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Mitchell selected as 2014-15 VA chief resident for quality improvement and patient safety

Mitchell_Aaron_172_5_2Aaron Mitchell, MD, senior assistant resident, has been chosen to be the Durham VA Medical Center chief resident for quality improvement and patient safety for 2014-15.

Dr. Mitchell will be part of a network of such chief residents across the country who will be leading QI projects, receiving expert training from mentors and participating in a national curriculum meant to help usher in a new generation of QI leaders who will help residents implement QI initiatives. He will work closely with David Simel, MD, vice chair for Veterans Affairs in the Department of Medicine, Ryan Schulteis, MD, the first to serve in the chief resident role, and current chief Joel Boggan, MD, MPH.

Dr. Simel said second- and third-year residents interested in the chief resident position should have a passion for quality improvement, teamwork and systems thinking.

“Residents also need to be committed to doing the didactic work that it takes to learn the skills and techniques required for understanding statistical process control, team building, and negotiating to get to consensus,” Simel said. “Aaron fit all those parameters and Drs. Schulteis, Boggan, and I are looking forward to working with him in the coming year.”

by · Posted on December 6, 2013 in Chief Residents, Durham VA Medical Center, Internal Medicine Residency · Read full story · Comments { 0 }

2013-14 Fellowship Match success

Congratulations to our senior assistant residents who have placed into many of the nation’s top fellowship training programs today, including our own. Find a list of where they are headed below.

Where the residents matched for fellowship

Bobby Aertker – Cardiology at Texas Heart Institute
Lindsay Anderson – Hospital Medicine/Primary Care at Indiana
Mandar Aras – Cardiology at UCSF
DeAnna Baker – Rheumatology at MUSC
Armando Bedoya – Pulmonary-Critical Care Medicine at Duke
Stephen Bergin – Pulmonary-Critical Care Medicine at Duke
Tyler Black – GI at UAB
Kimberly Bryan– Primary Care at Alabama
Elizabeth Campbell – Endocrine at Duke
Laura Caputo – Hospital Med at DVAMC
Wendy Chan – Hospital Med at Taiwan
Jennifer Chung – Geriatrics at Washington University, St. Louis
Matt Chung – Cardiology at Washington University, St. Louis
Alex Clark – Endocrine at University of Pittsburgh
Meredith Clement – Infectious Diseases at Duke
Carter Davis – Hem/Onc at Duke
Mallika Dhawan – Hem/Onc at UCSF
Hany Elmariah – Hospital Medicine
Amanda Elliott – post-doc research at Duke
Alex Fanaroff – Cardiology at Duke
Nikki Frederick – Pulmonary-Critical Care Medicine at Boston University
Bronwen Garner – Hospital Medicine at Duke
Jim Gentry – Cardiology at Cleveland Clinic
Jeremy Gillespie – Hospital Medicine at Northwestern
Jodel Giraud – Hospital Medicine
Jeremy Halbe – Hospital Medicine
Benjamin Heyman – Hospital Medicine
Christopher Hostler – Infectious Diseases at Duke
Scharles Konadu – GI at Duke
Ashley Lane – GI at Wake Forest
Howard Lee – Hospital Medicine at Taiwan
Philip Lehman – Cardiology at Duke
Nancy Lentz – GIM at Navy
Anne Matthews – Pulmonary-Critical Care Medicine at Duke
Audrey Metz – Primary Care
Brian Miller – Hem/Onc at Dana Farber
Aaron Mitchell – DVAMC chief resident for quality improvement
Marianna Papademetriou – GI at NYU
Lauren Porras - Sports Medicine
Trevor Posenau – Cardiology at Washington University, St. Louis
Marcus Ruopp– Hospital Medicine at Boston
Jennifer Rymer – Cardiology at Duke
Mike Shafique – Hem/Onc at University of South Florida
Wassim Shatila – Cardiology at Texas Heart Institute
John Stanifer – Nephrology at Duke
Matt Summers – Cardiology at Cleveland Clinic
Kaley Tash – Infectious Diseases at University of South Florida
Carling Ursem – Hem/Onc at UCSF
Sarah Wingfield – Geriatrics at Duke
by · Posted on December 4, 2013 in Fellowship programs, Internal Medicine Residency, Medical Education · Read full story · Comments { 0 }

Duke Marines win 2013 Turkey Bowl

Hats off to the Duke Marines who won the 2013 Duke Internal Medicine Residency Turkey Bowl on Thanksgiving Day.

Group-Shot-TBTB-Action-1

by · Posted on December 2, 2013 in Internal Medicine Residency · Read full story · Comments { 0 }

Internal Medicine Residency News: December 2, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Happy thanksgiving everyone! I am certainly thankful for being part of the best program in the country. Turkey bowl was spectacular, with the Marines posting a victory, followed by everyone returning triumphantly to Duke to share in a thanksgiving lunch. Again, thanks to our coaching staff of Ryan Schulties and Tony G. for letting Jonah and Jake into the game! It was especially great to hear of all the “friendsgiving” dinners you all had. I’ve been telling our applicants that they have no idea how important a new group of people will become to them until they start residency – proof of that is in how many of you spent the holiday together.  We also raised nearly $1000 to support the families at Hope Valley Elementary who were in need this thanksgiving.

Kudos this week to Aaron Loochtan for stepping up to fill in a schedule hole on CAD, to all the attendings who let their residents get to Turkey Bowl, and to Marc Samsky, Brian Miller, Rachel Titerance and Hany Elmariah for resident share with the applicants. Also thanks to our ACRs Meredith Clement, Jim Gentry and Chris Hostler for planning the pre turkey bowl MKSAP jeopardy noon conference.

It’s a busy week this week – no doubt people will be gathering to watch Duke vs Michigan on Tuesday. On Wdnesday we have the first annual Kussin vs Klotman vs Zaas latke cookoff in the med res library at 4:30, followed by the fellowship match party.  we have SAR talks on Thursday as well, and then Duke football watching on Saturday.  Don’t forget to also sign up for Voices in Medicine (see Vaishali for details), and be watching your email for 2014-15(!) schedule request forms.  Yep, time is flying by.

This week’ pubmed from the program goes to Mandar Aras for his AHA presentation:  Peripheral metabolite profiles predict cardiomyopathy in a cohort of cardiac catheterization patients. Poster presentation at the American Heart Association annual meeting in Dallas, Texas in November 2013;  mentor: Svati Shah, MD

Have a great week!

Aimee

QI Corner

First off, Happy Thanksgiving!turkey

QI Noon Conference
Thanks also to Dr. Dani Zipkin for her recent presentation on High-Value Biostatistical Concepts by Dr. Dani Zipkin as part of the HVCC lecture series.

QI Abstracts and Meetings
The submission date is 12/9 for the upcoming Patient Safety and Quality Conference here at Duke in March.  Also, the submission date is 12/14 for the NC ACP conference at the end of February.  If you need us to help or review anything you’re planning to submit, please send us an email!

