Northeastern Spotlight Fall 2007

Dear Colleague:
As most of you know, during the first 6 months of this year I was on sabbatical at the Stop TB Partnership in Geneva to promote global advocacy and to promote the Global Plan to STOP TB. I am encouraged that activities there will help TB control efforts in our country and region as well. Certainly, the universal interest in TB in response the growing specter of XDR TB provides a unique opportunity to reach health care providers serving patients at risk for TB through training and medical consultation services.

On September 26, Jorge Sampaio, United Nations Special Envoy to Stop Tuberculosis (and former President of Portugal), visited the Global TB Institute in his international quest to raise awareness and identify ways to combat TB. I invite you to learn more about the Stop TB Partnership at http://www.stoptb.org/. The NationalCoalition for Elimination of TB (originally created in 1991 in response to the resurgence of TB in the US) has recently been re-named STOP TB USA, to provide a more distinctive name and clear linkage to the global STOP TB Partnership. You can sign up to receive the STOP TB WIRE (the official newsletter of STOP TB USA) by sending an email to John Seggerson at jseggerson@tbcoalition.com.

This issue features a Tuberculin Skin Test Train the Trainer Workshop held in July. This highly interactive course utilized the “teachback” training technique which was highly rated by the nine nurse participants. Attendees received the recently updated NJMS GTBI resource Mantoux Tuberculin Skin Testing Training Guide. Based on their attendance at this Workshop, many participants are already planning TST training courses in their own areas. This issue also features the history and accomplishments of the NE RTMCC Advisory Council which was created earlier this year. This geographically and professionally representative group of experts provides guidance and feedback in order to improve the services of GTBI and its partners. I look forward to our continued collaboration to prevent and control TB in the Northeastern Region.

Lee B. Reichman, MD, MPH
Executive Director
NJMS Global Tuberculosis Institute

TST Train-the-Trainer Workshop

In the midst of summer heat and vacation season, NJMS Global Tuberculosis Institute (GTBI) offered its first Tuberculin Skin Test (TST) Train the Trainer course in several years. The 2-day course, How to Teach Tuberculin Skin Testing: A Train the Trainer Workshop, took place July 26-27th. Nine participants attended from five different states and a variety of occupational settings including a hospital , a military facility, and state and local TB programs. All participants had three things in common: all were nurses, all were experienced in administering and interpreting TSTs, and all were responsible for training others in this skill. The 2005 GTBI needs assessment identified TST training in many different settings as a high priority. It was also clear that nurses within TB Programs and other institutions with much TSTing experience lacked formal training on how to train others in this technique. The GTBI course was intended to fill that need.

The small group of nine nurses was ideal for this particular course, which is highly interactive and utilized the “teachback” training technique. In this approach participants learn about various training techniques and strategies, observe demonstrations where these skills are utilized, and then practice these skills by “teaching” the material back to others in the course. In this case, the material presented included principles of adult learning and training techniques including how to teach TST administration and interpretation. Each participant had an opportunity to practice these skills in small groups by delivering segments of a TB 101 lecture, and—in a very highly rated activity— teaching nursing and physician assistant students how to administer and interpret TSTs. During these activities course participants first instructed students in how to administer TSTs and then provided guidance and feedback while the students practiced this skill on volunteers from the GTBI staff. Course participants also provided feedback as the students read TST reactions using artificial arms and counseled patients about the significance of the test results and follow up measures required.

In addition to teaching training skills, the course also included segments on the logistics of designing a TST training activity, techniques for providing feedback, and effectively using evaluation data. Participants were provided a copy of the recently updated NJMS GTBI resource Mantoux Tuberculin Skin Testing Training Guide, which includes detailed and updated information on planning and conducting TST training, including resources and sample agendas.

