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Northeastern Spotlight
Winter 2017
Volume 12 - Number 1

Dear Colleagues,

We would like to wish you all a happy new year!

This edition of the newsletter features a profile of Anna Shauer, RN, TB Program coordinator at the Baltimore City Health Department. These staff profiles provide an introduction to key TB program partners in the region and hopefully is a springboard for you to network and draw on experiences from one another. You can also read about some of the recent collaborative training activities in New Jersey, New Hampshire, Connecticut and Maine. We also highlight the recipient of the Union Medal, our very own Lee B. Reichman, MD.

We look forward to working with you in the coming year on TB education, training and medical consultation activities!    

Sincerely,
Alfred Lardizabal, MD

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Training Highlights:

Global & Local Tuberculosis: Updates Relevant to Your Practice-Manchester, NH

The New Hampshire Department of Health in collaboration with GTBI held a one-day conference on September 29, 2016 at the Manchester Health Department in Manchester, NH. The conference focused on providing updates in the diagnosis and treatment of TB infection and disease, including addressing TB among high-risk groups such as refugees. There were 47 healthcare professionals from New Hampshire and Massachusetts who attended, including physicians, nurses and physician’s assistants from a number of practice settings.

Faculty and topics were carefully chosen by the planning committee to address specific needs of the audience. Speakers included faculty from Dartmouth College Geisel School of Medicine and staff from the New Hampshire Department of Health and the Manchester Health Department. Topics included a patient narrative, an overview of the local epidemiology, testing and treatment for TB infection, TB in refugee populations, infection control, and drug-resistant tuberculosis. The attendees were engaged by the content, particularly the patient experience and drug-resistant case studies.

Submitted by Jennifer K. Campbell, MPH, CHES - Training and Consultation Specialist

10th Annual TB Medical Consultant’s Meeting – West Orange, NJ

GTBI hosted its 10th Annual TB Medical Consultant’s Meeting on October 13-14, 2016. This one and half day meeting brings together TB medical consultants from the 15 TB programs in the Northeast region and provides an opportunity to discuss current and emerging topics in TB. The keynote address was given by Dr. Jennifer Flood, Chief of the California Department of Public Health Tuberculosis Control Branch. Dr. Flood’s talk focused on the elimination of TB from the perspective of the patient, primary care physician and TB specialist. Plenary sessions touched on updates in diagnosis and treatment of TB infection and disease. Dr. Bob Horsburgh, Professor of Medicine at Boston University School of Medicine, discussed expanded efforts for testing and treatment of latent tuberculosis infection in the United States. Dr. Lynn Amon, Senior Scientist in the Aderem Lab at the Center for Infectious Disease Research in Seattle, Washington, reviewed a recent study on the role of blood biomarkers in TB diagnosis.

Dr. Maunank Shah, Associate Professor at Johns Hopkins University, outlined the role of repurposed drugs for the treatment of patients with MDR TB. Dr. Barry Kreiswirth, Director of the TB Center at the Public Health Research Institute, presented on the topic of genomics and clinical implications of genotyping antibiotic resistance. Finally, Dr. John Bernardo, Professor of Medicine at Boston University School of Medicine, highlighted practical applications of the use of Xpert MTB/RIF® assay in making decisions to discontinue airborne infection isolation in healthcare settings. The meeting concluded with discussion of cases by consultants with input from fellow colleagues and faculty. The consultants rated the content, caliber of speakers, different viewpoints and high level discussions as major strengths of the meeting. The combination of basic science, clinical and public health and the opportunity to network with other TB consultants were definitely a plus!

Submitted by Anita Khilall, MPH - Program Director, Education & Training

Tackling TB: Making the Goal of Elimination – Hartford, CT

The Connecticut Department of Health and GTBI held a co-sponsored conference on November 2, 2016 in Hartford, CT. Seventy five healthcare professionals attended the conference which provided updates on national and local priorities for TB prevention and addressed TB among high-risk groups.

Speakers and topics were carefully chosen to address local needs and areas of interest. The opening talk highlighted a patient narrative which was given by a former TB patient and advocate who shared his experience with the disease. The content touched on national and local priorities, a look ahead at global TB elimination, patient-centered TB care, refugee and immigrant populations, and managing co-morbidities such as diabetes and hepatitis C. The participant feedback indicated that the conference provided an important updates in TB and the opportunity for networking. The most relevant sessions included the patient narrative, global perspective and TB and diabetes. As a result of the participation in the conference, attendees also plan to make changes in practice.

Submitted by Patty Woods, RN, MSN– Nurse Educator

Preparing for the Future: Strategies for Management of TB - Augusta, ME

GTBI in coordinated with the Maine Center for Disease Control GTBI held a one-day conference on November 15, 2016 at Kaplan University in Augusta, Maine. Speakers included experts from throughout the Northeast region who are well versed in the local and global challenges of TB prevention and care. The topics were chosen by the planning committee to address local needs in Maine, including testing and treatment for TB infection, management of drug resistant TB, infection control practices, TB contact investigation, and DOT vs. self-administered therapy for treatment of TB. It also featured the experience of a person affected by TB.

