From the Director
MATCH WEEK! Can’t wait! Looking forward to meeting the newest members of the #dukefamily!
Also had a really fun week on Gen Med. Thanks to my awesome team members John Yeatts, Emily Ray, Tanya Aylward, Betty Jiang, MS II El Beday and PA student Alissa Binford! And also to our night JARs Juan Sanchez, Kara Wegermann, Mike Dorry, Laura Miller and Ryan Orgel. Other kudos this week to Jordan Pomeroy for a really cool chair’s conference and to Peter Hu for getting the diagnosis. Also kudos to Vedran Oruc from Steph Giattino for helping out in clinic while Steph had some very sick patients. I also got a kudos from Africa – medical student Jigna Solanki sent kudos to Bhavana Singh for being an amazing teacher at KCMC.
We are looking forward to seeing all of you at our upcoming match party on Friday night.
Don’t forget to fill out your brackets for March Madness! Chris Hostler is in charge of the residency program bracket, so please see the email from Chris for full details. And, of course, Go Duke!
This week’s pubmed from the program goes to Brian Sullivan for his abstract accepted to Digestive Diseases Week! Work was done with mentor Dawn Provenzale. “Risk Factors Associated with the Development of Adenoma Multiplicity in a Screening Cohort”
Have a great week!
Aimee
What Did I Read This Week?
Submitted by Suzanne Woods, MD
A clinical approach to diagnosis of autoimmune encephalitis. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Höftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Prüss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostásy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J.
Lancet Neurol. 2016 Feb 19. pii: S1474-4422(15)00401-9. doi: 10.1016/S1474-4422(15)00401-9. [Epub ahead of print] Review.
Why did I read this?
To be honest, I just finished two weeks on the peds ward so have not been reading much adult literature. However, we admitted a fascinating 5yo boy with no significant pmhx, with 6 week history of regression in language, slurring of speech, inability to walk, ataxia even while sitting, and lack of inhibition. Mom came to Duke given OSH had done an extensive evaluation and tried many meds for unclear reasons and he is worsening. His clinical picture is consistent with autoimmune encephalitis, possibly NMDA receptor antibody encephalitis.
Key issues: this article reviews how advances in autoimmune encephalitis (AE) research over the last decade have led to the identification of new syndromes and biomarkers that have transformed the diagnostic approach to this disorder. The brain inflammation generally causes a rapid progressive encephalopathy over 6 weeks and affects patients of all ages. The most frequently recognized causes are infectious, however autoimmune cases are increasing in number. The algorithm for the dx of AE is below.
At Duke, we have an autoimmune brain disease program. It is under the co-direction of William Gallentine, DO (neuro) and Heather Van Mater, MD,(rheum) and the program provides an integrated, interdisciplinary approach focused on the diagnosis and treatment of these disorders and associated co-morbid conditions. Definitely a resource you will want to be aware of.
And…..for your reading enjoyment here is the Barnes and Noble summary for Brain on Fire by Susannah Cahalan.
A gripping memoir and medical suspense story about a young New York Post reporter’s struggle with a rare and terrifying disease, opening a new window into the fascinating world of brain science.
One day in 2009, twenty-four-year-old Susannah Cahalan woke up alone in a strange hospital room, strapped to her bed, under guard, and unable to move or speak. A wristband marked her as a “flight risk,” and her medical records—chronicling a month-long hospital stay of which she had no memory at all—showed hallucinations, violence, and dangerous instability. Only weeks earlier, Susannah had been on the threshold of a new, adult life: a healthy, ambitious college grad a few months into her first serious relationship and a promising career as a cub reporter at a major New York newspaper. Who was the stranger who had taken over her body? What was happening to her mind?
In this swift and breathtaking narrative, Susannah tells the astonishing true story of her inexplicable descent into madness and the brilliant, lifesaving diagnosis that nearly didn’t happen. A team of doctors would spend a month—and more than a million dollars—trying desperately to pin down a medical explanation for what had gone wrong. Meanwhile, as the days passed and her family, boyfriend, and friends helplessly stood watch by her bed, she began to move inexorably through psychosis into catatonia and, ultimately, toward death. Yet even as this period nearly tore her family apart, it offered an extraordinary testament to their faith in Susannah and their refusal to let her go. Then, at the last minute, celebrated neurologist Souhel Najjar joined her team and, with the help of a lucky, ingenious test, saved her life. He recognized the symptoms of a newly discovered autoimmune disorder in which the body attacks the brain, a disease now thought to be tied to both schizophrenia and autism, and perhaps the root of “demonic possessions” throughout history. Far more than simply a riveting read and a crackling medical mystery, Brain on Fire is the powerful account of one woman’s struggle to recapture her identity and to rediscover herself among the fragments left behind. Using all her considerable journalistic skills, and building from hospital records and surveillance video, interviews with family and friends, and excerpts from the deeply moving journal her father kept during her illness, Susannah pieces together the story of her “lost month” to write an unforgettable memoir about memory and identity, faith and love. It is an important, profoundly compelling tale of survival and perseverance that is destined to become a classic.
QI CORNER
Thanks to all the residents who joined us at PSQC last week and to those who made it to the Duke Patient Safety Conference! We hope you will all join us for QI noon conference on Thursday, March 17th. We will be sharing some of YOUR OWN data from this year's share point project. We also plan to provide some updates on the paging culture project and would love your input as we brainstorm about next year's individual performance improvement (share point) project.
In addition, if you have a case that you would like discussed at our monthly patient safety/M&M conference, please email or page me.
Thanks and hope you all have a great week!
CLINIC CORNER
by Sharon Rubin, MD
We have had a busy month at Pickett.
We celebrated American Heart Month and showed support wearing red!
We are proud of our Residents who presented at the NC ACP and Dr. Eric Black Maier who won best poster for research
Plans for donation drive for the Veterans Association are under way for Tax day Friday April 15th.
We will be celebrating Earth Day on Saturday April 23 by planting a garden with flowers and vegetables with our patients.
Sincerely,
Sharon Rubin, MD, FACP
Assistant Professor, Duke University Medical Center
Residency Director at Pickett Road
Internal Medicine
Duke Primary Care at Pickett Road
From the Chief Residents
Grand Rounds
Friday, March 18 - Hospital Medicine, James Davis
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 3/14/16 |
MKSAP Endocrine |
Chiefs |
12:00/2002 | Domino's |
| 3/15/16 |
Curbsides in Endocrine |
Elizabeth Campbell |
12:00/2002 |
Panera |
| 3/16/16 |
Osteoporosis Cases |
Kenneth Lyles |
12:00 | Subway |
| 3/17/16 |
QI Patient Safety Noon Conference |
|
12:00 |
Hungry Leaf |
| 3/18/16 |
Chair's Conference |
Chiefs | 12:00 | Nosh |
From the Residency Office
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
2016 NANCY WEAVER EMERSON LECTURESHIP
"A Singular Intimacy: Connecting the Bridge Between Caregiver and Patient"
Thursday, April 7, 2016 5:45 p.m. Great Hall, Trent Semans Center
Please see the attachment below for more information.
Charity Auction 2016 -Save the Date!
The Internal Medicine Residency program Charity Auction, benefiting Senior PharmAssist will take place Friday, April 29th, 2016 @ 7:00 p.m. at Motorco in Durham! Tickets will go on sale the first week in April. We look forward to seeing you there.
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.
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!
Duke Division of Hematology Newsletter - March 2016
See link below for PDF.
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
March 18 - Match Day Celebration
April 29 -Charity Auction
May 19 - Resident Research Night
June 4 - SAR Dinner
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