Duke Patient Safety and Quality Conference site:
https://www.dtmi.duke.edu/news-publications/updates/save-the-date-annual-duke-patient-safety-and-quality-conference-march-13-2014-abstract-deadline-dec-9

NC ACP site:
http://www.acponline.org/about_acp/chapters/nc/news_meet.htm

QI Champ
Congrats to Wassim Shatila, our QI Champ for November.  We now need only one more Champion for the We Follow-Up project, primarily based at the DOC. Contact Jon or Joel if interested . .

 

What Did I Read This Week?

By Vaishali Patel 

“Proton Pump Inhibitors and Risk for Recurrent Clostridium difficile Infection Among Inpatients?”

Freedberg DE et al.  Am J Gastroenterol 2013; 108:1794–1801

 I know what you’re thinking.  Yes, Vaishali picked a GI article.  As biased as I may be, give me a chance to prove to you why delving into the controversy surrounding the recurrent infection risk associated with proton-pump inhibitors (PPIs) in inpatients may worth your time (and money!).  There has been conflicting data exploring the association between PPIs and several infections, including pneumonia, spontaneous bacterial peritonitis and clostridium difficile infections (CDI).  One of the challenges of treating CDIs is the high rate of recurrence after treatment. The risk of recurrence is the highest between 7-30 days after finishing antibiotic treatment, but actually persists for up to 90 days.  This combined with an increasing rate of community-acquired infection has resulted in a continuously rising incidence of CDI.  This makes it imperative to identify risk factors for recurrence, so that they can be targeted by preventive measures.  Previous studies have suggested that PPIs are a risk factor for about new CDIs (systematic reviews and meta-analyses, Janarthanan S et al, Am J Gastroenterol 2012; Kwok CS et al, Am J Gastroenterol 2012; Tleyjeh IM et al, PLoS One 2012).  Similar to the data regarding PPI use and the risk of pneumonia, the evidence suggesting the risk of CDI associated with PPI use has sparked controversy and is conflicted.  There is evidence to suggest that PPI use is associated with recurrent CDI, though some of this data comes from smaller observational studies (one was a larger study done across eight VA medical centers in outpatients and inpatients, Linsky et al, Arch Intern Med 2010).  Furthermore, there is very little data focusing on the population most at risk for recurrent CDI – hospitalized patients!This retrospective cohort analysis by Freedberg et al, was conducted in hospitalized adult patients. Patients with new CDI (defined as having a first positive C. difficile stool toxin B PCR test and having received treatment) who had undergone CDI treatment were identified by electronic records.  After excluding patients who were lost to follow-up by their hospital system within 90 days, 894 patient records were reviewed for in-hospital administration of PPIs (minimum of 2 days exposure) as well as other acid suppressives, non-CDI treatment antibiotics and other comorbidities.  They looked for a second positive stool test within 15-90 days of the first to define recurrence (seems reasonable since most patients should respond to CDI therapy within ~3 days and over 90% should be cured after 14 days of treatment, after which is it okay to test again for recurrent symptoms).  Recurrence rates were compared between patients unexposed and exposed to in-hospital PPI therapy either during or shortly after CDI treatment, and analyses were controlled for potential confounders including age, sex, race, the modified Charlson score which signifies comorbidities, type of Cdiff treatment, ICU stay, hospital length of stay, receipt of antibiotics and inpatient immunosuppressant exposure.

The cumulative incidence of recurrent CDI in this cohort was 23% – this is close to most estimates of recurrent CDI of 25%-30% in patients who have been treated with either metronidazole or vancomycin.  The hazard ratio for recurrent CDI associated with concurrent PPI treatment was HR =0.82 (95% CI = 0.58-1.16).  In the subset of patients who survived 90 days of follow-up, there was again no association between PPIs and CDI recurrence (HR=0.87, 95% CI = 0.60-1.28).  Increased duration or dose of PPIs also did not make a difference.  Factors that actually were associated with increased risk for recurrent CDI included increased age, black race, and increased comorbidities.  Older age has been previously identified as a risk factor in both inpatients and outpatients.  This is the first study to find an association between black race and increased risk of recurrent CDI.

Previous observational studies suggesting that PPI therapy is a risk factor for new CDI is relatively convincing, but it remains unclear whether there is a causal relationship or if there are underlying confounding factors.  Perhaps the greatest strength of this study is that it was focused on hospitalized patients, which somewhat helps to minimize heterogeneity between patients.  Furthermore, 41% of their patients were treated with both metronidazole and vancomycin compared to 10% in other studies, and they had a higher proportion of these patients in the PPI group compared to the non-PPI group.  This may suggest that this study had a higher portion of patients with more severe incident CDI, and would have a higher rate of refractory or recurrent CDI.  If anything, this should have moved the results away from the null hypothesis of finding no association between PPI therapy and recurrent CDI.  This was a much larger study than those that have been done previously.  In spite of this, however, the paper did not include information about their power analysis.  Clinically, you may actually care about detecting a small difference in CDI recurrence rate (especially in older, sicker patients) and this study may not have been adequately powered to detect it.  It also would have been important to control for patients being discharged on PPI therapy, non-CDI antibiotic therapy, or immunosuppression.  Lastly, when you are interpreting the results of retrospective chart review studies, it is important to remember that the results are only as good as the data that was available for analysis: though it was good that patients who did not have good follow-up were excluded, it would have been helpful to know if the investigators obtained outside medical records to find out if patients were diagnosed with recurrence elsewhere.  The recurrence rate found in their study is similar to previous estimates, so that is reassuring.

What did I take home from all of this?  Well, I think carefully about the indication for PPI therapy in my elderly patient with several comorbidities who may be at risk for CDI infection.  If my patient has already had a recent episode of CDI, they have about a ~30% risk of recurrence, especially if they are elderly and have several comorbidities – and giving them in-hospital PPI therapy will not increase their risk for recurrent CDI…but I should think carefully about the indication for giving them PPI therapy anyway!  As any other medication, PPI use obviously has unanticipated consequences.  Pathophysiologically, this sort of makes sense for new CDI – altering the pH of the stomach and its contents may affect gastrointestinal flora that play a role in the immune barrier mechanisms of GI mucosa.  If they have had a recent CDI, the GI microbiome is already altered, so perhaps a PPI does not have much effect.  PPIs are highly effective for the treatment of pathology associated with increased gastric-acid but also are overused and often prescribed when not indicated.  As with any other medication, it is important to use PPIs for the correct indication and with the minimum dose and duration needed for effective therapy.

 
 

From the Chief Residents

Turkey Bowl 2013 RevisitedGroup Shot TB

Great game, no major injuries, and another turkey bowl goes down into the record books.  TB Action 1The trophy is now residing in the office of the Duke Chief Resident after making its way across the street.  There were a few surprise plays – and players – as Jona and Jake BOTH came in off the bench.  The collection of pictures will tell the story for many years to come.

