NIH's TB awards boost interest and skill
NIH's TB awards boost interest and skill
Students hone leadership skills
This year marks the midpoint of a cycle of five-year grants known as the Tuberculosis Academic Awards, which are bestowed by the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health.
The awards program is far-ranging in scope, says Hannah Peavy, PhD, leader of the AIDS/TB Scientific Research Group of the Lung Biology and Disease Program of the Division of Lung Diseases at the NHLBI.
"These awards were conceived to encourage people to improve the curriculum at medical schools, increase community outreach, and improve the way TB is taught," Peavy says. "They're aimed primarily at medical students, but they also target other health professionals, including residents, house staff, attending physicians, and nurses."
To be chosen, recipients first need to be able to evaluate the curriculum at their respective schools and then must possess the ability to change the curriculum, says Peavy. They also have to have enough contacts in the community to be able to provide components of outreach.
"They have to know a lot about TB and be effective teachers," says Peavy. "They need to know more than just how to teach students to produce the right answer on a test; they need to be able to change students' behavior, to teach them where to go for information, and to show them how to interact with patients in different situations."
In New Orleans, a teach-the-teachers program
One of last year's final cycle of recipients is Juzar Ali, MD, an associate professor of medicine in the pulmonary disease section at Louisiana State University School of Medicine and Medical Center in New Orleans.
For his grant project, Ali devised a teach-the-teachers program. He began by issuing invitations to members of the medical school's sophomore class. Selected students received special instruction about TB and then were divided into teams, and sent out into the community to teach others.
Student teams went to homeless shelters, prisons, and substance-abuse centers, where they provided instruction to members of the general population or, in some cases, other health care providers. Teaching sessions were designed to be as interactive as possible, with time for feedback and for question-and-answer sessions, Ali says.
At the end of the year, the teams re-grouped, compared their experiences, and composed and distributed a booklet of most frequently asked questions and answers, which they distributed in the community.
Last year, out of a class of 170, about 15 to 20 students joined the program, Ali says. This year, in the second year, twice as many students have joined, including three who want to come back for the second time.
The same kind of program model would work equally well with other diseases, Ali says. But for better or worse, so far at LSU, only TB has such a champion.
"It's not the usual didactic-type classes with clinical correlates," Ali says. "For one thing, it's taking academics to the community; for another, it helps the students to have a better focus. If they decide to take up practice as a family physician in urban or rural areas, they'll have a better focus; they'll be able to be opinion leaders."
Genne D, Siegrist HH. Tuberculosis of the thumb following a needlestick injury. Clin Infect Dis 1998; 26:210.
Describing a rare case of transmission of localized tuberculosis via needlestick, the authors underscore the need for infection control measures in laboratory settings to prevent accidents that will involve needles and syringes about one-fourth of the time.
The lab technician received a cervical lymph node for microbiological analysis from an HIV-positive, severely immunocompromised patient who had active pulmonary tuberculosis. A mycobacterial culture was requested.
While trying to insert the needle through the membrane of the bottle, the technician stuck it deeply into the tip of his left thumb, touching the bone. He accidentally injected a bolus of the liquid deeply into his finger. Ten days after the needlestick, the technician felt numbness at the site of the wound. The acid-fast bacilli in the lymph node were identified as Mycobacterium tuberculosis. Susceptibility tests showed that the organisms were susceptible to the four principal antituberculous drugs - isoniazid, rifampin, ethambutol, and pyrazinamide.
Infection with tuberculosis by direct injection is rare. The skin is naturally resistant to tuberculosis; therefore, a breach of the cutaneous barrier is necessary to provoke infection. This can occur following circumcision, tattooing, intramuscular injection, or mouth-to-mouth resuscitation, the authors note.
"To our knowledge, only one [previous] case has been described where a syringe used on an HIV-positive patient with tuberculosis caused an accidental infection," they conclude. "In that case, a nurse injured herself with the needle of a catheter removed from an HIV-positive patient with pulmonary tuberculosis."
The condition of the technician's thumb improved slowly while he was treated with 300 mg of isoniazid and 600 mg of rifampin daily for six months. The pain progressively disappeared, and no bone involvement was seen. It took more than one year, however, for complete recovery from the needlestick.
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