From the Director
And another ‘snow’ day! We are getting pretty good at this by now. Thanks to all for staying on top of the weather updates.
Fun-bruary appears to be going well. (See pics below). Special kudos to Jenn and Chris for their Cupid antics on Friday! Other kudos to SJ Stephens, Jackie Bolwell, Eric Pollak from Jenn Rymer for being her partners in crime for Gen Med and from John Yeatts to his team (AJ Blood, Juan Magana and Lakshmi Krishnan) and to Anne Weaver for chair’s conference. Belated kudos to David Sterken from Dani Zipkin for great care of a patient in clinic as well.
Thank you to all who signed up for dinners with the DIO! The SAR dinner is being rescheduled due to icy conditions today, so stay tuned for a make up date. Thus far, intern and JAR dinners are on as scheduled. Also make your plans for the Duke vs UNC game on Wednesday, hosted by the medical alumni at Tobacco Road.
SARs, don’t forget to register for the boards. Prices are going up, so get your registration in.
This week’s pubmed from the program goes to Ben Peterson, who will be representing at the upcoming Heart Rhythm Society meeting!
Benjamin E. Peterson, MD, Zachary Finn, BS, Zhen Huang, MS, Michael MacKenzie, MS, Karen Chiswell, PhD, Kristen Bova-Campbell, PharmD, Vinayak Venkataraman, MS, Kevin Underhill, BS, Svati H. Shah, MD, Eric Ossmann, MD, Susan Schreffler, MD, Christopher B. Granger, MD, James P. Daubert, MD and Albert Y. Sun, MD. Majority of Out of Hospital Cardiac Arrests Are Preceded by Recent Physician Encounter. Heart Rhythm 2016.
Benjamin E. Peterson, MD, Sean D. Pokorney, MD, Meena Rao, MD, Sana M. Al-Khatib, MD, Brett D. Atwater, MD, Eric D. Velazquez, MD, James P. Daubert, MD, Eric D. Peterson, MD and Tracy Y. Wang, MD. Left Ventricular Function Recovery after Myocardial Infarction. Heart Rhythm 2016.
Benjamin E. Peterson, MD, Sean D. Pokorney, MD, Meena Rao, MD, Sana M. Al-Khatib, MD, Brett D. Atwater, MD, Eric Velazquez, MD, James P. Daubert, MD, Eric D. Peterson, MD and Tracy Y. Wang, MD. Implantable Cardioverter-Defibrillator Use and Reasons for Non-Use Among Patients With Reduced Ejection Fraction after Myocardial Infarction. Heart Rhythm 2016.
Please see the announcements regarding the upcoming specialty meet and greets, the gen med careers meet and greet as well as the IM Book Club.
Have a great week
Aimee
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 among hospitalized patients, with negative impact on morbidity and mortality, even after adjusting for things like illness severity and age. Delirium is an independent risk factor associated with longer ICU and hospital LOS, both functional and cognitive decline, and higher short and long-term health care costs.
When we have looked at delirium at Duke, we also see that it is common and associated with negative outcomes. A group has recently been convened to look at how we can leverage work that is already being done and how we can improve detection, prevention and management of delirium.
As many of you have probably noticed, once delirium occurs, we often struggle to find a clear reversible cause that might improve the clinical course. Moreover, there is certainly no pharmacologic panacea to treat delirium. Delirium is almost always multifactorial in nature, due to predisposing factors and intervening factors or insults to the brain. 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 established risk factors from the literature.
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 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
There is moderate strength evidence that multicomponent interventions prevent the onset of delirium in the hospital. The risk of bias in these studies is also 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. There do not appear to be any harms associated with the interventions, and the two studies that examined costs showed significant savings.
Moreover, the heterogeneity across studies limits conclusions - we don’t yet know which components lead to the most benefit. More direct comparison of the individual components might shed light on what aspects are most effective or highest yield. More investigation of how to implement prevention strategies and ensure fidelity to the intervention might lead to a more impactful approach to delirium prevention in the hospital.
QI CORNER
Thanks to everyone who was able to make it on Thursday to PSQC - we have a bunch of interesting projects getting going in 2016. Please let me know if you would like to get involved but couldn't make the meeting.