Hats off to the Duke Marines !score

Sar Talks

     Thursday, December 5, 2013

     Meredith Clement and Aaron Mitchell

 

Grand Rounds

 
Dr. David Holland HIV Prevention in 2013
 

Noon Conference

Date Topic Lecturer Time Vendor Room
12/2 FUO Evaluation Susanna Naggie 12:00 Rudinos 2002
12/3 MED PEDS INTERVIEW
12/4 MSK Exam Part 1 Irene Whitt & Lisa Criscione 12:00 China King 2002
12/5 SAR talks Meredith Clement /    Aaron Mitchell 12:00 Chick-Fil-A 2001
12/6 INTERVIEW

From the Residency Office

Wanted: Future leaders in ambulatory care

Have you thought about how your training provides the kinds of knowledge and skills you’ll need in your career?  For many medicine residents, a background in leadership, clinical teaching, advanced EBM, communication, and strong ambulatory clinical skills will best support their career.  This is particularly true for our residents wanting to pursue careers in academic medicine or perhaps as physician leaders — which led me to create the Ambulatory Care Leadership Track (ACLT) a few years ago, with the support of Aimee and Randy and the MedRes Office.

Four JAR spots and two SAR spots are now open for the 2014-15 academic year.  I encourage you to consider applying, and talk to residents in the program or ambulatory faculty to see if the ACLT is the right choice for you.  The track was designed not only for residents interested in primary care, but also for those of you who are interested in ambulatory subspecialty careers.  We can promise you social events and camaraderie with like-minded residents and faculty, too, organized by Sharon Rubin and others.

If interested or if you have questions please contact current ACLT leaders Alex Cho, Stephen Bergin, Daniella Zipkin, or me.  A brief, one-page application will be due Monday, December 30. You can also go to http://residency.medicine.duke.edu/duke-program/training-pathways/ambulatory-care-leadership-track for more information.  Thanks!

Alex Cho  MD, MBA

ACLT application form

Noon Conference Lunch Options

Lynsey is picking up the ball from Lauren and has continued to explore options for the lunch menu.  This week we are giving China King a chance on Wednesday, and the following week she has arranged for a baked potato bar.  It is quite a challenge to find alternatives that work, so please share your feedback.

One request please:  Both of these options do bring an increased risk of creating a “mess”, so if you would – help clean up if something drops/dribbles/spills.

Faces of Flu Prevention 2013

Throughout Duke, our team members are stepping up to protect our patients, their loved ones and each other by getting the flu vaccine. Follow the link below to check out this year’s Faces of Flu Prevention poster, read some of the stories behind the vaccinations, and find out how to
share your story.

Stephanie L. Giattino, MD
PGY-1, Internal Medicine
Duke University Hospital

Duke Hospital Resident Stephanie Giattino, MD, came in on her day off to get a flu shot. She shared, “It just makes sense to get the flu shot. How many other health care interventions can you think of that take only a few minutes and then last for a full year? It is fast and easy, and by getting a flu shot, you can help protect your own health as well as that of your family, friends and patients!”

https://intranet.dm.duke.edu/influenza/SitePages/Faces%20of%20Flu%20Prevention%20Intro.aspx

 

Information/Opportunities

 STL_InternalMedicineFlyer2
 

Upcoming Dates and Events

  • December 4:  Fellowship Match Party
  • December 14:  DoM Holiday Party
  • January 15th:  “Voices in Medicine”

 

Useful links

by · Posted on December 1, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Weekly News: November 25, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone! The last practices are in, the jerseys are ordered, and the videos are getting serious…only 4 days to turkey bowl. Join us at 11 am Thursday at Old Chapel Hill field (behind Githens Middle School) for some football.  It’s the 41st annual legendary Marines vs Jets!

Thanks to everyone also for continued recruiting spirit! Applicants continue to talk about the camaraderie and enthusiasm that you show and the discussions in report and chairs have been excellent (thanks Deanna Baker for report and Carter Davis for chairs presentations!). Jim Gentry has been spectacular at organizing getting applicants to rounds and also thanks to Myles Nickolich, Deanna Baker, Angela Lowenstern, and Lindsay Boole for resident share.

Other kudos to Phil Lehman for being a great team leader on gen med (from his interns!) and to Marcus Ruopp from the endocrine team and to Alana Lewis for her presentation at intern report.  Final kudos to the whole program for raising nearly $1000 for our thanksgiving food drive!

This weeks pubmed from the program goes to alum Seth Martin for his JAMA article!  Comparison of a Novel Method vs the Friedewald Equation for Estimating Low-Density Lipoprotein Cholesterol Levels From the Standard Lipid Profile;  Seth S. Martin, MD1; Michael J. Blaha, MD, MPH1; Mohamed B. Elshazly, MD1; Peter P. Toth, MD, PhD2,3; Peter O. Kwiterovich, MD4; Roger S. Blumenthal, MD1; Steven R. Jones, MD1  JAMA. 2013;310(19):2061-2068. doi:10.1001/jama.2013.280532.

Have a great week and see you at the game!

Aimee

In our current health care environment any data that can improve quality and reduce cost is data worth mentioning.Or perhaps better said when we read articles today we should be thinking how can this information can be applied to improve care quality with minimal cost. It is through this lens I viewed the current article in which the authors retrospectively evaluated a drug that initially in theory had a better side effect profile than others in its class but still resulted in significant complications. Moreover in today’s world we should be thinking how to program the latest EHRs to actively extract this data and implement simple safety solutions.Verma

Background:

Tamsulosin is a uroselective alpha blocker that in clinical trials has lower a rates of severe hypotension when compared to the non-selective blockers terazosin and doxazsin. It doesn’t carry the black box warning for hypotension and syncope that the less selective blockers carry. However in clinical practice it is unknown whether tamsulosin would increase the risk for hypotension requiring admission to a hospital.

Method:

Design – Retrospective cohort study utilizing the IMS Lifelink database which contains paid claims from 102 US healthcare plans.  Patient population – US men aged 40-85 who filled a perscription for tamsulosin or a 5-alpha reducatase inhibitor (5ARI) between Jan 2001 and June 20011

Outcomes – Hypotension requiring a hospital admission at various intervals after initiation were modeled by Cox proportional hazards model which estimated rate ratios at various intervals after initiation.

Results – The incidence of hospitalization was 42.4 per 10,000 person years which was greater than 5ARIs. These rates were greater than the rates for the overall cohort (29) and for patients taking 5ARIs (31). The rate ratio was greatest at weeks 1-4 after initiation (2.12) than weeks 5-8 (1.51) and there was no significant increase in weeks 9-12.

Comments:

I thought the study was interesting in that took 10 years of data to quantify the increased risk for significant hypotensive events. Although the initial clinical trials for tamsulosin indicated a 12% incidence for hypotension, the trials did not suggest a need for further treatment. The study however suggests that hypotension is real world side effect that usually occurs in the first 1-4 weeks and can place a significant burden on the patient and our health care system. They authors go on to suggest that the “first dose phenomena” be taken into account when starting the drug.

It is now 12 years since the first patient enrolled in the study and we are just now getting some system level data that may impact our management of patients starting on tamsulosin. Now that we can reasonable validate a first dose phenomena maybe we can program our new systems to automatically make a follow up phone call or appointment to ensure patient safety. Maybe in the future we can program our systems to start to intelligently assessing adverse events and not have to wait the full 10-12 years to recognize complications.

