Internal Medicine Residency News: December 30, 2013

By admin3

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hello! "It's the last Medicine Residents News (the blog formerly known as Weekly Updates) for 2013! To all that enjoyed the first part of the holiday block with their families, welcome back! To those who are now enjoying the holiday block vacation, thanks for your work over Christmas.  The first half of this year has gone incredibly quickly, and I want to thank you all once again for your hard work, and for making this the best residency program/residency family anywhere! A special thanks to your families and loved ones for supporting you during residency.  Here's to an equally fantastic 2014! Kudos this week goes to the VA crew from Vaishali for their hard work, to the Duke crew from Krish, Hany and I and to the DRH crew as well! Thanks to our ACRs Hany Elmariah, Meredith Clement and Chris Hostler! Welcome to our new ACRs Lindsay Boole, Mandar Aras and Carter Davis.  Thank you to Dr. Klotman for the outstanding Foster's Xmas dinner and to Dr. Kussin for underwriting the Christmas Day Chinese extravaganza.  For the especially brave, there are still leftovers in the ACR refrigerator. Please remember to send in your 2014-15 schedule requests to the chiefs.  Any questions, please let either the chiefs or I know.  Recruitment begins again in full force on Monday January 6th.  We look forward to seeing you all at the dinners and lunches with the applicants.  For SARs, please remember to register for the ABIM exam and avoid paying any more than it already costs by incurring a late registration fee. Congratulations to Jonathan and Ashley Hansen on the birth of their beautiful baby girl! She has the special honor of being the first baby born to the intern class this year. This week's pubmed from the program goes to John Wagener and Marc Samsky. Their landmark article was published just yesterday in "Duke Outlook Email". Again, I wish you and your families a very merry Christmas and the happiest and healthiest of New Years." Aimee [box]

What Did I Read This Week?

"Submitted by Aimee Zaas, MD“

The survival time of chocolates on hospital wards: covert observational study

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f7198 (Published 14 December 2013) BMJ 2013;347:f7198

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Why did I read this:  Have you seen the amount of food available on the wards in December? This is a highly relevant study, although, as the authors point out, the results might be very different if conducted after New Year's when resolutions are in full effect. What did the authors do: They were curious as to what the consumption pattern of chocolates was on a hospital ward, as observational data suggests that the survival time of a chocolate in a hospital setting is quite low.  They compared the survival of two brands of chocolates (Nestle and Roses) and also the variance of consumption between different types of healthcare providers (nurse, assistant, MD).  Once chocolates were placed on a ward, a covert observer recorded: 1)time to box opening and 2) survival time of chocolates (primary outcome variable) as well as type of provider eating the chocolate.  A literature search did not reveal any data on which to base a power calculation, so their expert opinion based on years of working over Christmas on a hospital ward provided the following calculations: No previous studies were available on which we could base power calculations. We estimated that a total of 210 chocolates would be needed to provide 80% power (P<0.05, two sided) to detect a 50% change in the hazard ratio between groups (Quality Street and Roses), assuming a median survival of 60 minutes for an individual chocolate, and follow-up of four hours maximum.2 Assuming a 350 g box of chocolates contained 30 chocolates (based on pilot data), we estimated that we would need eight boxes, totally around 240 chocolates. Chocolates left after the observation period were considered lost to follow up. What did they find:  The mean time taken for a box of chocolates to be opened after being placed on the ward was 12 minutes (95% confidence interval 0 to 24). The time to opening of Quality Street and Roses boxes did not differ significantly (19 v 5 minutes, 95% confidence interval for difference -19 to 46 minutes, P=0.35). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Rosesv Quality Street 0.70, 95% confidence interval 0.53 to 0.93, P=0.014, fig 1?). They also found that nurses and healthcare assistants ate more  chocolates than MDs, however this calculation is biased due to the larger total number of nurses and healthcare assistants involved in the study.  How should I interpret the results? DO they apply to our wards?  These results are likely generalizable across the pond. While we do not have Roses candy generally available, it is likely that any box of quality chocolates would have a similarly short survival time on the wards here or in a US hospital.   In fact, this study could be easily repeated by Lauren or Lindsay, noting an extremely short survival time of any food put into the residency office food basket.  A priori, I predict that fruit snacks have a survival time on the order of minutes despite having a shelf life of likely > 1000 years. Happy holidays!  Check out the remainder of the Xmas BMJ at www.bmj.com for classics like "Was James Bond's shaken martini due to alcohol induced DTs?"  

From the Chief Residents

SAR Talks

SAR talks resume January 9th, 2014

Grand Rounds

Grand rounds resumes January 10th, 2014

Noon Conference

Noon conference resumes on January 8th with the first Schwartz Rounds of the new year

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