From the Director
“Hi everyone! We are making progress on the ACGME survey…at last check we were at 47%. Please fill yours out so we can 1) hit the 70% expected by the ACGME and 2) see your opinion regarding the program. More reminders to come to those who have yet to do their survey!
Belated Compliments this week go to Josh Thaden who went above and beyond responding to a code in the VA garage and also to Eric Chu for helping the Duke night floats with a busy night.
Please note a new way to order pip-tazo (better known as Zosyn!) via extended infusion…standard dosing should be 3.375 g IV q 8 hours, with infusion running over 4 hours. This provides better time over MIC – look for this in CPOE. Please see the attached info from pharmacy! DUH Protocol for Extended Infusion PTZ
Lots of fun events to come in the next few weeks….don’t forget to sign up for the Stead Tread! See details below.
Pubmed from the Program this week goes to Mandar Aras and Ryan Schulteis who will be presenting “variation in vancomycin dosing intervals predicts non therapeutic drug levels” at the Academy for Healthcare Improvement in Arlington VA.
Have a great week
What Did I Read This Week
(submitted by Jason Webb, MD)
JAMA Psychiatry. Cancer-Related Mortality in People with Mental Illness. Kisely S, Crowe E, Lawrence D. 2013; 70 (2): 2009-217.
As many of you know I am deeply interested in the interface between Palliative Medicine and Mental Health, so I could not help but delve into this article, which evaluated the mortality rates from cancer in patients suffering from mental illness. Below is a modified version of the JAMA Psychiatry abstract, with some take home points from my perspective on the article.
Background: Mortality rates in psychiatric patients are much greater (30% higher) than in the general population, including Nordic countries where longstanding egalitarian health and welfare policies might be expected to facilitate treatment access. Chronic physical disorders such as cardiovascular disease and cancer are the main cause, accounting for 10 times the absolute numbers of suicide in one study but receiving far less attention. In cancer, overall mortality is higher in psychiatric patients, even though the incidence is similar to that in the general population. The disparity between incidence and mortality is most marked for several common sites such as prostate and colorectal cancers. Possible explanations might be delayed diagnosis or lack of access to screening, leading to more advanced staging at diagnosis, and reduced access to or use of appropriate treatments after diagnosis.
Objective: To assess why psychiatric patients are no more likely than the general population to develop cancer but are more likely to die of it.
Design, Setting, and Patients: A population-based record-linkage analysis compared psychiatric patients with the Western Australian population, using an inception cohort to calculate rates and hazard ratios. Mental health records were linked with cancer registrations and death records from January 1, 1988, to December 31, 2007, in Western Australia.
Main Outcome Measures: Metastases, incidence, mortality, and access to cancer interventions.
Results: There were 6586 new cancers in psychiatric patients. Cancer incidence was lower in psychiatric patients than in the general population in both males (rate ratio=0.86; 95% CI, 0.82-0.90) and females (rate ratio= 0.92; 95% CI, 0.88-0.96), although mortality was higher (males: rate ratio=1.52; 95% CI, 1.45-1.60; females: rate ratio=1.29; 95% CI, 1.22-1.36). The proportion of cancer with metastases at presentation was significantly higher in psychiatric patients (7.1%; 95% CI, 6.5%-7.8%) than in the general population (6.1%; 95% CI, 6.0%-6.2%). Psychiatric patients had a reduced likelihood of surgery (hazard ratio=0.81; 95% CI, 0.76-0.86), especially resection of colorectal, breast, and cervical cancers. They also received significantly less radiotherapy for breast, colorectal, and uterine cancers and fewer chemotherapy sessions.
Conclusions: Although incidence is no higher than in the general population, psychiatric patients are more likely to have metastases at diagnosis and less likely to receive specialized interventions. This may explain their greater case fatality and highlights the need for improved cancer screening and detection.
