From the Director
Hi everyone! Happy Fall! We are moving into Block 4 for the interns, turkey bowl practice is starting and over 3000 applications have been downloaded from ERAS! The chiefs, Randy and I are looking forward to the "feedback from the program" noon conference tomorrow, plus we have our second installment of high value cost conscious care on the 25th with Dan Kaplan! Then get ready for paintball on the 28th.
Kudos this week to Bronwen Garner for leading chairs conference 21st century style on video from DRH, to Carter Davis from the team at the DOC for outstanding work in a tough case, and to the amazing effort that has 49% of the medicine residents already vaccinated for flu! The blitz was a success and we know we can get the rest of you vaccinated by our target date of Oct 1!
Thanks to all who got their global health rotation applications in. The global health team looks forward to talking with you in the next few weeks!
Pubmed from the program this week goes to Mike Woodworth: Predictors of Disease Severity in Patients Admitted to a Cholera Treatment Center in Urban Haiti; Claude-Lyne Valcin, Karine Severe, Claudia T. Riche, Benedict S. Anglade, Colette Guiteau Moise, Michael Woodworth; tropmed130170
Have a great week
Aimee
QI Corner
QI Conferences A big thank you to the always entertaining Dan Ariely who let us all know that everyone but me is a total liar. This coming Wednesday, 9/25, we have Dan Kaplan bringing us the next in our high-value, cost-conscious care series. Dr. Kaplan will be discussing "Healthcare Costs, Wastes, and Over-Utilization of Tests" Food to be provided by Panda Express (SPECIAL REQUEST) Flu Vaccination Campaign Thanks to everyone who already has received their flu shot this year - we are still shooting for fewer than 35 days to reach 100% compliance, as long as Kempner pulls it off one day faster than everyone else. . .
As of 3PM 9/20/2013, our vaccination rate for the program (w/results still coming in) was 49%!
And it looks like Stead Society - Warren was dominating the competition. Take a look at Stead Leader Whitson getting in the game to get her society vaccinated!
Site Visit for QI Award Duke has an upcoming visit for the Baldrige Award, which is the national award for patient safety and quality of care. It is a HUGE honor to even be considered, and you will see visitors around between 9/30 and 10/4. If you are a resident interested in participating in some of the planning over the next week or two, please contact Aimee, Jon, and/or myself.
Some quick details on the Baldrige Award:
Duke is in consideration for THE award in Patient Safety and Quality. It is a HUGE honor to be considered, as only 10 institutions are being considered this year.
As part of the consideration, eight site visitors representing the Award are scheduled to visit 9/30-10/4. They will be meeting formally with certain program representatives across the Medical Center, but they will also be visiting the wards and likely asking to discuss safety/quality topics with housestaff and attendings.
Things to keep in mind as they visit -
First, there is a safety reporting system in place (known as SRS). Anyone can place a report, from students to faculty, and they are intended to be used to identify processes we can influence at a systems-level. Bad events aren't the only target - we REALLY want both more near misses and more entered by our housestaff and attendings.
Second, we have a robust quality education curriculum and improvement infrastructure compared to many peer institutions. All our housestaff participate in the QI curriculum of lectures and modules, and all JARs/SARs participate in a program-level initiative annually (this year, the 'We Follow-Up' labs campaign). This is in addition to the numerous resident-led projects ongoing (10-15 at last count)
Key Areas of focus:
o The Duke Experience (Living our Values, the Mission, Vision, and Values statement) o Commitment to Delivering Highest Quality Care (Multidisciplinary teams) o Patient Focused Culture (Rounding, Community support) o Alignment of Goals and Objectives (Balanced Scorecard) o Financial Stewardship (Expense management, community support)
Examiners goal is to speak to 10% of DUH Staff (700-800 people) including residents! Visit the Journey to Excellence Website (under quick links on the DUH Intranet homepage) to find prep materials.
QI Craigslist The latest need is for one PICKETT ROAD and one DOC resident to join Aparna Swaminathan as a site-based champion for this year's Sharepoint 'We Follow-Up' project.
Goal: Increase awareness of appropriate ways to send results to patients and the timeline in which to do so, and IMPROVE PATIENT CARE!!!
Time: 1-2 hours/month
If interested, please contact me and/or Jon Bae.
Hand Hygiene Update Actual Hand Washing Rate for August = 86% (Goal = 91%) ONLY 8100 MET THE GOAL FOR OUR SEVEN WARDS!!! REMEMBER . . .
