From the Director
HI everyone!
First, thanks to all for your well wishes and support for Randy. I know he appreciates your thoughts and concern. Jennifer will be sending more information about how you can do more to help if interested. Unexpected happenings always serve to remind us how well we take care of each other…much appreciated.
Kudos and congratulations to Bronwyn and Dave Garner on the birth of Rhys! He's super cute and all are doing well. Other kudos go to the following interns who have received gold stars in the past week…Nick Rohrhoff, Hal Boutte and Deng Madut. I have also heard kudos regarding care from Rachel Titerance on 9300, as well as Hassan Dakik at the VA. Participation in report and conference has been excellent, which is very much appreciated…Josh Thaden rocked the report for applicants on Monday, with great discussion from the crowd, as did Laura Caputo at Chair's conference. Eric Chu brought EBM to Duke report which was also very well done. Look for the ACRs and Chiefs to be sending more articles about the clinical questions raised at all of our conferences. Applicants have also commented on how well the teams on gen med are running, with excellent bedside presentations by the interns. Nice work!
Moustaches continue to grow, and will clearly be intimidating on the Turkey Bowl field. Looking forward to a great battle between the Jets and Marines. Even if you aren't playing, come out and root for your friends! Unfortunately the Zaas family will be out of town this Thanksgiving (blame my husband for wanting to get out of town on our 15th anniversary…) but we are looking forward to hearing the updates from what will certainly prove to be a great contest! Join everyone in the med res library for turkey afterwards!
Please donate to the food drive…let's beat our total from last year AND crown a winner of the Stead Cup.
Coming soon is the DOM Holiday Party…its early this year (Dec 1) but get ready to dress up, see some awkward faculty dancing, and have a great time with your friends and colleagues.
This week's
PUBMED FROM THE PROGRAM goes to
John Stanifer for his article in American Journal of Medicine "What Started This: Debilitating Longitudinally Extensive Myelitis" Stanifer JW, George R, Keenan RT, Massey EW. Am J Med. 2012 Nov;125(11):1071-3. doi: 10.1016/j.amjmed.2012.07.010.
Have a wonderful Thanksgiving week!
Aimee
QI Corner (by Drs. Jon Bae, Ryan Schulteis, and George Cheely, Jr)
Thank you to Jennifer Rose from Duke Performance Services for her discussion of Value-Based Purchasing at this week's Patient Safety and Quality Improvement Noon Conference. Our next conference will be 12/13/2012 featuring the Dept of Pharmacy discussing Medication Reconciliation
See you there!
Check Yourself Before You Med Rec Yourself: A Message From Pooh Setji, Duke Hospital Medicine, and Dept of Pharmacy
Please see the details below regarding a new process being implemented by pharmacy in our emergency department. From our recent meeting with Paul Bush, this medication history is being taken during day time hours in the ER and does not apply to our Outside hospital transfers or direct admits. I believe the activation for their techs occurs when the admit flag is raised in Wellsoft, so in most instances for day time admissions, an accurate admission medication history should be visible when the patient is receives a bed on gen med. This process has started approximately 3 weeks ago.
Dear Providers: The Department of Pharmacy Continuity of Care team is pleased to announce that you will start seeing a new note in eBrowser. This note, titled “Pharmacy Home Medication List,” will contain the medication history obtained by the Continuity of Care pharmacy technicians who are interviewing patients in the Emergency Department and serve as a source of information regarding all the medications a patient is taking at home. These interviews are primarily focused on patients being admitted. The pharmacy technicians will review available records, interview the patient and/or caregiver, and call outpatient pharmacies and/or physicians as needed to compile the list. The list will then be reviewed by a pharmacist. This review is not to fulfill the medication reconciliation requirement, which will still be completed by the inpatient clinical pharmacists, but rather to help ensure the accuracy and completeness of the medication list. Once reviewed, the pharmacist will sign off on the note and the “preliminary” status will be removed. The goal of the Department of Pharmacy Continuity of Care team is to produce the best possible home medication list for patients being admitted to Duke. Having an accurate medication list at admission is a foundation to improving transitions of care for our patients. Utilizing a separate note in eBrowser allows the information to be readily available to all staff, both inpatient and outpatient. This is an exciting step forward for the Continuity of Care team and the Department of Pharmacy.