Take Home Point: The study suggests that despite a lower incidence of cancer in psychiatric patients (which likely has to due to with a bias of decreased screening for these patients), that patients with psychiatric illnesses are more likely to die from their malignancies, and less likely to receive comparable cancer care. Due to often poor access to primary preventative care, less aggressive cancer interventions, often due to perceived poor social support, as well as poor medical literacy, patients with psychiatric illness likely need a different treatment paradigm for improved cancer screening, detection, as well as treatment (i.e. a med-psych oncology practice model?). On analysis of the validity of the study, the authors use registry data, which often is subject to recording bias, and lacked significant amounts of demographic data, which might have explained some of the outcome differences. In addition, the ability to detect differences that may have also existed might have been limited by a relatively small sample size for the overall cohort when they broke the data down by cancer type. However, the data does suggest significant screening, diagnosis and treatment gaps for patients with psychiatric illness who have cancer. Further research would need to identify mechanisms to reduce the discrepancies in cancer care for patients with psychiatric illnesses.
In the mean time, we can benefit our own patients by bearing in mind that having a psychiatric illness increases the risk for death from cancer, and that these patients need an increased level of vigilance in the outpatient setting for screening for common malignancies such as breast, prostate, and colorectal cancers.
From the Chief Residents
April 19, 2013 Dr. Frank Neelon Topic: Physician Burnout
|4/15||SAR talks||Sam Horr, Eric Chu||The Picnic Basket||2002|
|4/16||Med-Peds Conference: Allergy/Anaphylaxis||Patricia Lugar||Sushi||2002|
|4/17||Financial Planning for Residents||Marc Flur||Rudinos||2002|
|4/18||Health Care Disparities in the LGBT Community||Shane Snowdon||Dominos||Great Hall|
(submitted by Sarah Wingfield, MD)
I just wanted to let you know that Eric and I welcomed our son, Otto William Hanson, on April 2,2013 at 1:52 AM. He was 8 lbs, 4 oz, 21 inches long and has a full head of strawberry blonde hair:)
From the Residency Office
ACGME Resident Survey
By now you have all received the emails from Dr. Zaas, and reminders from Jen Averitt regarding the survey. If you have not yet logged in, please take the time to do so today.
This anonymous survey is used by the ACGME to evaluate our program, and program leadership use the survey data as one tool in making program improvements.
The links and instruction can be found on the following attachment: ACGME Resident Survey
Annual Faculty – Resident Basket Ball Game
Let the fun begin – and come cheer for the “winning team”!!
- When: Wednesday, May 1st
- Where: Cameron Indoor Stadium
- Time: Optional warm up at 6:00pm, GAME STARTS AT 6:30PM
Ronald McDonald House Dinner
Warren Society (formerly known as the Rankin Society) would like to invite you to an exciting event on the afternoon / evening of Thursday, April 25:
All medicine residents (and their families) are invited to help us serve dinner to the families staying at the Ronald McDonald house on Alexander Avenue 2 minutes from the hospital (see directions below). For anyone who can arrive early (i.e. Ambulatory Blockers), we will begin preparing food there at 4pm in order to serve the dinner at 6pm, but we would love to have your participation at any time during the afternoon or evening. The menu will be Tacos (so we’ll need to do lots of vegetable chopping), salad, and Dr. Lyles’ fabulous poundcake. Anyone who helps out is absolutely entitled partake of this tasty dinner as well.
Directions to Ronald McDonald House from Duke North. Head east on Erwin Rd (toward 9th street) for 0.7 miles. Then turn right onto Alexander Ave. The House is on your right 0.3 miles down. Thanks!
If you are interested in participating, please contact Steve Crowley at email@example.com.
Smith Society Faculty Meet-and-Greet Series
Our first faculty member to for this new series of events is Dr. Thomas Owens, Chief Medical Officer for the Duke University Health System and prior VA Chief Resident. Dr. Owens will be speaking on negotiating contracts, a topic our SARs in particular were very interested in hearing.
The Meet-and-Greet will be in the Med Res Library on Wed 4/17 from 7-8 pm. Pizza and salad dinner will be provided by the Smith Society.
