Internal Medicine Residency News, October 20, 2014

October 20, 2014

By residency1

From the Director

It's getting really close to recruitment time….prelim intern day is Oct 31, and the first categorical applicants (aka "future Duke residents") join us on Monday Nov 3. I took a few minutes to read through all of your profiles on the website the other day – it looks fantastic! We are really excited about the upcoming recruitment season, and look forward to showing what makes the Duke Medicine residency family so great. Interns are starting BLOCK 5 tomorrow…officially 1/3 down! Plus it was a beautiful weekend for a Duke win and some turkey bowl practice! Glad to hear our "choosing wisely" teams are off to a great start, led by Lish Clark and Aaron Mitchell. Kudos this week to Venu Reddy from his VA team (Amanda Verma, Alana Lewis and Maggie Infeld) for being a great teacher and help on day float, to Marc Samsky for an excellent chair's conference, to Brian Andonian from Bassem Matta for great work at the VA, and to Cards fellow Alex Fanaroff from the CCU teams. Also congrats to Jenny Van Kirk for being our "Go Green" Doctoberfest winner of the week. We had a fantastic celebration this week of the 20th Anniversary of the VA PRIME Clinic. What started as the brainchild of Dr David Simel and former Duke/DVAMC attending Dr. Sheri Keitz has grown into a 52 resident clinic serving > 2500 patients. Hearing one of the PRIME patients speak about what the clinic means to him was very powerful, and it was wonderful to see the whole PRIME team there celebrating. See some of the attached pictures, including resident speaker Kevin Trulock!

Interested in health care? (that should be a rhetorical question, folks)…if you are able, please join Kevin Shah and others at the 2014 Duke MBA Health Care Conference Curing Health Care Through Innovation Date: Saturday, November 15, 2014 Time:8:15 am - 6:00 pm Location:Duke University, the Fuqua School of Business Register:Please visit the conference website *Admission is FREE and open to the public, but space is limited This week's Pubmed from the program goes to Dinushika Mohottige for her incredible work on residentmurmurs.org. One of the best parts of working with you all is finding out new things about you – this is yet another on my list of how you all amaze me! Have a great week Aimee [divider] [box]

What Did I Read This Week?

Submitted by: Sharon Rubin, MD

Use of 13- Valent Pneumococcal Conjugate vaccine and 23- Valent Pneumoccocal Polysaccharide vaccine Adults Aged > 65 years: Recommendations of the Advisory Committee on Immunization Practices (ACIP)” page 822 in Morbidity and Mortality Weekly Report, from Centers for Disease Control and Prevention, Volume 63, No. 37, September 19, 2014.

http://www.cdc.gov/mmwr/pdf/wk/mm6337.pdf

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What I Read This Week: We discussed at the ambulatory meeting the need to educate all internal medicine residents of the new CDC recommendations for 13-Valent pneumococcal vaccine (PCV13/Prevnar 13) and when to vaccinate in relation to 23-Valent pneumococcal vaccine (PPSV23/Pneumovax23). Why the change in recommendation? Since the introduction of PCV13 vaccination in children, this has reduced pneumococcal infections directly and indirectly in children and INDIRECTLY in adults (almost 50%). But there were some pneumonia cases still caused by PCV13 strains that could have been prevented if patients were vaccinated. The CAPiTA Trial conducted in the Netherlands in 2008-2013 in 85,000 adults age >65 verified 45.6% efficacy of PCV13 in preventing pneumococcal pneumonia. 2 randomized, multi centered studies showed PCV13 was able to elicit more immune response than PPSV23. Studies show better immune response when PCV13 is given first then 1 year later give PPSV23. Probablistic models show decreased pneumonias and additional health benefits. PCV 13 + PPSV23 gives broader coverage of more bacteria subtypes. Sequential administration and recommended intervals

Age> 65, if it has been 12 months since their last PPSV23 OR if they are due for a PPSV23, administer the PCV-13 first and then administer PPSV23 6-12 months later.
If they received Pneumovax 23 at age <65, it should be 6-12 months before they receive PCV-13 after the age of 65. Then 5 years since first PPSV23, revaccinate with PPSV23.

Practicality/Cost: Medicare will only pay for 1 pneumonia vaccine. So if patients have already received Pneumovax and they are given PCV-13, you should ask them to sign an ABN and let them know they may receive a bill for this. At Pickett we have been printing out the PCV13 prescription and allowing patients to obtain at pharmacies for ~$100. For review ACIP recommendations for PCV13

in adults >19 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak or cochlear implants. Immunize with PCV13 first then 8 weeks later, immunize with PPSV23.
Adults aged 19 years or older with the aforementioned conditions who have previously received one or more doses of PPSV23 should receive a dose of PCV13 one or more years after the last PPSV23 dose was received. For those that require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years since the most recent dose of PPSV23.
When indicated, PCV13 should be administered to patients who are uncertain of their vaccination status history and there is no record of previous vaccination.

