Weekly Updates: April 22, 2013

Sunday, April 21, 2013

From the Director

Hi everyone! Thanks for getting us to the magic > 70% rate on the ACGME survey! Much appreciated. There's still time if you haven't filled it out yet - it's open until April 28th.  Also, if you didn't hear Dr Neelon's grand rounds on burnout (and how to avoid it!), listen to it on medhub. Really well done.

Lots of compliments came my way this week - from the DOC to Eric Chu, Armando Bedoya, Lindsay Boole and Nick Rohrhoff for helping colleagues and great patient care. To Tom Holland for keeping it fun on gen med and supporting America and the wardrobe of his team - nice shirts JoeBro and Jason Rose. Also to Zach Healy for gold star worthy patient care and to Krishn Sharma for teaching while on cards consults.

We had our first how to be a JAR session, with help from the chiefs, as well as current Jars Lindsay Boole, Carter Davis, Armando Bedoya, Tim Mercer and Kevin Shah. Also thanks to Rob Harrison and Cory Miller for running the code simulation.  Also thanks to Susanna Naggie, Tom Owens and the Smith Society for hosting a meet the professor on Wednesday. Great attendance for what was an excellent conversation.

Get ready for the Stead Tread next week! Dr Klotman is making a donation in the name of the Stead Society with the most participants .... Another great reason to support a fantastic event.  Don't pull a hammie on the 5k bc we've got the housestaff - faculty bball game coming up as well!

Have a great week


Pubmed for this week goes to Marianna Papademetriou!   Biliary sarcoidosis: early diagnosis minimizes the need for surgery.  Buxbaum J, Papademetriou M, Klipfel N, Selby R, Fong TL, Sharma O. Am J Respir Crit Care Med. 2013 Mar 1;187(5):556-9.

Have a great week


QI Corner (submitted by Jon Bae, MD)

Please join us for our next Quality Improvement and Patient Safety Noon Conference

  • When:  Wednesday, April 24, NOON
  • Who: Melissa King as well as George and Ryan w/QI Updates!
  • What: Safety Reporting Systems!


What Did I Read This Week

(submitted by Sarah Rivelli, MD)

In-facility delirium prevention programs as a patient safety strategy:  a systematic review.  Reston, JT; Schoelles KM., Ann Intern Med 2013;158:375-380.


Background:  Delirium is a common occurrence among hospitalized patients with negative impact on morbidity and mortality even after adjusting for things like clinical severity and age.  It is associated with longer LOS, both functional and cognitive decline, and higher short and long-term health care costs. In fact, delirium was the discharge diagnosis for about 25% of all discharges from 8100 and 8300 over a three year period.  As many of you know, once delirium occurs, we struggle to find reversible causes that might improve the clinical course.  Moreover, there is certainly no pharmacologic panacea to treat delirium.   This article reviews multicomponent prevention strategies that target multiple known modifiable risk factors for delirium.

Methods:  The authors performed a systematic review of multicomponent interventions for delirium prevention and found 19 studies that carefully evaluated the incidence of delirium and compared it with a control group, 17 were in the hospital setting.  Because of variability across studies in their design, including different interventions, a meta-analysis was not performed.  One study was in a nursing home and one was in a palliative care setting.

Intervention:  The common components of the multicomponent interventions are based on known risk factors.  The interventions studied tended to include some or all of the following:

  • Anesthesia protocols
  • Assessment of bowel/bladder functions
  • Early mobilization
  • Extra nutrition
  • Geriatric consultation
  • Hydration
  • Medication review
  • Pain management
  • Prevention and treatment of medical complications
  • Sleep enhancement
  • Staff education
  • Supplemental oxygen
  • Therapeutic cognitive activities/orientation
  • Vision and hearing protocols

All of the interventions were comprised of multidisciplinary teamwork that included members such as physicians, nurses, physical and/or recreational therapists.  Studies often described in fairly general terms the training required for staff members.  Less common was evidence of monitoring for adherence to the intervention, the impact of such adherence and ongoing efforts to maintain compliance to the intervention.   Finally, the most substantial threat to validity was the risk of bias present in most studies due to lack of randomization and blinding.

