About Us

Problem

Poor Health Literacy about measles.
Misconceptions about the MMR vaccine.
Measles is very contagious and can spread quickly.
Measles is accompanied by many short-term and long-term complications.
Measles is a preventable disease but is making a comeback

Solution

Early recognition of measles symptoms can help in isolating the disease process. We, therefore have designed KnockoutMeasles.com to educate people and eliminate misconceptions and provide accurate information. KnockoutMeasles.com is a patient education portal designed for an easy recognition of the signs and symptoms of measles, which in turn can facilitate easy communication between health providers and patients.

We used Neil D Fleming's VARK model (Visual, Aural, Read/write, and Kinesthetic) to design this KnockoutMeasles.com patient education portal. According to VARK Model, people have different learning styles and shouldlearn according to their soughtout style to gain the best understanding. However, some people have a multi-modal learning style and prefer multiple ways to learn. We use a chalk and draw method to teach patients, which may improve health literacy. We have alsoincorporated Barbara Oakley's chunking principle in our checklist for easy recall and memorization. Dr. Atul Gawande and Dr. Peter Pronovostused The checklist to save patient lives and healthcare dollars. With similar principles inspired from Dr. Gawande and Dr Pronovost, we have designed our checklist for measles.

There is plethora of information but we wanted to provide an easy way to recognize the measles. We could have just published our measles checklist in a blog or a journal,but this would have lost in the oblivion.Our main premise is to educate general population with long-lasting complications of measles if they opt not to receive MMR vaccinations. We implemented an easy two-dimensional picture with the checklistin order to make information easily understood. Using imaging helps readers have lasting pictures to refer back to the information that was read – it has a bigger impact. Allan Paivio's research has shown us how the dual-coding theory (words and pictures) helpsus to recall more as we can recall at least one pathway.

Should we draw decorative pictures or two-dimensional images to convey the message? Harper and Mayer in their research published in Journal of Educational Psychology, “The Role of Interest in Learning from Scientific Text and Illustrations: On the Distinction Between Emotional Interest and Cognitive Interest” concluded that cognitive and explainer images are better than decorative and seductive images. Healthcare providers can educatetheir patientabout adisease with easy to draw two-dimensional pictures or doodles. We have adopted Dr. Richard Mayer's Cognitive Theory of Multimedia Learning to improve the health literacy of the patients. According to this Multimedia theory, our brain has finite capacity; and if taught actively, we will remember more. This is the reason we have designed tools and a checklist which serves as a crutch to hold vast amount of information.

These meaningful chunked checklists with an explainer picture is what we call the Vital Checklist.
Why did we use a Knockout Measles Domain?
Our Inspiration comes from Stephen Reed's book—Thinking Visually, where he confirms concrete words are better than the abstract words. We could have invested heavily in measles.com but wanted to provide actionable words and therefore used Knockout as the prefix to measles so that we could construct a mnemonic called KO Measles.

Knockout Measles written as KO Measles, mayprovide easy memorization of the pathognomonic sign of measles – Koplik Spots.

The characteristic feature of Koplik spots:

Bluish white lesions on a red base measuring 1mm to 3mm.
Koplik Spots are located opposite the first molar but may be present on the hard, soft palate or mucosa
They appear 48 hours before the exanthema stage or the rash stage.
Some measles patients may not have Koplik spots.

Chunked Knockout Measles Cartoon represents all the four stages of the measles –

Stages of Measles—A/I-PERC			Timing
Stage 1	A/I	Asymptomatic/ Incubation	6—21 days
Stage 2	P	Prodromal Fever, 3 C's, Koplik Spots 3C= Conjunctivitis, Coryza, and Cough	2—4 days (may last till eight days)
Stage 3	E	Exanthema	2—4 days after fever
Stage 4	R	Recovery	Days to months. The cough may last for 1 to 2 weeks
	C	Complications	If fever persists after 3rd or 4th day after rash, this suggests measles-related complications

The asymptomatic period is also called the Incubation Period and maylast for 6 – 21 days. Stage 1(asymptomatic stage) is represented by a hat and is shaped like an “A” in the Knockout Measles Cartoon. This is followed by Stage 2(Prodromal stage) or the 3 C's, represented by the facial features- eyes, mouth, and droplets. Inside the mouth are Koplik Spots which may last for 2-4 days and follow by the rash which spares palms and soles. The trunk represents stage 3(exanthema), and finally, the legs represent the stage 4 (recovery).

