Internal Medicine Residency News: February 10, 2014

By admin3

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi Everyone! Congrats interns on finishing a long post-holiday block! The days are getting a bit longer, and hopefully it will get a bit warmer soon, too.  There are a lot of exciting things happening in the program in the next few months, so please take a look at the important dates posted at the bottom of Med Res News!  This week, we have the first "Fellowship Information" meeting on Feb 12 in the Med Res Library as well as the Duke-Carolina game at Tyler's, sponsored by the Duke Med Alumni association.  The "Fellowship Information" meeting is for rising SARs thinking about applying to fellowship this summer, as well as current SARs who deferred fellowship plans this year.  Looking forward to seeing you there. We had another successful week of the new and improved noon conference! On MKSAP Monday, we proved that we know more about anticoagulation than we do about rheumatology, we heard fantastic global health themed SAR talks from Lindsay Boole and Scharles Konadu, a great review of the novel oral anticoagulants from Krish, and solved some challenging outpatient anticoagulation cases with our DOC pharmacists Shannon and Ben.   We finished the week with a great Chair's Conference presented by Carling Ursem!  A belated congratulations to Rebecca Sadun and Shaliesh Balasubramanian on great SAR talks last week as well. Thanks Lynn Bowlby and the DOC team for a great visit to the DOC this week.  It was great to see the precepting process, talk with the residents and staff and also bump into  Sonal Patel from VA PRIME who was visiting the DOC to learn about some of the best practices that happen there. Congratulations to our 2014-15 Assistant Chief Residents! 
  • Duke:  Carli Lehr, Angela Lowenstern, Alyson McGhan, Kevin Trulock,  Sneha Vakamudi, and John Wagener 
  • VA:  Adam Banks, Katie Broderick-Fosgren, Tim Mercer, Nick Rohrhoff, Iris Vance, and Mike Woodworth 
  • Duke Regional: Adrienne Belasco, Christine Bestvina, Erin Boehm, Claire Kappa, Venu Reddy, and Aparna Swaminathan
Other kudos this week go to Dinushika Mohogitte from her VA JAR Carli Lehr for her great work on VA Gen Med and to Duke ACR Lindsay Boole and the recent Duke night residents from the Duke ED attendings for a stellar job managing 1010 during a very very busy month.   Also another thanks to ED Program Director Josh Broder for arranging ULTRASOUND SIM TRAINING for our residents when they rotate through the ED.  This is a fantastic opportunity to learn ultrasound technique.  You will receive an email prior to your ED rotation telling you how to sign up.  Did you already have ED this year and want to do BryanULTRASOUND SIM TRAINING? Please contact me and we will work with you to find a time to train. Welcome to the newest member of the Duke Family….Jason Daryl Bryan, born on Feb 7th!  Congratulations to the Bryan Family We have hit the magic "70%" mark for the ACGME survey.  Thank you to everyone who filled it out so far. This is great, but last year we got to 84%.  If you have not done your survey yet, please take 10 minutes to complete your survey.  Ideally, we would get 100% participation….if that doesn't happen, let's at least match last year! SARs are in the lead for the most participants.  The survey closes on FEB 16.   This week's pubmed from the program goes to Hany Elmariah!  Hany is one of 11 residents in the United States who is a recipient of the 2013 American Society of Hematology HONORS (Hematology Opportunities for the Next Generation of Research Scientists) Award .  This is Hany’s ASH HONORS project. Mentor: Marilyn Telen, MD;  American Journal of Hematology 2014 Jan 30. doi: 10.1002/ajh.23683. Factors Associated with Survival in a Contemporary Adult Sickle Cell Disease Cohort  Elmariah H, Garrett ME, De Castro LM, Jonassaint J, Ataga KI, Eckman J, Ashley-Koch AE, Telen MJ. Have a great week, and GO DUKE! Aimee

QI Corner (submitted by Joel Boggan)

