Internal Medicine Residency News: October 28, 2013

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From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi Everyone! We are entering the last week of Doctoberfest….this week starts with our RECRUITMENT KICKOFF PARTY! Erin and Lynsey found us a great location, and we are looking forward to seeing you all there.  Hard to believe, but prelim interviews are on Friday and the first applicants to the categorical program arrive on Sunday night!  Your participation is vital so that our new class can be as good as the current 3 classes – we will see applicants on rounds on Duke Gen Med, Oncology and in the MICU, and also at lunch on Mondays and Fridays (after chairs conference which moves to 11:30 am starting 11/8).  Med Peds also starts interviewing, so look for Med Peds applicants to be rounding with us and having lunch with us on Tuesdays.  A few more Doctoberfest questions will come this week, so be on the lookout for a final chance to answer. Kudos this week go to Allyson Pishko from Jan Dillard at the DOC for outstanding patient care.  Additional kudos to our DOCTOBERFEST-recognized nurses (Valencia from Pickett Road, Anderson and Joey from 9100, the team at the VA CCU,  Brittany from 9300, Kim, Lashonda, Dee, Gina and Keisha from the DOC, PRM Ron Campos, Shannon Venditelli from 7800, Kara Richey, and Desta Abate from the VA.   Our nurses sent in recognition for the following residents: Myles Nickolich, Alan Erdmann, Hal Boutte, Matt Atkins, and  Marc Samsky.  A few more days left, so please send in comments about the nurses who help us do our jobs everyday.  Thank you also to our outgoing ACRS…Matt Summers, Alex Fanaroff and Lauren Porras.  Turkey bowl is less than a month away, so trash talk should start heating up. Thanks to all who have volunteered to work on our noon conference task force.  More information to come…if you are interested, please let Steve Bergin know! This week's Pubmed from the Program goes to APD Jon Bae and the QI team for our upcoming poster at the IHI National Forum…"Improving Quality Improvement Residency Education and Provider Performance Through a Shared Online Experience" Have a great week! Aimee QI Corner Burn-out survey Hany is still collecting survey information for resident resilience/burnout after each rotation.  Interns, please fill them out for your most rotation and JARs/SARs look for the surveys this week!  Help us pump up the response numbers . . .

Burnout graphic

QI Noon Conference Our next QI conference is this WEDNESDAY, 10/30, with Joanna Kipnes in 2002 talking about health insurance.  Come and get the latest Hand Hygiene updates, as well . . . Flu congratulations Also at the conference, we will watch the Martin Society and Susanna Naggie win the trophy for fastest Stead Society to reach 100% flu compliance! Business Cards Now that everyone has had their business cards for a while, remember to keep handing them out to patients in both the inpatient and outpatient settings.  Watch for some more follow-up about this over the next few weeks . . . Joel [box]

What Did I Read This Week

Submitted by Suzanne Woods, MD

Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU  JAMA 2013; 310 (15): 1571 - 1580 Authors:  Anthony D. Harris et al (Benefits of Universal Glove and Gown (BUGG) Investigators

[/box] Why did I read this article: I am currently rounding on gen med and the frequent donning and doffing of yellow gowns and gloves always leads me to question if this garb really does anything for patient safety….not to mention the cost of such equipment.  Is this really efficacious and safer for our patients?  Just last week JAMA had an article on this very topic! Known:  Infections with antibiotic resistant bacteria are associated with higher patient morbidity and mortality.128708_suzanne_woods_prd Unknown:  Do gowns and gloves for all patient contact in the ICU decrease the acquisition of antibiotic resistant bacteria? Study:  20 medical and surgical ICU’s in 20 US hospitals.  In the intervention ICU’s:  all health care workers (HCW’s) wore gown and gloves for all pt. contact anytime entering a patient’s room.  Control group:  Gowns and gloves used based on CDC guidelines (only for pts. with clinically identifiable antibiotic resistant bacteria).  The investigators looked at acquisition of MRSA and VRE colonization.  9 month study with 26,180 patients enrolled. Results:
  • Universal gown and glove use did not appear beneficial overall in preventing MRSA or VRE acquisition (primary outcome)
  • Rates of MRSA or VRE acquisition per 1000 patient days decreased from 21.3 at baseline to 16.9 during the study period in the intervention ICU’s;  in the control units a decrease of 19.0 to 16.3 was seen.  Not statistically significant.
  • Secondary outcomes:  individual VRE and/or MRSA acquisition, frequency of HCW visits to patients rooms, hand hygiene compliance, HCW associated infections, and adverse events.
    • Of these outcomes – there was a lower risk of individual MRSA acquisition in the intervention group but no difference with individual VRE acquisition.
    • Using universal gloves and gowns did decrease entry into the pts. room by HCW’s and did increase room-exit hand hygiene compliance when HCW’s did go into the rooms
    • There was no statistically significant effect on the rates of adverse events between the groups.
In the accompanying editorial “Preventing Infections in the ICU, One size does not fit all” by P Malani, several points for consideration were brought up:
  • ? if lack of benefit with universal gowns/gloves is due to the lack of reducing VRE acquisition. Could there be have been errors with assessment of baseline VRE colonization.  ? false negative screening tests to blame
  • Study did not look at other bugs, such as multidrug resistant gram neg pathogens so maybe universal gowns/gloves would make a difference for those bugs
  • Intervention units had higher baseline rates of MRSA acquisition than control units.  ? higher “colonization pressure” with increased risk of transmission, especially in an ICU setting
  • With no difference in adverse event reported….maybe harm was not measured in all categories.  Did the use of gloves and gowns make the patients feel more isolated?  Do HCW’s have a change in behavior with patients that they have to gown and glove universally for? With an overall increased awareness/culture of patient safety maybe this is not an issue?
  • Should patients be bathed daily with chlorhexidine gluconate?  Should all patients have intranasal mupirocin?
Take home points: 
  • Is there really potential value in universal gown and glove use to prevent infection?  The evidence to support this is lacking.
  • Don’t look for the yellow gowns to go away anytime soon!  And….I plan to see if I can obtain cost data for these supplies at Duke Hospital. 
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From the Chief Residents

