1 00:00:03,389 --> 00:00:04,109 Sara Dong: Hi, everyone. 2 00:00:04,230 --> 00:00:07,900 Welcome to Febrile, the cultured podcast about all things infectious disease. 3 00:00:08,780 --> 00:00:13,650 We use consult questions to dive into ID clinical reasoning, diagnostics, and antimicrobial management. 4 00:00:14,339 --> 00:00:17,070 I'm Sara Dong, your host and a MedPeds ID doc. 5 00:00:17,730 --> 00:00:20,360 Today, I am joined by several friends, Dr. 6 00:00:20,360 --> 00:00:27,240 Sax, Vijayan, and Tunkel, who are going to let you know a little bit about what is going to be a new series for Febrile. 7 00:00:27,305 --> 00:00:32,674 But first I was hoping you all could tell the audience a little bit about yourself and give a quick introduction. 8 00:00:33,184 --> 00:00:33,864 Tara Vijayan: Hi everyone. 9 00:00:33,885 --> 00:00:35,194 I'm Tara Vijayan. 10 00:00:35,195 --> 00:00:38,725 I'm a faculty member at the University of California, Los Angeles. 11 00:00:39,394 --> 00:00:41,275 Here I have a couple of different roles. 12 00:00:41,275 --> 00:00:46,955 I do a lot of teaching for both our medical school as well as in our residency and our fellowship. 13 00:00:47,425 --> 00:00:55,805 I am currently the medical director of adult antimicrobial stewardship as well as the medical director of our CARE clinic, which is our HIV clinic here at UCLA. 14 00:00:56,695 --> 00:01:04,315 The role of co editor of the State of the Art Reviews in Clinical Infectious Diseases is the role of a lifetime. 15 00:01:04,364 --> 00:01:07,155 It's one of my dream jobs, and I'm really happy to be here. 16 00:01:07,974 --> 00:01:09,074 Allan Tunkel: I'm Allan Tunkel. 17 00:01:09,085 --> 00:01:13,405 I'm currently at the Warren Alpert Medical School of Brown University. 18 00:01:13,845 --> 00:01:16,145 I practice adult infectious diseases. 19 00:01:16,145 --> 00:01:19,304 I have a special interest in central nervous system infections. 20 00:01:19,895 --> 00:01:34,685 A lot of my career has been around medical education, so I've been an Internal Medicine Residency Director, Fellowship Director, and most recently at Brown, I was Senior Associate Dean for Medical Education, overseeing everything related to the medical students. 21 00:01:34,685 --> 00:01:37,374 I retired from that role about a year and a half ago. 22 00:01:37,935 --> 00:01:59,825 And in my retirement, I was fortunate enough that Paul asked me to take on this role as co editor of the State of the Art Review section of Clinical Infectious Diseases, but I'm also doing some other work as Deputy Editor of ACP MKSAP and I'm a health careers advising expert in residence at Brown University, helping students who would like to go to medical school. 23 00:02:00,335 --> 00:02:07,864 Paul Sax: I'm Paul Sax, and I'm the clinical director of the ID Division at Brigham and Women's Hospital, and I'm on the faculty at Harvard Medical School. 24 00:02:08,105 --> 00:02:26,209 The reason I'm here today is because I'm Editor in Chief of Clinical Infectious Diseases, and when I was, uh, pitching my candidacy for this role, one of the key things I included was a new series, and this is one of them, and it's a thrill that we've been able to pull it off thanks to what Tara and Allan have done. 25 00:02:26,420 --> 00:02:31,269 Sara Dong: And before we jump in a little bit further, we always pause to do one other introduction piece. 26 00:02:31,779 --> 00:02:40,370 Febrile is everyone's favorite cultured podcast, so we love asking the guests to share a little piece of culture, something that brings you joy outside of work. 27 00:02:41,000 --> 00:02:42,179 Allan, maybe I'll start with you. 28 00:02:42,654 --> 00:02:50,375 Allan Tunkel: There are a lot of things, especially things that I'm doing in retirement that have introduced me to new things, but I've always loved classic movies. 29 00:02:50,725 --> 00:02:59,645 I'm an aficionado of TCM and I love watching those old black and white movies that I think they don't make them like that anymore. 30 00:03:00,404 --> 00:03:04,835 My favorite movie is To Kill a Mockingbird with Gregory Peck. 31 00:03:05,035 --> 00:03:10,333 The greatest movie hero who's ever been in film, at least as part of that movie. 32 00:03:10,333 --> 00:03:12,945 So that's been great and I enjoy doing that. 33 00:03:13,465 --> 00:03:14,465 Sara Dong: Trying to switch up the order. 34 00:03:14,465 --> 00:03:15,845 Maybe I'll ask you, Paul, next. 35 00:03:16,470 --> 00:03:22,060 Paul Sax: When I turned 40, my wife gave me a tennis racket because she saw that I was just messing around on the tennis court. 