There were 40 attendees at the conference including physicians, nurses, infection control practitioners and other healthcare professionals. The content was well received, particularly the updated guidelines and case studies included in all the talks. The conference was definitely successful as some attendees requested a multi-day workshop for future TB conferences in Maine!

Submitted by Arpita Jindani, MSW, MA – Health Educator

 

Staff Profile: Anna Schauer, BSN, RN - Baltimore City, MD

Anyone who meets Anna Schauer is struck by her warm and approachable demeanor. Anna is the Program Coordinator at Baltimore City Health Department where she brings her leadership, compassion and administrative skills to the table. In her current role, she spends half of her time on patient care and the rest on education, program evaluation, infection control and clinic administration.

In the photo above: Anna Schauer at the TB Clinic in Baltimore

Anna joined the TB program at Baltimore City Health Department in May of 2015 as a Nurse Case Manager. Earlier this year, she was promoted to her current position. Prior to joining the Health Department, Anna worked as an ICU nurse, specializing in surgical oncology for three years. She is quick to compare her nursing experience in a hospital setting versus a public health setting, “I came from a surgical background where a lot of egos are in play but the TB world is so refreshing. Switching from surgical oncology to public health has been a positive change. Working in a low resource setting is very different, but it certainly make you more creative as you want to achieve good outcomes with less resources.”

For many of us, our life experiences shape our professional choices. That seems to be the case with Anna as well. She grew up in California and attended University of California, Davis to purse her undergraduate course in neurobiology, physiology and behavior. While pursuing her undergraduate degree, she traveled frequently with her parents who were missionaries and did a lot of non-profit work internationally. “I spent a fair amount of time in Zambia as my parents were based there. That experience definitely stayed with me and has helped me in my nursing profession by giving me a deeper insight into cultural competency.”

When reflecting on what prompted her to be a nurse, Anna shares that she was initially on a pre-med trajectory but as she spent more time in patient care settings, she realized that the nurses played a vital role in the care of patients. She was also struck by the fact that nurses had more patient interaction compared to the providers. This solidified her desire to pursue a degree in nursing and she completed a Bachelor of Science in Nursing from Johns Hopkins University School of Nursing.

Anna recalls a patient encounter when she was still new to TB, “I still remember this situation very vividly, while I was taking care of this young lady who was a foreign-born student. The GeneXpert® results showed that she had MDR-TB. She was started on an MDR-TB regimen and experienced adverse drug reactions.” The patient was still in isolation and Anna was going to her house every day to monitor her. She could tell that the daily injectable medications were wearing her out and it was very hard to watch the patient feeling helpless. “This made me realize that the emotional burden of isolation can be very rough for the patients. It also showed me how everyone needs to come together to care for the patient. If we want the patient to complete treatment, it is up to the care team to make sure we eliminate barriers for them in order to complete treatment.”

Anna finds that one of the major obstacles she faces in her clinic setting is adherence. In many instances, patients have competing priorities such as employment, homelessness, substance abuse or other medical or social circumstances which makes TB treatment not as urgent. “TB does not happen in a silo. Linkage to care such as getting assistance for housing and connecting patients to various services are essential for treatment completion.”

When asked about what she enjoys about the TB world, Anna adds, “I find TB fascinating! I am intrigued by the complexity of disease management. However, what really moves me is the compassion and dedication in our cohort across the board. The success of our TB program depends on the people and we seem to have the most wonderful people working in the field of TB.”

According to Dr. Maunank Shah who is the Medical Director of Baltimore City TB Program, “Anna is a wonderful colleague and it is a pleasure to work with her. Despite the many resource constraints common to public health TB programs, she goes above and beyond to help ensure that our patients (and community) are well cared for and that the program runs smoothly and efficiently. Her commitment, compassion, and intelligence are a tremendous asset to TB control in Baltimore.”

This sentiment is conveyed by many of her colleagues including Nurse Consultant, Karla Alwood, CRNP, who also gushes with accolades. “Despite having been a nurse for only a few years, Anna walked into this role like it was a complete match on all levels. She truly embraces the best of what nursing brings to public health, from both a clinical and administrative perspective. She came to the clinic during a time of chaos and has transformed our service into a much more efficient, hands-on, competent resource. She has done so with a calm and competent attitude that you sense the first time you meet her. She is thoughtful, kind, and has amazing poise for one still so young in her career!”

 In the photo above: Anna enjoying some Middle Eastern food

In addition to being a devoted TB nurse, Anna is also a food connoisseur who loves to cook in her free time. A few of her favorite chefs happen to be British celebrity chefs Yotam Ottolenghi and Jamie Oliver, who cook diverse cuisines. She likes all kinds of food but Asian food is undoubtedly her favorite cuisine! Anna also enjoys water sports such as Kayaking and swimming. These pastimes help to bring a well-rounded perspective that serves to provide a much needed balance with work and play. Undoubtedly, her appreciation for all types of food also gives her an appreciation for different cultures which enriches the type of nursing care she provides and ultimately benefits those individuals that the health department serves. We wish Anna tremendous success in navigating the intricacies of the clinical and public health management TB, including all the opportunities and challenges that come along with it.