This course benefited tremendously from the skill and diverse experience of both participants and faculty. The formal instructors and facilitators came from GTBI, Charles P. Felton National Tuberculosis Center (a partner in the Northeastern Regional Training and Medical Consultation Center) and the New York City Department of Health and Mental Hygiene Bureau of Tuberculosis Control. The evaluations revealed that participants were very satisfied with the course. All participants anticipated making changes to their practice as a result of the course. Some anticipated changes included using tools provided at the course such as checklists as well as using surveys and pretests to assess knowledge and skills prior to training. Major strengths of the course identified by participants included the “teachback” methods, having a diverse group of skilled instructors, and the focus on teaching and hands on skills. Since this was the first time the course had been given utilizing the teachback methodology we were very interested in suggestions to improve the course. Suggestions included tighter organization for the TST administration and reading activities, and perhaps shortening the time allotted for these sessions. We plan on implementing these suggestions when we offer the course in 2008. In the meantime, several participants have already told us that they are in the process of planning TST trainings using the skills and techniques they learned at the workshop!

For further information on this course and about the “teachback” training method, contact DJ McCabe at 973-972-0978 or mccabedj@umdnj.edu.

Submitted by Nisha Ahamed, MPH, CHES
Director, Education & Training Section
NJMS Global TB Institute

Advisory Council for the Global Tuberculosis Institute’s Northeastern RTMCC

On February 13th, 2007 the Advisory Council for the Northeastern Regional Training and Medical Consultation Center (NE RTMCC) met for the first time. The concept for the Advisory Council was initially raised at the 2006 Northeastern TB Controllers Meeting, after which GTBI staff contacted each TB program for volunteers. The Advisory Council is comprised of 9 members, each representing their project area, as well as several NE RTMCC staff, both GTBI and its partners. Membership is voluntary and our goal is to include members that bring diversity with regard to discipline, geography and incidence. Present members represent TB Controllers, Program Managers, Nurse Consultants and TB Training and Education Focal Points; come from all corners of our region; and reflect high medium, and low incidence areas. The purpose of the Council is to provide guidance and feedback on the training programs, educational products, and medical consultation activities of the RTMCC. Conference calls are scheduled to occur on a quarterly basis, throughout the year.

At our first meeting (conference call) we took the opportunity to discuss our mutual expectations as well as identify several issues for further exploration. Scheduled times for webbased seminars was one such topic identified and, after a survey of project areas in our region, it was determined that the present time (late morning mid-week) was convenient for most areas. However, participants were most pleased that the web-based seminars could be accessed with reasonable ease and in a timely manner. A second call took place May 11th at which council members provided input towards developing the 2008 Workplan and recommendations for the agenda for the RTMCC breakout session at the National TB Controller’s Meeting. The Council also provides a forum for discussion of new ideas and another avenue for ensuring ongoing communication.

We are very excited about the input of this geographically and professionally representative group of experts in TB Control, and look forward to implementing their suggestions to further improve the training and medical consultation services we provide in the region.

Submitted By Eileen Napolitano
Deputy Director
NJMS Global Tuberculosis Institute

Name	Title	Project Area
Cathy Goldsborough, RN	Nurse Consultant	Maryland
Sue Etkind, RN, MS	Director, TB Prevention and Control	Massachusetts
Mark Lobato, MD	CDC Consultant	New England
Lisa Roy	Training Focal Point	New Hampshire
Karen Galanowsky, RN, MPH	Nurse Consultant	New Jersey
Diana Nilsen, MD	Medical Director	New York City
Noelle Howland, RN, MS	Training Focal Point	New York State
Maureen Murphy, RN	Program Manager	Ohio
Pending replacement	Training Focal Point	Pennsylvania
Erin Howe, MPH	Health Educator	RTMCC
Paul Colson, Ph.D	Program Director, CPF NTBC	RTMCC

Conveners at the NJMS Global Tuberculosis Institute:

Lee B. Reichman, MD, MPH, Executive Director
Eileen Napolitano, Deputy Director
Nisha Ahamed, Program Director Education and Training

Upcoming NE RTMCC Training Courses

Courses are open to participants in the 20 project areas (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, NJ, New York State, New York City, Pennsylvania, Michigan, Indiana, Ohio, West Virginia, Delaware, Maryland, Washington DC, Detroit, Baltimore, and Philadelphia) which are served by the Northeastern National Tuberculosis Center.