For review ACIP recommendations for PPSV23 Pneumovax

Adults younger than age 65 years with chronic lung disease (including chronic obstructive pulmonary disease, emphysema, and asthma); chronic cardiovascular diseases; diabetes mellitus; chronic renal failure; nephrotic syndrome; chronic liver disease (including cirrhosis); alcoholism; cochlear implants; cerebrospinal fluid leaks; immunocompromising conditions; and functional or anatomic asplenia (eg, sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, or splenectomy [if elective splenectomy is planned, vaccinate at least two weeks before surgery]); — Residents of nursing homes or long-term care facilities; and — Adults who smoke cigarettes.
Revaccination with PPSV23
One-time revaccination 5 years after the first dose is recommended for persons aged 19 through 64 years with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (eg, sickle cell disease or splenectomy); and for persons with immunocompromising conditions.
Persons with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis.
When cancer chemotherapy or other immunosuppressive therapy is being considered, the interval between vaccination and initiation of immunosuppressive therapy should be at least two weeks. Vaccination during chemotherapy or radiation therapy should be avoided.

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Clinic Corner

Will return next week...stay tuned!!

QI Corner

[caption id="attachment_16361" align="aligncenter" width="141"]

Aaron Mitchell, MD[/caption] A big thank-you to everyone on the Choosing Wisely team. We are off to a great start already! This week we will be having our first department-wide Morbidity and Mortality conference of the academic year. This will be in the Grand Rounds time slot on Friday morning. We have a great case to discuss, so I look forward to seeing everyone there. In a note that has nothing at all to do with quality improvement, I wanted to make sure that everyone knows that the state fair is happening all this week in Raleigh! Especially for everyone who is new to NC, take this opportunity get out, have some fun, learn about your new home state, and eat some deep-fried Oreo cookies." Aaron P. Mitchell Chief Resident for Quality and Patient Safety Durham VA Medical Center

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From the Chief Residents

Grand Rounds

Fri., Oct. 17: Stead Speaker/Alumni Weekend, Dr. John B. Simpson (Avinger)

Noon Conference

Date	Topic	Lecturer	Time	Vendor
10/20/14	Interpretation of PFTs	C. Giovacchini/Hargett	12:15	Dominos
10/21/14	Fun Lunch		12:00
10/22/14	COPD Management & Pearls	Scialla	12:15	We Care Wednesday
10/23/14	SAR Emergency Series: Diabetes Emergencies	Deng Madut	12:00	China King
10/24/14	Chair's Conference	Chiefs	12:00	Picnic Basket

From the Residency Office

Kudos from Dr. Rivelli for the MedPsych Team!

Duke Medicine-Psychiatry had an exceptionally strong showing at the national Association of Medicine and Psychiatry Oct 10-11^th. Jim Lefler (PGY3) won 1^st place in the Vignette Competition and Greg Brown (PGY4) won the Best Poster Award. Both very well deserved! Also thanks go to Jane Gagliardi for organizing a great meeting. There were also excellent oral presentations by MedPsych faculty Wei Jiang, Chris Kenedi, Kristen Shirey and Jason Webb.

Many Thanks to Dr. Eugene Oddone!

I wanted to share with you that Dr. Eugene Oddone recently made a very generous donation to SENIOR PHARMASSIST in our name, in honor of The Kerby Society's win last year for having the highest response rates on the housestaff survey. And even better news – his donation was matched by another donor. Thank you , Dr. Oddone!!Best,Heather E. Whitson, MD, MHS

New Badge-Backers Required by GME

If you have not already done so, please come by the MedRes office as soon as possible and pick up your new badge backer that is required by GME. The backers indicate your level of training via a color-coded system and are necessary to ensure appropriate levels of supervision are in place at all times. In addition, they more clearly ID you as a Doctor to all patients, visitors and staff!

CLER Visit Information

As part of the ACGME Accreditation System, we will participate in a CLER (Clinical Learning Environment Review) at some point during the current academic year. We will only be given 2-weeks notice prior to the visit. There is a large amount of helpful information, for both faculty and trainees, located in the Resource/Documents area of MedHub, as well as this great informational flyer put together by the GME office. Please take time to review it and if you have any questions about the visit, do not hesitate to contact the MedRes office or the GME office.

Doctoberfest is Going Strong!

DOCTOBERFEST IS HERE! “This is OUR Community” October 1-31, 2014

Join the Internal Medicine Residency Program in our 3^rd annual Doctoberfest celebration! This year our continued focus will be on building and strengthening our community – both locally and on a global scale!

October 1, 2014 will mark the start of our Doctoberfest celebration with “We Care Wednesdays.” A special treat will be provided during Noon Conference to kick things off!