 

Submitted by Arpita Jindani, MSW, MA - Health Educator  

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 Announcements and Awards: GTBI Founder Lee Reichman, MD receives the Union Medal - Liverpool, UK

Dr. Lee Reichman, Senior Advisor and Founding Executive Director of the New Jersey Medical School Global Tuberculosis Institute (GTBI), was awarded the Union Medal at the opening session of the 47th Annual Union World Conference on Global Health. The Union Medal is The Union's highest honor and traditionally awarded to an individual who has made a significant commitment to TB control or lung health.

In the photo above: Dr. Jane Carter presenting the Union Medal to Dr. Lee Reichman

Presenting the award, Union President, Jane Carter said: "Dr. Reichman is perhaps most widely recognized for his accurate public prediction in 2001 that global failure to control basic tuberculosis disease would become a 'time bomb' leading to the explosion of nearly untreatable multi-drug resistant tuberculosis. A prediction that is most fitting as we gather to consider how to confront resistance."

In the photo above: A closer look at the Union Medal (front and back)

Dr. Reichman’s passion and dedication to advancing TB prevention, care and elimination continues to be an inspiration to those of us who work with him locally and around the globe. Congratulations on this well-deserved honor and distinction!!

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GTBI TB Consultation Service

GTBI has over 25 years of experience in offering TB clinical care, prevention and education services. Our experts are available to answer a wide variety of TB-related questions, including clinical, nursing, public health, and programmatic issues. Consultants can be reached by calling the TB Info-line (1-800-482-3627) or by email (mc_gtbi@njms.rutgers.edu)

During each consultation, the GTBI consultants will advise callers about resources/TB Programs in their jurisdiction. More information about our consultation service can be accessed at: http://globaltb.njms.rutgers.edu/services/medicalconsultation.html

Web-Based TB Grand Rounds

Twice a month, TB medical consultants, nurses and TB program staff are invited to participate in our web-based TB Grand Rounds. Consultants are encouraged to present challenging TB cases on which they would like feedback from their colleagues or teaching cases that have an educational value. The regular day and time are Fridays at noon, while specific dates vary. A list of upcoming sessions with topics, speakers and login information is shared via email. If you would like to be added to this email list or if you have a case to present, please contact Arpita Jindani at 973-972-4811 or arpita.jindani@rutgers.edu.

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Upcoming Northeast RTMCC Training

GTBI sponsors courses and webinars on tuberculosis. Webinars are open to all participants in the United States.  For in-person courses, GTBI prioritizes participants from the Northeast Region (Baltimore, Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York City, New York State, Pennsylvania, Philadelphia, Rhode Island, Vermont, and Washington, DC). Click here for a list of upcoming trainings.

Links - Other TB Resources

Division of Tuberculosis Elimination
The mission of the Division of Tuberculosis Elimination (DTBE) is to promote health and quality of life by preventing, controlling, and eventually eliminating tuberculosis from the United States, and by collaborating with other countries and international partners in controlling tuberculosis worldwide.

Find TB Resources Website
This website provides a central, comprehensive searchable database of international, national, state, and local TB-related education and training materials for TB healthcare workers, health professionals, patients, and the general public. Users can also submit their education and training materials as well find information on funding opportunities, TB organizations, TB mailing lists, and TB images.

TB Education & Training Network (TB ETN)
The TB Education and Training Network (TB ETN) was formed to bring TB professionals together to network, share resources, and build education and training skills.

Registration is now open for the TB ETN and TB Program Evaluation (PEN) conference. For additional information, please send an email to tbetn@cdc.gov

Regional Training and Medical Consultation Centers' TB Training and Education Products
This website provides a searchable list of all RTMCCs' resources.

TB Wire Newsletter
Content include announcements, current journal articles, available resources and training activities, upcoming meetings and conferences, etc. To subscribe to this service, click here

Other RTMCCs  
The Curry International Tuberculosis Center serves: Alaska, California, Colorado, Hawaii, Idaho, Nevada, Oregon, Utah and Washington.

The Heartland National Tuberculosis Center serves: Arizona, Arkansas, Kansas, Louisiana, Missouri, New Mexico, Nebraska, Oklahoma, and Texas.

The Mayo Clinic Center for Tuberculosis serves:  Illinois, Indiana, Iowa, Michigan, Minnesota, Montana, North Dakota, Ohio, South Dakota, Wisconsin, and Wyoming

The Southeastern National Tuberculosis Center serves: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Puerto Rico, West Virginia, and the U.S. Virgin Islands.

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Key Contacts

  • Alfred Lardizabal, MD - Executive Director
  • Amee Patrawalla, MD - Medical Director
  • Rajita Bhavaraju, MPH - Deputy Director
  • Anita Khilall, MPH - Program Director, Education and Training
  • Lee B. Reichman, MD, MPH - Senior Advisor

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