Individuals outside of this region who wish to attend our training courses, should first contact their Regional Training and Medical Consultation Center to check whether the same or similar course is being offered. If this is not the case, the out-of-region participant may then register for this course.

Click here for the list of upcoming courses.

TB Medical Consultation

Medical Consultation Services: NE RTMCC physicians respond to requests from providers seeking medical consultation through:

Our toll-free TB Infoline: 1-800-4TB-DOCS and
Email

During each consultation, the NE RTMCC physicians will advise providers of TB Program resources for consultation in their jurisdiction. In addition, TB programs will be informed of TB cases with public health implications.

Medical Consultant Web-Based Grand Rounds: Every other month, designated TB program medical consultants are invited to participate in a web-based TB case conference (or grand rounds). Consultants are encouraged to present challenging TB cases on which they would like feedback from their colleagues throughout the Region. The next conference is scheduled for June 26 at 4:00 p.m. TB program medical consultants who would like to present a case should contact Dr. Alfred Lardizabal at 973-972-8452 or lardizaa@umdnj.edu.

Upcoming TB Program Training Courses

Click here for the list of upcoming TB program courses.

What's New

LTBI Card Updated to Reflect QuantiFERON Results This wallet-sized card provides LTBI patients with a permanent record of their tuberculin skin test or QuantiFERON results, chest x-ray results, and treatment status. Patients can carry the card at all times and show it whenever they are seen by a new healthcare provider. This card is available in PDF format and MS Word and is in multiple languages. This updated product can be accessed at the NJMS Global TB Institute website: http://www.umdnj.edu/globaltb/products/ltbicard.htm

Updated Mantoux Tuberculin Skin Testing Training Guide This training manual includes materials on TB fundamentals and administration, reading, and interpretation of the Mantoux tuberculin skin test. It provides the methodology for training and educating staff. The manual includes lecture materials and teaching strategies for individual/group training, in addition to course participant materials. This product can be accessed at the NJMS Global TB Institute website: http://www.umdnj.edu/globaltb/products/mantoux.htm

Multidrug-Resistant Tuberculosis (MDR TB) and Extensively-Drug Resistant (XDR) TB: A Web-based Seminar This web-based seminar was originally held on August 17, 2007 by the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC) in joint sponsorship with the Curry International Tuberculosis Center, Heartland National Tuberculosis Center, Southeastern National Tuberculosis Center, and the New Jersey Medical School Global Tuberculosis Institute. This seminar can be view (and associated slides downloaded) at the following website: http://www.cdc.gov/tb/CE/mdrandxdrtb/default.htm

Tuberculosis Information for Employers in Non-Healthcare Settings In September 2007, CDC’s Division of TB Elimination published a 2-page fact sheet which provides basic information on the difference between LTBI and TB disease, how TB is transmitted, and how the local TB program can assist in a contact investigation. This can be accessed in HTML or PDF format at: http://www.cdc.gov/tb/pubs/ tbfactsheets/nonhealthcare_employers.htm

Tuberculosis in the US 2006 Surveillance Slide Set In September 2007, CDC’s Division of TB Elimination published this slide set which provides trends for the recent past and highlights from data collected through the National Tuberculosis Surveillance System for 2006. This slide set can be accessed at: http://www.cdc.gov/tb/pubs/slidesets/surv/surv2006/default.htm

Trends in Tuberculosis, 2006 Fact Sheet CDC’s Division of TB Elimination recently published this 2-page fact sheet which summarizes data from the latest surveillance report, “Reported Tuberculosis in the United States, 2006”. The fact sheet can be accessed at: http://www.cdc.gov/tb/pubs/tbfactsheets/Trends.pdf

The TB Infection Control Manual The Curry National TB Center (CITC) has recently published this Manual which will help health care providers implement effective infection control practices in clinics, airborne infection isolation rooms, emergency departments, and homeless shelters. Five of CITC’s existing infection control products have been revised and combined to create this new manual, updated to reflect the CDC’s 2005 Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings. This easyto- use resource can be assessed at: http://www.nationaltbcenter.edu/TB_IC/ and is also available as a printed book, and on CD-ROM

On The Lighter Side - Match the Artist with the Bio Sketch

Many famous artists suffered and likely died from tuberculosis. Others were deeply affected by seeing family members or close friends ravaged by this disease. Still others were obsessed with the languid beauty of their emaciated tuberculosis models.