Measles Table

Stages of Measles—A/I-PERC Timing

Stage 1
A/I
Asymptomatic/ Incubation
6 - 21 days

Stage 2
P
Prodromal
Fever, 3 C's, Koplik Spots
2 - 4 days (may last till 8 days)

Stage 3
E
Exanthema
2 - 4 days after fever

Stage 4
R
Recovery
Days to months. The cough may last for 1 to 2 weeks during the recovery period

C
Complications
If fever persists after 3rd or 4th day after rash, this suggests measles-related complications

Why are we focusing about educating general population about measles?

This is because of the complications ofmeasles that have a dreaded and long-term effects on the human body.

We have useda Lean Patient Experience model and explained how caregivers should talk to the patients about Measles. We have always told patients to get the vaccines and change their routine, and hopefully, they will get the reward of not getting measles or other devastating illnesses. However, we have not succeeded. If we want to make patients aware of the complications, we need to adopt the shared decision making approach where the patient invests theirtime to learn and have a non-biased opinion on measles vaccine. Usually, people do not get vaccinated as vaccinesget“bad press”. What we have done is to highlight the pain points or the complications of the measles as the emotions.

Lean Patient Experience Model derived from the Benzene Loop.
Sources: Charles Duhigg's Habit Loop, Nir Eyal's Hooked Model, Dan Pink's Drive, Dr. Beck, and Dr. Burns Cognitive Behavior Model.

M	A most common complication is diarrhea and ear infection. One out of 10 people report Diarrhea in measles. An ear infection occurs in 1 out of every ten children with measles (Information assessed from https://www.cdc.gov/measles/about/complications.html, Assessed 1st May 2018) A most common cause of death in measles is respiratory infection and encephalitis. Measles myocarditis
E	One out of every 1000 children who develop measles will develop encephalitis. (Information assessed from https://www.cdc.gov/measles/about/complications.html, Assessed 1stMay 2018). The symptoms of encephalitis include fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, convulsion, and coma.
A	Acute disseminated encephalomyelitis (ADEM). ADEM is characterizedby a brief but a widespread attack of inflammation in the brain and spinal cord.
S	Secondary bacterial infection Measles infection results in suppression of both innate and adaptive immunity.
L	Lungs- Pneumonia, Bronchopneumonia, laryngotracheobronchitis and bronchitis.
E	Eye Complications- like keratitis and corneal ulceration
S	Subacute sclerosing panencephalitis(SSPE)- Rare but fatal disease of the central nervous system. Usually develops 7-10 years after a primary infection with measles virus. (Information assessed from https://www.cdc.gov/measles/about/complications.html, Assessed 1st May2018) The reported frequency of SSPE in the United States was one per million childhood population from 1960 to 1970. Early symptoms - behaviors changes, intellectual disability. Later symptoms include motor symptoms and myoclonic jerks. (Garg RK Subacute sclerosing panencephalitis Postgraduate Medical Journal 2002;78:63-70)

About Dr. Singh MD

Dr. Harpreet Singh is a renowned medical doctor, co-host of Talk Medicine radio show on WBRN, medical author, speaker, creator of “Vital Compass” and “Shoes and Socks off in the Clinic”, founder of “Vital Checklist” and “iCrush.org.” He started his American Dream on September 23, 2003, with 54 dollars and an M.B.B.S degree from KMC, Manipal, India. After completing his residency, he worked as a hospitalist and was a Medical Director. He has excellent bedside manners and his passion for patients has gained him the title of “Dr. House with a good personality.” Some of his patients call him a detective, and others investigator. One of his peers has referred to him as the William Osler of 21’st century. Because of his love for patient-care and patient experience, he was appointed as Chief Experience Officer of Michigan Primary Care Partners. Read More...

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