1. Current State of Global Infectious Disease (GID) Global travel poses a risk for transmission of foreign infectious diseases by travelers returning to the US. Given the diversity of these diseases local physicians may not be prepared to accurately diagnose and manage them. This study, from the family medicine residency program at Southside Hospital, under the Hofstra North Shore-LIJ School of Medicine, intends to demonstrate this risk, create awareness, and develop suggestions on how to optimize diagnosis and management. Our study takes place in Suffolk county, Long Island, New York which has a high incidence of incoming travelers and travel related infectious diseases. Malaria: 2007 – 1505 in US (326 in NY; ) 2010 – 1773 in US (357 in NY) Dengue: 2001-2004: 366 in US (37 in NY) 2010 – 290 in US (144 in NY) Giardiasis 2010 - 19,811 in US (2289 in NY) Southside Hospital Statistics : 2007-2012: Malaria: 7 Cases Dengue: 3 Cases Giardiasis: 2 Cases Travel statistics: 2010 - Overseas visitors to NY state: 8,647 (32.8% of US total) Conclusions Physician Knowledge of Global Infectious Disease and Strategies for Improvement Freddy Gomez De Cordova MD, Sunil Sood MD, Tochi Iroku-Malize MD,MPH Hofstra North Shore-LIJ School of Medicine’s Family Medicine Residency Program at Southside Hospital Results Bibliography 1.David O. Freedman et al, For the GeoSentinel Surveillance Network. Spectrum of Disease and Relation ton Place of Exposure among Ill Travelers,. N Engl J Med 2006;354:19-30. 2.Edward T. Ryan et al. Illness after International Travel. N Engl J Med, Vol. 347, No. 7. 3.Mary E. Wilson et al, for the GeoSentinel Surveillance Network. Fever in Returned Travelers: Results from the Geosentinel Surveillance Network. CID, 2007:44:1560-8. 4.Daniel O’Brian et al. Fever in Returned Travelers: Review of Hospital Admissions for a 3- Year Period. CID, 2001;33:603-9. 5.David R Hill et al. Health Problems in a Large Cohort of Americans Traveling to Developing Countries. JTravel Med 2000; 7:259-266. 6.Robert Steffen et al. Health Problems After Travel to Developing Countries. Journal of Infectious Diseases, Vol. 156, N. 1, July 1987. 7.CDC - Webpage. 8.US Department of Transportation – Webpage. Barriers to GID training: Awareness of the importance of GID training Curriculum availability for faculty Resources for physicians Methods to improve GID training: Gather information from the CDC on local risks to various GID. Utilize the Global Health Curriculum from AAFP and STFM. Create a resource guide for physicians. We are currently developing this type of resource for physicians which will serve as a complete but concise, quick and practical diagnostic tool. It will link the country of origin and symptoms of the patient/traveler, to the probable differential diagnosis. We hope to eventually develop it into an online application. Introduction Survey Tool We are conducting a survey to establish the baseline awareness of global infectious disease amongst physicians in our community. Please rate your responses to questions 1-7 below based on the following scale: 1-Poor 2-Below average 3-Average 4-Above average 5-Excellent 1) In your opinion, the average non-infectious disease physician’s knowledge of the medical management of global infectious disease in this community is 12345 2) Your knowledge of global infectious disease in this community is 12345 3) Your knowledge of the various countries of origin of our the residents in this community is 12345 3) Your knowledge of the top 10 global destinations of the average American is 12345 4) Your knowledge of the prevalent infectious diseases in the countries from questions 3 and 4 is 12345 5) Your of the medical management of potentially life threatening global infectious diseases that could affect this community is 12346 6) knowledge of the symptoms of potentially life threatening global infectious diseases that could affect this community is 12345 7) Your knowledge of the medical management of potentially life threatening global infectious diseases that could affect this community is 12345 8) Please rate your knowledge of the signs and symptoms of the most frequent and life threatening global infectious diseases from the following regions: a-South America12345 b-Central America & the Caribbean12345 c-Africa12345 d--South East Asia12345 e-Middle East12345 f-Oceania12345 g-Eastern Europe12345 h-Western Europe12345 i-Asia12345 Please circle the response as appropriate for the following questions: 9) Have you practiced medicine outside the US?Yes No 10) If you have, when was the last time?0-5yrs6-10yrs 11-15yrs>15yrs 11) Have you lived outside the US?YesNo 12) If so, which regions? ____________________________________ 13)Do you think you would benefit from more international medicine training? No Maybe Yes 14)Do you plan on practicing international medicine in the future? No MaybeYes 15) Do you think this survey is relevant to your practice? No Maybe Yes 16) What specialty are you?_________________________________ 17) What level of training? PGY1PGY2PGY3Attending 41 physicians were surveyed asking 17 key questions (see survey tool). 24 Family medicine residents 17 Attending Physicians (9 ER, 5 hospitalists, 1 ICU and 2 Family Medicine) Method Graph #1: Question 1-8. Attendings & Residents Percentages per answer All Physicians: Knowledge of Global Infectious Disease (GID) Attending Knowledge of GID Resident Knowledge of GID SAMPLE: Global Infectious diseases Diagnostic Guide for Returning Travelers Main Signs and Symptoms Diagnostic CluesMost likely Differential Diagnosis Eg: Sub-Saharan AfricaFeverJaundice, anemia, chills Malaria: Plasmodium Falciparum h/o Tick Bite, Arthralgia Ricketsial Infection DiarrheaBloatingParasitic Diarrhea: Giardia, Amebiasis Etc… Eg: Next Region South Central AsiaFever…… *Note: Diagnoses will be shown in order of incidence in relation to one another (from top row down) for every symptom per Region. **Note: Diagnoses will not always be shown in order of incidence from top row down in relation to other symptom categories. + Guide will be based on well documented data from latest articles on Travel Medicine, encompassing this topic. Null hypothesis: Physicians are well prepared to manage foreign infectious diseases in returning travelers. Our Goals: 1)Find out if the Survey negates the Null Hypothesis. 2)If it does, create awareness with the results of our survey. The data collected showed self reported knowledge to be: average for attending physicians average/below average for residents Our study also revealed that the majority felt they would benefit from more training and guidance. Both groups need better education to be adequately prepared to diagnose and manage global infectious diseases. This data doesn’t specify the level of knowledge in other US cities but it does serve to create awareness on this topic. We see this as a first step towards developing a larger study. Our future goal is to increase the power of the study by increasing our sample size; we intend to this by surveying physicians in other cities and hospitals.