From the Director
"Hi everyone!
Looking forward to
Doctoberfest -
Saumil started us off with Pumpkin Spice M and M's - curiously good! On Saturday, We had a pre-Doctoberfest kickoff with housestaff vs faculty paintball! Fun had by all (including those of us who were here rounding instead - we were thinking of you!). Pretty certain a rematch will be called by disgruntled faculty. Thanks again to
Chris Hostler for working so hard to plan this event!
Turkey bowl trash talk has begun. Who knew DRH had cheerleaders??? Hope you all an make it to practice on Sundays!
Kudos to everyone for our amazing flu shot compliance rate. Details below, but the interns are about to hit 100% as is the
Warren and Martin societies. Our goal is Oct 1 so if the remaining 11% of residents could find their way to ANYWHERE in Duke, DRH or the DVAMC or the clinics by Tuesday, we will accomplish this. It's easy, and it protects our patients!
Block change tomorrow for the SARs - strong work by all this month. Being on gen med, it's been great to see all the teaching by
Bobby Aertker, Wendy Chan, Jeremy Gillespie, Ben Heyman and
Mandar Aras. Plus, we have opened up the 4300 floor and workroom - come visit gen med 4 in our new home!
Be on the lookout for the residency values google DOC from the chiefs. We are very committed to putting the vision for the program into words and YOUR input is critical! Look for more updates on this exciting project soon.
Pubmed from the program this week goes to VA Chief Vaishali Patel for her upcoming poster presentation at ACG: De Novo Tuberculosis Infection presenting with Ocular Granuloma in a Patient on Infliximab for Crohn’s Disease; Vaishali Patel, Dr Roger Liddle
Have a great week! Happy Doctoberfest !!!
Aimee.
QI Corner
Flu Shots - the Home Stretch
The number of residents who have not received their vaccinations is dropping by the hour - and the race is on for the 1st Stead Group to hit 100%. October 1 is next Tuesday - let's see who rings the bell first!
QI Conference
Thanks to
Dan Kaplan for leading us through a discussion of appropriate test ordering using syncope as an example. Thanks also to our residents for learning and participating - these are not easy topics and there are no easy answers!
QI Champion
Congrats to
Aparna Swaminathan, our Champ of the month, for her role in designing our We Follow-Up campaign and taking on a leading role at PRIME.
QI Craigslist
Join
Aparna and help us improve our appropriate lab follow-up rate at the DOC and Pickett Road - contact
Jon or Joel if interested!
Baldrige Site Visit
As you well know, next week we will receive a site visit by a team of
Malcolm Baldrige National Quality Award examiners. This year, only 10 U.S. sites were chosen across all industries to receive site visits; eight of those sites are from the health care industry.
From Monday, Sept. 30 through Wednesday, Oct. 2, eight examiners will be onsite to talk to you and find out more about how our team delivers the Duke Experience to our patients, their loved ones and each other.
We want you to keep doing the excellent work you do every day, and we want your responses to be guided by your passion for patient care.
To learn more about our Journey to Excellence, and to review site visit prep materials including videos and potential site visit questions, visit the
Journey to Excellence website from any Duke Hospital-based computer.
We’re proud of the work our team does every day, and we’re pleased that others outside the organization are also recognizing you for all you do.
Thank you for being an important part of the Duke Experience.
Visit the Journey to Excellence Website:
https://intranet.dm.duke.edu/baldrige/SitePages/Baldrige%20and%20NCAfE.aspx
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
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What Did I Read This Week
Submitted by Sharon Rubin, MD
Screening for Lung cancer with low dose Computed Tomography: a systematic review to Update the US preventative Services task Force recommendation
Humphre LL, Deffebach M. Pappas M, Baumann C, Artis K, Mitchell JP, Zahker B, Fu R, Slatore CG. Annals of Internal medicine September 17, 2013
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Why did I read this? I first heard about this in the news in August and looked on the USPSTF home page
and finally the article has been in print. Lung cancer is the 3
rd most common cancer and the leading cause of cancer related death in the US . If there is any way primary care doctors can prevent this, we should try. The debate has raged on to screen with chest xray/Ct scan or not to screen. The pendulum from the article supports screening.
What did the authors do? Review of 4 major trials: 1 US (majority of patients) and 3 European trials, looked at mortality reduction with LCDT screening. The conclusions were mainly driven by the US study National Lung Screening Trial. Conclusions that LCDR screening decreased mortality in 20% smokers/former smokers age 55-75.