What Did I Read This Week (by Suzanne Woods, MD)
[box]Cluster of skin infections associated with tattoos - AAP News Vol 33, No 11, November 2012[/box]
Why did I read this article: This article showed up in my Outlook inbox during Gen Med since I receive weekly updates from the American Academy of Pediatrics (AAP). It was very timely as Jennifer Chung, Leah Rosenberg, Venu Reddy and I had just cared for a 23yo woman who presented with a rash following a recent tattoo to her RUE performed in a friends home. The rash progressed and was erythematous and papular and involved the majority of her skin but spared mucus membranes. She was febrile and had a mild transaminitis. HIV, Hepatitis panel, blood cultures were negative. A skin biopsy revealed perivascular dermatitis with eosinophils. A parvovirus B 19 PCR later returned positive.
Summary: Approximately 21% of adults in the US report having at least one permanent tattoo (my note: given the combined Med-Peds population of Durham I see I think this is many times greater!) Outbreaks caused by nontuberculous mycobacteria (NTM) have been reported infrequently after tattooing. There have been clusters of such infections however in four states (Colorado, Iowa, New York and Washington) in 2011-12. The first reports were from New York where all infections were associated with the use of the same nationally distributed, pre-diluted gray ink manufactured by a given company. Twenty-two cases were identified and 19 were caused by
M chelonae and the others by
M abscessus. Infections with NTM can range from mild inflammation (rash, papules or nodules) to severe abscesses requiring extensive and multiple surgical debridements. These infections can be hard to treat and require combination antibiotics for prolonged courses.
Public health tips:
- Use tattoos parlors registered by local jurisdictions
- Request that only inks that are manufactured specifically for tattoos be used.
- Request that only sterile water be used for any dilutions. Several NTM organisms are found in water, so addition of nonsterile water to tattoo dye may lead to infection.
- Ensure tattoo artists follow appropriate hygienic practices.
- Be aware of the potential for infection following tattoos and seek medical advice if persistent skin problems occur.
- Notify the tattoo artist and the FDA’s MedWatch program if an adverse event occurs.
From the Chief Residents
Grand Rounds
Due to the Thanksgiving Holiday, there will be no Grand Rounds on 11/23/12
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
| Monday |
11/19 |
INTERVIEW |
|
12:00 |
Saladelia |
| Tuesday |
11/20 |
Osteoporosis |
Richard Lee |
12:00 |
Sushi |
| Wednesday |
11/21 |
SAR Talks |
Callie Coombs, Rex Cheng |
12:00 |
Papa John's |
| Thursday |
11/22 |
THANKSGIVING |
MedRes Library |
1:00 |
Bullocks |
| Friday |
11/23 |
THANKSGIVING BREAK |
No Conf. |
|
No lunch |
Additions to "Our Family" (sent by Wassim and Mayane Shatila)
"My wife Mayane delivered a beautiful baby girl Yasmine Shatila. She was born on Nov 4,2012. I thank the program including Jeff Clarke, Aimee Zaas, Randy Heffelfinger, Nicole Greyshock, and Jason Webb for helping me through this and answering all the questions I had. You were all so helpful." Wassim
Movember - First "Stash" Posted in the Med Res Office
The "growth" of facial hair has started, and many jokes have all ready been shared. But, on the serious side this is a fantastic opportunity to raise awareness of men's health issues, and all of the funds raised go directly to a great cause! Over $450 has been collected so far, which is AWESOME news.
How to support your team? Go to the following website:
www.movember.com.
And, on a more local level you can stop by the office to post a picture of your favorite faculty member or resident on the "wall". All we ask for is a donation and a chance to view your fancy artwork. Below you can see a snapshot of our "EARLY CONTENDERS"
Annual Stead Society Thanksgiving Donation Challenge
NOTE: MONDAY, NOVEMBER 19, 2012 IS THE LAST DAY TO DONATE!
What's better than eating all of those things together in large quantities?? Donating them to people who might not otherwise get to have any!
Donation totals as of Monday, 11/19/12
1. Kerby (A): $325
2. Orgain (C): $185
3. Kempner (B): $170
4. Rankin (E): $100
5. Smith (D): $10
So what is up for grabs this year? Not only current Stead Society bragging rights to the new Stead Cup Trophy (to be passed amongst the Stead Societies for winning future events) but also a "social hour" for the winning group, hosted by the Orgain Society (if you can beat us), for the passing of the Stead Cup.