How Do YOU Go Green? – Ride a bike to work? Use a recyclable water bottle? We want to hear how YOU Go Green both at home and at work! Please feel free to come by the MedRes office and post your ideas on our Go Green wall, or submit them online using the link below. All submissions will be entered in our weekly drawings for gifts and prizes and all of the ideas will be compiled and shared at the end of the month. Bleed Blue/Live Green!!

https://duke.qualtrics.com/SE/?SID=SV_9TBHGku53op13uJ

October 21 is "Taco Tuesday!"

Join us in the Duke Hospital Courtyard (across from Starbucks) for a special lunch to honor our house staff. Eat, relax and re-connect with your friends and colleagues!

October 31 As Doctoberfest 2014 draws to a close, enjoy some Halloween treats of donuts and cider as we welcome our first group of applicants on our 1^st official recruiting day!

Flu Vaccination Update

**Please Note: There has been an issue with the EOHW reporting system not showing compliance even if you got your shot at a Duke facility. If you have gotten your flu shot but are still showing as non-compliant, please contact the MedRes office. If you have not yet gotten your shot, please see the information below for locations where you can have it done. If you have any questions, please call EOHW 684-3136

A schedule of vaccination clinics is posted on the employee intranet at https://intranet.dm.duke.edu/influenza/Lists/Calendar/calendar.aspx. This list will be updated throughout the flu season. Vaccination is also available at Employee Occupational Health and Wellness (EOHW) during business hours.

If you have questions about the flu vaccine or its availability, please visit the DUHS Influenza Resource Guide or duke.edu/flu, ask your manager or contact EOHW.

Together, we can stop the flu. Thank you for your commitment to keeping our patients, and our community, safe and healthy.

Register Now for BLS Blitz - November 10-14, 2014

Use the Swank system to register for BLS classes. If you do not have an account in Swank contact the DHTS Service Desk 919-684-2243 to establish an account. You may register for one session. Detailed Registration Instructions and Informational Flyer When you attend class, arrive 15 minutes before session begins and you must have your:

Class Registration Confirmation
Duke ID Badge
AHA BLS Healthcare Provider Manual 2010

All sessions are held at Hock Plaza - G07 Auditorium. Parking is not available at Hock Plaza. No one will be admitted to the session after it starts or if you do not have your AHA BLS manual.

Trent Center Colloquium Series

Please join us at the Trent Semans Center for Health Education, Room 4030 for this upcoming colloquium and forward to interested faculty, students, residents and fellows. Space is limited. RSVP by Wednesday, November 5: trent-center@duke.edu. The slow food movement has transformed the ways we think about eating. Could a ”slow medicine” movement transform the ways we think about illness and health? In this discussion of the work of the physician, historian, and writer, Victoria Sweet, we will consider what it means to renew the practice of medicine. Abraham Nussbaum, MD, MA directs the adult inpatient psychiatric service at Denver Health. His research interests include the history of psychiatry, medical professionalism, psychiatric diagnosis, and the treatment of people with schizophrenia. The Trent Center Colloquium Series explores interdisciplinary topics in ethics and the social and cultural aspects of medicine. It is an opportunity for interested faculty, students, residents and fellows to both engage with current scholarship and, through informal, lively conversation, find avenues for collaborative exchange. This talk is also part of the Theology, Culture and Medicine Seminar Series co-sponsored by the Duke Divinity School and the Trent Center.

Open Enrollemnt for Benefits Begins 10/27/14!

Enrollment Period is from October 27th – November 7th 2014.

Open Enrollment

Open Enrollment is the only time of year when all Duke employees can enroll in or change their medical, dental, vision and reimbursement account benefit selections. If you have questions about Open Enrollment, please contact Jill Watkins at 684-2897.

Housestaff Healthcare, Dental and Vision Premiums 2015

Open Enrollment Information

If you take no action during Open Enrollment, the selections you made for 2014 for your medical, dental, and vision coverage will continue for 2015. However, to continue to use a reimbursement account, you must re-enroll for 2015.

Reminder: Your coverage term for benefits through Duke HR is one year. Changes in plan coverage can only be made outside of the Open Enrollment period for life changing events.

Qualifying events include, but are not limited to:

Marriage, divorce, or legal separation,
Birth or adoption (or placement of adoption) of a child,
Death of a covered dependent,
Loss or gain of eligibility for insurance coverage for you or a covered dependent (coverage must not be a student or individual policy),
Change in spouse's employment status, and
Change in health insurance eligibility due to a relocation of residence or work place.
Change in your child's full-time student status(marriage, death, baby, job, etc).

Job changes within Duke (e.g. GME to Duke Faculty) are not considered a life changing event. Please keep this in mind when you finalize your enrollment.

Movember is Coming!

Colleagues and Friends, November is nearly upon us – a time of fall leaves, turkey bowl, and most importantly hideous facial hair. For the past 3 years, Duke internal medicine residents have grown mustaches for Movember. This year, our Urology colleagues have asked us to formally join them in this endeavor and raise money for a good cause. Please contact Dr Kevin Shah <kevin.shah@dm.duke.edu> if you'd like to participate!