given the Stroop task where they had to quickly state whether a string of letters were colored red or blue with some incongruent trials thrown in with the word "RED" written in blue and "BLUE" written in red. While each group took the same amount of time to complete the tasks, the subjects wearing lab coats made half as many errors on the incongruent trials. Thus, it appears that wearing a lab coat improved selective attention.

In the second (N=74) and third studies (N=99), they investigators explored the impact of the clothes "meaning."  They divided the cohort into three random groups: (1) wearing a "doctor's" lab coat; (2) wearing a painter's lab coat and (3) seeing or identifying with a doctor's lab coat. The outcome they tested was sustained cognition by showing subjects identical photos except for four minor differences and asking them to find the four differences. Test yourself using the photo below while wearing and not wearing your white coat. (You can click to enlarge the photos)

The results were very interesting. The subjects in a doctor's coat found 20-30% more differences in the pictures than subjects in a painter's coat. Thus, wearing a lab coat improves sustained attention but only if it is a certain kind of lab coat - namely a doctor's white coat - the meaning of the coat matters.

So where does this leave us?  First, I would want to see how persistent this effect is. Does the effect wear off very quickly after the "white coat ceremony"?  Does it work immediately after you put on the white coat but then work less effectively by the end of rounds?  Of course, does it have to be a "doctor's coat" in particular or can we slowly wean clinicians off their white coat addiction while maintaining the cognitive benefits with a creative replacement, say, a doctor's cummerbund?

Source: Adam H and Galinsky AD. J Soc Psych 2012

ESCMID-SHEA Training Course: Potsdam 1-4 October

Looks like it's going to be a busy fall.  In addition to IDWeek (October 17-21), ICAAC (Sept 9-12), SMDM (October 17-20), there is the annual ESCMID-SHEA Training Course in Hospital Epidemiology in Potsdam, Germany.

The course is made up of 3 modules: the Healthcare-associated Infection Prevention and Management Core Module, the Applied Infection Control Module and the Healthcare-associated Infection Advanced Epidemiology Module. Course fees are 1290 Euro for Society members, which includes hotel and food. Of note, 1290 Euro = $1721.2470 US if you sign up...exactly.......now!  Oh, shucks, too late it just changed.

Update: 28 March at 1pm CT: Cost is now $1715.57

The course coordinators are Marc Bonten, Bart Gordts, Jan Kluytmans, Leonard Mermel and Andreas Voss. The course faculty spans the globe with five faculty from The Netherlands and two faculty from The Iowa.  Sign up now!

• Marc J. M. Bonten, Utrecht, The Netherlands
• Ben Cooper, Oxford, UK
• Markus Dettenkofer, Freiburg, Germany
• Bart Gordts, Antwerpen, Brussel
• Loreen Herwaldt, The Iowa, USA
• Arno Hoes, Utrecht, The Netherlands
• Jan Kluytmans, Breda, The Netherlands
• Leonard Mermel, Rhode Island, USA
• Eli N. Perencevich, The Iowa, USA
• Evelina Tacconelli, Rome, Italy
• Christina Vandenbroucke-Grauls, Amsterdam, The Netherlands
• Andreas Voss, Nijmegen, The Netherlands
• Andreas F. Widmer, Basel, Switzerland

Today is World TB Day

• 1/3 of the world's population is infected with Mycobacterium tuberculosis
• Nearly 1.5 million people globally die due to tuberculosis yearly
• With regards to deaths due to infection, TB is second only to HIV