Case Report: Recurrent Staphylococcal Scalded Skin Syndrome in Healthy Term Neonate Despite Full Course of Antibiotic Therapy

Background Staphylococcal scalded skin syndrome (SSSS) describes a blistering skin infection caused by the exfoliative toxin in the bacterium Staphylococcus aureus. It more commonly affects the infant population and is characterized by large blistering bullae that rupture upon application of pressure. Case description We describe a case of recurrent SSSS in a healthy term neonate who initially presented with a perioral rash on day of life (DOL) 11 that quickly became vesicular with new lesions on the sternum and extremities. The patient’s rash began to resolve upon administration of culture-specific IV antibiotics. She was appropriately treated with a 14-day course and was discharged home. The patient returned on DOL 35 with a perioral rash and generalized reddening of the skin. She was admitted and placed empirically on nafcillin, clindamycin, and vancomycin for concerning recurrence of SSSS. At this time, consults were placed to Dermatology, as well as Allergy & Immunology for possible Epidermolysis Bullosa and immune deficiency. Skin biopsy revealed development of recurrent SSSS. Patient finished another 14-day course of IV antibiotics and was discharged home with resolution of the rash. Conclusion This report discusses a case of recurrent SSSS in a term neonate who received two full courses of antibiotics and has since fully recovered. Key words: Staphylococcal scalded skin syndrome, epidermolysis bullosa, disease recurrenc

The challenges of exploring the impact of genogram construction on an Appalachian family\u27s health consciousness

Abstract Purpose Appalachians exhibit high rates of chronic disease-related behaviors which might improve with heightened health consciousness. Knowing one\u27s family history can be an important health maintenance tool. Appalachians\u27 health attitudes are shaped in large, closely knit extended families in which matriarchs play central roles. We sought assistance from West Virginian grandmothers in a family medicine practice in engaging their extended families with their genogram to assess the impact on family members\u27 level of health consciousness. Methods The family physician identified West Virginian grandmothers in his practice. We sent each of them invitations to participate, along with their extended family, in constructing a genogram,. However, none of the thirty-four women contacted agreed to participate. We explored the reasons for their non-participation. We mailed a follow-up survey to all the potential participants. We made follow-up phone calls after sending a reminder letter. Twenty-seven women responded. We collated and arranged in order of frequency their reasons for non-participation. Results The most frequently cited reason for non-participation was that the respondent perceived her extended family to be too busy or to live too far from one another to participate. Her own sense of not feeling up to what was being asked of her was the second most frequently expressed reason, almost as often as the first. Conclusions The hypothesis that family physicians might improve health consciousness of Appalachian extended families by engaging them with their genogram remains untested. Testing it will require being mindful of several methodological lessons regarding recruitment of subjects, use of written materials and inclusion criteria. The researcher will be wise to adopt a collaborative, collegial approach such as employed in participatory research

COVID-19 Epidemiology and Google Searches

We read “Increased internet search interest for GI symptoms may predict COVID-19 cases in US hotspots” by Ahmad et al with interest. The authors compared search volume for gastrointestinal (GI) symptoms with coronavirus disease 2019 (COVID-19) incidence in 15 states to observe that searches for the terms ageusia, loss of appetite, and diarrhea correlated with disease burden at 4 weeks. In our own analysis of Google Trends, we made similar observations with a few distinctions. We assessed COVID-19 plus diarrhea searches and United States COVID-19 epidemiology by using the Pearson correlation coefficient. We used Centers for Disease Control and Prevention (CDC) data for reported incidence and mortality (deaths per capita), cross-referencing with U.S. census data.Our findings suggest that diarrhea searches do not correlate well with disease burden; however, although analysis of online searches for GI symptoms and COVID-19 is not likely to be a good substitute for more traditional epidemiologic methods, search activity could still be useful as part of a more complex model. As you have concluded, Google Trends is a valuable tool, and it is our responsibility to carefully understand and refine its role in this global pandemic

Virtual Gastroenterology Fellowship Recruitment During COVID-19 and Its Implications for the Future

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Background and Aims Amid the COVID-19 pandemic, medical education organizations endorsed a virtual recruitment format, representing a stark change from traditional in-person interviews. We aimed to identify the attitudes and perceptions of Gastroenterology Fellowship Program Directors (PDs) and applicants regarding the virtual interview experience and the role of virtual interviews (VI) in the future. Methods We designed separate surveys targeting PDs and applicants using the Qualtrics software. At the end of the interview season, we e-mailed both survey links to all PDs and requested that they forward the applicant survey to their interviewed candidates. Surveys were voluntary and anonymous. Descriptive statistics were used to analyze the data with results presented as percentages. Results A total of 29.7% of PDs completed the survey. Compared to traditional interviews, VI were viewed by 46.5% of PDs to be very suboptimal or suboptimal. Yet, 69.1% envisioned a role for VI in the future. A total of 14.2% of applicants completed the survey. Compared to traditional interviews, VI were viewed by 42.3% of applicants to be very suboptimal or suboptimal. However, 61.8% saw a future role for VI. While both applicants and PDs reported that establishing an interpersonal connection was a disadvantage with VI, applicants placed more emphasis on this need for connection (p = 0.001). Conclusion Overall, PDs and applicants report mixed views with regard to VI but anticipate that it may continue to have a future role. VI may augment future recruitment cycles with care taken to not disadvantage applicants, who rely heavily on the interview process to create personal connections with programs

