Internal Medicine Residency News: May 19, 2014

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From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi Everyone! Countdown is on for it is almost start of Seersucker Tuesday time. Hold out this Tuesday and be ready to honor Phil Lehman with your stripey finest on the first Tuesday after Memorial Day!  Thank you all for continuing to fill out the housestaff survey. Over 50% completion! We will close it on Friday so please take a few minutes to fill it out. Also there is the SAQ from the hospital - look for a pascal metrics email. It is a bit longer but very important to the hospital. Kudos this week to Deng Madut from a patient for excellent compassionate care on Duke nights (sent by Jon bae), to Kristen Glisinski for coordinating the most complicated VA discharge AND avoiding re-hospitalization afterwards from Nick turner, and to Jeremy Gillespie for helping at the DOC ( from Adrienne Belasco).  This weeks pubmed from the program goes to Pubmed from the program goes to Fola Babatunde who presented her work at the Heart Rhythm Society meeting in San Francisco. Mentor is Brent Atwater. Have a great week    Aimee [box]

What Did I Read This Week?

Autosomal Dominant Polycystic Kidney Disease (ADPKD) by Jared J Grantham in NEJM 2008

David Butterly, MD 

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I originally read this review on Autosomal Dominant Polycystic Kidney Disease (ADPKD) by Jared J Grantham in NEJM 2008 back when it was first published. I have reviewed it a few times over the past years and have handed it out to Fellows and Residents on service when consults come up with Polycystic Kidney Disease. It is a comprehensive and well written review by one of the national experts in the area and a great resource on the topic. On a side note, the author is the former Chief of Nephrology and Chair of Medicine at Kansas and was the primary mentor of Steve Schwab who was my first clinical director and a mentor of mine here at Duke.128907_butterly005 This week I relooked at this article as I had 3 patients in clinic with ADPKD.   One patient is a younger man (younger at least by my definition of young!) with ESRD due to ADPKD. Multiple members of his family had PKD and many have reached ESRD by age 30-40. He is now s/p transplant in his early 30’s and doing remarkably well eight years out from transplant with a creatinine less than 1.0. The second patient is a 75 year old who was incidentally found to have PKD when a CT was done for diverticulitis five years ago. He was adopted and not aware of his family history but he continues to do well with minimal symptoms and normal renal function. The final patient was a young woman with no known family history and was found to incidentally have ADPKD during pregnancy when an ultrasound revealed bilateral renal cysts. How her disease may impact her health long-term is currently unclear. The varied clinical presentations in these cases illustrate the spectrum of clinical disease seen in ADPKD. ADPKD occurs in 1 in 800 births and affects roughly 500,000 persons in the US and 4-6 million worldwide. It is the most common genetic cause of renal failure and patients with PKD makeup about 5-10% of patients on dialysis. The disease is caused by mutations in genes encoding for Polycystin 1 (PKD-1) accounting for 80-90% of patients and Polycystin 2 (PKD-2) making up the other 10-20%. The genes are both 100% penetrant. The two types of ADPKD have similar pathophysiologic features but PKD-1 patients tend to present earlier in life and progress to ESRD at a younger age (53 years of age on average) while patients with PKD-2 present later and reach ESRD in their late 60’s-70’s. Roughly 25% of patients report no known family history of PKD. Many of these are due to undetected disease in a family member, but spontaneous mutations are estimated to account for 5% of cases. Clinical features include gross hematuria, flank pain, hypertension, recurrent UTI’s, and nephrolithiasis, along with CKD. Renal disease progression can be followed with regular checks of serum creatinine and both hypertension and kidney volume correlate with disease progression.  Extra-renal manifestations include colonic diverticuli, mitral valve prolapse and regurgitation, and aortic and cerebral aneurysm. Although there are currently no drugs FDA approved to slow progressive renal disease in these patients, treatment with TOR-Inhibitors and Vasopressin Receptor Antagonists (Torres NEJM 2012) show promise and have both been demonstrated to slow cyst growth and decline in renal function.  