Hand Hygiene 8th Floor Cultures Thanks to our fantastic Gen Med teams who allowed us to culture the implements we use to do our every day work.  Just to bring out a highlight, you can see two of my favorite pictures from the wards, along with a late push on day 2 from a foam dispenser on 8300 to grow the grossest stuff imaginable.  We will have updates from our Micro lab this week on what sort of bacteria we picked up, as well as a winner (by Wednesday) of the cleanest / dirtiest item on the ward. Candidate 1Candidate 7Foam Day 2 QI Conference Our next High-Value Cost-Conscious care lecture will be on 2/20.  We are also planning on leading a resident M&M format on 2/19, so stay tuned for more details and make a special effort to join us! Save the Dates Please plan to stop by and see your fellow residents' work at the Duke 9th Annual Patient Safety and Quality Conference on 3/13/14.  Location and time of poster sessions will be determined soon! Next PSQC meeting This coming Wednesday, 2/12, at 5:30 in the Med Res Library, we will be having our February meeting of the Patient Safety and Quality Council.  Please RSVP if you're able to make it so I can order enough food, otherwise please feel free to show up last minute!   [box]

What Did I Read This Week?

"Submitted by Joel Boggan, MD."

Are Physicians Aware of Which of their Patients Have Indwelling Urinary Catheters?

Sanjay Saint et al.  Am J Med.  2000.  109: 476-480.

[/box] I read this older article this past week after joining a Durham VA team serving as part of a VA national collaborative to reduce catheter-associated urinary tract infections (CA-UTIs).  This topic was a big focus at Duke Hospital last year, and we will be working on reducing the number of catheters over at the VA over the next several months.  The collaborative is being led by thefirst author of this study, who performed this study back in 2000 after previous literature had shown almost ¼ of urinary catheters to have been inappropriate by accepted indication, and that these inappropriately placed catheters accounted for up to ½ of patient catheter-days. The authors’ hypothesis was that physician team unawareness of the presence of catheters led to these inappropriate catheters being left in place, and that catheters of which physicians were aware would be more likely to be appropriate. Methods:  Over an eight-month period, students and physicians at 4 teaching hospitals intermittently were asked a series of questions (usually once monthly) about the presence of urinary catheters in patients for whom they were responsible.  They were all allowed to use whatever documentation they had with them (cards, lists, etc) to answer the questions, but they were not allowed to use records or examinations at the time they were asked.  The authors then compared the student and physician responses to the actual presence or absence of a catheter corresponding to the time frame in which the provider was asked.  To assess the appropriateness of catheterization in patients with catheters, the researchers then determined if the catheter was in place for one of five situations deemed appropriate. [caption id="attachment_12759" align="alignright" width="175"]Joel Boggan, MD, MPH Joel Boggan, MD, MPH[/caption] Results:  256 providers responded to the survey over the study period, including 76 students, 72 interns, 59 residents, and 49 attendings.  25% of observed patients had an indwelling catheter, of which providers were unaware 28% of the time.  Students were the most likely to know about catheters in patients they were following (21% unaware), while attendings were least aware (38% unaware).  Respondents were correct 96% of the time about patients without an indwelling catheter.  The only significant factor in logistic regression predicting unawareness of the catheter was the number of patients being taken care of by a team at the time of survey.  31% of catheters were in place inappropriately by their criteria, and inappropriate catheters were much less likely to be known to be in place by the primary team (21% unaware for appropriate vs 41% for inappropriate, p<0.001). What does it mean?  Overall, providers had substantial lack of knowledge about indwelling catheters in their patients, particularly if the reason for the catheter being in place was not one typically considered ‘appropriate’.  This, again, is an older study, and the landscape around CA-UTIs, in particular, has changed significantly in the past fourteen years.  Hospitals (and payors) track these rates of infection much more closely, and institutions have emphasized putting this information in front of providers, especially hospitalists.  As a result, I would expect that 1) the overall use of catheters has been reduced and 2) that providers are more aware of ones that are present.  Of course, I don’t know if that is true.  So, for our housestaff, don’t be surprised if I come bug you the next time you’re rounding at the VA to ask similar questions . . . and, in the meantime, if you haven’t made presence of/need for a catheter part of your daily rounds, please do!