Follow Us on Twitter
- @DukeMarines - Duke Chief Resident Updates - @JonBae01 - QI and Patient Safety (general news and program updates) - @DukeDOMQuality - Duke DOM Quality Updates - @bcg4duke - Maestrocare and health informatics
[box]
What Did I Read This Week
Submitted by Suzanne Woods, MD
A Host-Based RT-PCR Gene Expression Signature to Identify Acute Respiratory Viral Infection Science Translational Medicine 18 Sept 2013 Vol 5, Issue 203, p 203ra126 ra126
Authors: Aimee K. Zaas, Thomas Burke, Minhua Chen, Micah McClain, Bradly Nicholson, Timothy Veldman, Ephraim L Tsalik, Vance Fowler, Emanuel P Rivers, Ronny Otero, Stephen F Kingsmore, Deepak Voora, Joseph Lucas, Alfred O Hero, Lawrence Carin, Christopher W Woods, Geoffrey S Ginsburg http://stm.sciencemag.org/content/5/203/203ra126
[/box]
Why did I read this article: Well a few obvious reasons….this article received a lot of publicity this week in the media, this is a Duke publication, I know and work with many of the authors and happen to be married to one of them! Plus as Med-Peds primary care physician, if there a way to diagnosis the cause of sniffles, sneezes and wheezes it would be very helpful in the clinical setting. The Challenge: Diagnosis of acute viral respiratory infections Goal: Early differentiation between viral and bacterial etiologies of respiratory symptoms. This can help to then direct more appropriately therapy and minimize the overuse of antibiotics. Such differentiation could also play an important role in triage of a potential viral pandemic. Hypothesis: A host response-based diagnostic could be used to differentiate viral from nonviral etiologies of respiratory infection. This is because the immune response of humans differs based on the infecting pathogen class (bacterial vs viral). Study: The authors previously derived a host gene expression signature based on multiple human viral challenges (influenza , respiratory syncytial virus, and human rhinovirus). This “gene signature” was initially validated on a microarray platform that would not be useful in a clinical setting. The authors now have transitioned the gene “signature” to a reverse transcription polymerase chain reaction (RT-PCR) assay which could be used in a diagnostic capacity. This new assay’s performance was first assessed in two healthy human volunteer influenza challenges with both H3N2 and H1N1. The assay was then validated in a cohort of emergency department patients with either a confirmed respiratory viral infection or a systemic bacterial infection. Results revealed that: The RT-PCR assay accurately classified patients from the human challenge studies with H3N2 (100%) and influenza H1N1 (87%). Furthermore, the assay performed extremely well in the emergency department cohort (89% sensitivity, 94% specificity). Importance: The development of this new assay and validation with patients is a very exciting and important development because RT-PCR assays are widely available in clinical laboratories. Although the current turnaround time is still estimated to be about 12 hours, the authors hope that improvements in the technology, particularly extraction, will allow for the test to be available during an acute care or emergency department visit. In that setting, the test could greatly benefit clinical decision making, leading to a reduction in inappropriate antibiotic use and potentially more directed antiviral use. The authors also allude to potential use in detection of new pandemic viruses. This new assay signals a major shift in our approach to infectious disease diagnostics. It will certainly not replace pathogen based approaches, but could prove to be a strong complement. Great job Aimee et al! [divider]From the Chief Residents
Grand Rounds
Date: September 27, 2013 Presenter: David Boyte, MD; Perioperative AssessmentNoon Conference
| Date | Topic | Lecturer | Vendor | Room |
| 9/23 | Your Residency - Behind the Scenes | Chiefs | The Pita Pit | 2002 |
| 9/24 | Electrolyte abnormalities | Dave Butterly | Bullock's BBQ | 2002 |
| 9/25 | QI Patient Safety Noon Conference - HVCC Syncope Mgmt | Dan Kaplan |
Panda Express |
2002 |
| 9/26 | PFT Interpretation | Talal Dahan | Moe's Burritos | 2001 |
| 9/27 | Research Conference | Panera | 2002 |
[divider]
From the Residency Office
We Do Listen - Really
We received a request on the comment line to offer either Chineese or Tai at noon conference. So, we are giving it a try - Wednesday of this week. Thanks go to Lauren for sourcing the vendor (Panda Express). One request: Please take extra effort to clean up at the end of conference and not leave anything behind.
Enjoy!