Comment: Multicomponent interventions to prevent the onset of delirium in the hospital appear to be effective, though the risk of bias in these studies is at least moderate given the lack of randomization and blinding.  Staff might tend to rate patients participating in the trial as less delirious given their belief that their intervention is effective, leading to false positive results. moreover, the heterogeneity across studies limits conclusions - we don’t yet know which components lead to the most benefit.  More direct comparison of the elements of the interventions and how to implement them might lead to a more standardized approach to delirium prevention in the hospital.


From the Chief Residents

Grand Rounds

Date                     Speaker             Topic             

April 26, 2013    Dr. Pisetsky      SLE Serology

Noon Conference

Day Date Topic Lecturer Vendor
Monday 4/22 Head & Neck Cancer Dr. Ready Jersey Mike's
Tuesday 4/23 Inflammatory   myopathies Irene Whitt Moe's
Wednesday 4/24 QI/Patient Safety   Conference Jon Bae Saladelia
Thursday 4/25 SAR talks Philip Lehman Bullock's BBQ
Friday 4/26 Medicine Research   Conference Chiefs Panera



From the Residency Office

ACGME Resident Survey

This is the last week to complete the survey.  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

Maestro Training and Retirement of E-Bowser Scheduled

All Internal Medicine Residents who need Maestro Inpatient Training have been scheduled for it in  Wave 4 – For most, this will mean two 4-hour sessions (IP MC 400 & 500).  Your schedule in Amion has been updated to show when your training will be.  PLEASE ALSO USE THE LINK BELOW (YOU SIGN IN USING YOUR DUKE NET ID AND NET ID PASSWORD) TO DOUBLE-CHECK YOUR TRAINING DATE, START TIME AND LOCATION!


If you have any questions or concerns, please feel free to contact Jen Averitt in the MedRes office 919-681-4510”

The plans for retiring legacy systems, including E-Browser, have also been announced.  Please refer to the following attachment for the details:   Retirement of Ebrowser Begins

Ronald McDonald House Dinner

  • When:  Thursday, April 25
  • Where:  Ronald McDonald house on Alexander Avenue 2 minutes from the hospital (see directions below)
  • What:  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 steven.d.crowley@duke.edu.

Stead Tread 2012

Time to taper - this is the week !

  • -  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


violinVOICES IN MEDICINE!! Our program's annual Humanities in Medicine event for the year

We invite you to participate in a Voices of Medicine program for the Talk Story narrative variety show, featuring the stories, poetry, music and other artistic outlets of physicians and housestaff in the images pianoDepartment of Medicine. Come join in a unique and fun opportunity to share your outlets of creativity and see who each other are outside of medicine!

  •  Date: Wednesday, May 15th, 2013
  • Time: Doors open at 7:00pm, Event Starts at 7:30pm
  • Location: Casbah, 1007 West Main Street, Durham, NC 27701

Please email Erin Payne at erin.payne@duke.edu if you are interested in participating by Friday, April 26th. For questions, feel free to contact Jason Webb, Juliessa Pavon, Anton Zuiker, or Erin Payne.

Please note: Jeff Polish from the Monti organization will be providing professional storytelling coaching for those who are interested in sharing a story. Jeff has a PhD in genetics from Washington University in St. Louis. This is a great opportunity to help bring your story to life!

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:

Date Topic Faculty  
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

Contact Information/Opportunities


Upcoming Dates and Events

  • April 25:  Ronald McDonald House Dinner (Warren Society)
  • April 28:  2nd Annual Stead Tread
  • May 1:  Annual Resident/Faculty BB Game
  • May 14/15:  Conflict Management Workshop     Register for the morning session, 7-9 am     Register for the afternoon session, 4-6 pm
  • May 15:  Voices of Medicine /  Humanities in Medicine
  • 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

Useful links