QI Corner (Joel Boggan, MD)

Hand Hygiene We are in the final two week push for the Incentive Program and need to hit upwards of 94% this month to reach the goal - KEEP WASHING! Safety Attitudes Questionnaire We have broken into double digits, but we're barely keeping pace with general surgery.  And, as you can see in the figure, we're WAY behind other programs.  The goal is 80% by the end of the month, so fill out the survey from Pascal Metrics (search in your email with that term) while you're enjoying the sunshine this weekend.     SAQ Completion    SAQ 3 Urinary Catheter Awareness I have harassed many of you over the past two months about whether or not your patients have Foleys or condom catheters.  It turns out, we only know about urinary catheters 77% of the time, regardless of training level.  So, check under those bed sheets or along the sides of the beds and have the nurses discontinue them, if possible.  More graphics to come next week . . . Next QI Noon Conference on High Value, Cost-Conscious Car  The next HVCC lecture will be Health Care Costs & Payment Models  at noon by Cara O'brien.  Please plan to attend. Next Resident M&M Mark your calendars - the next resident M&M Noon Conference will be 5/29 at noon, led by Dr. Lish Clark.   [divider]

From the Chief Residents

Grand Rounds

Presenter:  Dr. Aimee Zaas Topic: State of the IM Residency

Noon Conference

Date Topic Lecturer Time Vendor
5/19 MKSAP Mondays - Hepatology V. Patel / Chiefs 12:00 Subway
5/20 MED-PEDS Combined: Health System Financial and Political Landscape OR Difficult Death Debrief Kevin Sowers / Galanos 12:00 Pita Pit
5/21 Approach to Abnormal LFTs Vaishali Patel 12:00 China King
5/22 Cirrhosis Case Studies V Patel/Chiefs 12:00 Domino's
5/23 Chair's Conference Chiefs 12:00 Chick-Fil-A
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From the Residency Office

Duke Hospital Medicine Social

If you are considering a career within Hospital Medicine, the following is an opportunity to meet with our hospitalist team to discuss opportunities in greater detail.
  • What:  Hospital Medicine Interest Meeting
  • Date:   Monday, May 19, 2014
  • Location: Nosh Café Trent Semans Center
  • Time:  5:00pm
For more information feel free to touch base with Jeffrey White, Hospital Medicine Physician Recruiter Jeffrey.white@duke.edu

Changes to the Med Res Library

If you wonder who absconded with the PIN station and printer - not to worry.  We have relocated one of the PIN units to the first work station on your left as you enter the program office (8254 DN). Why? To give us more space in the back for serving lunch during noon conference, and to make it more accessible for resident use whenever the library is occupied for meetings. The other change you will see coming is a major upgrade to the IT system - all so that we can improve on transmitting conference - not only to Duke Regional Hospital, but possibly to multiple locations.  Yes, we are replacing the old digital system, installing ceiling mikes, and large flat screen monitors mounted to the walls.  This will all happen during the week of June 2nd, at which time the library will be strictly off limits.

How to Order Prescription Pads

Change in procedure for ordering prescription pads:  There is no longer a link to order prescription pads on your MedHub homepage.  To order, please call GME directly at 919-684-3491.  The pads will be delivered to the MedRes office and you will receive a page when they are ready for pick up.

Reminder: Safety Attitudes Questionnaire

What is it: Culture of Safety Survey, second full cycle for DUHS When is it: Survey runs May 5-May 30. Who does it: All ACGME program members will be included (if at least 8 members); other clinical departments throughout the health system also doing survey How is it done: Participants will get an email from support@pascalmetrics.com,with subject “DUHS Safety Culture Survey from Pascal Metrics”; in the body of the email, the target/referent for the survey is listed. For GME it is the GME Program (e.g. GME-Medicine-Internal Medicine). Last cycle, GME participation rate was 71%. We are looking for at least 80% response rate from each program! Your input is very important.

Information/Opportunities

 SWVA IM Flyer (5 Opps) (5-13-2014)      Terre Haute - Internal Medicine (5-13-2014)   Frankfort IM Flyer (1-23-14)                     Richmond IM Flyer (HDH) (5-21-2013 Hosp $200K

Upcoming Dates and Events

  • May 19: Hospital Medicine Social/ Interest Meeting
  • May 23: Deadline to complete "Trainee Evaluation of Program" survey
  • May 24: Housestaff Party - Elodie Farms
  • May 30: Program pictures, Trent Semans West Steps, 9:15
  • May 31: SAR Dinner, Hope Valley CC
  • June 3: Annual Resident Research Conference
  • June 6: Serve dinner at the Ronald McDonald House

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