"Clinic Corner" - Pickett Road210_RubinSharon

Hello from Pickett Road. You missed all the commotion yesterday when a transformer blew and the clinic had to close for the morning. This closed off the power for most of the block! Fortunately the power came back on and we are operating as normal. Lets hope we survive 6 more weeks of winter. We are into our 3/6 week of the Pickett Road Weight Loss Challenge. Doctors, CMA LPN, RNAs, MA and front desk are participating. The pot is over $130 at this point. Encourage our staff to stay strong and healthy! Please welcome the newest members of our team:  HCA Lisa janeLowe, Jane De Jesus Interim Nurse Manager and CMA Joanne.lisa Miles brought up and issue on call this last week. He was getting calls for General Internal 20140204_093959medicine. Residents at Pickett Road are only responsble for patients at Pickett Road, not the peds, or DOC or General Internal medicine. If there are issues please let your attending on call that week know and also tell the telecom that those patients need to be triaged to the appropriate practice. Glenn has worked on the templates for the SARS, there should be no new patients on your schedule. Now is the time for SARS to let your patients know you are leaving in June. Closer to March, April you may want to assign your more difficult patients to a rising intern or Jar (let the Intern or Jar know and reassign PCP). I have not yet gotten any emails for the Pickett Roads three committees. We have PIPS (work on patient safety), Patient satisfaction and work culture. This is NEW here at Pickett which we have implemented in the last few months. The challenge is getting here for the meetings. The PIPS and Patient Satisfaction committee meets the first Wednesday of the month from 7:30-8:20am and the Work Culture meets the 3rd Wednesday of the month from 7:30 - 8:20am. If you are interested please let me know. This is your clinic and if you have ideas to make things better we would be glad to have your input. EPIC : try to get your patients signed up for my chart,  including:
  • There are many smart phrases starting with .myc
  • There are instructions, the phone number to call, the website etc
  • You can put this in the Patient instructions
Thanks to Nina and Miles for bringing this to my attention. YES there is a problem with Medicare patients and Diabetic supplies. Residents are not signed up for Provider Enrollment Chain Ownership System (PECOS). I have brought this to the ambulatory leadership and we are trying to figure out the best way to get ALL residents enrolled. More to come later. And lastly our Maestro Updates from Lisa Nadler  incoude the following:
  • They are in the Enc tab in Chart review, listed by date (Patient email)
  • Go to the Misc reports tab in Chart Review and look at My Chart Pt Msg review report
  • Under more Activities in a patient encounter go to My Chart Utilities->Pt Message review. If you want it to live out on the Activity list as seen below, click the yellow star.
 

From the Chief Residents

SAR Talks

February 4, 2013: Jim Gentry;  Bobby Aertker

Grand Rounds

Dr. Tim McMahon – Pulmonary/Critical Care

Noon Conference

Date Topic Lecturer Time Vendor Room
2/10 MKSAP Mondays - GI Chiefs 12:00 Chick-Fil-A 2002
2/11 SAR TALKS Jim Gentry / Bobby Aertker 12:00 Pita Pit 2002
2/12 MSK Exam Part 2/ Difficult Death Debrief Irene Whitt & Lisa Criscione / Galanos 12:00 Cosmic Cantina 2002/ Med Res Lib
2/13 "What about my future?  Do I know what money is?" Galanos 12:00 Sushi 2001
2/14 Chair's Conference Chiefs 12:00 Domino's/ Treat 2002
   

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DukeMed Triangle Hoops Watch

Join local DukeMed alumni from the classes of 2004-13, current and recent house staff

to cheer the Blue Devils on to victory over our Tar Heel neighbors!

Duke Blue Devils vs. UNC Tar Heels

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Wednesday, February 12  |  8:30 pm Tyler's Taproom 324 Blackwell St Durham, NC 27701 (919) 433-0345

Complimentary appetizers and one drink ticket per person provided.

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From the Residency Office

SAR Class Pictures

This week - Friday, February 14th immediately after Grand Rounds.  The group picture will be taken at 9:15am in the Duke Cancer Institute healing path (the lobby)  

BLS BLITZ - Registration Open NOW

Each participant must register for the BLS session they prefer to attend, provided the class has open slots. If the session is full, please choose another session. Being on a wait list does NOT confirm registration.

