The top 10 Questions people ask Google

Just reading Becker’s Hospital Review.

It is fascinating to learn the questions we ask Google.

There are a myriad of categories including medical symptoms, dogs, movies, fashion,  diets and even celebrity pregnancies!

Here are a few “Top 10” that caught my eye…

Symptoms Questions Dog Questions Fashion Questions
1.     Flu 1.      Why do dogs wag their tail? 1.       How to walk in heels?
2.     Gallbladder Infection 2.      How to crate train your puppy? 2.      What to wear on the first day of school?
3.     Measles 3.      How to register a dog as a service animal? 3.      How to fray jeans?
4.     Listeria 4.      How to register a dog with the AKC? 4.      How to tie a shirt?
5.     Sinus Infection 5.      How to keep puppy from eating poop? 5.      What should a bride wear to the rehearsal dinner?
6.     Gastritis 6.      When do puppies get shots? 6.      What to wear booties with?
7.     Anxiety Attack 7.      Why do dogs chew their paws? 7.      What are mules shoes?
8.     H. Pylori Infection 8.      What breed is the ‘Target’ dog? 8.      What to wear to a wedding in the woods?
9.     Heat stroke 9.      How to paper train a puppy? 9.      How to dress up like Miranda Sings?
10. Lactose Intolerance 10.  How to stop dogs from biting? 10.   What color shoes goes with a black and blue dress?

 

For the 42 other categories see https://www.google.com/trends/topcharts#vm=cat&geo=US&date=2015&cid.

WHO prioritises world Epidemic Threats

A panel of experts met at WHO Geneva this week to prioritise the top five to ten emerging pathogens likely to cause severe outbreaks in the near future, and for which few or no medical countermeasures exist.

These diseases are a blueprint for R&D preparedness to help control potential future outbreaks.

The initial list, to be reviewed annually, comprises:

Three other diseases were designated as ‘serious’, requiring action by WHO to promote R&D as soon as possible; these were chikungunya, severe fever with thrombocytopaenia syndrome, and Zika.

Other diseases with epidemic potential – such as HIV/AIDSTuberculosisMalaria,Avian influenza and Dengue – were not included in the list because there are major disease control and research networks for these infections, and an existing pipeline for improved interventions.

Sierra Leone is at ZERO – it’s official!

On Sat Nov 7th, WHO officially declared Sierra Leone free of Ebola – after 42 Ebola-free days.

Jubilationn in Sierra Leone

I have watched and waited for each of the 42 days and on Sat Nov 7th, while in USA, I sat at my laptop watching the National Ebola Response Centre‘s Ebola Clock click the seconds down to ZERO .

Surprisingly the website did not erupt into digital fireworks as I expected, perhaps because they are now on a 90 days of enhanced surveillance as it is not quite “over” – neighbouring Guinea still has a few Ebola cases.

What I guarantee is the music- and fun-loving people of Sierra Leone will be celebrating for days, maybe weeks. God knows they deserve it!

It was a privilege to be a tiny part of the recovery.

 

 

A shared syringe – and $80mill bill

With social media and education outreach, major outbreaks of Bloodborne Pathogens (BBP) should be a thing of the past. Not so.

Alarm bells rang when 11 new HIV cases occurred in Nov-Jan in a small Indiana community – double that normally seen in a year .

This “handful of cases” from shared syringes among opioid drug users, had grown to 26 cases when reported in Feb by the Indiana State Department of Health, and by March had grown to 79 cases. By April the number had risen to 135 cases, 84% of whom were coinfected with HCV.

In a US CDC-Medscape Expert Commentary released this week, the number is now at 170 HIV cases, almost all HCV coinfected. The article states, “The lifelong medical care costs alone for treating the persons …will be more than $80 million“.

WHO in 2004 examined the alarming increase in BBP transmission among drug injectors and after a review of over 200 publications concluded that: the evidence for BBP reduction with needle and syringe exchange programs (NSEP) was overwhelming; NSEP need be country-wide; and any contrary legislation needs be repealed.

PS. Proudly, Australia and New Zealand were two of the first countries to use NSEPs nationally – and now via vending machines!

Interestingly, USA banned federal funding of NSEP in 1988, removed the ban in 2009, and reinstated the ban in 2011 (the legislation does not ban NSEPs; just federal funding of them). Opponents of federal support for NSEPs argue that it signals governmental acceptance of, and would facilitate the uptake of, illegal drug use. WHO says not so. Thankfully, in 2011, at least 221 non federal NSEPs operated in the US.

CDC recommends drug injectors be referred to “programs that provide access to sterile injection equipment.” A wise, evidence-based recommendation.

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Travel history is essential – not just for Ebola

There are many lethal, more frequently occurring diseases than Ebola, entering our countries.

Recently, on the chat room of USA Assoc. for Professionals in Infection Control & Epidem (APIC), members have asked how much longer hospitals should ask patients about overseas travel (to alert staff for Ebola).

