ID

New Vaccination Frontiers – Reasons for 3 Cheers!

by Deepak Asudani, MD, MPH, FHM Whether it is the prompt and expeditious international collaboration to develop an Ebola vaccine, or tardy but promising development of the first anti parasitic malarial vaccine or the fascinating technology utilizing synthetic DNA for vaccine development against MERS, these developments promise to highlight significant strides in vaccine development for both established infections and newer and emerging infections. From a global health perspective, the recent news surrounding the development of vaccines against some of the infections has stirred rejuvenated excitement. Besides having the potential to save millions of lives, it is fascinating and compelling to see several technological advances that go into developing these vaccines. While the promise of the Ebola vaccine comes in an astonishingly short time of within a year, the malaria vaccine has been in the pipeline for long 27 years unleashing the first reasonably effective anti-parasitic vaccine. The promise of synthetic DNA MERS vaccine lies in the…

Catch Me If You Can. With My Dirty Hands That Is.

  Economists describe preferences in two ways: revealed and stated.  Say, for example, I asked you to implement a penalty program for your team with the goal of decreasing the number of occasions members did not clean their hands after a patient encounter.  Because you know bad hands equal bad outcomes, you're apt to offer up a more than token sanction.  Maybe it's a financial levy or required service beyond the expected, but you will probably suggest a "punishment" that does not quite smart, but imparts just a bit of a sting.  Your stated preference. (more…)

Antibiotic Stewardship and Hospitalists: The Bedside Is the Front Line

by Eric Howell, MD, SFHM “Tell me what you know about antibiotics.” That’s the discussion I start with hospitalized patients all the time, right after they ask me to prescribe antibiotics for their simple cough, or other viral-like illness. And, from their perspective, asking for antibiotics makes sense. After all, antibiotics have been the physician’s knee-jerk reaction to a number of patient symptoms for decades, especially for a cough or upper respiratory infection. And we have inadvertently trained our patients that there is an easy solution to almost any common medical problem. But patients often answer my question with something like “not much” and a little surprise that I haven’t already started ordering the prescription. That’s when I talk about the potential harms of antibiotics. And that’s also when their eyebrows go up. I start with the easy harms, like that many antibiotics can cause diarrhea, a symptom nobody wants…

My Interview With Health Policy Expert Mark Smith

Mark Smith, MD, MBA, was the founding CEO of the California HealthCare Foundation; he served in that role for 17 years before stepping down last year. I’ve known Mark since we were residents together at UCSF in the mid-1980s, and both of us were influenced by training at the epicenter of the AIDS epidemic. Mark continues to see AIDS patients at San Francisco General Hospital one day each week. He was the lead author of Best Care at Lower Cost, a major Institute of Medicine report, published in 2012. Mark is one of those rare people who can take complex and politically charged concepts and distill them into sensible nuggets – while managing to be hilarious and profound at the same time. In the continuing series of interviews I conducted for my upcoming book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, here are…

The CDC Must Do Better

The USPTF got schooled in 2009 when they released their guidelines for breast cancer screening.  They did not prepare for the backlash nor did they have media personnel or training to deal with the public’s ire.  The task force learned a lesson, and guideline release and dissemination has changed as a result.  The USPTF has become less forthcoming with information related to pending reviews--mostly due to politics. Last year, the CDC had its own imbroglio over Ebola: The Centers for Disease Control and Prevention (CDC) has been widely criticized for projecting overconfidence in U.S. hospitals' capacity to manage Ebola. When two nurses at Texas Health Presbyterian Hospital Dallas became infected after caring for Thomas Duncan, critics cited the CDC's assurance that “U.S. hospitals can safely manage patients with Ebola disease.”2 When the CDC said the nurses probably became infected because of a protocol breach and it turned out there was no protocol, things got…
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