Artist	Bio Sketch	Sample Painting
Edward Munch	1525(?)-1569(?) A Flemish Renaissance painter, he is well-known for painting popular scenes, with the desire to deliver a universal message. Although he is believed to have died from TB, nothing of his own sickness comes through in his work.
Jean-Antoine Watteau	1884-1920 Born in Italy, he moved to Paris in 1906 where he died at the age of 35 of tubercular meningitis, exacerbated by poverty, overworking and an excessive use of alcohol and narcotics. This famous self-portrait, completed a year before his death, shows the thinness of his face which may have been due to the effects of TB.
Pieter Bruegel	1863-1944 Born in Norway, he lost his mother to tuberculosis when he was only 5 and his favorite sister when he was age 14. Obsessed with these events, much of his work explored the themes of love, fear, death, and melancholy. Between 1892 and 1908, he spent much of his time in Paris and Berlin. After 1910, he remained in Norway.
John Everett Millais	1684-1721 A French painter, he moved to Paris in about 1702 when he first began suffering from the symptons of TB. It was said that when he began to paint, his sombre, angry mood disappeared and he assumed the attributes of his paintings: amiable, tender, and pastoral.
Amedeo Modigliani	1917- Born in rural Pennsylvania and summering in Maine, he was tudored at home during his childhood and adolescence due to a “sinus condition” later diagnosed as TB. Of this portrait, he commented, “I felt the loneliness of that figure—perhaps the same that I felt myself as a kid.”
Andrew Wyeth	1829-1896 Born to a prominent family in England, he formed the Pre-Raphaelite brothers with William Hunt and Dante Gabrielle Rossetti. In this painting, he is suspected of aggravating his model’s TB by forcing her to pose in a bath of cold water. Many artists of this period preferred tuberculous models.

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.

TB Education and Training Resources Website
This website is a service of the Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination. It is intended for use by TB and other healthcare professionals, patients, and the general public and can be used to locate or share TB education and training materials and to find out about other TB resources.

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.

TB-Related News and Journal Items Weekly Update
Provided by the CDC as a public service, subscribers receive:

A weekly update of TB-related news items
Citations and abstracts to new scientific TB journal articles
TB conference announcements
TB job announcements
To subscribe to this service, click here

TB Behavioral and Social Science Listserv
Sponsored by the DTBE of the CDC and the CDC National Prevention Information Network (NPIN), this Listserv provides subscribers the opportunity to exchange information and engage in ongoing discussions about behavioral and social science issues as they relate to tuberculosis prevention and control.

Other RTMCCs

The Curry International Tuberculosis Center serves: Alaska, California, Colorado, Hawaii, Idaho, Montana, Nevada, Oregon, Utah, Washington, Wyoming, Federated State of Micronesia, Northern Mariana Islands, Republic of Marshall Islands, American Samoa, Guam, and the Republic of Palau.

The Heartland National Tuberculosis Center serves: Arizona, Illinois, Iowa, Kansas, Minnesota, Missouri, New Mexico, Nebraska, North Dakota, Oklahoma, South Dakota, Texas, and Wisconsin.

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

Key Contacts

Lee B. Reichman, MD, MPH - Executive Director
Reynard J. McDonald, MD - Medical Director
Bonita T. Mangura, MD - Director of Research
Eileen C. Napolitano - Deputy Director
Nisha Ahamed, MPH, CHES - Program Director, Education and Training
Chris Hayden - Northeastern Spotlight Editor
Alfred S. Paspe - User Support Specialist/Webmaster