Why is this study important? This has up dated the USPSTF 2004 recommendation that low dose computed tomography (LDCT) from insufficient to strong evidence to screen. This review has been more comprehensive in terms of patients and studies. Overall the reductions in lung cancer and all cause mortality suggest benefit of screening out weigh harm of over diagnosis.
| Intervention |
Outcome |
NNT |
| Breast cancer screen MMG |
Prevent one breast cancer death women 50-59 after 11-20 years follow up |
1339 |
| Cervical cancer screening |
Prevent one death over ten years |
11402 |
| Flex Sig |
Prevent one colon cancer death |
8176 |
| Antihypertensive therapy |
Prevent one stroke, MI, death over one year |
7001 |
| LCDT screen lung cancer |
Prevent 1 lung cancer death |
NNS 3207 |
| LCDT screen lung cancer |
Prevent 1 death over all (6.5 years) |
NNS 2197 |
| Statins |
Prevent one death over five years |
1071 |
| GP brief advice to stop smoking (3 – 5 minutes) |
Prevent one premature death* |
803 |
| Add pharmacological support |
Prevent one premature death* |
38-564 |
| Add behavioural support |
Prevent one premature death * |
16-405,6 |
| In all smoking cessation |
Smoking related disease |
10 |
*Over half of all continuing smokers will die prematurely from a smoking-related disease. For every two long term quitters, one premature death is avoided (Doll and Peto). 1 Bandolier. 2 Gates, Amer Fam Phys 2001. 3 West 2006. 4 Bandolier 2006. 5 Cochrane 2007. 6 Anthonisen, Ann Inter Med 2005. 7 Schoen NEJM 2012. 7. Church NLST N Eng J Med 2013
Who to screen and other lingering questions? Still awaiting the final recommendation from USPSTF: high risk patients ages 55 to 74 screen with LDCT yearly ? Radiation exposure for LCDT 0.61-1.50 mSv = similar to mammography mSv but for 10-20 years? Subsequent procedures from screening, false positive, concern for over diagnosis and overtreatment? Consider the psychological consequences of screening. Is this generalizable to women and other racial groups?
Bottom line: Smoking cessation and discuss with your patient risks and benefits of radiation with LDCT to screen smokers/former smoker for lung cancer. I am still waiting for the official recommendations and I still wary of CT scan for all smokers even at low dose for 20 years to screen for cancer.
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From the Chief Residents
Grand Rounds
Date: October 5, 2013
Presenter: Gowthami Arepally, MD; Apheresis
Noon Conference
| Date |
Topic |
Lecturer |
Time |
Vendor |
Room |
| 9/30 |
Staph Aureus Bacteremia - Essentials of Management |
Vance Fowler |
12:00 |
Picnic Basket |
2002 |
| 10/1 |
Peripheral Blood Films |
Murat Arcasoy |
12:00 |
Saladelia Salad |
2002 |
| 10/2 |
PFT Interpretation |
Talan Dahhan |
12:00 |
Moes Quesadillas |
2002 |
| 10/3 |
DNR Discussions: Fun Role Play with Dr G. |
Tony Galanos |
12:00 |
Dominos |
2001 |
| 10/4 |
Chair's Conference |
Chiefs |
12:00 |
Chic-fil-a |
MEDRES |
Note from the Chiefs:
Thank you to everyone who was able to attend the Town Hall noon conference where we presented what goes on behind the scenes in the program with regards to duty hours, scheduling, and some of the improvements we are working on this year! Was the presentation helpful? Were there topics that we did not cover about which you want more information? Please feel free to reach either the Chiefs or ACRs directly, or contact your Residency Council representatives with your questions! They can find out the answers to your questions from us on your behalf and get back to you. Alternatively, you can use the confidential comment line! Whatever you choose, we would love to hear any feedback or questions that you have about the content we presented!
[divider]
From the Residency Office
Lunch – Things we Learned at Conference on Wednesday
Thank you all for persevering through our first attempt offering Chinese food at noon conference. Comments that we heard included:
“amazing”, “let’s try
Thai food next”, and “let’s have a
repeat performance”. We also learned that the best plans do not always work out, and Panda Express is sincerely apologetic for NOT delivering at the appointed time. So, a few take aways to consider, and yes – we will do this again.
- Timing is crucial, and we will continue to make every to have our vendors to be on time
- Be considerate of your fellow residents – some of the folks who actually attended noon conference Wednesday didn’t get any food because other people left with a heaping plate of food (as in over flowing) without attending conference. Please be mindful of the fact that when you do this, someone else does not get to eat.