Last year, the
Smith Society edged Orgain out for the win with a total group donation just over $500, and we made a total residency-wide donation of $1449.59. We're sure we can beat this year with a little stead smack-talking drama!
This year our
donations will go to benefit both the
Durham Rescue Mission's Annual Thanksgiving Community Dinner on Main Street (including their free grocery giveaway), as well as our usual
DOC patient food cards.
WHAT: The Annual Stead Society Thanksgiving Donation Challenge.
WHEN:
MONDAY, NOVEMBER 19, 2012 IS THE LAST DAY TO DONATE!
CHALLENGE: Largest collective food/monetary donation from the members of a Stead Society
Donating is Easy!
1. PayPal Account here:
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=YGR55TRWRB8VA
2. Food Donations Box in the Med-Res Office (label your food)
3. Money Envelopes by Stead Society in the Med-Res Office
As per tradition,
bulk quantities of canned yams can be stacked into a large pyramid directly on the VA chief's desk...particularly if you play for the Marines!
Survey Opportunity
The following is an invitation to all house staff to participate in a research survey from Principal Investigator Mitchell Heflin, MD, MHS and Study Coordinator Megan von Isenburg, MSLS.
We welcome you to participate in important research into evidence-based medicine (EBM) education in Graduate Medical Education (GME). The purpose of this survey is to assess GME trainees’ current evidence-based medicine (EBM) skills and attitudes; to inventory program educational opportunities; and to develop educational materials to support EBM training across all programs in Graduate Medical Education (GME). This is an Innovations-funded project.
This survey should take you 5-10 minutes to complete. The survey is web-based and asks questions about your program and level, about how you use EBM in clinical care, and about EBM in your program.
The major benefit of participation in these surveys is that your input will be used when designing new educational opportunities in evidence-based medicine across GME programs. We hope that this study will facilitate creation of relevant and engaging educational online modules and/or in person classes to support EBM. Individual responses will not be matched to their email addresses or other identifying information, and every effort will be made to preserve confidentiality.
Completion of the survey indicates implied consent to participate. Your participation is voluntary. If you wish to decline, simply do not fill in the survey. There are no negative consequences to your employment or education if you refuse to participate in this survey. Please contact this study’s Principal Investigator at
mitchell.heflin@duke.edu, the study coordinator at
megan.vonisenburg@duke.edu, or the Duke IRB at (919) 668-5111 with any questions or concerns.
https://redcap.dtmi.duke.edu/redcap/surveys/?s=xaFWhT
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From the Residency Office
Randy Update
As of Friday, November 16th, we are thrilled to announce that Randy has returned home from the hospital to continue his recovery from his cycling accident last week. From all of us in the MedRes office, we would like to thank everyone for the outpouring of concern, kind words and support you have shown towards Randy and his family during this difficult time. To Randy, Mindy, Abby and Erin - Our thoughts and prayers are with you each and every day!
The Baby Blanket and Stuffed Animal Drive for the Duke NICU was a Great Success!
Thanks to your generous donations, we delivered 49 baby blankets and 12 brand new stuffed animals to the Duke NICU on Friday, November 16th! A special thanks to Lauren Dincher whose passion for this drive helped to make it such a success!
Interested in Teaching (sponsored by The Office of the Primary Care Leadership)
Please save the date for the upcoming “
Teaching the Outpatient Teachers” workshop sponsored by the Primary Care Leadership Track. This half day workshop will be on
Friday January 11, 2013. There will be a morning and afternoon session for this workshop. The morning session will run from 8:00 am to 12:00 pm, and the afternoon session will run from 1:00 pm to 5:00 pm.
Topics to be covered include: giving streamlined feedback, using an iPad, staying on time in a busy practice, improve your musculoskeletal exam, and a review of compliance issues.
To enroll in the workshop for either the morning or afternoon session please contact: Blake Wiggins at
blake.wiggins@duke.edu
CVRC Retreat
The next CVRC Retreat is scheduled for Saturday January 12, 2013 at the Searle Center Lecture Hall. Our Keynote speaker will be
Michael S. Parmacek, Herbert C. Rorer Professor of Medical Sciences, Director, Penn Cardiovascular Institute, Chief, Cardiovascular Division -
“Transcriptional Programs Resulting Cardiovascular Development and Disease”.
