Bailey K. Ashford and Robert A. Phillips Research Awards

Last week I ended up spending more time than I would have liked at Walter Reed National Military Medical Center, because on Monday and Wednesday, I was competing for the two research awards at the hospital the Bailey K. Ashford Award and Robert A. Phillips Award. It was the first year that preventive medicine residents from WRAIR were allowed to compete, so I submitted my abstract on poisoning hospitalizations that I did at AFHSC several months ago, and was selected as a finalist for both.

Here's a picture of Bailey K. Ashford. He was an Army physician in the Spanish American War. After the war, he was sent to Puerto Rico to command the medical department troops (which today would a job given to a Medical Service Corps officer, not a doctor, because it's a pretty thankless job and kinda like herding cats. We don't listen to directions well). While he was there, he noticed that the Puerto Ricans were not only shorter than Americans, but that most of them were anemic. This led him to discovering a new species of hookworm and spent a year working on treating around 300,000 Puerto Ricans, reducing the death rate from anemia by 90% on the island. After this, he established the Puerto Rican Institute of Tropical Medicine and Hygiene, which is now part of the University of Puerto Rico School of Medicine. 

And this is Robert A. Phillips. He was a Navy physician and served in the Naval Reserves during WWII. In 1945-46, he was sent to Cairo to study typhus and ended up establishing the US Navy Medical Research Unit #3 (NAMRU-3), which is still there today. His first big assignment as the commanding officer of NAMRU-3 was a cholera outbreak in Egypt. In that outbreak, his research on cholera and treatment made him pretty much the world expert in it until he died in 1976.

In the good old days of the National Capital Region, when the Army had Walter Reed and the Navy had Bethesda, these were two separate competitions (Bailey K. Ashford at Walter Reed and Robert A. Phillips at Navy), and the two had nothing to do with each other. Four years ago, however, we all had to learn how to play well together, and both competitions were open to residents and fellows from either service. The main difference is that Bailey K. Ashford is for graduating residents, and Robert A. Phillips is for any resident. So there was quite a lot of overlap in the people competing for these awards, including me.

I didn't get the Robert A. Phillips award--it went to an Army orthopedic surgery resident who came up with a new system of classifying lumbosacral fractures--and the Bailey K. Ashford won't be announced until residency graduation in June, but I'm not exactly holding my breath. These are clinical research awards, which judges who are clinicians, and these people rarely consider epidemiology to be clinical research. Whatever. I was just happy that I was selected to be a finalist in both, because that meant that: a) someone recognizes the value of epidemiologic research; and/or b) someone thought my research was interesting enough that they wanted to hear me talk about it. And it got me out of clinic for two days, which is always a plus.

First week at AFHSC

Last week was my first of six weeks at the Armed Forces Health Surveillance Center (AFHSC--don't try to say it as a word; it's not one of those kinds of acronyms. Just the letters). I wish I could say I accomplished a lot, but that wouldn't be entirely true. I do have a project, so that's a start (and honestly, all anyone ever accomplishes in the first week).

My original idea for a project came from my surgeon friends, who have said that they've noticed different rates of mucor infections in war wounded between Walter Reed and Bethesda, suggesting that maybe there's a difference in either the conditions the Army and Marine Corps are fighting in, or there's a difference in care. (Mucor, by the way, is an invasive fungal infection that's pretty rare and very bad). Well, difference in rates between the two hospitals or not, there haven't been enough cases in the last ten years to do any sort of analysis. So that idea was scrapped.

I didn't really have any back-up plans, so my project mentors suggested that I read through the Medical Surveillance Monthly Report (http://www.afhsc.mil/msmr?clear), which is the military's version of CDC's Morbidity and Mortality Weekly Report. Well, I didn't see too much exciting, but I did notice that they always clumped injuries and poisonings together, and while injuries have been a big priority, nobody's ever done an analysis of poisonings. So that's what I'm doing. I'm going to do an analysis of who has the highest rates of being hospitalized for poisonings (of both medical and non-medical types), looking at age, sex, race, branch of military service, rank, education level, and marital status (and maybe more categories; I don't remember).

We also found an article from the civilian medical literature that described how you can estimate which injuries and poisonings are intentional (ie, suicide attempt), using the type of injury/poisoning (all poisonings fit this category) and certain psych diagnoses within 180 days of being hospitalized. So we're going to be looking at psych diagnoses before poisonings, to estimate which ones were intentional and which were not.

At least, that's the plan. My request for data just went in today, so we'll see if I get any usable data from any of that.

As if I didn't have enough to do with that project, my project proposal that I presented for my degree is just getting started (yes, I was supposed to have this done before finishing my degree...). At this point, we're still at the stage where we contact people and beg them to participate in the study. There are over 200 people on the list, and we've gotten (wait for it...) one set of surveys back. Yes, one. So part of my job is to find a way to reach the ones we haven't to also beg them to join. It's all sorts of fun. At least it's not very intellectually challenging. Just time consuming. It's great fun.