- Our office staff are not there to pick up or mop the floors. If you drop something or accidents happen, you need to help take care of the problem – not just walk away
Lauren and Lynsey are working on plans for October. With your help we will give it another try.
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 in Durham (below)
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!
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 COMING
Building our Community - Doctoberfest Fun(d)
Submitted by Erin Payne
The Northstreet community started with a few families gathering together to dream about what it could look like for their children with intellectual and developmental disabilities to live in community. To be in a place where they could have greater independence, be deeply valued, and truly thrive. Just a few years later, we are being given the incredible gift of seeing this dream become a reality and I have the honor of being a part of it!
This community is rare; in fact, it’s the first in North Carolina! 18 houses in downtown Durham that were abandoned and drug infested are being renovated and have already brought such new life to the area. Each person and home is unique- adding such beauty in diversity. Not all of the houses have been completed yet but it’s a combination of two
Friendship Houses (Duke students doing life with and building close friendships with adults with special needs), a community house (an open space to build community not just within the neighborhood but more so with Durham as a whole), a
Jubilee House (a home where young men who have been incarcerated can transition and be built up/taught independence), families, care givers, and a large amount of adults with and without developmental disabilities. All of us have very different stories of why we are here but come together with the common realization that each person is a gift in which we have a lot to learn from! That we flourish that much more when the people around us are flourishing as well!
AMAZING things are happening and it’s still just the beginning! There is a lot of joy even in the small things; such as
block parties, street soccer, magnet making, karaoke nights, tutoring, meals together, etc.
As mentioned above, a huge part of our community is having a place where many who are often overlooked and pushed aside can belong! Currently my friend Sloan who lives in my house and many of our friends who are in wheelchairs are held back from fully engaging because only 2 of the 18 houses currently have handicap ramps.
We need your help!!
Our hope is to raise money to buy a portable ramp ($1,239.99) so that all of our friends ALWAYS have the option of joining in on the fun that’s going on!
http://www.discountramps.com/roll-a-ramp.htm
Residents! Recruiting Ideas! (submitted by Erin Payne)
We are looking for volunteers to help with the recruitment of applicants who are especially interested in Duke and would greatly appreciate your participation! The goal is to pair each applicant with a resident that has similar interests. The idea is that the resident could then provide more information about how they were able to explore those interests at Duke. We hope that by adding this personal touch, applicants can get a clearer sense of what they can accomplish here!
If you are willing to help us recruit, please fill out a few basic questions about yourself through the following link:
https://www.surveymonkey.com/s/X566W59.
Harvard Biomedical Informatics Research Training Program
Infomatics is a major theme and methodology for biomedical science as well as for health care delivery, public health, and health care education. Biomedical Informatics is the convergence of biomedicine, at every level of biological scale, with a variety of technological and quantitative disciplines, including computer and information sciences, biostatistics, and cognitive science.
Applications for the 2014-2015 academic year, with a start date of July 2014, are now being accepted. The deadline for applications is October 28, 2013. The fellowship program is funded by a grant from the NIH’s National Library of Medicine and is, therefore, open only to US citizens and permanent residents.
Please see the attached document for additional information.
Harvard_Biomedical_Informatics_Training_Program
- Alexa T. McCray, PhD
- Associate Professor of Medicine
- Harvard Medical School
- Director, BIRT program
- Co-Director, CBMI
1st Annual Advanced Heart Failure Symposium
Details / registration link on the attached flyer
Heart Failure Sumposium - REGISTER NOW
Duke Cardiovascular Research Center Seminar Series
October 2, 2013 - 4:00pm; 143 Jones
Sudha Shenoy, PhD, Associate Professor in Medicine, Assistant Professor in Cell Biology, Department of Medicine, Duke University
“Ubiquitination of Seven-Transmembrane Receptors and Beta-Arrestin : Impact on Signaling and Physiology”
October 9, 2013 - 4:00pm; 143 Jones
David Pollock, PhD, Regents Professor, Section of Experimental Medicine, Department of Medicine, Georgia Regents University
“
Endothelin and sodium regulation: Implications for salt-dependent hypertension”
October 16, 2013 - 12:00pm; 143 Jones
Howard Jacob, PhD, Director, Human and Molecular Genetics Center, Warren P. Knowles Chair of Genetics, Professor, Department of Physiology & Pediatrics, Medical College of Wisconsin, Vice Chair of Research, Department of Pediatrics, Children’s Hospital of Wisconsin
“Use of Whole Genome Sequencing in Clinical Medicine”
Information/Opportunities
Sourtheast Opportunities
Upcoming Dates and Events
- 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 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