When I think about all the pressures on and changes to our health care system I suspect that we will have to respond with innovation so that we can leverage our investments to maximize the potential for population based health and the care of our patients.

 
 

From the Chief Residents

 

Grand Rounds

 
Grand Rounds will resume on December 6th
 

Noon Conference

 

Date Topic Lecturer Vendor
11/25 INTERVIEW
11/26 Common   Outpatient HIV Management Issues Chuck   Hicks Cosmic   Cantina: B
11/27 MKSAP Turkeybowl Style – Marines vs Jets ACRs Domino’s
11/28 NO   NOON CONFERENCE
11/29 NO   NOON CONFERENCE

From the Residency Office

Dear Internal Medicine ( submitted by Thomas O. Dalton, MD, Fellow in Geriatric Medicine )

“This is a request for you to participate in a multi-institutional research study. The goal of the the research is to understand the need for further development of educational initiatives aimed at caring for hospitalized older adults. We would like to know how often internal medicine and family medicine residents are assessing common issues that arise in this patient population.

To this end, we are asking you to complete an anonymous survey. The survey will take about 2 minutes. Taking part in this study is voluntary. If you would like to participate, please click on the link below and complete the survey. Please do not record you name or other identifying information on the survey form.

https://redcap.dtmi.duke.edu/redcap/surveys/?s=dv2FQc

If you have already completed this survey, thank you and please disregard this reminder emai

Please feel free to contact me with questions

Sincerely,

Thomas O. Dalton, MD,  Fellow in Geriatric Medicine

Department of Medicine

Duke University “

 

Information/Opportunities

 
 SunTrust – Dr -Medical – Resident Flyer
 

Upcoming Dates and Events

  • November 28:  Annual “Turkey Bowl”
  • December 14:  DoM Holiday Party
  • January 15th:  “Voices in Medicine”

 

Useful links

by · Posted on November 24, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: November 18, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone!

How ’bout those Blue Devils!! Glad they are getting us ready for the real upcoming football game!Looking forward to the final weeks of trash talk.Recruiting continues to go well…thanks for all your enthusiasm and support! And thanks to Dr Klotman for hosting a fantastic networking event for JARs, fellowship directors and division chiefs. As it gets close to resident research grant submission time, happy to see all the career connections being made. We also had a great turnout for the CIMIgro internal medicine interest group event on Thursday…lots of students making the best career choice!Kudos this week to Marcus Ruopp from the endocrine team, to Emily Ray, Nick Rohrhoff, Kevin Shah, Chris Hostler, Aparna Swaminathan and Gena Foster for doing the end of recruitment day resident share and to Adrienne Belasco for chairs conference. Greg Brown was our Duke basketball ticket winner for best chairs conference participation.Don’t forget to donate to our “Thanksgiving Food Drive to benefit the kids of Hope Valley Elementary.

PubMed:  Congratulations to Liz Gilbert, MedPsych PGY1 for winning the 1st prize poster award at the Academy of Psychosomatic Medicine! Liz presented a poster based on worked carried out while she was a student at Brown with Dr. Colin Harrington entitled  “Unintentional Injuries in Patients with Dementia:  Hospital Course and Outcomes”

Have a great week!

Aimee

 

QI Corner, Submitted by Joel Boggan, MD

QI Conference:  Join us this Wednesday, 11/20, at noon for a presentation on High-Value Biostatistical Concepts by
Dr. Dani Zipkin 
for the next in the HVCC lecture series.

QI Abstracts and Meetings If you have something you’d like to submit for either the Duke Patient Safety and Quality Conference or the NC ACP meeting in March, the abstract submission dates are coming up in early December.  Contact Jon or I for more details . . .

We Follow-Up:  Be on the lookout for data about our lab follow-up rates in your clinic over the next 1-2 months.  If you’re willing to help Jon and I brainstorm ways to present these data at either the DOC or Pickett sites, please let Jon or I know.

PSQC Updates:  At our meeting last week, we celebrated our improvements in hand hygiene compliance.  Last month was our first month of meeting the collective goal, so keep up the good work!   And, just to remind you of how important hand hygiene is, take a look at this photo shot of just a few of the “dirty hands” at our last noon conference – SCARY !!Hands

What Did I Read This Week, Submitted by Jonathan Bae, MD

Yanovski, J, et al. “A Prospective Study of Holiday Weight Gain.” NEJM, 2000; 342: 861-7.

With Halloween now two weeks past, and the holiday season briskly approaching, I wanted to read something more festive for this week’s installment of “What I Read This Week”. With a pumpkin bucket half filled with the ghosts of ingested candy, I began to muse on any preventative steps for an expanding waistline I would need to take with Thanksgiving just around the corner. A quick pubmed search led 072709_jonathan_bae_prdme to the article of interest in which the authors attempted to explore long held assertions that Americans gain weight (5 lbs. or more) during the holiday period from Thanksgiving to New Years Day. It is a plausible hypothesis in that there is data cited by the authors suggesting that people are more likely to gain weight during different periods of the life cycle including adolescence, pregnancy and midlife. Apparently this includes “the period after marriage in men” as well although I neglected to pull the citation directly despite its very compelling title (Sobal J, et al. “Marital status, fatness, and obesity.” Soc Sci Med, 1992; 35: 915-23.). In order to answer this critical question of Yuletide weight gain, the authors recruited a convenience sample of 195 adults and recorded weights at 4 periods:Pre-holiday (late September/early October to mid-November), holiday (mid-November to early/mid-January), post-holiday (early/mid-January to late February/early March) and September/October the following year. The authors also recorded vital signs and self reported health measures and attempted to mask the intent of the study to the participants. After all was said and done, there was found to be a statistically significant weight gain during the holiday period although much less then the prior anecdotal evidence from my Uncle Billy would have suggested: only 0.37 kg (or 0.81 lbs) on average was gained. My initial presumption was that this increase was simply due to the number of festive sweaters worn during the holiday period. But as it turns out, the authors adjusted for this by weighing all participants in the same drab, un-festive hospital gowns which most certainly lacked any reindeers, snowmen, or unnaturally generous bearded elders in red suits. Of note, this study was completed in 2000 so it does not account for new food industry standards such as chocolate covered Slim Jims, Locos Doritos Tacos, Chicken ‘n Waffle potato chips, and Double Chocolate Blasted Krispy Crème Taco Burgers (I only made up one of these items). Interestingly, weight that was gained during the holiday period often was maintained the following year suggesting that weight gain during the holiday period is certainly a factor in the incremental increase in body weight noted during adulthood. Over a lifetime of holiday seasons and deep-fried turkeys, one can reasonably conclude that holiday dietary habits do put us at risk for weight gain (and the subsequent health risks) although much more insidiously. Is there anything that can be done to combat this? Perhaps. The authors found that weight gain was inversely related to how active you were during the holiday season (Figure 4A), which should come as a shock to no one. As an aside, the authors also found a direct relationship between weight gain and participant hunger levels leading to a graph that made me laugh out loud (attached below). What did I take away from all of this? Holiday weight gain is real, increased activity levels may blunt the effects, and Double Chocolate Blasted Krispy Crème Taco Burgers on Christmas morning may be a bad idea. Happy Holidays!