36 00:03:22,745 --> 00:03:30,955 And had such a great time and I think she regrets it to this day because ever since then I have been obsessed with playing tennis. 37 00:03:32,225 --> 00:03:40,275 It's not very cultured, but it certainly brings me joy outside of work and each time I'm on the way to the tennis court, I'm excited like a kid going to a candy shop. 38 00:03:40,635 --> 00:03:41,664 So playing tennis. 39 00:03:42,365 --> 00:03:42,875 Sara Dong: Love it. 40 00:03:43,135 --> 00:03:44,015 Tara, how about you? 41 00:03:44,370 --> 00:03:53,050 Tara Vijayan: Definitely watching movies and funny TV series while actually doing a thousand piece puzzle is probably with my kids, preferably. 42 00:03:53,450 --> 00:03:58,830 Although, uh, my preferred TV shows are shows that I don't really, I can't really watch with my kids. 43 00:03:58,850 --> 00:04:00,399 So there's a little bit of a dilemma there. 44 00:04:00,529 --> 00:04:06,420 And I'll just put out one of my favorite recent TV series was a show called The Brothers Sun, which I would highly recommend. 45 00:04:06,470 --> 00:04:07,150 Sara Dong: Love it. 46 00:04:07,630 --> 00:04:11,700 That's one of my favorite weekend activities to have the big old puzzle laid out. 47 00:04:12,295 --> 00:04:19,084 Well, thank you guys for sharing, you know, we're recording this quick session to introduce everyone to, I mentioned, a new ongoing series. 48 00:04:19,644 --> 00:04:27,955 Many of those who listen to Febrile probably already know this, but CID, or Clinical Infectious Diseases, has been publishing these awesome State of the Art Reviews. 49 00:04:28,520 --> 00:04:44,470 So I try to mention them on Puscast or link them if they're relevant to a topic in some of the Febrile Consult Notes, but moving forward, Febrile is going to try to bring these authors or some of the authors onto the podcast to chat through some of the learning pearls related to their review topic. 50 00:04:44,839 --> 00:04:51,450 You know, we're still trying to think of all these in clinical questions, but of course the topics themselves are common subjects that we encounter all the time. 51 00:04:51,920 --> 00:05:02,350 And the other thing that of course I love and fits with Febrile really well is all these articles have great, incredible infographics that we can share and link for you all to review as well. 52 00:05:02,800 --> 00:05:07,019 So I personally would just love to hear about how the State of the Art Reviews came about. 53 00:05:07,030 --> 00:05:12,190 Paul, you sort of started to mention that, but kind of what you have in mind as the goals for these papers. 54 00:05:12,660 --> 00:05:13,090 Paul Sax: Sure. 55 00:05:13,380 --> 00:05:25,839 Really, what I had in mind was when you go on clinical service or you see an outpatient and a common clinical problem comes up and you're wondering, you know, how do the experts do an evaluation? 56 00:05:25,930 --> 00:05:26,850 How do they manage it? 57 00:05:27,455 --> 00:05:30,844 And I wanted this to be the go to place for those questions. 58 00:05:31,145 --> 00:05:38,625 So, you know, if you have a person with Staph aureus bacteremia, how do the top experts in Staph aureus bacteremia manage this common challenge? 59 00:05:39,065 --> 00:05:41,505 How do they manage diabetic foot infections? 60 00:05:41,534 --> 00:05:44,385 How do they manage people on high dose corticosteroids? 61 00:05:45,015 --> 00:05:50,305 A State of the Art Review in CID would be a really nice thing to reference if you're seeing such a patient. 62 00:05:50,455 --> 00:05:53,594 It would be a place where you could look at that infographic you mentioned, Sara. 63 00:05:53,945 --> 00:06:03,705 Could be a place where you could see the executive summary, a sort of short version, and a place where you could see the typical ID doctor's obsessive accumulation of details and references. 64 00:06:04,304 --> 00:06:05,885 So that was the idea behind it. 65 00:06:05,915 --> 00:06:14,445 And as I mentioned earlier, I'm really delighted that Tara and Allan accepted the invitation to be the editors of this series because without them it really couldn't happen at all. 66 00:06:14,505 --> 00:06:18,135 Sara Dong: There's obviously endless topics that we think about in ID. 67 00:06:18,475 --> 00:06:24,665 I was curious, Allan and Tara, if you could tell us about how you approached identifying a list. 68 00:06:24,765 --> 00:06:26,904 You know, how do you find authors that are a good fit? 69 00:06:26,914 --> 00:06:28,075 What's your process been? 70 00:06:28,435 --> 00:06:37,284 Allan Tunkel: As practicing infectious disease physicians, we have a good sense of, you know, the challenges we face, whether we're on the inpatient service or in the outpatient setting. 