History in your hand.

In the swirl of current events including a pandemic and new chapters in the awareness of race and gender, it is the professional responsibility of librarians and archivists to create durable records for future scholars, so they can understand our present.

The Changing Epidemiology and Microbiology of Patients With Prostate Abscess: Increase in Staphylococcal Infection.

BACKGROUND: Prostatic abscesses are rare and have been most commonly associated with gram-negative bacteria; however, Staphylococcus aureus has emerged as a leading cause, particularly in persons who are immunocompromised. METHODS: We conducted a retrospective chart review of all patients discharged from Ben Taub Hospital with a diagnosis of prostatic abscess during January 2011-January 2019. Demographic, clinical, microbiologic, and radiographic data were abstracted from the patients' charts and analyzed for comorbidities, causative organisms, clinical course, and outcomes. RESULTS: We identified 32 patients with a prostatic abscess during the study period. S. aureus was the most common causative organism (18/32, 56%). Most patients (24/32, 75%) were admitted to a general medicine service, and the median length of stay was 9 days. Twenty-one patients (66%) were treated with a combination of surgical drainage and antibiotic therapy; 11 (34%) were treated with antibiotics alone. All patients treated with antibiotics alone had full clinical recovery. Two patients (6.3%) died, both of whom had septic shock secondary to disseminated S. aureus infection. CONCLUSIONS: Prostatic abscesses are rare and can be difficult to diagnose, leading to significant morbidity and mortality. S. aureus is a frequent causative organism especially in persons with diabetes mellitus or other immunocompromising conditions. Hematogenous spread of S. aureus infection to the prostate appears common. Prostatic abscesses can serve as the nidus of disseminated S. aureus infection.

I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration.

BACKGROUND: The I-PASS framework is increasingly being adopted for patient handoffs after a recent study reported a decrease in medical errors and preventable adverse events. A key component of the I-PASS handoff included assignment of illness severity. OBJECTIVE: We evaluated whether illness severity categories can identify patients at higher risk of overnight clinical deterioration as defined by activation of the rapid response team (RRT). METHODS: The I-PASS handoff documentation created by internal medicine residents and patient charts with overnight RRT activations from April 2016 through March 2017 were reviewed retrospectively. The RRT activations, illness severity categories, vital signs prior to resident handoff, and patient outcomes were evaluated. RESULTS: Of the 28 235 written patient handoffs reviewed, 1.3% were categorized as star (sickest patients at risk for higher level of care), 18.8% as watcher (unsure of illness trajectory), and 79.9% as stable (improving clinical status). Of the 98 RRT activations meeting the inclusion criteria, 5.1% were labeled as star, 35.7% as watcher, and 59.2% as stable. Patients listed as watcher had an odds ratio of 2.6 (95% confidence interval 1.7-3.9), and patients listed as star had an odds ratio of 5.2 (95% confidence interval 2.1-13.1) of an overnight RRT activation compared with patients listed as stable. The overall in-hospital mortality of patients with an overnight RRT was 29.6%. CONCLUSIONS: The illness severity component of the I-PASS handoff can identify patients at higher risk of overnight clinical deterioration and has the potential to help the overnight residents prioritize patient care.

Resilience, relevance, remembering: history in the time of coronavirus.

In a time of unprecedented and rapid change, what are the roles of librarians and archivists in documenting the course of a pandemic?

Claire Fraser, RN, MD, OMG: history of medicine in the Outlander novels and series.

This article discusses how Claire Randall, RN, MD, the fictional protagonist of Diana Gabaldon's widely popular Outlander series, uses her knowledge of twentieth century medicine in her adventures in eighteenth century Scotland, France, and America.

Medical history: as it was; as it will be.

Born shortly after World War I in 1919 and living through multiple wars, conflicts, and cultural changes in his ninety-six years, Erich Meyerhoff remained a student of history throughout his long life. He regularly attended the annual meetings of the American Association for the History of Medicine and other history groups such as the Medical Library Association's History of the Health Sciences well into his nineties. This essay traces how the field of history and historical methods changed during Erich's life and suggests that he saw history and librarianship as a means for achieving social justice and social equity.

Update on Human Rhinovirus and Coronavirus Infections.

Human rhinovirus (HRV) and coronavirus (HCoV) infections are associated with both upper respiratory tract illness ("the common cold") and lower respiratory tract illness (pneumonia). New species of HRVs and HCoVs have been diagnosed in the past decade. More sensitive diagnostic tests such as reverse transcription-polymerase chain reaction have expanded our understanding of the role these viruses play in both immunocompetent and immunosuppressed hosts. Recent identification of severe acute respiratory syndrome and Middle East respiratory syndrome viruses causing serious respiratory illnesses has led to renewed efforts for vaccine development. The role these viruses play in patients with chronic lung disease such as asthma makes the search for antiviral agents of increased importance.

Costs of the residency match for fourth-year medical students.

A vital step in the career of a physician is applying and interviewing for a position in a residency program. Unfortunately, the costs associated with this process are often not anticipated by fourth-year medical students. The authors collected data on these costs from fourth-year medical students in Texas (N=274) during 2012-2013. Results suggested that the average cost of this process was significant (M=$4783). The costs varied greatly, depending on the medical specialty for which the fourth-year medical student applied, with a range exceeding $12,000. Most students (60%) paid for these costs with personal savings. The authors suggest that documentation of the average cost of applying and interviewing for residency would allow future fourth-year medical students to make more accurate financial plans, provide evidence for increased financial need during the final year of medical school, and initiate an evaluation of the current residency match process for cost-saving strategies to decrease the financial burden on students.