 WDIRTW Pic

 
 

From the Chief Residents

 
SAR Talks, Noon Conference, 11/21/13
 
Dr Kevin Shah and Dr Carling Ursem
 

Grand Rounds

M&M Conference – 2002 DN
 

Noon Conference

Date Topic Lecturer Time Vendor Room
11/18 INTERVIEW
11/19 MED PEDS INTERVIEW Med Res Lib
11/20 QI Patient Safety Noon Conference Dr. Zipkin 12:00 Pita Pit 2002
11/21 SAR   talks Kevin Shah / Carling Ursem 12:00 Rudino’s 2001
11/22 INTERVIEW

 

 

From the Residency Office

Choosing a Career as a Clinician Educator

(sponsored by the Martin 210_McNeillDiana2010Society)

 

Presented by Diana McNeill, MD

Monday, November 18th

7:00 PM Medical Residents Library

 
 
 

USMLE Step 3

JAR’s:  For those of you who have not already done so, please be sure that you register to take the USMLE Step 3 exam.  We HIGHLY recommend that you plan to take it no later than February 2014 to ensure that test scores will be available prior to 6/30/14.  You will not be allowed to begin your PGY3 year until you have taken and passed the USMLE Step 3 exam.

Please be should to let the Chiefs know as soon as you have a scheduled test date so that they can approve it and make any scheduling changes necessary.  Once you have taken the test and received your official scores back, you will need to provide a PDF copy to our office, which we will forward to GME.  If you have any questions about the process, please feel free to contact Jen Averitt.  As a reminder, Lauren Dincher is a notary for the residency program!

For those of you who have let us know your dates for testing and/or submitted your scores, THANK YOU!

 

Thanksgiving Food Drive – Off to a Great Start

This week marked the beginning of our Annual Thanksgiving Food Drive! In the past, we have attempted to help the local food kitchens that serve the homeless and poor in our local area of Durham and we have been quite successful. This year we have decided to help one of our local schools, Hope Valley Elementary.

Hope Valley Elementary is a Title I school that has a student population of 648 students. Out of those, 58% participate in the free and reduced lunch program. Furthermore, many of the students live in low income apartment complexes that are in our attendance district. One of these apartment communities partners with the Cascade Drug and Alcohol Rehabilitation Program, in which several of our single mothers participate.

These families are among the poorest in Durham. Several Hope Valley Elementary families are currently homeless and there are children that are dependent on the school to meet their nutritional needs. There are children who on EACH Friday of EVERY week have their backpacks lined up in a row by the social worker and have food placed in them to take home because they do not eat enough on the weekend.

This year our hope is for the house-staff to help these families. We have established a pay-pal link in order to raise funds: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=UNV67MVQQQH3N. These funds will help the social worker continue to provide food to the families that cannot feed their own children especially on Thanksgiving. Even the smallest amount can help. The drive deadline is November 21.

Thank You!

Armando Bedoya & Jeremy Halbe

 

Wanted: Future leaders in ambulatory care.

Interested in careers in ambulatory medicine – i.e., primary care and/or an outpatient subspecialty like Endo or Rheum?  Interested in Choleadership?  The Ambulatory Care Leadership Track (ACLT) is an opportunity for upper-level residents to gain additional clinical experiences and training that will help them function as leaders in the ambulatory environment.  Four JAR spots and two SAR spots will be open for the 2014-15 academic year.  If interested or if you have questions please contact Alex Cho, Stephen Bergin, or Daniella Zipkin.  A brief, one-page application will be due Monday, December 30.  You can also go to http://residency.medicine.duke.edu/duke-program/training-pathways/ambulatory-care-leadership-track for more information.

ACLT application form

 

Respiratory Fit Testing Schedule for November 2013

Fit Testing is available at Duke North Room 4000C.  (4th Floor beside service elevator) or at Duke South EOHW. Walk-ins allowed.

We are still experiencing a shortage in the TB testing solution- TB testing is still suspended unless your group has been notified differently. We are adding more TB Testing groups back at this time, managers are being notified this week. Others groups will be added as we continue to evaluate the situation.

Also available:

  • Color Vision
  •  (T-Dap) vaccine (Diphtheria, Tetanus, Pertussis) Required for all employees working with Children 18 months of age or younger.
  • Flu Shots

Fit Testing Schedule is attached below and is also available on the HR website— http://www.hr.duke.edu/about/departments/eohw/

November 2013 Resp Fit Testing-T-Dap-TB Skin Testing Flyer

 

Information/Opportunities

 
 

Upcoming Dates and Events

  • November 28:  Annual “Turkey Bowl”
  • December 14:  DoM Holiday Party
  • January 15th:  “Voices in Medicine”

 

Useful links

by · Posted on November 17, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

IM Residency Program News: November 11, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone!

Some great Duke victories this past week! Will there be 2 pick 6’s in the Turkey Bowl?

Thank you for your great energy for recruiting. Couldn’t have asked for a better kickoff week- special thanks to our tour guides, to Nick rohrhoff and Bronwen Garner for presenting at report and chairs, and to Joanne Wyrembak, Jason Zhu, Hal Boutte, Carling Ursem and Chris Hostler for talking with applicants at the end of the days.

Other kudos to Nick Turner from the MICU nurses, Erin Boehm and Amy Jones from the VA teams for taking some extra admits, to Jason Zhu from Nick Rohrhoff for strong work at the VA, and to Myles Nickolich and Brittany Dixon for coming in after a CAD night to say hi to applicants from their med schools.  And, from Steve Bergin, a BIG thanks to Jessie Seidelman and Carling Ursem for being more than willing to help out in the very busy, short-staffed ACC last week.

If you haven’t read Chris Hostler’s email about Veterans Day, please do. If you are working at the VA tomorrow (or enjoying a free day on amb bc the clinics are closed), remember to thank a veteran for their service.

Big week this week – come out to watch the Duke-Kansas game, JARs are headed to Dr Klotmans for a networking event with the fellowship directors and division chiefs and we have a med student event on Thursday!

This weeks pubmed from the program goes to alum Steve SumnerAssociation Between Earthquake Events and Cholera Outbreaks: A Cross-country 15-year Longitudinal Analysis;  Authors Sumner SA, et al, Prehosp Disaster Med. 2013 Oct 29:1-6. [Epub ahead of print]

Have a great week

Aimee

 

I reread this article this week after hearing about Jenn Rymer’s presentation at the AAMC conference about our housestaff incentive program.  The UCSF incentive program, which began in 2007, was the prototype for our program here at Duke, and this paper from BMJ Quality and Safety from earlier in 2013 shows one of the successes they have had engaging residents in program-wide quality initiatives.