71 00:06:37,815 --> 00:06:43,215 So a part of it, I think, was taken from our experience in terms of what we wanted to get across. 72 00:06:43,794 --> 00:06:49,135 But also, I think we did it with a focus on the continuum of care. 73 00:06:49,570 --> 00:07:02,870 From the inpatient to the outpatient setting or vice versa, recognizing that multidisciplinary care was an important part of everything that we do, and being able to bring non infectious diseases experts into the fray. 74 00:07:03,469 --> 00:07:11,320 We saw some ideas on the IDea Exchange, which I think gave us some things of how we want to move certain topics forward. 75 00:07:11,770 --> 00:07:17,870 And we're certainly open to hearing from many in the field of infectious diseases, the great challenges they face. 76 00:07:18,250 --> 00:07:30,959 Tara Vijayan: The way I sort of start to conceive of it was really thinking about the bread and butter cases, humbly acknowledging that those bread and butter cases actually have a lot of complexity, and navigating uncertainty. 77 00:07:31,169 --> 00:07:33,079 You know, we have our clinical guidelines, right? 78 00:07:33,110 --> 00:07:36,460 And those are constructed in a very specific way. 79 00:07:36,460 --> 00:07:38,320 You have 25 recommendations. 80 00:07:38,330 --> 00:07:41,200 This is what you maybe should be doing. 81 00:07:41,510 --> 00:07:45,580 But the reality is, is that the patient in front of you is always more complicated than that. 82 00:07:45,870 --> 00:07:51,864 And really highlighting how do you even share some of what you are thinking and the uncertainty with your patients? 83 00:07:51,905 --> 00:07:55,844 You know, how do you engage patients and share decision making in some of these complicated issues? 84 00:07:55,905 --> 00:08:08,664 And I think the very first state of the art review that we published was actually the one on diabetic foot infections, which I, all of them are my favorite, but you know, I have, this one has a special place for me because, you know, I think people take for granted. 85 00:08:08,664 --> 00:08:14,479 Um, Uh, and I hear this all the time in our, among our trainees, just it's, it's sort of boring, right? 86 00:08:15,199 --> 00:08:24,509 It's perceived as sort of a boring topic, but in fact, it is one of the, those topics that we actually can, can provide a lot of impact for these patients' care. 87 00:08:24,509 --> 00:08:28,749 You know, we could spare them an amputation, which is a really big deal. 88 00:08:29,279 --> 00:08:34,639 Navigating those areas of uncertainty, how do you share these, these thoughts with your patients? 89 00:08:35,299 --> 00:08:38,120 How do you navigate the RCTs like OVIVA? 90 00:08:38,860 --> 00:08:49,989 This idea that oral is equivalent to intravenous antibiotics, which is true in most cases, but then, you know, when you're thinking about choosing that oral antibiotic, such as, you know, are you going to choose a beta lactam? 91 00:08:49,989 --> 00:08:50,939 Are you going to choose something else? 92 00:08:51,470 --> 00:08:55,555 How do you make those informed decisions and and share that with your patients. 93 00:08:55,615 --> 00:09:05,464 And safety netting, how do you make sure that when you make those decisions that you sort of follow through and decide when those decisions are the right decisions or maybe you have to change course. 94 00:09:05,884 --> 00:09:13,845 Allan Tunkel: Yeah, I also wanted to add, I think as Tara mentioned, the patient focus is really very, very important here and that's something we've tried to highlight. 95 00:09:13,845 --> 00:09:33,799 You know, I'll give you the anecdote that, you know, I was fortunate to chair the IDSA practice guidelines committee on encephalitis, and after they were published, which is more than 15 years ago now, we formed this group called the International Encephalitis Consortium, and we invited patients to be part of that organization in thinking about 96 00:09:33,800 --> 00:09:43,140 how we were treated, and suddenly the guidelines were one part of it, but then we certainly recognize that there are patients who have survived their episode of encephalitis. 97 00:09:43,170 --> 00:09:44,540 What happens to them now? 98 00:09:45,260 --> 00:09:51,850 And thinking about the long term management, I think, is really a critical part of what we'd like to get through with these state of the art reviews. 