It’s a bird. It’s a plane. No, it’s an infectious agent that zipped past country borders, infecting international passengers who shared the same commercial aircraft as a person who had symptomatic illness.
The buzzer rings. And the correct answer is: What is severe acute respiratory syndrome?
This fall, a combined team from Children’s National in Washington, D.C. and the National Institutes of Health (NIH) will compete against three other teams testing their collective infectious disease knowledge through IDBugBowl, a Jeopardy-style quiz geared toward fellows, residents and medical students. The competition is held during IDWeek2019. “From anaplasmosis to Zika, any topic is fair game,” according to organizers.
“BugBowl has become so popular that the IDWeek 2019 program committee carved out a separate time for the contest to ensure it would not conflict with any other symposia,” says Roberta L. DeBiasi, M.D., MS, chief of the Division of Pediatric Infectious Diseases at Children’s National. “On a day-to-day basis, we all contend with serious infectious diseases that have the potential to jeopardize human health. However, this event helps to expand knowledge among the general public in a fun and engaging way.”
The Children’s National/NIH team participating in the Oct. 5 trivia contest includes:
- Kevin Lloyd, M.D., third-year pediatrics resident
- Maria Susana Rueda-Altez, M.D., third-year pediatrics resident
- Kanal Singh, M.D., fellow, adult infectious diseases at the National Institutes of Health (NIH) and
- Alexandra Yonts, M.D., fellow, pediatric infectious diseases at Children’s National
Even though she has little formal training in infectious diseases, team member Dr. Rueda-Altez says: “One thing I have in my favor is that I’m from Peru. We’re used to seeing infectious diseases that are less common elsewhere, including tuberculosis and hantavirus.”
And while disease-carrying mosquitoes aren’t abundant at Peru’s higher altitudes, closer to sea level and in its rain forests, infected mosquitoes spread chikungunya, dengue, malaria and Zika, she adds.
Take this quiz to test your infectious disease knowledge.
Children’s urologist Michael H. Hsieh, M.D., Ph.D., knew from age 10 that he would become a doctor. Proof is at his parents’ home. For an elementary school art project, students were instructed to fashion a coat of arms out of clay. In addition to panels for truth, justice and Taiwan, in the shield’s M.D. panel, a snake twists around a rod, like the staff for Asclepius, a Greek god associated with healing.
“I liked science. When I can use it to help patients, that is very rewarding,” says Dr. Hsieh, the first doctor in his family.
Tinker/tailor is shorthand for the mystery drama, “Tinker Tailor Solider Spy,” he explains, adding that the “tinker” part also refers “to the fact that I am always questioning things, and science is about experimentation, trying to seek answers to questions.”
While still in medical school during a rotation Dr. Hsieh saw a bladder operation on a young child and thought it was “amazing.” That experience in part inspired Dr. Hsieh to become a urologist and bladder scientist. His training in immunology and study of the bladder naturally led him to study urinary tract infections and parasitic worms that affect the urinary tract. In addition, thanks to R01 funding from the National Institutes of Health (NIH), Dr. Hsieh is co-principal investigator with Axel Krieger, University of Maryland, and Jin U. Kang, Johns Hopkins, on a project to develop imaging robots for supervised autonomous surgery on soft tissue.
The $1 million in NIH funding pushes the boundaries on amazing by using multi-spectral imaging technology and improved techniques to reduce surgical complications.
Anastomosis is a technique used by surgeons to join one thing to another, whether it’s a vascular surgeon suturing blood vessels, an orthopedic surgeon joining muscles or a urologist stitching healthy parts of the urinary tract back together. Complications can set in if their stitching is too tight, prompting scar tissue to form, or too loose, letting fluid seep out.
“The human eye can see a narrow spectrum of electromagnetic radiation. These multi-spectral imaging cameras would see across greater set of wavelengths,” he says.
The project has three aims: figuring out the best way to place sutures using multi-spectral imaging, accurately tracking soft tissue as they model suturing and comparing the handicraft of a robot against anastomosis hand-sewn by surgeons.
“I like challenges, and I like new things. I am definitely not interested in doing permutations of other people’s work,” Dr. Hsieh explains. “I would much rather go on a path that hasn’t been tread. It is more difficult in some ways, but on a day-to-day basis, I know I am making a contribution.”
In another innovative research project, Dr. Hsieh leveraged a protein secreted by a parasitic worm, Schistosoma haematobium, that suppresses inflammation in hosts as a new therapeutic approach for chemotherapy-induced hemorrhagic cystitis, a form of inflammation of the bladder.