And, in case you missed it - Lauren found another treat that is now available in the Med Res Office -
DOCTOBERFEST IS COMING!
"Building Our Community" October 1-31, 2013 Join the Internal Medicine Residency Program in our annual celebration as we recognize members of our Duke Medicine community and give back to our neighbors in the Durham community! October 1, 2013 will mark the start of our 2nd Annual “Doctoberfest” celebration! Fundraiser As part of our effort to give back to our friends and neighbors in our local community, we will be having a fundraiser to benefit a local charity (TBD) in Durham. . October 15 Join us at noon conference for a traditional “beer” garden treat! October 31 Halloween Tricks and Treats! Join us at Noon Conference for some Halloween goodies and for the announcement of our fundraiser’s “winning” Chief! Be sure to read “Med Res News” each week for more Doctoberfest Updates We look forward to celebrating with and honoring our incredible Duke Medicine community all month long! Open the following PDF for more details, click on the pumpkin tab at the bottom- and see which Chief Resident you think belongs to which pumpkin!! DOCTOBERFEST IS COMINGClinical Science Day
Clinical Science Day will take place on Friday, October 18 in the Great Hall of the Mary Duke Biddle Trent Semans Center during Medical Alumni Weekend with the goal of bringing together alumni, faculty, and trainees to celebrate clinical research and the vast and diverse array of activities taking place across our campus, showcase these activities, and encourage collaborations.- Poster Session and Competition.
- Registration is required.
- Visit the website to register.
Free Help with Your Student Loans
Paul Garrard, an independent student loan consultant and national expert on educational debt management, will be at the DUMC October 7 through October 9. He will be providing individual consultations to medical students, residents, and fellows who have questions about their student loans and subsequent repayment strategies. Mr. Garrard is a frequent visitor to Duke and you will not want to miss this opportunity to spend some time with him. You can access the online sign up for individual consultation times with him via this link: http://www.signupgenius.com/go/10C0C45ACAF238-fall1 He is planning to return the last week in February so, should you miss him in October, you will have another chance at that time. If you have any questions, please contact Amy Coppedge at amy.coppedge@duke.edu.9th Annual Patient Safety & Quality Conference
- Thursday – March 13, 2014
- Fuqua School of Business, Durham NC
- Early call for abstracts - details on the attached flyer
Faculty-Resident Research Grant Request for Applications
REQUEST FOR APPLICATIONS
Purpose: To provide funding for Internal Medicine Residents to develop their skills in clinical or laboratory-based research, to carry out research projects, to present their research findings at scientific meetings and to publish their work Application Instructions Eligibility:-
Interns and residents in the Department of Medicine, Med-Peds, Med-Psych are eligible
-
Clinical or Basic Science research proposals are acceptable
-
Research project must be performed at Duke under the direction of a Duke faculty member
-
Grants will be funded up to $2,000
-
The term of the award must NOT extend beyond the residency training period at Duke. The beginning date for funding is July 1, 2014 and end date is June 30th 2015. Interns who are awarded may apply for extension to use the funds for use during their SAR year.
-
An itemized budget must be included with the application (use attached forms)
-
Application deadline is April 11, 2014 by email to murat.arcasoy@dm.duke.edu
-
Late or incomplete applications will not be accepted. Please submit on time!
-
A faculty committee will review applications for scientific merit
-
Letter of support from faculty mentor is requested and must accompany grant please, Letter addressed to “Award Review Committee, Faculty Resident Research Grant”
-
Use application forms online and follow instructions please. Scientific proposal – strict 3 page limit with tables and figures (excluding references, budget page, and human subjects sections) http://residency.medicine.duke.edu/duke-program/resident-research/research-funding
-
Itemized budget may include but is not limited to research supplies, reagents, temporary personnel time for data collection, data analysis costs and statistician time, poster preparation, travel expenses to present abstract at scientific meeting, publication costs of research project
Upcoming Dates and Events
- September 17: Application deadline for Global Health Electives
- September 18/19: Flu Shot Blitz
- October 1: Duke’s Global Health-Internal Medicine Residency deadline to submitt applications
- October 18: SoM Clinical Science Day
- October 28: Annual Recruitment Kickoff
- November 28: Annual "Turkey Bowl"
- December 4: "Voices in Medicine"
Useful links
- https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
- August 2013 Resp Fit Testing-T-Dap-TB Skin Testing Flyer
- http://duke.exitcareoncall.com/.
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Department of Medicine
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.