From the Director
So, clearly a HUGE week for our residency program family! Cannot possibly explain how excited we are about the new interns. And another THANK YOU to our incredible team of residents, chief residents, APDs (especially "
King Of Recruitment"
David Butterly), staff (especially "
Goddess and Ambassador of Recruitment"
Erin Payne),
faculty and Dr. Klotman for showing our newest team members why Duke Medicine is the greatest. See below for the AMAZING class list!
2014 - 2015 Categorical 2014 - 2015 Prelim
2014 - 2015 Med-Peds 2014 - 2015 MedPsych
We have another new member of our family….
William Shumate! Congratulations
Jenn Rymer 
and Daniel Shumate on the birth of your son!
Cameron Hostler told me at the recruitment party that he plans to tease his "little chief" brother mercilessly, since he learned this from his dad.
Lots of kudos came my way this week about our current residents….from a patient (via
Dr. Aimee Chung) to Amanda Verma for outstanding and compassionate care on Gen Med, to
Ashley Bock, CeCe Zhang and Sarah Goldstein from Stephanie Norfolk for outstanding "JAR level" work in the DRH MICU, from
Susan Spratt to Monica Tang, Alex Clark and Amanda Elliott for their work on the diabetes phenotyping project, to
John Stanifer for his work screening for renal disease in Tanzania on WORLD KIDNEY DAY, to
Laura Musselwhite, Kevin Trulock, Allyson Pishko and Venu Reddy from Kedar Kirtane for being a great Duke Night Resident team, to
Joel Boggan for leading our resident M and M, to
Anne Mathews and Ashley Lane for excellent SAR talks, and to
Andrea Sitlinger from Alice Grey for excellent work on the pulmonary transplant service.
Things start to move really quickly at this point in the year….How to Be A JAR is coming soon, as is the auction, and a CPC, and next year's schedule, and many other end of year activities. Keep up the MINI CEX work during CEX madness. It's not brackets, but it's important to your learning and development!
This week's pubmed from the program goes to
Phil Lehman, to be presented at the 2014 AHA Quality of Care and Outcomes Research Conference in June, 2014!
Title: Early Telephone Follow-up Fails to Reduce Readmission Rates for CHF & AMI; Authors: Lehman EP, Granger BM, Pura J, Lohknygina Y, McCarver C, Shah B.
HAVE A GREAT WEEK….next week, updates come at you from guest writer
BILL HARGETT!
Aimee
The "Clinic Corner - PRIME Clinic - VA Medical Center"
(submitted by Sonal Patel, MD)
I can’t believe Spring is here and hopefully no more snow or ice. You would think living in Chicago for 12 years would make me immune to the weather but unfortunately not the case. I also can’t believe it is March and the year is wrapping up. It has been my absolute pleasure to work in PRIME clinic with you residents and while it will be bittersweet to see the seniors graduating and moving on it has also been gratifying seeing the interns and juniors graduating and gaining self confidence in their skills.
During this last month I have noticed a few things that I wanted to share:
1. All of you have been so gracious helping out your fellow residents when unforeseen hitches in clinic require another residents assistance
2. The number of ACS messages you receive are TNTC (too numerous to count) and you have been able to manage them so seamlessly with all of your other responsibilities
3. Each and every resident that has voiced a problem in clinic has also brought up possible suggestions for improvement, which is so appreciated. Please continue to think outside the box and be innovative with solutions.
4. All of the residents that are helping implement changes in PRIME clinic are doing them willingly and with full effort. I am in awe of your dedication and willingness to help
.
On to the updates:
1.
Monday AM huddles- The PRIME staff have enjoyed getting the residents perspectives during our Monday am huddles, please continue to speak up and voice any suggestions either in the meetings or outside of them
2.
FLOW analysis- Data was gathered on Wednesday March 18, thanks to everyone in clinc that day entering the data, I will keep you posted on the results
3.
Our 3rd LPN will be joining us shortly, we are so excited to have our full complement of nurses, our MSAs (Clerks) are still short staffed but hopefully we can get those positions filled ASAP
4.
Chronic Pain Management- we have moved to the first of the month, seems to be working well, please let us know of any issues/suggestions
Looking forward to wrapping up the year with you.
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What Did I Read This Week?
Submitted by Sharon Rubin, MD
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When I first read on the USPSTF web site in 2013, I was skeptical. Was Hepatitis C so prevalent that now every adult born between 1945 to 1965 should be offered Hepatitis C screening?
The USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection. The USPSTF also recommends offering one-time screening for HCV infection to adults born between 1945 and 1965.
Grade:
B Recommendation (which will be covered by Affordable Care Act)
There is an estimated >3 million people in the US have chronic HCV infection (this was extrapolation from blood samples in NHANES which underestimates the number as this did not include homeless or the incarcerated). Now with current treatments of pegylated interferon, ribavirin, and a protease inhibitor (either boceprevir or telaprevir) especially for genotype 1 can cure HCV, decrease HCC and death. There are new drugs coming down the pipeline which can improve compliance and down stream effects. Many people are unaware of their status as they are asymptotic. There are more HCV deaths now than HIV.