Watching his first surgery nearly 30 years ago, he had no idea robots might one day vie to take over some part of that complicated procedure, or that parasite proteins could be harnessed as drugs. However, he has a clear idea which innovations could be on the horizon for urology in the next three decades.
“My hope is 30 years from now, we will have a solid UTI vaccine and more non-antibiotic therapies. UTIs are the second-most common bacterial infection in childhood and, in severe cases, can contribute to kidney failure,” he says.
Globally, parasitic worms pose an ongoing challenge, affecting more than 1 billion worldwide – second only to malaria. People persistently infected by schistosome worms fail to reach their growth potential, struggle academically and lack sufficient energy for exercise or work.
“There is a feeling that the infection prevalence might be decreasing globally, but not as quickly as everyone hopes. In 30 years perhaps with more mass drug administration and additional drugs – including a vaccine – we’ll have it close to eliminated globally. It would become more like polio, casting a slim shadow with small pockets of infection here or there, rather than consigning millions to perpetual poverty.”
Next-generation medical education looks like this: A white-coat wearing avatar with the voice, face, and know-how of one of the nation’s leading infectious disease experts walks you through the twists and turns of how to diagnose malaria, making stops in a variety of hospital settings. If you make the right diagnostic and treatment decisions, you get instantaneous gold stars. If your choices are off-the-mark, at each decision point you get a clear explanation of why your answer was incorrect.
“This is the future of medical education,” says Barbara Jantausch, M.D., F.A.A.P., F.I.D.S.A., an infectious disease specialist at Children’s National Health System. She’s the female avatar with the John Travolta dance moves and expertise about malaria’s epidemiology, diagnosis, and treatment.
Dr. Jantausch will present a poster, “The Hot Zone: An Online Decision-Centered Vignette Player for Teaching Clinical Diagnostic Reasoning Skills,” during IDWeek 2016, the annual meeting of the Infectious Diseases Society of America. “It’s case-based, interactive e-learning where you choose your own adventure. The beauty of this module is the training can be self-directed,” Dr. Jantausch adds.
“At Children’s National, we’re pioneering the effort to build discovery-based learning platforms,” says Jeff Sestokas, Director of eLearning. In the vignette player, he’s the male avatar named Dr. Bear. Malaria is the first infectious disease training module but others are planned for the global health series, including Chagas disease and Zika virus, Sestokas says.
Identifying the illness
According to the Centers for Disease Control & Prevention (CDC), in 2015 an estimated 214 million people around the world had malaria, a mosquito-borne illness, and 438,000 of them died. Because of the lengthy incubation period, many international travelers do not show malaria symptoms until they return to the United States and experience flu-like symptoms including high fevers, shaking chills, and dehydration. Their lab results may include metabolic acidosis, hypoglycemia, normocytic anemia, or thrombocytopenia. At Children’s, 25 percent of children admitted with travel-related malaria are admitted to the intensive care unit.
“This started as a way to offer people in areas that do not see as many patients with malaria an opportunity to learn the same critical thinking skills,” she adds.
People who click through the vignettes play the role of a clinician working in the emergency department whose patients include a 10-year-old girl who has just returned from vacation two weeks prior. The exhausted girl lies on a bed amid weeping parents and grandparents. She suffers from a headache and muscle pain and has a 39.8 C fever, though it spiked higher before her arrival at the ED.
“Because symptoms for malaria can mimic other infectious diseases, clinicians need to be able to recognize it in order to ask the most appropriate questions,” she says.
Making real-time decisions
In the vignette, participants are asked to type additional questions to help with diagnosis. Then, they select one of three geographic regions to explore in the 20-minute module in order to gain a better appreciation of the epidemiology of malaria, including the Plasmodium species that cause disease in those regions; to recognize a patient with symptoms of malaria; and to manage their care in keeping with the CDC’s guidance.
Within a few clicks, participants select the degree of the girl’s parasitemia, view slides from thick and thin blood smears, choose the medicine best suited for the parasite causing illness and geographic region the family visited, and decide on follow-up care.
“The timed sections force decision-making in real-world situations,” Sestokas adds. “Behind the scenes, we can look at how well clinicians recognize the subtleties prior to making their decisions and we provide feedback in real-time. Ultimately, our goal is to stimulate deliberate, reflective practices.”
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