99 00:09:52,530 --> 00:10:00,589 Sara Dong: And if people have an idea or a suggestion for a future topic, is there a way that they can get that idea back to you? 100 00:10:00,699 --> 00:10:01,839 Tara Vijayan: Yeah, they can email us. 101 00:10:02,660 --> 00:10:17,264 They often email Paul first, uh, because you know, Paul is definitely the face of CID, but sometimes I get direct emails, and then I'll share the email with, with both Paul and Allan, you know, we'll decide whether it's appropriate for a state of the art review or whether it should be considered for something else. 102 00:10:17,525 --> 00:10:21,325 Allan Tunkel: Yeah, I was thinking that the IDea Exchange has given us a lot of great ideas. 103 00:10:21,345 --> 00:10:41,199 I mean, one recent example was that someone, had written in about what do I do with antibiotics at end of life and as it turned out, you know, and Tara happened to be a co author of that particular state of the art review, was a chance to highlight what we thought about that we understand this is very important and you're going to see this great review coming out soon. 104 00:10:41,439 --> 00:10:49,080 Paul Sax: One thing that's really remarkable about the ID community is that an old technology like a listserv is really very active. 105 00:10:49,090 --> 00:11:02,209 I mean, I, I'm amazed at how many people read that, certainly I do, as a way to get an idea across that is another good way, in addition to emailing Allan and Tara and myself directly with proposed ideas. 106 00:11:02,919 --> 00:11:06,409 Sara Dong: And I'm sure you'll get plenty of emails since there's so many topics. 107 00:11:06,469 --> 00:11:25,500 You know, I think doing some of the behind the scenes work for Febrile has made me probably more curious about these types of logistical questions, but as editors of these reviews, I know it must be a huge undertaking to coordinate authors, schedule the papers, you know, coordinate all the tasks to getting to publication. 108 00:11:25,810 --> 00:11:30,850 Maybe you can give us a little insight into help you might have with the process, how you go about it. 109 00:11:31,250 --> 00:11:41,609 Allan Tunkel: Well, I would say we do have help, certainly from the staff at, uh, Clinical Infectious Diseases, who I think have been invaluable in keeping us on track in terms of everything that we're doing. 110 00:11:42,309 --> 00:11:45,959 In terms of reaching out to potential authors, 111 00:11:46,660 --> 00:11:48,940 I don't think I've had anyone turn me down. 112 00:11:48,980 --> 00:11:59,789 I really have been pretty impressed with the interest in being able to do this and to be able to talk about these topics or write about these topics. 113 00:12:00,230 --> 00:12:02,819 And we have assistance to practicing physicians. 114 00:12:03,040 --> 00:12:09,860 Tara Vijayan: I have had a couple of people that just decided that this was not the right time for them and I really appreciate their honesty. 115 00:12:10,090 --> 00:12:18,309 But what's especially helpful is that they're more than willing to share other authors that they think would be appropriate for any given state of the art reviews. 116 00:12:18,569 --> 00:12:21,500 And I will say we're a little bit flexible with, with deadlines. 117 00:12:21,500 --> 00:12:28,750 We sort of make our sort of initial deadline and then we realize that people have a lot You know, life comes up and any number of things come up. 118 00:12:29,060 --> 00:12:38,670 So we have the luxury of being able to push it a little bit, especially since we're just starting this and we're sort of getting the rhythm, but it's an ongoing dialogue with us and our authors. 119 00:12:38,900 --> 00:12:44,579 Paul Sax: And one, one other thing I can mention on a practical basis is that it's good to have a few of these in the works. 120 00:12:45,430 --> 00:12:52,260 Because one of the things that makes a series popular in a journal or in a magazine is that it appears regularly. 121 00:12:52,360 --> 00:13:03,979 And so thanks to the planning of Tara and Allan and the editorial staff at CID, we have a few of them in the works at all times so that we're going to be able to, we hope, publish them on a monthly basis. 122 00:13:04,160 --> 00:13:22,085 Sara Dong: And then the last thing I was going to pivot a little bit, you know, I hope that in the future, Febrile can do a little bit more thinking about career development, but for fellows who, you know, really fellows or junior faculty that might be interested in learning more about the editorial process and getting involved, are there things that 123 00:13:22,085 --> 00:13:32,945 you did in training or as early faculty to gain experience, perhaps getting involved in journals, maybe intimidating to some who don't feel like they're part of that process. 