From the Director
T-1 week until the new interns arrive for orientation! We are looking forward to having the SARs at our house this weekend, and the current interns (the nearly JARs!) at our house on the 28th. Current interns, we will be emailing you the name of the new intern who will be shadowing you for the day on June 30th this week. They won't have Duke email until next week, but it would be great if you could send them a quick note to introduce yourself.
Kudos this week go to
Krish Patel for his outstanding Grand Rounds, and also to our many award winners and nominees. Congratulations to our
Appleseed Teaching Award winners (given by the med students — thanks
Wynn Hunter for organizing!)
Interns: Andrea Sitlinger, Cece Zhang, Eric Yoder, Jonathan Hansen,Paul St. Romain
PGY 2+:
Adrienne Belasco, Hal Boutte, Tyler Black, Michael Woodworth, Sneha Vakamundi, Armando Bedoya, Brian Miller, Carling Ursem, Jay Mast, Dana Clifton, Timothy Mercer
To the
Duke Regional Teaching Award Winner Jessica Chia (nominees:
Nijra Nugogo, Stan Branch, Christina Barkauskas)
The
Ambulatory Teaching Award winner
Lynn Bowlby (nominees:
Anne Phelps, Daniella Zipkin, Sharon Rubin, Diana McNeil, William Yancy, Ken Lyles, John Rubin ).
The
Community Service Award winner
Carling Ursem (nominees:
Meredith Clement, Mandar Aras)
We also celebrated our
ACLT graduates this weekend –
Kim Bryan, Lauren Porras, Jodel Giraud, Jeremy Halbe and Alex Clark. Thanks
Larry Greenblatt for hosting and to
Alex Cho and
Sharon Rubin for organizing! More kudos to
Ben Peterson for a great chair's conference. Also kudos to
John Stanifer for receiving grant a sub-award from Dr. John Bartlett's MEPI grant: Medical Educational Partnership Initiative (MEPI) (#T84-HA21123) Mentored Research Training Program (MTRP) sub-award. ($25,000) Moshi, Tanzania. June 2014.
We did receive a
confidential comment line comment that the work rooms are really messy at both Duke and the VA. Yes, they are! A reminder that Environmental Services is responsible for cleaning the floors and emptying the trash ONLY. They cannot clean the counters or throw away anything that is not already in the trash cans. So, please be sure to recycle any PHI that is no longer needed in the confidential recycling bins, and to throw away any trash into the trash cans. If the trash cans are not being emptied when they are full, please let Randy, Jen or I know, and we can discuss with the EVS team. For the next couple of weeks there will be members of the Respiratory Therapy team working in rooms 8214-16. Please be sure to give them the space they need while they are there.
Pubmed from the program this week also goes to
John Stanifer for his publication in
Historia Medicinae..A Peculiar Type of Dyspnea: Kussmaul, Cheyne Stokes and Biot Respirations.
Have a great week!
Aimee
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What Did I Read This Week?
submitted by: Lynn Bowlby, MD
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One of my areas of interest is medical problems in pregnancy. Dating back to my med school years I have been lucky to be exposed to internists working in this area. I love thinking about the changes in physiology that occur in pregnancy and how that impacts all illnesses.
As a general internist, NEJM is a great source of both original work and review/summary pieces. I check out every issue and last week's issue had a great summary of ID and pregnancy. The evidence is slim for many pregnancy issues, with expert opinion often being dominant, but this article is a great summary of the available evidence and current thinking.
Pregnant women have an increased risk of infection, but not all infections. As any of us who took care of pts. in 2009 were reminded with the H1N1 flu epidemic, mortality and morbidity was much higher. Pregnant women are more severely affected with the flu, Hep E , HSV and malaria.
It seems that the cardiac and pulmonary changes, with reduced lung capacity, increased HR and SV as well as urinary stasis, of normal pregnancy may increase the severity of the response to infection.
There certainly may be bias in determining severity of illness in pregnancy since they likely have more testing and hospitalization.
One very interesting fact-- 5% of the deaths from H1N1 in 2009 in the US were in pregnant women, who comprise just 1% of the US population.
There is increased mortality from HEV (SE Asia, Middle East and Africa).
Primary HSV carries an increased risk of dissemination and hepatitis in pregnancy.
Pregnant women have x3 the risk of severe malaria. Mean maternal mortality from malaria is 39% in parts of Asia/Pacific region.
Coccidioidomycosis does not seem carry the increased incidence in pregnancy that once was thought.
Varicella infection seemed to have increased mortality in pregnancy based on some studies, but more recent review of data showed no change in mortality.
Increased incidence of infection as well as increased severity are both an issue in pregnancy.
Increased incidence is the clearest for P falciparum and Listeria monocytogenes.
The changes in sex hormones and the immune system are felt to affect the risk of and response to infection. Estradiol seems to increase immunity response. The concept that the pregnant woman is immune suppressed to avoid the loss of the fetus is likely oversimplified. Pregnant women are not susceptible to all infections.
From the Chief Residents
Grand Rounds
Presenter: Dr. Stephen Bergin
Duke Regional/Ambulatory Services Chief Resident Grand Rounds
Noon Conference
| Date |
Topic |
Lecturer |
Time |
Vendor |
| 6/16 |
MKSAP Mondays - Healthcare Maint. |
Bergin / Chiefs |
12:00 |
Picnic Basket |
| 6/17 |
Resistant HTN Case Studies |
Bergin |
12:00 |
Pita Pit |
| 6/18 |
Primary Care Controversies |
Zipkin |
12:00 |
China King |
| 6/19 |
QI Patient Safety Noon Conference |
Bae / Clark |
12:00 |
Rudino's |
| 6/20 |
Chair's Conference |
Chiefs |
12:00 |
Domino's |
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From the Residency Office
C Diff Shedding Study
This study is being led by Luke Chen, MD, who is asking for your assistance to identify appropriate patients as noted below:
- When you have a patient with - suspected C-difficile associated diarrhea (CDAD)
Or
- –PCR +ve for C. difficile and starting treatment for CDAD
Who is able to receive any of the 3 oral antibiotics (metronidazole/vancomycin/fidaxomicin)
– > 1 dose of CDAD therapy
– Receiving Other CDAD therapy (e.g. IV metronidazole
Please page Kathy Ramadanovic, Clinical Research Coordinator (CRC) at 970-11773
C-Diff Shedding Ad.
Information/Opportunities
North Dakota Internal Medicine
Idaho Internal Medicine
Idaho Hospitalist
Montana Hospitalist
Practice in one of Americas happiest states
Upcoming Dates and Events
- Intern Welcome Celebration: June 27 @ the PIT
Useful links