Picornavirus, the most common respiratory virus causing infection among patients of all ages hospitalized with acute respiratory illness.

We evaluated the prevalence of respiratory virus infection (RVI) in 403 illnesses of 364 persons hospitalized over a 2-year period with acute respiratory conditions using virus-specific reverse transcription-PCR (RT-PCR) assays in addition to cell culture and serology. RVIs were identified in >75% of children under 5 years of age and 25 to 37% of adults. The molecular assays doubled the number of infections identified; picornaviruses were the most frequent in patients of all ages, followed by respiratory syncytial virus and influenza viruses.

Update on rhinovirus and coronavirus infections.

Rhinoviruses and coronaviruses cause significant morbidity in immunocompetent people of all ages and in patients with underlying chronic medical or immunosuppressed conditions. Newer diagnostic tests, such as polymerase chain reaction (PCR), have expanded our understanding of these respiratory viruses in clinical infections. These sensitive diagnostic tests have been used to describe new members of these virus families, such as human rhinovirus C (HRVC) and human coronavirus NL-63 (HCoV-NL63). The epidemiology of these newly described viruses will help us develop better intervention strategies.

Rethinking CME: an imperative for academic medicine and faculty development.

To help address the clinical care gap, a working group discussed the future of faculty development in academic medicine, explored problems within the large, current enterprise devoted to continuing medical education (CME), and described four domains core to its revitalization and reformation. These domains are (1) preparing and supporting an engaged clinician-learner, (2) improving the quality of knowledge or evidence shared, (3) enhancing the means by which to disseminate and implement that knowledge and evidence, and (4) reforming the patient, health care, and regulatory systems in and for which the process of CME exists. Reshaping these domains requires the consideration of a more seamless, evidence-based, and patient-oriented continuum of medical education. Revitalizing CME also requires the full engagement of the academic medical community and its faculty. To achieve the goal of creating a new, more effective, seamless process of CME, the working group recommended an active faculty development process to develop strong clinician-learners, strong involvement of academic health center leaders, the development of an educational home for clinician-learners, and a meaningful national conversation on the subject of CME.

Human rhinovirus proteinase 2A induces TH1 and TH2 immunity in patients with chronic obstructive pulmonary disease.

BACKGROUND: Tobacco-related lung diseases, including chronic obstructive pulmonary disease (COPD), are major causes of lung-related disability and death worldwide. Acute exacerbation of COPD (AE-COPD) is commonly associated with upper and lower respiratory tract viral infections and can result in respiratory failure in those with advanced lung disease. OBJECTIVE: We sought to determine the mechanism underlying COPD exacerbation and host response to pathogen-derived factors. METHODS: Over a 24-month period, we assessed the viral causes for upper and lower respiratory tract infections in patients with COPD (n = 155) and control subjects (n = 103). We collected nasal and bronchoalveolar lavage fluid and peripheral blood under baseline and exacerbated conditions. We determined the effect of human rhinovirus (HRV) proteinases on T-cell activation in human subjects and mice. RESULTS: HRVs are isolated from nasal and lung fluid from subjects with AE-COPD. Bronchoalveolar lavage fluid and CD4 T cells from patients with COPD exhibited a T(H)1 and T(H)2 cell cytokine phenotype during acute infection. HRV-encoded proteinase 2A activated monocyte-derived dendritic cells in vitro and induced strong T(H)1 and T(H)2 immune responses from CD4 T cells. Intranasal administration of recombinant rhinovirus proteinase 2A in mice resulted in an increase in airway hyperreactivity, lung inflammation, and IL-4 and IFN-gamma production from CD4 T cells. CONCLUSION: Our findings suggest that patients with severe COPD show T(H)1- and T(H)2-biased responses during AE-COPD. HRV-encoded proteinase 2A, like other microbial proteinases, could provide a T(H)1- and T(H)2-biasing adjuvant factor during upper and lower respiratory tract infection in patients with severe COPD. Alteration of the immune response to secreted viral proteinases might contribute to worsening of dyspnea and respiratory failure in patients with COPD.

The great contribution: Index Medicus, Index-Catalogue, and IndexCat.

OBJECTIVE: The systematic indexing of medical literature by the Library of the Surgeon-General's Office (now the National Library of Medicine) has been called "America's greatest contribution to medical knowledge." In the 1870s, the library launched two indexes: the Index Medicus and the Index-Catalogue of the Library of the Surgeon-General's Office. Index Medicus is better remembered today as the forerunner of MEDLINE, but Index Medicus began as the junior partner of what the library saw as its major publication, the Index-Catalogue. However, the Index-Catalogue had been largely overlooked by many medical librarians until 2004, when the National Library of Medicine released IndexCat, the online version of Index-Catalogue. Access to this huge amount of material raised new questions: What was the coverage of the Index-Catalogue? How did it compare and overlap with the Index Medicus? METHOD: Over 1,000 randomly generated Index Medicus citations were cross-referenced in IndexCat. RESULTS: Inclusion, form, content, authority control, and subject headings were evaluated, revealing that the relationship between the two publications was neither simple nor static through time. In addition, the authors found interesting anomalies that shed light on how medical literature was selected and indexed in "America's greatest contribution to medical knowledge."