Impact of the COVID-19 Pandemic on the Clinical Learning Environment: Addressing Identified Gaps and Seizing Opportunities

The clinical learning environment (CLE) encompasses the learner’s personal characteristics and experiences, social relationships, organizational culture, and the institution’s physical and virtual infrastructure. During the COVID-19 pandemic, all four of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizing the CLE in the post–COVID-19 world

Coaching for competency: cultivating agency and improving learning outcomes in post-graduate education

Detailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern’s Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin

How to Become a Leader as a Fellow

Leadership skills are vital for gastroenterology fellows to cultivate to adapt to advancing practice environments and promote lifelong personal and professional development. Although leadership is a key component of the physician’s role, leadership skills are not always formally taught. Fellows in gastroenterology should recognize opportunities to build these skills. Through this article, we aim first to argue that all doctors are leaders. We then describe ways that fellows can develop self-leadership. Finally, we highlight pathways for trainees to take on roles to lead others. As a supplement, we provide examples of fellows’ leadership journeys

The Challenges of Constructing a Genogram on an Appalachian Extended Family Health Consciousness

Introduction According to the Centers for Disease Control and Prevention (CDC), Appalachians exhibit high rates of chronic disease-related behaviors such as smoking, unhealthy eating and sedentary lifestyle. Heightened health consciousness, being aware of and valuing one\u27s health, might lead to healthier lifestyles. Knowing that matriarchs are influential in closely-knit Appalachian extended families, a West Virginia family physician identified thirty-six older Appalachian women in his practice. They were each sent 6-page mailings inviting them to participate, along with their extended family, in constructing a genogram. A genogram displays inter-generational patterns of health and disease. It was hypothesized that family members\u27 health consciousness might increase after participation in the project. However, none of the thirty-four women contacted agreed to participate. The reasons for their non-participation were explored. Methods All the potential participants were mailed a survey and follow-up phone interviews were conducted with twenty-five women. The reasons given for non-participation were collated and arranged in order of frequency. Narrative written and verbal comments were examined for recurring themes. Results The primary reasons offered were that the correspondents were uncertain of what was being asked or felt overwhelmed about participating. Also, they cited their families as too sparse, scattered and busy to participate. Nevertheless, in phone conversations, many correspondents indicated willingness to participate in the future. Conclusion The recruitment mailings posed significant obstacles for participants who, when subsequently engaged by phone, were actually favorably disposed. Recruitment of patients from Appalachian practices for similar projects might require personal, oral engagement

S0143 Association of Search Engine Queries for COVID-19 and Diarrhea With COVID-19 Epidemiology

INTRODUCTION: Coronavirus disease (COVID-19) is a far-reaching pandemic that has changed the landscape of human interaction. Gastrointestinal symptoms, such as diarrhea, are part of the spectrum of disease. Previous infectious disease studies have shown good correlation between online search engine queries and disease burden, thereby allowing tracking. We aimed to assess the relationship between Google searches for COVID-19 and diarrhea with COVID-19 epidemiology, including incidence and mortality. METHODS: Google Trends, a publicly available and free service that tracks online search frequency, was utilized to identify online searches for combined diarrhea plus COVID-19 from March 3, 2020 to May 4, 2020. These results were stratified by state and then compared with publicly reported incidence data from the US Centers for Disease Control and Prevention (CDC) for the same timeframe. A control search of other COVID-19 associated symptoms listed by the CDC was performed. Additional control searches of the individual search terms diarrhea and COVID-19 were conducted. Correlations between geographic location and epidemiologic trends were analyzed using the Pearson correlation coefficient. RESULTS: State-by-state searches for COVID-19 plus diarrhea were correlated with mortality reported as deaths per capita (R = 0.31; P = 0.03) [Figure 1], but not incidence reported as cases per capita (R = 0.19; P = 0.19). New Hampshire had the highest number of COVID-19 plus diarrhea searches while Alaska, Hawaii, Montana, and West Virginia had the lowest relative search frequency. Diarrhea was the second most searched symptom in conjunction with COVID-19 [Figure 2]. Fever and cough, which are thought of as more traditional upper respiratory viral symptoms, were also commonly searched. Diarrhea alone was more frequently searched than COVID-19 alone or COVID-19 plus diarrhea [Figure 3]. CONCLUSION: Our data show weak correlation between mortality and COVID-19 searches. This indicates that, for COVID-19, online search analysis is unlikely to be a good substitute for more traditional methods of patient testing, case tracking, and early detection. However, Google Trends of searches for COVID-19 plus diarrhea, in addition to being a marker for disease interest, may still be useful as part of a more complex model for tracking disease as they parallel search activity for COVID-19 in general