Joel Boggan, MD, MPH

Joel Boggan, MD, MPH

Background:  Prior to the study, resident discharge summaries were completed at an average of 3.5 days after discharge.  The goal of the project, decided on by residents and program leadership, was to have 75% of discharge summaries completed within 24 hours of discharge at UCSF’s main hospital.  If this metric was achieved over a year-long period, each resident would receive an additional $300 of salary.Two residents commandeered the effort, leading other residents and faculty through brainstorming, analyzing the data, and performing PDSA cycles about what to include in a new discharge template.  These residents also took a lead updating their peers biweekly on the performance metric when they rotated at UCSFMC.

Methods:  To improve discharge summary timing, the group created an electronic discharge summary template, which included medication changes and full reconciliation, functional status at discharge, follow-up plans, pending tests and discharge instructions.  Any team member could edit the template at any point during the hospitalization, and the template served as the discharge day note if completed on the same date as discharge.

Measurements included the time from patient discharge to resident completion of the discharge summary in days, the proportion of discharge summaries completed on the day of discharge, as well as frequency of use of individual aspects of the template that were considered to be important for a ‘quality’ summary.  Assessment of these ‘quality’ measurements from the summaries was performed by chart review and compared results for 80 summaries in the pre-intervention period to 160 from the near intervention (first two months) and further intervention periods (more than six months, with 80 from each period).  Chi-square statistics were used to compare proportions completed on the day of discharge and for presence/absence of individual quality metrics.  Results were presented to rotating residents twice weekly for the year-long incentive period, although the measurements were continued for an additional six months after the cessation of resident feedback and incentive target date to assess longer-term influence.

Results:  2560 discharges occurred during the study period, and the template was used in more than 96% of the summaries.  Average time to completion of discharge summaries decreased from 3.5 days to 0.6 days (p<0.001) and the percentage completed on the day of discharge increased from 38% to 83% (p<0.001).  The residents earned their extra $300, and the increased frequency of completion on the day of discharge was sustained for six months after the incentive period finished (see run chart below).

The percentage of summaries that included all recommended quality criteria also increased significantly, from 5% to 88%, including a full medication reconciliation (from 10% to 88%) and pending tests and follow-up (from 34% to 98%, p<0.001 for all).

WIRTW graph

What does this all mean? 

Mostly, it means that engaged residents, like we have here at Duke, make a real difference in care.  The residents in this study not only performed the discharge work that determined the success of this project, they also helped choose the metrics and led the project.  Furthermore, the residents were motivated by the quality of the work itself:  A follow-up survey found that several factors about the project were more important to the residents than the money being offered, including improving workflow by having the summary replace the day of discharge note, sharing the summary as an editable ‘team’ document prior to finalizing it, and that the timeliness of the discharge summary could improve continuity of care.

And, the project did improve continuity of care.  Prior to this study, 38% of outpatient providers surveyed by this group saw a patient in the outpatient setting ‘often or always’ prior to receiving a discharge summary.  With this project, that number dropped to 4%, and the information provided in the summaries was much more uniform and complete.

Overall, much of what they included in their summary template is already captured in our EPIC and CPRS templates, but I think their discharge timing speed could serve as a potential goal for our program in the future.  In the meantime, let’s work on hand hygiene and flu vaccination . . .

 

From the Chief Residents

SAR Talks, Noon Conference, 11/14/13

12:00-12:30: Angiogenesis and VEGF – The history of Avastin – Ben Heyman, MD

Grand Rounds

 

11/15/2013 Dr. Andrew Wolf

 

Noon Conference

 

Date Topic Lecturer Time Vendor
11/11 INTERVIEW
11/12 MED PEDS INTERVIEW
11/13 Schwartz Rounds Lynn O’Neill, Lynn Bowlby 12:00 Jersey Mike’s
11/14 SAR   talks: Angiogenesis and VEGF – The history of Avastin Ben   Heyman 12:00 Domino’s
11/15 INTERVIEW

 

From the Residency Office

The Martin Society Invites You To Dinner with Senior Faculty

This is the first in a special series hosted by the Martin Society to provide an opportuity to meet with senior faculty and discuss key topics over a light dinner.

Watch for the “INVITE” in your email, and please respond no later than Friday, November 14th, so that we can plan accordingly

Choosing a Career as a Clinician Educator
Presented by Diana McNeill, MD

Monday, November 18th at 7:00 PM
Medical Residents Library
10 Searle Drive, DUMC 3702, Durham, NC

 

Geriatric Curriculum Needs Assessment Survey (submittted by Tom Dalton, MD)

“This is a request for you to participate in a multi-institutional research study.  The goal of the research is to understand the need for further development of educational initiatives aimed at caring for hospitalized older adults.  We would like to know how often internal medicine and family medicine residents are assessing common issues that arise in this patient population.

To this end, we are asking you to complete an anonymous survey.  This survey will take about 2 minutes.   Taking part in this study is voluntary.  If you would like to participate, please click on the link below and complete the anonymous survey.  Please do not record your name or other identifying information on the survey form.”

https://redcap.dtmi.duke.edu/redcap/surveys/?s=dv2FQc

Please feel free to contact Thomas Dalton (thomas.dalton@dm.duke.edu)  with questions

 

GME Research Training Series for Residents

Registration for the SATURDAY sessions (November 16th and 23rd) will close on Monday, November 11th.

Take note of the learning opportunties shown below, offered by Duke’s GME office.  These sessions focus on enhancing resident QI and research experiences, and help ensure residents follow sound research principles and practices now and upon graduation.

Registration Link:

 https://www.surveymonkey.com/s/GME_Research_Training

Workshops

1. Human Subjects Research &Research Data Collection and   Security

 

Tuesday October 22, 2013 7:00am – 9:00am
Saturday November  16, 2013 8:00am – 10:00am
Wednesday January 15, 2014 12:00pm – 2:00pm
Thursday March 6, 2014 4:00pm – 6:00pm
2. How to Ask and Answer Research   Questions Using Library Resources &Ethics of Conducting Research Tuesday October 29, 2013 7:00am – 9:00am
Saturday November  16, 2013 10:15am-12:15pm
Wednesday January 22, 2014 12:00pm – 2:00pm
Thursday March 13, 2014 4:00pm – 6:00pm
3. IRB Overview, Informed Consent   and Regulations  Tuesday November  5, 2013 7:00am – 9:00am
Saturday November  23, 2013 8:00am – 10:00am
Wednesday January 29, 2014 12:00pm – 2:00pm
Thursday March 20, 2014 4:00pm – 6:00pm
4. Presentation and Dissemination   of Data  Tuesday November  12, 2013 7:00am – 9:00am
Saturday November  23, 2013 10:15am – 12:15pm
Wednesday February 5, 2014 12:00pm – 2:00pm
Thursday March 27, 2014 4:00pm – 6:00pm

Blitzes

Training in Advanced Research   Principles and Practices Saturday February 8, 2014 8:00am – 12:30pm
Saturday April 26, 2014 8:00am – 12:30pm

If you have questions, please feel free to contact:

  • Alisa Nagler in the GME office
  • Holly Tiemann in the DOCR office

 

**REMINDER: The deadline to submit your abstract(s) is Saturday, December 14, 2013 at midnight.**

The North Carolina Chapter is excited to announce the Call for Abstracts for the 2014 Chapter Scientific Session, taking place February 28 – March 1 at the Grandover Resort in Greensboro, NC.