Malaria is another reason why travel history must CONTINUE to be sought.

Several decades ago as a Malariologist in a developing country, I strove to remind colleagues in developed countries to ALWAYS ask a travel history when any patient presented with fever, chills or headache (FC&H). I have seen a patient walk in unassisted with FC&H at 5pm, and die from P. falciparum cerebral malaria at midnight.

The deaths of two tourists from cerebral malaria in a Springfield Missouri motel last month shows how rapidly and insidiously this disease can kill travelers. And underpins why travel history is essential if patients present with fever to an emergency dept.

In 2011 USA hit an all-time high with nearly 2,000 cases of malaria being diagnosed in travellers.  In 2012 1,687 cases of Malaria were diagnosed in USA, with 1,683 (99.8%) occurring in travelers. Six of the cases died.

Ebola pales into the background in the face of other imported diseases for which a travel history is needed for diagnosis.

 

Sierra Leone Ebola surge – curfew needed

You probably noted my excitement, after I returned from Sierra Leone, when a week of “zero” days occurred in early May. However recently in Port Loko and Kambia cases have surged and the President has declared a 21 day dusk-to-dawn curfew in these districts.

The graph below (compiled from Ministry Reports) shows why the decree was issued – cases had fluctuated from 0 to 2 per day, but in the last two weeks, 5 cases were reported in one day, then 9 on another, all from the two districts. 15 cases in one week is the highest since March.
Picture of graph
Of the recent cases some have occurred in individuals unlinked to known cases, and others in areas  free of cases for over 40 days – two signs of loosening of behaviours. The good news is that the previous “hotspot”, Freetown Western Urban, had zero cases – the first time in 10 months.

WHO in their latest summary, said the decline had “stalled”. I feel sad for the people of the two curfew districts – and for the contact tracers – and all aid workers and national staff arduously trying to reach zero.

Hopefully in this Ebola warzone, the curfew is the last offence needed to win the battle.

 

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EXPO-STOP 2012 – US largest blood exposure study published

EXPO-STOP:2012 Survey of US blood exposures is published in JAOHP

Linda Good and I, and the US Association of Occupational Health Professionals in Healthcare (AOHP) are pleased to announce the publication of our 2012 EXPO-STOP Survey in the recent edition of JAOHP.

The survey, the largest in US, examined the 9,494 blood exposures reported from 157 hospitals in 32 states, and calculated annual incidences using 4 denominators.

The 7,119 sharps injuries (SI) and 2,375 mucocutaneous exposures (MC) resulted in incidence rates of:
• 28.2 SI / 100 occupied beds; 2.2 / 100 staff; 3.3 / 100 nurses; and 0.43 / 100 Adjusted Patient Days.
• 10.1 MC / 100 occupied beds; 0.8 / 100 staff; and 0.15 / 100 Adjusted Patient Days.
• Of Total reported SI, 42% were among nurses and 36% among doctors.
• 44% of reported SI occurred during surgical procedures

The 2012 exposure incidences were significantly higher than those reported in the most recently published surveys by EPINet and Massachusetts Dept Public Health, and, disturbingly, higher than the EPINet incidence published in 2001 following the enactment of the OSHA needlestick Safety and Prevention Act (NSPA).

The study concludes that compliance with the NSPA is, in itself, insufficient to achieve the national reduction in exposures needed

The top 5 lowest-incidence hospitals had incidences 60% lower than their counterpart same-size hospitals. Their successful strategies were reported in the study and included education, repeated competency training, rapid investigation, unflagging diligence, and searching for safer safety devices.

A pre-publication Author Copy of the study is available for personal use and the definitive article is purchasable from AOHP

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Handling New Zealand’s 1st Ebola suspect- excellent test of smooth planning

There is no substitute for repeated, detailed practice.

Ruth Barratt’s Open Access Case Report this week in Healthcare Infection is testimony to thorough planning and training, with the “real run” showing improvements can still be made.
The Report is a clear expose of the importance of Infection Prevention and Control and the availability, use, suitability and shortfalls of Personal Protective Equipment (PPE).
Having returned from Sierra Leone, I can confirm Barratt’s “real-life” is “real-life”. Her emphasis on the necessity of preparedness through practice drills, reflects that required in Ebola Red Zones.
Other mirrorings they found were:
• Staff preferring certain PPE over others (WHO state gown+hood vs coverall is personal choice – there is no evidence one is safer over other, and staff may find gown safer through familiarity, and, in certain cultures, more gender-acceptable);
• Fogging of eye-protection (CDC now recommends face-shields over goggles and many Red Zone staff leave face-shield bottoms outside their hood). Some Ebola Red Zones rub toothpaste on inside of lenses as a defogger (an old SCUBA-diving technique);
• Swapping thick outer gloves for long-cuff surgical outer gloves aids dexterity – others agree;
• Locating in-country sources for preferred PPE;
• Some PPE items being too small for taller/larger staff;
• Gowns not lasting (UNICEF recently published recommended product-specifications for PPE).