124 00:13:32,965 --> 00:13:39,535 So I was wondering if you had any practical things that you could suggest or advice that you might have for folks that are thinking about it. 125 00:13:40,025 --> 00:13:53,859 Paul Sax: We did start a mentorship program this year and it's a mentorship program that actually there was one mentee for CID, one for JID, and one for OFID, and we limited it to junior faculty. 126 00:13:53,860 --> 00:13:56,549 We decided not to take fellows this time around. 127 00:13:57,029 --> 00:14:00,649 And it turned out to be, I think, a very favorable experience for everybody. 128 00:14:00,659 --> 00:14:04,149 You know, the mentees got their ID week expenses covered. 129 00:14:04,180 --> 00:14:05,839 They got to come to our editorial meetings. 130 00:14:06,379 --> 00:14:09,109 They then acted as associate editors for a while. 131 00:14:09,520 --> 00:14:13,129 So that opportunity exists, but of course, it's not very many people who can do that. 132 00:14:13,540 --> 00:14:17,470 So I would say that the best way to get involved is to do two things. 133 00:14:17,640 --> 00:14:25,930 First is to offer to be a, a reviewer, especially when you're senior fellow, junior faculty, that really is worthwhile. 134 00:14:25,939 --> 00:14:28,949 I know that it's time consuming, but we really appreciate it. 135 00:14:28,959 --> 00:14:33,539 And it's great to see the range of things that are being submitted and how they go through the process. 136 00:14:34,009 --> 00:14:39,725 And the second thing is to participate in an actual paper by writing it as first author. 137 00:14:40,135 --> 00:14:51,275 And if you have a good mentor, a mentor who's established in ID research or clinical care or clinical education, that person who's established should allow you to be first author and take the lead on a paper. 138 00:14:51,775 --> 00:15:10,869 Allan Tunkel: Now, that's something we've tried to, that Tara and I've tried to encourage in terms of the people we've reached out to, I would say we've reached out to senior authors to, to lead the state of the art review, depending upon the individual topic, but we've encouraged them to invite fellows, uh, junior faculty, to consider 139 00:15:10,869 --> 00:15:32,029 diversity and their selection of co authors, and hopefully this is an opportunity to get people more involved, I would say, you know, junior faculty and fellows, even getting more involved in IDSA is another great opportunity to meet people and understand what they may need to do or how they might be able to advance their careers. 140 00:15:32,370 --> 00:15:48,270 Tara Vijayan: Yeah, I don't, I don't have anything more to add to this, except highlighting how much, as with anything, deliberate practice is a really important part of your skillset, you know, being a reviewer, being a writer, really honing in those skills is something that takes time and practice. 141 00:15:48,310 --> 00:15:52,570 And the more you do it, the more likely you will be to get these kinds of positions. 142 00:15:52,970 --> 00:15:56,690 Sara Dong: Thanks again to Tara, Allan, and Paul for joining Febrile today. 143 00:15:57,179 --> 00:16:05,370 We are so excited to debut this series, and I really hope that this can be an additional way to try to build some synergy among the ID resources you have available. 144 00:16:06,680 --> 00:16:07,550 Stay tuned. 145 00:16:07,780 --> 00:16:14,650 You'll now see these state of the art review partnership episodes labeled as "StAR" in the episode title. 146 00:16:14,940 --> 00:16:23,379 We are actually going to release four back to back episodes over the next four weeks to kick this project off, starting with diabetic foot infections. 147 00:16:23,704 --> 00:16:32,145 So, I'm hard at work to connect you with the authors of the previously published reviews, and then we'll continue to have ongoing episodes as they are released in the future. 148 00:16:33,354 --> 00:16:35,614 Don't forget to check out the website, febrilepodcast. 149 00:16:35,614 --> 00:16:43,714 com, where you can find the consult notes, which are written supplements of the show with links to references, our library of ID infographics, and a link to our merch store. 150 00:16:44,574 --> 00:16:49,035 Febrile is produced with support from the Infectious Diseases Society of America, IDSA. 151 00:16:49,585 --> 00:16:52,075 Audio editing and mixing is provided by Bentley Brown. 152 00:16:52,854 --> 00:16:56,834 Please reach out if you have any suggestions for future shows, or want to be more involved with Febrile. 153 00:16:57,175 --> 00:16:59,604 Thanks for listening, stay safe, and I'll see you next time.