This NHANES study looked at data from 2003 to 2010, blood samples and interviewed patients to determine risk factors for HCV. The estimate is 1.3% patients = 3.6 million people had past or current HCV; 1%= 2.7million people have chronic HCV which is actually a decrease from past estimates (they do not attribute this decrease to treatment as people who know they have HCV do not go for further treatment). They postulate that deaths from HCV were underreported and mortality from people with HCV has increased. They attribute more of theses deaths from the “Baby Boom” generation (1945-1965). Identified risk factors were still the same: injection drug users, person who received blood transfusions before 1992. Their analysis showed that people born between 1945 -1965 had 6x greater prevalence (making up 81% of all the people with HCV). The hope is to identify 800,000 more people with HCV, guide them to treatment and save 120,000 deaths.
I needed to put this information into the perspective of HIV. HIV was a new and scary disease in the 1980 that received generous media coverage and funding for virology and for treatment. Taken from USPSTF “An estimated 1.2 million persons in the United States are currently living with HIV infection, and the annual incidence of the disease is approximately 50,000 cases. Since the first cases of AIDS were reported in 1981, more than 1.1 million persons have been diagnosed and nearly 595,000 have died from the condition. Approximately 20% to 25% of individuals living with HIV infection are unaware of their positive status.” The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults ages 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened. Grade:
A Recommendation The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. Grade:
A Recommendation”
For HCV there is estimated 2-3% =130-170 million people world wide with HCV and 500,000 died of HCV related conditions A YEAR compared to the 595,000 HIV deaths that in the US in total from HIV. 2.7 million people with HCV vs 1.2 million people with HV. Focusing on patients who have risk factors (homeless, incarcerated, instutionalized, IV drug abuse, blood transfusions) is a start but I understand now to at least offer the Hepatitis C screen to patients born between 1945-65 without risk factors. I am relieved that insurance, the affordable care act, will cover the screening for HCV but I do worry about the cost of evaluation and treatment of HCV as these are still new treatments, not generic, who will pay then? I understand the hopes of the CDC. HCV is a disease that can be easily identified, possibly treated, and hopefully eradicated.
QI Corner (submitted by Joel Boggan, MD)
High Value Care Lecture Series and QI Conferences
Wednesday, the 26th, features a couple of QI conferences. At noon, Dr. Alex Cho will be leading us in the next of the High Value, Cost-Conscious Care series, on 'Balancing Benefits with Risks and Harms' in 2002. Please be there right at noon so we can get started on time!
That evening, Dr. Bimal Shah will be presenting 'Quality in HealthCare' for the Incentive Task Force's High Value Care series in Trent Semans Classroom 3 from 7-8 pm.
Hand Hygiene Update
For those of you unable to make it to M&M this week, here are our ward numbers for February. March updates will be out in two weeks . . .
Ward Compliance Rate
7100 23 / 25 92%
7300 21 / 24 88%
7800 18 / 19 95%
8100 9 / 11 82%
8300 21 / 21 100%
9100 8 / 9 89%
9300 9 / 10 90%
OVERALL: 91.5%
AGGREGATE: 88.6%
From the Chief Residents
SAR Talks
March 25: Lindsay Anderson / Trevor Posenau
March 27: Kaley Tash / Mike Shafique
Grand Rounds
Dr. John Williams – General Medicine
Topic: Shared Decision Making
Noon Conference
| Date |
Topic |
Lecturer |
Time |
Vendor |
Room |
| 3/24 |
MKSAP Mondays - GIM |
Bergin/Chiefs |
12:00 |
Picnic Basket |
2002 |
| 3/25 |
SAR TALKS |
Lindsay Anderson / Trevor Posenau |
12:00 |
Pita Pit |
2002 |
| 3/26 |
QI Patient Safety Noon Conference |
Alex Cho |
12:00 |
China King |
2002 |
| 3/27 |
SAR TALKS |
Kaley Tash / Mike Shafique |
12:00 |
Domino's |
2001 |
| 3/28 |
Research Conference |
|
12:00 |
Panera |
2002 |
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From the Residency Office
Mini CEX Madness - Week 3
Week # 3 of Mini CEX Madness. We had 7 CEXs completed this week , and our winner is Stephanie
Giattino! We’ve got one more week to go – let’s keep those CEXs coming! As a reminder, everyone who has at least one completed during the month of March will be entered in a drawing to win a $50 dinner to a local restaurant of your choice (alcohol not included)!
World Kidney Day (submitted by John Stanifer)
Take note that the World Screening Kidney Day made it to the ISN website.
http://www.theisn.org/isn-blog/isn-blog/wkd-2014-screening-at-kilimanjaro-christian-medical-center/itemid-991
Information/Opportunities
140317 - INTERNAL MEDICINE-ALL
Upcoming Dates and Events
- April 11: Final Faculty Resident Research Grant applications
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- March 31: GI Interest Meeting (contact Jill Rimmer, GI PC)
- April 17: Financial Planning Seminar
- April 18: Charity Auction
- April 18: SAR Class Picture (rescheduled)
- April 22: CPC Event, 7 PM @ The Pit
- May 3: the Stead Tread 5K www.steadtread.org
- May 30: Program pictures @ Duke Chapel 9:15
- June 3: Annual Resident Reseach Conference
- May 31: SAR Dinner, Hope Valley CC
Useful links
