Internal Medicine Residency News, August 8, 2016

From the Director

Hope everyone had a great weekend.  I’m thinking we need a little Duke IM Olympics – page-answering relays by the chiefs in noon conference? Erwin Road crossing relay by VA Gen Med teams? Burrito power lifting at lunch? Speed MKSAP? Ok, getting a little ridiculous, but at least the page answering relay? C’mon …

Thanks to everyone who was able to make it to our Intern, JAR and SAR town halls with Dr. Klotman. She really enjoys hearing from you, and she will bring your thoughts and suggestions to me and the rest of the APDs. Also, I hear the SARs and Chiefs had a fun night at Ponysaurus on Thursday. I hear the challenge is on for the JARs and interns to have an even bigger turnout.  I’m also looking forward to our monthly JAR dinner this week at the Little Dipper—JARs, send any restaurant suggestions to Madi for September’s dinner!

The MedHub interview request process seems to be working well. We are trying for pretty rapid turnaround—let Lynsey or me know if you aren’t seeing the replies to your request show up in your MedHub account. For other schedule requests, the next set of Scheduling Committee replies should be out early this week. And, please fill out your bio for the website and the faculty information sheets if you haven’t already done so.

Kudos this week go out to Murat Arcasoy for planning physical exam week, as well as our ACRs Zach Wegermann, Kara Wegermann and Taylor Bazemore for the pre-conference pearls. Also to Mike Powers and Phil Liu for being the physical exam “guinea pigs.” Also a thanks to Bryan Kraft, who was seen using the glass windows in the MICU as a “white board” for pre-rounds chalk talks!

Congratulations to the Intern Class Residency Council Reps: Todd Brophy, Matt Labriola, Talisha Ramchal, Daniel Turner and Toi Spates. Looking forward to working with you!

Congratulations also to Sam Lindner, who has been selected to serve as the Durham VA Medical Center chief resident for quality improvement and patient safety for 2017-18. Read more about Sam and the CRQS role.

Keep sending me kudos for your colleagues! 

This week’s PubMed from the program goes to Wynn Hunter for his article published in the Journal of the American Heart Association: Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure. Great work, Wynn!

Have a great week,

Aimee

What did I read this week?

Contributed by Adam Banks, MD

Elkayam U, Goland S, et al. High-Risk Cardiac Disease in Pregnancy. J Am Coll Cardiol. 2016; 68 (4): 396-410. Doi: 10.1016/j.jacc.2016.05.048.

This is obviously a highly specialized topic, but as survival rates continue to improve in complex congenital heart disease, valvular disease, and cardiomyopathy the frequency of seeing these patients in primary care will continue to increase. In fact, at this point there are more adults than children living with complex congenital heart disease (CHD). As an internist, or even general cardiologist, you likely will not manage these patients without a sub-specialist. However, it is important to identify women with cardiac disease that would be high-risk pregnancies so they can be counseled on contraception to prevent morbidity and mortality in pregnancy.

The main takeaways from this article are:

Normal cardiac physiologic changes of pregnancy that lead to increased cardiac output (see Figure 1)

  • Increased plasma volume out of proportion to increase in red blood cell mass
  • Increased Pre-Load
  • Increased cardiac contractility and stroke volume
  • Increased heart rate
  • Decreased peripheral vascular resistance

Which cardiac patients are at high-risk in pregnancy? There are essentially 5 categories of patients that are classified as high risk listed below (see Figure 2). Of note regurgitant lesions are generally well tolerated in pregnancy.

  • Obstructive lesions (Aortic stenosis, Mitral stenosis, HOCM)
  • Pulmonary arterial hypertension
  • Aortopathy (Marfan’s, Ehler-Danlos, Bicuspid Aortic Valve, etc. )
  • Cyanotic congenital heart disease
  • Peripartum cardiomyopathy or pre-existing dilated cardiomyopathy​

Drugs during pregnancy:

  • Beta-blockers- category C
  • Calcium-Channel Blockers – category C
  • ACE Inhibitors/ARBs – category C
  • Statins – category X
  • Aspirin – safe at low doses (<150mg) should not be used over this dose
  • Clopidogrel – Category B

Physiologic changes at time of delivery. (First resident to read this far and contact me by e-mail gets a free 6-pack of their favorite “soda”)

  • Oxygen consumption increases 3-4 fold
  • Increase in both systolic/diastolic BP (increase afterload)
  • Immediately after delivery uterus contracts with relief of caval pressure and shift of blood from uterus back into systemic circulation causing abrupt increase in pre-load.

From the Chief Residents

Morning Report and MGR: August 8-12, 2016
Date Topic Lecturer Time Location
8/8/16

Smoking Cessation

Alex Cho

 7:15 a.m. DUH 8253
8/9/16

Pickett Morning Report: Chronic Pain

Larry Greenblatt

 7:30 a.m.