Scheduled Class Times:

March 17 - 20, 2014

8am – 10am, 10am – 12pm, 1pm – 3pm, 3pm – 5pm, 5pm – 7pm

Additional sessions on March 17 & 19, 2014 will be held at  7 pm – 9 pm.

Friday March 21, 2014

Sessions at 8am - 10am and 10am - 12pm only

Location: Hock Plaza, Suite G07

To register:   Go to Swank (https://duke.swankhealth.com)

   Details:   BLS Blitz 3-2014  

Diabetes Management and Technology Research Study (submitted by Emily Garber)

The main reason we are writing today is to see if any residents are interested in helping us with our upcoming clinical trial! The trial period itself will likely be from late-April through late-June of this year. à  We are looking for 1 primary resident to help with study design and coordination, which will be a paid / stipend-based position. Hopefully this person would be available starting sometime in February and able to commit to involvement at least through June of 2014. à  We are also looking for additional med students and residents who are interested in supporting our clinical trial in some way, whether it be with the study-design & recruiting between now and April, or during the actual 2-month trial period with data collection support, or after the data is in to support paper-writing and submission to professional Journals. We need all kinds of personnel! A stipend will be available for these individuals as well as a small token of our appreciation. Please let me know if you have an interest in participating in some capacity with our study, along with a brief statement about what intrigues you most about the project. This is a fabulous opportunity to learn about proper study-design and protocols, as you will be working with Dr. Lillian Lien (from adult Endo) and Dr. Robert Benjamin (from peds Endo) with the chance to receive mentorship from people experienced in clinical trial development. This would also be a great way to get involved in QI research as part of your experience here at Duke. Thanks for considering, and I look forward to hearing from you! Warm regards,  Emily emily.garber@duke.edu  

Faculty Resident Research Grant applications are due on April 11, 2014.

Please use the following link to our website where the application instructions, forms and NIH format biosketch example can be downloaded . http://residency.medicine.duke.edu/duke-program/resident-research/research-funding Please feel free to email murat.arcasoy@dm.duke.edu with any questions  

"How to Review a Scientific Paper" Workshops

The "How to Review a Scientific Paper" workshops summarize the peer review process, describe the elements of a high quality review and identify common errors made by authors that are missed by reviewers. Dr. Lee will be offering two workshops this Spring for interested trainees –
  • March 27th 12noon – 1:30pm
  • June 12th 12noon – 1:30pm
Each workshop is limited to 6-8 trainees. Participants are required to complete and submit a review of a mock manuscript 2-3 weeks prior to the workshop. Reviews will be scored and provided with individualized feedback (reviews will be anonymized before instructor review and grading). During the workshop, participants will review the steps of the peer review process, identify the essential components of a high quality review, and discuss commonly missed author errors. These workshops are intended to provide trainees with critical appraisal skills and dedicated instruction on the process of reviewing a scientific manuscript. Gaining reviewer experience and knowledge can help trainees gain opportunities to serve as peer reviewers, which can be an impressive addition to their CV. Please fuse the registration link below if interested. https://www.surveymonkey.com/s/PeerReviewWorkshop If you have any questions or concerns, please feel free to email mariah.rudd@duke.edu.  

Resident/Fellow Survey Instructions - LAST WEEK

Duke University Hospital Program - 1403621320 Survey Timeframe: January 13, 2014 - February 16, 2014 Directions as to how to log in, complete the survey can be found on the following attachment:   ACGME Survey

Information/Opportunities

 

Upcoming Dates and Events

  • Friday, February 14th :  SAR Class Pictures -  immediately after Grand Rounds
  • March 21:  Match Day CELEBRATION !!
  • March 22:   Gastrointestinal Cancers Program 1st Annual 5K Run/Walk   DukeCRC5K.org
  • April 11:  Fiknal Faculty Resident Research Grant applications
  • April 18:  Charity Auction
  • May 3:  the Stead Tread 5K
  • May 30:  Annual Resident Reseach Conference
  • Date to be confirmed:  SAR Dinner, Hope Valley CC

Useful links

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