We are particularly lucky to have some nurse champions helping with our paging pilot on 4300. For those of you who haven't heard the details - basically, the nurses are getting trained on sending pages using the following template:
pt name/ room #/ gen med team/ triage level & info / callback #
The nurses on 4300 are being encouraged to avoid using the HUC as a call back number and to use the "team communication" for non-urgent/FYI information instead of paging it.
In return, we have agreed to respond OR enter an order in an appropriate time frame based on the nursing assessment of the triage level of the question.
Routine = 60min
Urgent = 15min
Stat = 5min (or go to bedside, any STAT pages will also be routed through the charge nurse)
If you are tied up in a clinical emergency or don't think you will be able to respond according to these time frames - please ask for help. There is always someone around who can help answer the page even if only to tell them that it will take you a little longer to get back to it.
We are interested in hearing about your perspective on paging culture in general and will be sending out a qualtrics survey in the next week to hear more from you! Thanks everyone for listening.
Alicia Clark, MD
Assistant Professor of Medicine, Hospital Medicine Program
Associate Program Director, Duke Medicine Residency Program
CLINIC CORNER
We have gone popcorn crazy here at Pickett. We celebrated popcorn day 1/19/16 and rooting for Carolina Panthers!
We gladly welcome our new nurse manager Christy Pace and new CMA Chee-Chee Ward to the team.
A new event for patients will be planting a vegetable garden in the front area to be ready for the spring and fall.
Morning report for residents has come now twice to Pickett Road. The second Tuesday of the month Pickett welcomes the Internal medicine residents to DGIM Grand Rounds. January we discussed how to handle difficult patients and 2/9/16 Alice Cooper discussed common GYN dilemmas in outpatient practice. All are welcome to attend!
Sincerely Sharon Rubin
From the Chief Residents
Grand Rounds
Friday, February 19 - Rheumatology, Dr. Mala Kaul
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 2/15/16 |
Cardiac Hemodynamics and the Physical Exam |
Thomas Bashore |
12:00 | China King |
| 2/16/16 |
MED-PEDS Combined: Med-Peds SAR Talk |
Purohit & Tang |
12:00 | Domino's |
| 2/17/16 |
SNF Coordination |
Christina Kleinert |
12:00 | TBD |
| 2/18/16 |
QI Patient Safety Noon Conference - DNAR & Monitoring |
Lisa Pickett & Brian Griffith |
12:00 |
TBD |
| 2/19/16 | Chair's Conference | 12:00 | TBD |
From the Residency Office
Fellowship Program Info Sessions
Gastroenterology Fellowship Program
Monday, March 7th at 5:00pm in the Tyor Conference Room located in the GI Administrative Suite.
Hem-Onc Fellowship Program
March 1, 2016 4:00-5:00 PM. Room 405 Mudd (Conference Room). Pizza and drinks will be provided.
General Internal Medicine Career Night
General Internal Medicine Career Night
Interested in a career in General Internal Medicine?
Thinking about primary care medicine or hospitalist medicine?
Envision working in academics, research, Quality Improvement
or a combination?
Come to Gen Med Career Night
Tuesday March 15, 2016
6:30-8:30pm
Gen Med Resident Library
Dinner from Nosh
Come ask questions for our panelists about their path and journey:
Kevin Shah, Claire Kappa, Bruce Peyser, Sharon Rubin, David Edelman, Sonal Patel, Lance Teagen, Gene Odone, David Gallagher and Daniella Zipkin
Please RSVP to Sharon.rubin@dm.duke.edu by March 11, 2016
Teaching and Leading EBM: A Workshop for Educators and Champions of Evidence-Based-Medicine
Registration is now open!
Teaching and Leading EBM: A Workshop for Educators and Champions of Evidence-Based-Medicine
Duke Medicine, Durham NC
April 12-15, 2016
http://sites.duke.edu/ebmworkshop
This workshop focuses not only on learning EBM skills, but also on teaching EBM. Previous participants have included rising chief residents, faculty charged with developing an EBM curriculum, librarians, and other clinicians and faculty passionate about applying the best evidence to patient care. The program includes large group sessions in the morning, then supportive, small group, learner-driven sessions for the rest of the day.
The workshop will take place on the Duke Medicine campus in the new Trent Semans Center for Health Education and the Duke Medicine Pavilion.