This competition is open only to Associate and Medical Student members of the ACP North Carolina Chapter. First authors must be Medical Students or Associate-level members of ACP or have made official application for membership in order to enter this competition. There will be no exceptions to this requirement. If you have not joined ACP (medical students join for free; associates should contact their residency program directors), please visit ACP Online to find out more and apply.

Each abstract will undergo careful review and will be ranked for scientific merit, originality, proper presentation, and clinical application.  To view ACP’s guidelines and tips on preparing an abstract, click here.

We will accept as many posters for display and judging as time and space permit.

The deadline for submitting entries is Saturday, December 14, 2013 at midnight.

Abstracts can be submitted electronically online only.  To electronically submit an abstract, visit the Online Abstract Submission Form.

Why Submit?

  • Educational opportunity to showcase your work.
  • Best Clinical Research, Basic Research, Clinical Vignette, QI, and Student Poster will each receive a cash award of $300 and reimbursement of travel  expenses to the 2014 ACP Internal Medicine Meeting to present their poster.
  • Best Overall Poster will receive an additional cash award and reimbursement of travel expenses to the 2014 ACP Internal Medicine Meeting to present the winning poster.
  • Free meeting registration for all Associates and Students who attend.

For questions concerning this abstract competition, please contact Nancy Lowe, CMP, Associate Director of the North Carolina Chapter, at nlowe@ncmedsoc.org.

Thank you,

Byron J. Hoffman, Jr., MD, FACP
ACP Governor, North Carolina Chapter

 

General Medicine Grand Rounds on Tuesday, November 12, 2013

Clinical Psychology in treating Chronic Pain (and other diseases)

Presented by:  Katherine L. Applegate, Ph.D

  • 7:30am to 8:15am
  • 3024 Pickett road, 2nd floor
  •  Durham, NC 27705

 

AAIM Offers Free AJM Subscriptions to Residents in 2014! Sign Up by December 6

Details on the attached flyer

AAIM Offers Free AJM Subscriptions to Residents in 2014

 

Information/Opportunities

Idaho Internal Medicine

Idaho Hospitalist

Louisiana Internal Medicine

CentralNorth Dakota Internal Medicine

FM flyer

Upcoming Dates and Events

  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • January 15th:  “Voices in Medicine”

Useful links

by · Posted on November 10, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: November 4, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)

Doctoberfest/comes sadly to a close/hello, recruitment! ….or perhaps another haiku to get us started on the recruiting season  daylight savings time/longest call night of the year/turkey bowl is soon! 

We welcomed the preliminary intern applicants on Friday, with our first recruiting day, and Monday marks the first categorical recruiting day! We are looking forward to meeting our future Duke residents, and appreciate the efforts of everyone to make them feel welcome and to show off our fantastic residency program.  Coach K’s grand rounds certainly gave us some “street cred” to get the season started.  Please remember to sign up with Erin for the recruitment dinners, as well as take time to talk with the applicants at lunch and throughout the day.

Kudos this week to Jenn Rymer and Christine Bestvina – Jen presented the GME incentive program at the National AAMC meeting this weekend and Christine presented at the ASCO Quality Care Symposium.  Over the weekend, I received emails from our DIO Dr. Cathy Kuhn regarding Jenn’s superb presentation, and from Duke Med Res alum and current oncology fellow Tian Zhang about Christine’s outstanding talk as well.  Other kudos to Schell Bressler on her gold star for outstanding patient care,  Amera Rahmatullah for winning the final Doctoberfest question (what are ghost cells?), and to Noah Kalman and Landon Meekins for helping with prelim interview day.

To conclude our “Building Our Community” Doctoberfest, WE DID IT!!! We raised over $1200 to purchase the mobile wheelchair ramp for the North Street Community.  I am so proud of everyone for their efforts to help others and to make a difference in the lives of the residents of North Street.  Thank you so much for your thoughtfulness and generosity.  In addition, we took time to recognize the nurses who work with us everyday in the hospital and in the clinics.  And, as a result of all this, the chiefs and I have to sumo wrestle (honestly, it seemed like a good idea at the time).  Details to follow.

We are continuing to work to make our program even better.  Last week, we had our first Clinical Competency meeting.  This is an RRC requirement for all programs, and allows the advisors, chiefs and I to summarize each residents clinical performance, year to date.  Please take time to meet with your advisor and me to discuss the process and to set further learning goals for the year.  This week, we will be having our “Noon Conference” summit, where representatives of the residency council will work with the APDs, chiefs and I to analyze the information from the Noon Conference survey and plan how to improve noon conference. Thanks to Steve Bergin for organizing and leading this effort.

This weeks Pubmed from the Program goes to Josh Briscoe for his presentation at the Association for Medicine and Psychiatry national meeting in Chicago.  His presentation  “Bridge Over Troubled Water: Philosophy in Medicine and Psychiatry”  sparked great discussion among attendees.

Have a great week and HAPPY RECRUITING!

Aimee

QI Corner

QI Noon Conference

Please join me in thanking Dr. Joanna Kipnes and her discussion of “Health Insurance” as part of our High Value Cost Conscious Care Lecture series.

Stay tuned for our next HVCC lecture, 11/20/2013 with Dr. Daniella Zipkin discussing “High Value Biostatistical Concepts”

 

Flu Vaccine & QI Champs

Congratulations to Susanna Naggie and Martin Society for being the first recipients of our Flu Vaccine Compliance Trophy by being the first Stead Society to reach 100%.  They were also award the honor of QI Champs for the month of September.

We also want to acknowledge Jennifer Averitt as a QI Champ for her efforts helping to coordinate the flu vaccine campaign.  Special thanks to all residents and Stead Leaders who once again helped us protect our patients by getting vaccinated – 100% 3 years running!

2013 stead flu trophy presentationstead flu trophy
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Burnout and Resiliency Survey

Don’t forget to complete you burnout surveys as part of a resiliency study lead by Dr. Hany Elmariah. Our goal is >50% completion and we are currently around 30%.

 GME Incentive Program Update

Here is our current HH performance through Mid-October

 

Observations YTD Compliance YTD Non Compliance YTD Hand Hygiene Rate YTD
Unit 9300

46

41

5

89%

Unit 9100

57

50

7

88%

Unit 8300

38

34

4

89%

Unit 8100

47

43

4

91%

Unit 7800

58

50

8

86%

Unit 7300

51

41

10

80%

Unit 7100

43

35

9

82%

COMBINE

340

294

47

87%

 

 

What Did I Read This Week

Submitted by Lynn Bowlby, MD

What Would You do if it Were Your Kid?  NEJM October 3, 2013 369 (14) ;1291-1293, Author:  David N. Korones, M.D.