Grand Rounds

Dr. Gowtami   Arepally Apheresis

Noon Conference

Date Topic Lecturer Time Vendor Room
10/28 Noninvasive Ventilation Bill Hargett 12:00 Pita Pit 2002
10/29 Internist's Guide to   Contraception Sharon Rubin 12:00 Rudino's 2003
10/30 QI Patient Safety   Noon Conference 12:00 Cosmic Cantina: B 2002
10/31 Tobacco Dependence   Management Clint McSherry 12:00 Domino's 2001
11/1 Chair's Conference Chiefs 12:00 Chick-Fil-A MEDRES

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From the Residency Office

 

DOCTOBERFEST - Final Week!

"Building Our Community"  October 1-31, 2013 SummoThank you to everyone who has donated so far to our Doctoberfest Fundraiser for the Northstreet Community Project (info on page 2 of the attachment)!  We have raised $755 to date!  PLEASE help us our goal of $1240, the amount needed to purchase a new portable wheelchair ramp for the community.  Please donate using the link below and help us reach $1240 by October 31, 2013 – every penny counts! You may donate online using the link below, or in person in the MedRes office or outside of Noon Conference each day: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=4UF7XQFW9EGWS As Doctoberfest 2013 draws to a close next week, we would like to thank everyone for their participation and leadership this year.  We have gathered some wonderful tributes to both our trainees and nursing staff and we are thrilled with the success of our fundraising efforts to date! This week we will be unveiling the new trophy to be awarded to the winners of the flu shot campaign (Martin Society) Trick or Treat will also not be forgotten, with plenty of extra candy to be shared at various locations. Resident and Nurse "Wall of Fame":  If you have not yet seen the "wall of fame" in the Med Res office, you have to stop by and see the awesome comments we have received regarding both nurses and residents.  If you have someone you want to recognize, here is the link  to do so. https://www.surveymonkey.com/s/doctoberfest2013_greatnurses We look forward to celebrating with and honoring our incredible Duke Medicine community all month

Fleece, MKSAP, Business Cards, Posters

We are clearing up the office this week in preparation for recruiting.  If you have not picked up items that belong to you (and you know who you are) this is the last chance.  At the end of the week any remaining items will either packed away of disposed of.

Lynsey Michnowicz is Official

If you wonder who that person is who is sitting at the main desk in the office, assisting at conference, or emailing reminders - here is the answer.  Lynsey, who started with us as a temp, is now officially a member of the team.  In addition to what you might all ready know, Lynsey has taken over a long list of responsibilities, including: organizing and supporting clinical epidemiology, supporting academic half day, conference attendance and uploading recorded sessions to MedHub, QI and Sharepoint assignments/reporting, and backing up Erin and event support.  This is just the short list.  So, if you have not already met her, make a point of saying HI tomorrow at noon conference - or at the KICKOFF event in the evening

Hiking Picture

Med Res Hiking (Activities) Club?

Great times were had by the Kempner Society on their hiking trip to Hanging Rock last weekend! Led by the fearless Matt Crowley and David Simel, even SAR Marcus Ruopp was able to keep up with littlest Crowley!Hanging Rock Photo Group 3 Thanks to Matt and Dr. Simel for organizing!    

EBM Scholarship Opportunity

Interested in Evidence-Based Medicine? Apply to attend Teaching and Leading EBM: A Workshop for Educators and Champions of Evidence-Based Medicine (http://sites.duke.edu/ebmworkshop). This renowned workshop delivers core EBM knowledge through interactive sessions and allows participants to practice teaching EBM in innovative ways in supportive small groups. Three scholarships to attend the workshop are available to Duke trainees or faculty who want to further their knowledge and practice of EBM. Scholarships include:
  • full tuition ($1780)
  • a stipend (up to $500) to develop an EBM product or teaching session for the resident’s or faculty member’s home department after the workshop conclusion
Workshop dates are March 4 – 7, 2014. The workshop is held on Duke’s campus at the Fuqua School of Business. Participants will need to commit to attending all 4 days of the workshop. To apply, complete the online form located here http://tinyurl.com/dukeebmscholarship. You will be asked to provide narrative responses (250 words or less) about 1: your prior experience with EBM, including any formal coursework or training, and 2: a brief description of an educational project (such as a teaching session) that you propose developing with the knowledge and skills gained in the workshop. You will also be asked to send an email or letter of support from your Program Director or Division Chief noting your availability to attend the entire workshop (March 4-7). Deadline: November 1, 2013. Notification of acceptance will be given by November 15, 2013, to allow for planning. Questions? Please contact Megan von Isenburg, Medical Center Library, megan.vonisenburg@duke.edu or 919.660.1131. EBM Scholarship Notice  

Information/Opportunities

PIM 2013 pdf Aspirus Internal Medicine-IM Residency Programs 10.22.13 Recruting Flyer Hospitalist  

Upcoming Dates and Events

  • October 28:  Annual Recruitment Kickoff
  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual "Turkey Bowl"
  • December 4:  "Voices in Medicine"

Useful links

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