Drs. Paul Sax, Tara Vijayan, and Allan Tunkel join Febrile to chat about the debut of a new series called “StAR”!!  These upcoming episodes will highlight the outstanding Clinical Infectious Diseases (CID) journal State-of-the-Art Reviews (StAR), which cover common clinical topics that ID clinicians encounter.  Learn more about the creation of these articles from these CID editors before we kick off 4 back-to-back episodes!!

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Febrile is produced with support from the Infectious Diseases Society of America (IDSA)

Hi, everyone.

Welcome to Febrile, the cultured podcast about all things infectious disease.

We use consult questions to dive into ID clinical reasoning, diagnostics, and antimicrobial management.

I'm Sara Dong, your host and a MedPeds ID doc.

Today, I am joined by several friends, Dr.

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.

But first I was hoping you all could tell the audience a little bit about yourself and give a quick introduction.

Hi everyone.

I'm Tara Vijayan.

I'm a faculty member at the University of California, Los Angeles.

Here I have a couple of different roles.

I do a lot of teaching for both our medical school as well as in our residency and our fellowship.

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.

The role of co editor of the State of the Art Reviews in Clinical Infectious Diseases is the role of a lifetime.

It's one of my dream jobs, and I'm really happy to be here.

I'm Allan Tunkel.

I'm currently at the Warren Alpert Medical School of Brown University.

I practice adult infectious diseases.

I have a special interest in central nervous system infections.

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.

I retired from that role about a year and a half ago.

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.

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.

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.

And before we jump in a little bit further, we always pause to do one other introduction piece.

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.

Allan, maybe I'll start with you.

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.

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.

My favorite movie is To Kill a Mockingbird with Gregory Peck.

The greatest movie hero who's ever been in film, at least as part of that movie.

So that's been great and I enjoy doing that.

Trying to switch up the order.

Maybe I'll ask you, Paul, next.

When I turned 40, my wife gave me a tennis racket because she saw that I was just messing around on the tennis court.

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.

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.

So playing tennis.

Love it.

Tara, how about you?

Definitely watching movies and funny TV series while actually doing a thousand piece puzzle is probably with my kids, preferably.

Although, uh, my preferred TV shows are shows that I don't really, I can't really watch with my kids.

So there's a little bit of a dilemma there.

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.

Love it.

That's one of my favorite weekend activities to have the big old puzzle laid out.

Well, thank you guys for sharing, you know, we're recording this quick session to introduce everyone to, I mentioned, a new ongoing series.

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.

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.

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.

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.

So I personally would just love to hear about how the State of the Art Reviews came about.

Paul, you sort of started to mention that, but kind of what you have in mind as the goals for these papers.

Sure.

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?

How do they manage it?

And I wanted this to be the go to place for those questions.

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?

How do they manage diabetic foot infections?

How do they manage people on high dose corticosteroids?

A State of the Art Review in CID would be a really nice thing to reference if you're seeing such a patient.

It would be a place where you could look at that infographic you mentioned, Sara.

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.

So that was the idea behind it.

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.

There's obviously endless topics that we think about in ID.

I was curious, Allan and Tara, if you could tell us about how you approached identifying a list.

You know, how do you find authors that are a good fit?

What's your process been?

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.

So a part of it, I think, was taken from our experience in terms of what we wanted to get across.

But also, I think we did it with a focus on the continuum of care.

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.

We saw some ideas on the IDea Exchange, which I think gave us some things of how we want to move certain topics forward.

And we're certainly open to hearing from many in the field of infectious diseases, the great challenges they face.

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.

You know, we have our clinical guidelines, right?

And those are constructed in a very specific way.

You have 25 recommendations.

This is what you maybe should be doing.

But the reality is, is that the patient in front of you is always more complicated than that.

And really highlighting how do you even share some of what you are thinking and the uncertainty with your patients?

You know, how do you engage patients and share decision making in some of these complicated issues?

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.

Um, Uh, and I hear this all the time in our, among our trainees, just it's, it's sort of boring, right?

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.

You know, we could spare them an amputation, which is a really big deal.

Navigating those areas of uncertainty, how do you share these, these thoughts with your patients?

How do you navigate the RCTs like OVIVA?

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?

Are you going to choose something else?

How do you make those informed decisions and and share that with your patients.

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.

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.

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

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.

What happens to them now?

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.

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?

Yeah, they can email us.

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.

Yeah, I was thinking that the IDea Exchange has given us a lot of great ideas.

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.

One thing that's really remarkable about the ID community is that an old technology like a listserv is really very active.

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.

And I'm sure you'll get plenty of emails since there's so many topics.

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.

Maybe you can give us a little insight into help you might have with the process, how you go about it.

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.

In terms of reaching out to potential authors,

I don't think I've had anyone turn me down.

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.

And we have assistance to practicing physicians.

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.

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.

And I will say we're a little bit flexible with, with deadlines.

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.

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.

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.

Because one of the things that makes a series popular in a journal or in a magazine is that it appears regularly.

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.

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

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.

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.

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.

We decided not to take fellows this time around.

And it turned out to be, I think, a very favorable experience for everybody.

You know, the mentees got their ID week expenses covered.

They got to come to our editorial meetings.

They then acted as associate editors for a while.

So that opportunity exists, but of course, it's not very many people who can do that.

So I would say that the best way to get involved is to do two things.

First is to offer to be a, a reviewer, especially when you're senior fellow, junior faculty, that really is worthwhile.

I know that it's time consuming, but we really appreciate it.

And it's great to see the range of things that are being submitted and how they go through the process.

And the second thing is to participate in an actual paper by writing it as first author.

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.

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

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.

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.

And the more you do it, the more likely you will be to get these kinds of positions.

Thanks again to Tara, Allan, and Paul for joining Febrile today.

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.

Stay tuned.

You'll now see these state of the art review partnership episodes labeled as "StAR" in the episode title.

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.

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.

Don't forget to check out the website, febrilepodcast.

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.

Febrile is produced with support from the Infectious Diseases Society of America, IDSA.

Audio editing and mixing is provided by Bentley Brown.

Please reach out if you have any suggestions for future shows, or want to be more involved with Febrile.

Thanks for listening, stay safe, and I'll see you next time.