Workshop Objectives:
Train leaders in medicine to facilitate evidence-based clinical practice in their teaching and practice settings.
Practice the skills involved in evidence-based medicine including clinical question formation and acquisition of medical evidence from the literature.
Review and develop critical appraisal skills and application of available evidence to patient care and medical education.
Develop skills in teaching EBM in both large and small group settings.
Provide interactive experience with a variety of evidence-based resources guided by faculty with expertise in evidence-based practice.
Please contact Megan von Isenburg (megan.vonisenburg@duke.edu) or Laura Huffman (laura.huffman@dm.duke.edu) with any questions.
11th Annual Duke Health Patient Safety and Quality Conference
REGISTRATION NOW OPEN: 11th Annual Duke Health Patient Safety and Quality Conference
11th Annual Duke Health Patient Safety and Quality Conference
Thursday, March 10, 2016
Durham Convention Center
301 West Morgan Street, Durham, NC
Onsite registration/check-in begins at 7:00 AM
Conference program is from 8:00 AM-4:30 PM
Register online today!
Schwartz Center Rounds
Panelists:
Jamie Veasey, PACE Nurse
Kelly Forrester, Case Manager
Margarita Bidegain, MD
Heather McLean, MD (Pediatric hospitalist)
Wednesday, February 17, 2016, Noon - 1 p.m., Duke South Amphitheater
About Schwartz Center Rounds:
All members of the Duke Medicine community are invited to attend an ongoing series of discussions called the Schwartz Center Rounds about the human side of patient care. Schwartz Center Rounds is a monthly interdisciplinary conference that offers all of us from no matter which discipline as well as non-clinicians who work closely with our patients a regularly scheduled time.... We are excited to have brought this program here to Duke and hope many of you will be able to join us on a regular basis.
Please contact, Lynn Bowlby, MD (lynn.bowlby@duke.edu), or Nathan Gray, MD (nathan.gray@dm.duke.edu) with questions. There is no need to RSVP, but we do recommend that you arrive early as food and seats are at a premium!
Book Club Survey
If you haven't been to one of our events yet, please support the Dept of Medicine book club project by taking a quick moment to fill out the survey below! Your participation is totally voluntary and anonymous, and the questions only takes ~2 minutes. You may remember filling this out before -- if you have, try to use the same identifier you used last time (if you can't find it, just make up a new one).
Here's the link: https://duke.qualtrics.com/SE/?SID=SV_bfJqGFkA6HScRq5
Feel free to email Laura.Caputo@duke.edu if you have any questions. Thanks so much for your participation!
Teaching and Leading EBM Scholarships
Three scholarships are available for the nationally-recognized “Teaching and Leading EBM” Workshop, which will be held at Duke Medicine from April 12 – 15, 2016. These scholarships are funded by a GME Innovations project and are reserved for residents, fellows and junior faculty who can bring EBM back to Duke residency programs. The workshop focuses not only on practicing EBM, but also on teaching EBM, making it an ideal educational opportunity for rising chief residents or others involved in teaching and the education of your residents.
We invite you to apply or to identify a member of your program to attend the workshop.
Scholarship recipients will be expected to create an educational deliverable on EBM for their programs. Deliverables could be a live session or physical / online materials. After completion of the workshop and deliverable, recipients will be required to complete a short report detailing their contribution to their programs.
Selection will be based, in part, on how participants will use the skills gained in the workshop to foster EBM in your program.
Read more about the Duke EBM Workshop here - http://sites.duke.edu/ebmworkshop/. Please contact Megan von Isenburg at megan.vonisenburg@duke.edu or 919.660.1131 with any questions.
Apply online at http://tinyurl.com/dukeebm2016
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
February 17 - Duke vs UNC @Tobacco Rd.
March 2 - JAR Networking Event
March 5 - UNC vs Duke
March 18 - Match Day Celebration
April 29 -Charity Auction
Useful links
GME Mistreatment Reporting Site
https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
http://duke.exitcareoncall.com/
Main Internal Medicine Residency website
Main Curriculum website
Department of Medicine
Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response
Opportunities
www.bidmc.org/CentersandDepartments/Departments/BIDHC
http://www.careermd.com/employers/latestbulletins.aspx