3024 Pickett Rd.
8/10/16

Robert's case

Diana McNeill

 7:15 a.m. DUH 8253
8/11/16

COPD

Coral Giovacchini 

 7:15 a.m. DUH 8253
8/12/16

Medicine Grand Rounds: "So, a pregnant woman walks into my office…”

Megan Clowse, MD
Associate Professor of Medicine
Rheumatology and Immunology

 8:00 a.m. DUH 2002

 

Noon Conference: August 8-12, 2016
Date Topic Lecturer Time Location Lunch
8/8/16

MKSAP Renal

Aparna Swaminathan

 12:00 p.m. DUH 2002 Domino's
8/9/16

SAR Lecture Series: Acute Renal Failure

Pascale Khairallah

 12:00 p.m. DUH 2002 Mediterra
8/10/16

Renal physiology, edema/diuretics

John Roberts

 12:00 p.m. DUH 2002 Cosmic Cantina
8/11/16

Wellness

 

 12:00 p.m. DUH 2001 ChickFilA
8/12/16

Chair's Conference

Daniel Maselli

 12:00 p.m. DUH 2002 Firehouse Subs

From the Residency Office

Have You Logged Your Duty Hours??

With the start of the 2016-17 academic year, the residency program is asking all house staff to log their duty hours on a daily basis.  This will allow us even closer oversight of duty hour compliance across the program.  In order to use the MedHub mobile Duty Hour app, you will need to know your actual MedHub log in as it will not accept your NetID/password log in.  If you have forgotten you main log in, please go to the main MedHub site, and select "Forgot my password."  You will then be able to re-set it via email.  Lynsey Michnowicz will be sending reminders each Wednesday to those who have not yet logged their duty hours for the week.  Thank you in advance for your attention to this task!

 

Office hours for program leaders

Dr. Zaas will have the following office hours. Please feel free to stop by during these times and of course always feel free to reach out to her office to set up a meeting outside of these times if needed!

  • Mon., Aug. 8 from 3:00 p.m. to 4:00 p.m.
  • Thurs., Aug. 11 from 10:00 a.m. to 11:00 a.m.

The APDs also want to make themselves more available to you. We will post their weekly availability & we hope you take advantage!

  • Dave Butterly: Fri., Aug. 12 from 2:00 p.m. to 3:00 pm in DN 8291
  • Lish Clark: Thurs., Aug. 11 from 2:00 p.m. to 4:00 pm in the extra cubby space of the Med Res Office

Please note that the other APDs will be offering hours in the future. With their complex schedules, the timing & day might vary from week to week. Stay tuned!

 

Attend the 2016 Annual Kidney Week Meeting for Free

Any Duke Resident interested in pursuing a nephrology fellowship is invited to attend the annual American Society of Nephrology Kidney Week Meeting (at Chicago, IL from Nov 15-20). Airfare and lodging expenses will be covered by the Division of Nephrology. This is the 50th anniversary for ASN. Duke will also host a reception at the event as well. If interested, contact Matt Sparks (matthew.sparks@duke.edu) for more details.

“More than 13,000 other kidney professionals from across the globe will attend Kidney Week 2016 in Chicago, IL. The world's premier nephrology meeting, Kidney Week provides participants exciting and challenging opportunities to exchange knowledge, learn the latest scientific and medical advances, and listen to engaging and provocative discussions with leading experts in the field.”

 

Global Health-Internal Medicine Residency Program recruiting eligible candidates

Internal Medicine Residents who have successfully completed PGY1 are eligible to apply for the Duke Global Health Pathway for Residents and Fellows, an extended residency that leads to a Master of Science in Global Health and a total of nine months providing clinical care and conducting mentored research at a Duke University international partner site. Visit www.dukeglobalhealth.org for an in-depth description of the core curriculum including sites, global health competencies, and program requirements as well as application instructions. Watch past global health internal medicine resident John Stanifer discuss his decision to pursue global health training at Duke here. Applications will be accepted on a rolling basis until Sept. 1, 2016. 

 

Next Book Club Event

Welcome to the new academic year, and a particularly warm welcome to our new interns!  We're excited to announce that the Duke Internal Medicine book club is back!  Our first event will be on Thursday, August 18th from 5:30 - 7:30 pm in the Searle Center Faculty Lounge.  At the request of the residents (that's you!), our structure is changing a bit. This time we'll be reading All the Light We Cannot See by Anthony Doerr, a NYT best seller and winner of the 2015 Pulitzer Prize for Fiction.  Books are available at most local book stores or online.  Snacks and drinks will be provided. If you're interested in attending, or if you have any questions, please RSVP to me at laura.caputo@duke.edu.  We're looking forward to seeing you there!

 

Opportunities for Wellness

Feeling down? Need to talk to someone? 

All trainees at Duke have FREE access to Personal Assistance Services (PAS), which is the faculty/employee assistance program of Duke University. The staff of licensed professionals offer confidential assessment, short-term counseling, and referrals to help resolve a range of personal, work, and family problems. PAS services are available free of charge to Duke faculty and staff, and their immediate family members. An appointment to meet with a PAS counselor may be arranged by calling the PAS office at 919-416-1PAS (919-416-1727), Monday through Friday between 8:00 A.M. and 5:00 P.M. For assistance after hours, residents and fellows can call the Blood and Body Fluid Hotline (115 inside DUH, 919-684-1115 outside) for referral to behavioral health resources. Another resource is Duke Outpatient Psychiatry Referrals at (919) 684-0100 or 1-888-ASK-DUKE. https://www.hr.duke.edu/pas/

Upcoming Dates and Events

  • August 11 - Chief Happy Hour w/ JARs - Bull McCabe's
  • August 14 - IM Residency Durham Bulls Game (Kerby Society)
  • August 31 - Stead Trivia Night (Warren Society)
  • September 8 - Chief Happy Hour w/ Interns - Hope Valley Brewing
  • October 8 - Stead Tread 5K Fun Run (Kempner Society)

Useful links

Opportunities

 

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