Please use the following link to sign up: https://www.surveymonkey.com/s/8ZDTS5J
Stead Tread 2012
Keep training! Just 3 weeks till RACE DAY! Details—–>
- - Stead Tread 2013 website for information, registration, and donations: http://www.steadtread.org/
- - Race date/time: Sunday, April 28, 2013 at 2PM
- - Race location: Al Beuhler Trail, Washington Duke Inn and Golf Course (same as last year)
- - Race beneficiary: Lincoln Community Health Center
- - As always, your registration fee includes an official Stead Tread 2013 T-shirt
Invitation to Conflict Management Workshops
I) Effective Communication for Career Progressions: Nuances of Gender and Cultural Influences
When: Tuesday, May 14, 4:00-5:30 pm
Where: Duke North Room 2001
Details: This session will explore the ways in which our communication, leadership, and conflict management styles can be affected by unspoken gender and cultural influences. Examples will illustrate the impact these nuances can have on our careers. The session will focus on careers in academia specifically.
II) Difficult Conversations: How to Talk About the Tough Stuff
When: 2 Sessions to choose from: Wednesday, May 15, 7-9 am or 4-6 pm
Where: The Great Hall, Mary Duke Biddle Trent Semans Center for Health Education
Details: This seminar will present a model for effectively handling difficult conversations. Emphasis will be given to how to manage underlying emotions and approach conversations in a way that fosters positive outcomes. Based on the book Difficult Conversations by Douglas Stone, Bruce Patton, and Sheila Heen, this will be an interactive session using examples from academics and science.
Target Audience: School of Medicine Faculty
**Please note** Space in these seminars is limited. Please register only if you plan to attend the full 2-hours.
Technology Assessment Survey
Dear Attendings, Fellows, and Residents,
We are requesting your assistance to complete a 3-minute survey evaluating technology use among physicians. This is the continuation of an on-going study that has been previously published. The survey can be completed HERE. All information is anonymous and results will be publicly available.
Thank you for your help,
Orrin Franko, MD
Resident Physician, Post-Graduate Year 4
University of California, San Diego
Once again: SURVEY LINK HERE
SAR Board Review Schedule
Board Review Sessions will be held in the MedRes Library, Duke North, 8th Floor. Please contact Megan Diehl or Jeff Clarke if you would like to attend. The schedule is as follows:
|Wednesday April 17||Cardiology||Dr. Jones|
|Tuesday April 23||Hem/Onc||Drs. Riedel and Diehl|
|Tuesday April 30||Pulmonary||Dr. Govert|
|Wednesday May 8||Gastroenterology||Drs. Choi and Desai|
|Tuesday May 14||Endocrine||Dr. Matt Crowley|
|Wednesday May 22||Renal||Dr. Butterly|
|Tuesday May 28||Neurology||Dr. Skeen|
|Wednesday June 5||Dermatology/Rheumatology||Dr. Criscione|
|Tuesday June 11||Mixed Bag (Medical ethics, Palliative Medicine, Psych)||Dr. Zaas, Chiefs|
Upcoming Dates and Events
- April 17: Smith Society “Meet and Greet”
- April 19: Residency Program Pictures (rain date May 24)
- April 25: Ronald McDonald House Dinner (Warren Society)
- April 28: 2nd Annual Stead Tread
- May 1: Annual Resident/Faculty BB Game
- May 24: Chief Grand Rounds – Jason Webb, MD
- May 31: Chief Grand Rounds – George Cheely, MD
- June 4: Resident Research Conference, Searle Center
- June 7: Chief Grand Rounds – Nicole Greyshock, MD
- June 8: SAR Dinner, Hope Valley Country Club
- June 14: Chief Grand Rounds – Ryan Schulteis, MD
- June 21: Chief Grand Rounds – Jeffrey Clarke, MD
- April 2013 Resp Fit Testing-T-Dap-TB Skin Testing Flyer
- 2013 Life Support Offerings – January – June
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.
- Department of Medicine