The author stressed the importance of having a trained observer in addition to a “buddy”. In Ebola Red Zones such observers are called “hygienists” and their calm, talking-through of each PPE-removal step is considered a God-send by near-exhausted staff.

The patient (who proved Ebola negative) was an Ebola-trained nurse – and assisted the staff with some of her own care and gave feedback on their procedures!

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Two new ways to combat antibiotic resistance

Timely dosing and a body wash may help

Antibiotic resistance is not new – resistance genes have been found in 700 year old faeces!

But WHO state resistance is a major issue in healthcare today. In their Policy Paper, Ontario Medical Association state that antibiotic resistance results in infections being more severe, of longer duration and higher mortality, as well as longer hospital stays and more aggressive treatments with expensive “third-line” antibiotics. This means increased healthcare costs.

Judicious antibiotic use and banning of antibiotics as growth-enhancers in animals are essential. But additional measures are needed.

One new proposal is to change the timing of antibiotic dosing. In a recent paper, Meredith et al used computer modelling to determine that the timing of dose, relative to a bacteria’s recovery, may allow the bacteria to be killed before its production of beta-lactamase can begin.  If successful, it means first-line “old fashioned” antibiotics can still be used.

At last week’s SHEA meeting, a second novel method was proposed. McKinnell et al showed chlorhexidine (CHX) body wash can reduce colonization with MRSA. Compared to MRSA ‘Contact isolation’, they found CHX had fewer MRSA contamination events. Also, the authors argued that CHX use may result in a higher quality of care compared to isolation.

In another life (almost 40 years ago!), I researched the effect of whole-body CHX bathing on the normal flora of patients pre-operatively and concluded in a book chapter, “The course that is apparent is a return to the early concept of ‘total body’ reduction of Staphylococcus aureus carriage..” Goes to show – if you live long enough…:)

Sierra Leone – helping rebuild the local school

Walking by the local village, angelic children’s voices singing “ABCDEFG” enticed me to a dilapidated hut.

 First visit Through the broken doors I saw a room with about  30 children – who immediately stood and chanted in perfect unison, “Good afternoon sir“. I don’t know who had the biggest grin, the children or me!
Pre - rebuild I’d passed the small hut many times and never knew it was a school. It is voluntary, and Bailor and assistant-teacher Mustapha, unpaid. Classes are conducted six days a week from 3-6pm and on Saturdays they ask a 1,000 Leones (20 cents) “fee” from those who can afford it. few attend on Saturday.

In an impromptu geography quiz (“Where do you think I come from”), I noticed they had no map so my wife Jenny and I bought books, pencils etc and a large wall atlas – the children recognized Africa, and pointed to Sierra Leone – but couldn’t quite fathom New Zealand’s distance. And couldn’t believe NZ had fewer people than their country.

The school, originally built by a UN peacekeeping contingent from Mongolia in 2008, was in a poor state and on one of my visits Bailor gently asked could we help fund the repair of the leaking school. I suggested he obtain a quote and Momoh Sesay the village Chairperson, upon hearing this, took the lead. Momoh is an engineer, (unemployed since Ebola – as were most in the village) and next day he had a detailed written quote for me – $900! Low, because he would use the unemployed builders, painter and artist in the village.

I mentioned the project to WHO colleagues and without exception, all donated and raised the $900. After giving Momoh Sesay and the teachers the go-ahead, the village was soon abuzz. Leaving the following Wednesday, I was sad not to be able see the project finished . No problem they said “We’ll start tomorrow and finish it before you go“.

All hands on deck  Children painted

They started that Friday 8am and worked 5 days straight including Sunday, (“God will forgive us for not attending church”). At one stage I counted 15 men, women and paint-covered children lending a hand – the village was proudly rebuilding their own school.

Saving the animals    New animals

I suggested we preserve the Mongolian’s original painted animals (a panda, two lions and Pooh Bear) so I borrowed a hacksaw blade from my hotel and showed some helpers how to cut out the animals from the original plywood walls – by day’s end they had all four neatly cut out and edges sanded. The village artist bought paints and restored each animal to its former glory and attached them to the new walls – big smiles abounded! And he skillfully painted a sign acknowledging the WHO Ebola response team’s donation.

School completed

The finished school was fitted with mosquito netting all round and we had a grand opening Tuesday evening!

Momoh Sesay’s wife, Aisha, cooked all day and WHO staff and villagers reveled in the grand opening party. Aisha is Head of the nearby Dance Academy (they’ve performed nationally and internationally but had only had 2 engagements since Ebola) and she brought her dancers and drummers and “Rubberman”, the troupe’s contortionist – and the dusty street was transformed into a festive stage.

Rubberman on stool

Village gathered   Children performing v2

Hinta 1 - group at opening

What a profound, humbling, once-in-a-lifetime experience.