What would you do if it were your kid?

I hope that many of you have had an opportunity to attend the Schwartz Center Rounds, the monthly Rounds I lead with Lynn O’Neill where caregivers share their feelings and responses to a particular case, with the goal of improving our compassionate responses to patients and their families.

The next Rounds are in 2002 Noon Nov 13.

We can add you to the list serve to send you the monthly announcements, many are the 3rd Tues of the month during noon conference. Just email me to be added!

One of the many benefits to Rounds is the working across Departments and Divisions. The ED has presented several cases. David Gordon sent me the following article as a topic idea for the Rounds.

Have you ever been asked what you would do by a patient if they were your parent or spouse?

All of us know the very ill and complex patients we take care of and often the very difficult decisions that have to be made.

When we make medical decisions for our own family, we use our emotions just as much as our cognition. What we want for our family may be very different than what another family wants.

So how do we answer that question? Can we share with them what our instincts tell us? They ask for guidance, can we be a bit human with them and tell them?

Some families may be asking for our permission to do something different than what we might do..can we help give them permission to do what they feel is right?  Some words to use…explain how our decision is both emotional and rational, and we don’t know exactly what we would do…but here is what I think I would do…

Think about those time when it has been your family member with hard medical decisions….and you will feel some of what our patients and families feel in trying to make these tough decisions.

bowlbyphoto
 

 

 

 

 

 

 

 

 

From the Chief Residents

SAR Talks, Noon Conference, 11/5/13

12:00-12:30: “Blood Transfusions – From Monsters and Murderers to Modern Day Marvel” – Dr. Carter Davis

12:30-1:00: “TAVR – Past, Present, Future” – Dr. Wassim Shatila

Grand Rounds

Lord Ajay Kakkar
Cardiology

Noon Conference

Date Topic Lecturer Time Vendor Room
11/4 INTERVIEW
11/5 SAR talks: Blood Transfusions – From Monsters and Murder to Modern Day Marvel / TAVR – Past, Present, Future Carter Davis, Wassim Shatila 12:00 Bullock’s BBQ 2002
11/6 Ambulatory Town Hall  Clinic Directors 12:00 Chick Fil-A 2002 (8262 Pickett, 2003 PRIME)
11/7 Speed Bumps in the Head and Neck Ray Esclamado 12:00 Sushi 2001
11/8 INTERVIEW

 

From the Residency Office

DOCTOBERFEST was a Huge Success!

Summo

 

THANKS TO EVERYONE, WE RAISED $1560  FOR THE NORTH STREET COMMUNITY PROJECT!!!

Your contributions are SO appreciated and will more than pay for the new portable wheelchair ramp that is so needed! – We will be sharing information about a presentation of the donation soon!

In case you haven’t heard it recently, the Duke Internal Medicine Residency Program family ROCKS!!!

 

Opioid Safety
Have you been reading about opioid safety? Aware of the epidemic of accidental opioid overdose deaths? More people now die from accidental overdose then from motor vehicle accidents. We’ve seen a tripling in our state over the last 10 years or so. I currently serve as co-chair of the Opioid Safety Task Force and we are trying to take steps to protect our patients. Here something simple you can do- sign up for the North Carolina Controlled Substance Reporting System. This would allow you access via a website to all of the controlled substances prescriptions that your patients have filled. This allows us to identify drugs that might interact with an opioid such as benzodiazepines but also allows us to know who is prescribing to our patients and what prescriptions they are filling. Sign-up is easy though it does require renewal each year while you are in training. After your training is over, you don’t need to re-register.  Your application must be notarized and include a photocopy of your drivers license. At the medical residents’ office, find Lauren Dincher and at Duke Outpatient Clinic, look for Gloria Manley to notarize your application.   The website is reasonably easy to use and is quite current. Attached is a copy of the application form and a brief list of do’s and don’ts that you might review. Please take a minute and do this, you could save a life.

Do and Dont NCCSRS

NCcsrs-applicationform12-13-12

Larry Greenblatt, MD

DOC Stead C Chief

Medical Director, NPCC, and affiliate of CCNC (Medicaid Care Management)

 

The time has come to plan the 14th Annual Duke Charity Auction!

For those new to the Duke family, the Charity Auction is one of the most fun events of the year –  with heavy hors d’oeuvres, drinks, and best of all – a silent and live auction, with all proceeds going to Senior PharmAssist, a program that helps low income seniors afford their medications, and the DOC patient fund. Last year, we raised over $16,000!

It’s a chance to bid on and win awesome auction prizes– such as Dr. Zaas-coverage on the rotation of your choice, Dr. Zipkin- coverage of your clinic at the DOC, Duke Basketball tickets, or gift certificates to your favorite restaurants and bars around Durham.  BUT we need your help in planning, and would LOVE to have you join us on Monday, Nov 4th at 5:45pm at the Med Res library. Interns are especially welcome! This is a great opportunity to get involved in something fun that is also for a great cause!

So, to recap:

WHAT: Charity Auction Planning Meeting

WHEN: Monday, Nov 4th at 5:45pm

WHERE: Med Res library

WHO: YOU!!!

Thanks everyone!

Laura Caputo, Jen Chung, Meredith Clement, Marianna Papademetriou, Carling Ursem

 

NC ACP Meeting

The meeting this year is Friday and Saturday, February 28 – March 1, 2014, at the Grandover Resort in Greensboro, NC. They are accepting poster/abstracts until December 15th. There is an on line submission on the ACP web site

http://www.acponline.org/about_acp/chapters/nc/news_meet.htm

The prize is trip to the National ACP meeting to present the poster.  Flight, room board, and registration fees are included. The 2014 the meeting is in Orlando, Florida

Sharon Rubin, MD, FACP

Assistant Professor, Duke University Medical Center

Residency Director at Pickett Road

Internal Medicine

The annual enrollment period for medical, dental, vision and reimbursement account benefits for 2014 is now open. You have until 6 p.m. on Friday, Nov. 8 to review and make benefit selections to ensure appropriate coverage.

Please, remember that your participation in the Health Care and/or Dependent Care Reimbursement Accounts does not automatically continue from year to year. If you wish to use a reimbursement account in 2014, you must enroll to participate. However, your current selections for medical, dental and vision insurance will automatically continue for 2014 unless you make changes.

There are two ways to enroll or make changes to your benefits selections:

If you need assistance or have questions, contact the Duke Open Enrollment Service Center at 919-684-5600. Representatives are available weekdays from 8 a.m.- 6 p.m. from Oct. 28 – Nov. 8 and from 8 a.m.- 5 p.m. on Saturday, Nov. 2.

Information/Opportunities

PIM 2013 pdf

Aspirus Internal Medicine-IM Residency Programs 10.22.13

Recruting Flyer Hospitalist

 

Upcoming Dates and Events

  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • December 4:  “Voices in Medicine”

Useful links

by · Posted on November 4, 2013 in Chief Residents, Fellowship programs, General Internal Medicine, Internal Medicine Residency, Medical Education, Weekly Update · Read full story · Comments { 0 }