Keeping Clinicians in the Loop

The two patients had initially sought medical care in mid-October for "mild, nonspecific illnesses" and were sent home. The first had complained of abdominal pain, while the second had flu-like symptoms. Days later, both were dead.

Despite the different initial symptoms, the two postal workers shared the same cause of death: inhalation anthrax. With a more timely diagnosis and an immediate course of antibiotics, the postal workers would have had a better chance at survival.

Since last fall, John Bartlett, MD, has been working to ensure that clinicians across the country have the information they need to diagnose and treat any future victims of bioterrorism. Bartlett's method is to electronically link physicians and others to dependable information on biological agents like anthrax, smallpox, tularemia, and others.

Bartlett, a founding director of the Center for Civilian Biodefense Strategies and chief of the Division of Infectious Diseases in the School of Medicine, set up a listserv, essentially an e-mail list. He sends information weekly to more than 18,000 infectious disease specialists, microbiologists, clinicians, and others across the country.

"The perception is that the medical care community has never been in the loop and that always bothered me," says Bartlett. "But the Johns Hopkins Hospitals of the world, the practitioners, they are a very important part of the health care delivery team."

So far the listserv has distributed an anthrax primer with information on diagnosis, treatment, and prophylaxis; reports from scientific meetings; and updates on the latest research.

The Center for Civilian Biodefense Strategies was recently awarded a $1 million grant from the Blum-Kovler Foundation, a portion of which will bolster the listserv project by paying for technical help and adding content.

In addition to the listserv, Bartlett and his team have added the Center's recommendations on the treatment of anthrax and other biological agents to the Guide to Antibiotics and Infectious Diseases, a Hopkins-produced electronic antibiotics guide for desktop PCs or handheld devices like PalmPilots. The guide, designed to provide quick answers, is already used by 60,000 physicians, according to Bartlett.

Bartlett also plans to develop a regional listserv of all infectious disease specialists in Maryland. In the future, Maryland physicians in this network will be able to notify or query each other immediately via handhelds or e-mail about unusual illnesses, flu cases with atypical symptoms, and so on. - BWS

To join the current listserv, send an e-mail to


After several lengthy discussions on terrorism and public health, six doctoral students in Shannon Frattaroli's graduate seminar set off for Professor Tom Burke's office one afternoon in November. They told the director of Hopkins Public Health Scientists Working to Address Terrorism (SWAT) that they wanted to join the effort.

Burke, PhD, MPH, welcomed assistance from the first-year doctoral students in the Division of Health and Public Policy. But how would they fit the additional work into an already rigorous schedule of courses (up to 22 credits), capped by end-of-year qualifying exams?

Undaunted, Frattaroli and the students, who came to the program with extensive public health work experience and a slew of advanced degrees, lit on a solution: incorporate their terrorism research into their third-quarter Government II course taught by Tom Oliver, PhD. Oliver, Don Steinwachs, PhD, chair of Health Policy and Management, and Stephen Teret, JD, MPH '79, associate chair, gave their approval, and the students quickly began targeting research topics that would aid the public health response to terrorism.

"We really got excited about the contributions that first-year students could make," says Frattaroli, PhD '99, MPH '94, an assistant scientist in Health Policy and Management. "They are interested in being responsive to the research community, but as policy folks they also want to contribute to the formulation and implementation of policy."

The first-year students are taking on the following projects.

  • Roni Neff, ScM, and Sara Johnson, MPH '01, are performing a needs assessment by interviewing Maryland's 24 state health officers to find out how their roles have changed since Sept. 11, what steps they are taking in preparedness, and what types of support they need.
  • Theresa Thompson, MSN, MA, who came to the School with 20 years of nursing experience, is examining how the health care system and the public health system will work together in preparedness.
  • Frank Franklin, MPH, is interested in following the money. Franklin, who has work experience at the Centers for Disease Control and Prevention and state health departments, is tracking exactly where the billions in federal preparedness aid to the states end up.
  • Tom Mammo, MPH, is investigating the role of injury prevention in terrorism preparedness. Mammo intends to draw on the School's extensive expertise in injury prevention, by interviewing faculty members, including Professor Sue Baker, MPH '68, Teret, and others at the Center for Injury Research and Policy.

A sixth student, Kim Drnec, a veterinarian, plans to help on different components of the other students' projects. - BWS

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