Anyone who will be attending must RSVP no later than December 17, 2012 to: DUKECVRC@dm.duke.edu
Poster Contest: Three poster authors will be chosen to speak at the retreat. Your abstract will need to be emailed to
amberly.adams@duke.edu by
December 1, 2012, include name, abstract title and lab affiliation. Abstracts should be 1 page or less with 1 figure and sections for intro, materials and methods, results and discussion, and conclusion. The three speakers will be notified around December 21, 2012 so they will have time to prepare. There will be space to display a poster for submitted abstracts. If you would like to display a poster at the retreat please include a request for display and the size of the poster.
Amberly Adam, Duke Cardiovascular Research Center, DUKECVRC@dm.duke.edu
Dates to Add to Your Calendars /Contact Information/Opportunities
November 22 Turkey Bowl
Game @ 11:00 - grass field, corner of Cameron and Science Drive
Dinner @ 1:00 for residents and families in the Med Res Library
December 1 DoM Holiday Party
Opportunities
Virginia Commonwealth University Hospitalist Shifts
Job Desc Hospitalist with salary 10312012 (2)
Internal Medicine Stipends for Residents in Training November 2012
Useful links
"My wife Mayane delivered a beautiful baby girl Yasmine Shatila. She was born on Nov 4,2012. I thank the program including Jeff Clarke, Aimee Zaas, Randy Heffelfinger, Nicole Greyshock, and Jason Webb for helping me through this and answering all the questions I had. You were all so helpful." Wassim
Movember - First "Stash" Posted in the Med Res Office
The "growth" of facial hair has started, and many jokes have all ready been shared. But, on the serious side this is a fantastic opportunity to raise awareness of men's health issues, and all of the funds raised go directly to a great cause! Over $450 has been collected so far, which is AWESOME news.
How to support your team? Go to the following website: www.movember.com.
And, on a more local level you can stop by the office to post a picture of your favorite faculty member or resident on the "wall". All we ask for is a donation and a chance to view your fancy artwork. Below you can see a snapshot of our "EARLY CONTENDERS"
Annual Stead Society Thanksgiving Donation Challenge
NOTE: MONDAY, NOVEMBER 19, 2012 IS THE LAST DAY TO DONATE!
What's better than eating all of those things together in large quantities?? Donating them to people who might not otherwise get to have any!
Donation totals as of Monday, 11/19/12
1. Kerby (A): $325
2. Orgain (C): $185
3. Kempner (B): $170
4. Rankin (E): $100
5. Smith (D): $10
So what is up for grabs this year? Not only current Stead Society bragging rights to the new Stead Cup Trophy (to be passed amongst the Stead Societies for winning future events) but also a "social hour" for the winning group, hosted by the Orgain Society (if you can beat us), for the passing of the Stead Cup.
Last year, the Smith Society edged Orgain out for the win with a total group donation just over $500, and we made a total residency-wide donation of $1449.59. We're sure we can beat this year with a little stead smack-talking drama!
This year our donations will go to benefit both the Durham Rescue Mission's Annual Thanksgiving Community Dinner on Main Street (including their free grocery giveaway), as well as our usual DOC patient food cards.
WHAT: The Annual Stead Society Thanksgiving Donation Challenge.
WHEN: MONDAY, NOVEMBER 19, 2012 IS THE LAST DAY TO DONATE!
CHALLENGE: Largest collective food/monetary donation from the members of a Stead Society
Donating is Easy!
1. PayPal Account here:
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=YGR55TRWRB8VA
2. Food Donations Box in the Med-Res Office (label your food)
3. Money Envelopes by Stead Society in the Med-Res Office
As per tradition, bulk quantities of canned yams can be stacked into a large pyramid directly on the VA chief's desk...particularly if you play for the Marines!
Survey Opportunity
The following is an invitation to all house staff to participate in a research survey from Principal Investigator Mitchell Heflin, MD, MHS and Study Coordinator Megan von Isenburg, MSLS.
We welcome you to participate in important research into evidence-based medicine (EBM) education in Graduate Medical Education (GME). The purpose of this survey is to assess GME trainees’ current evidence-based medicine (EBM) skills and attitudes; to inventory program educational opportunities; and to develop educational materials to support EBM training across all programs in Graduate Medical Education (GME). This is an Innovations-funded project.
This survey should take you 5-10 minutes to complete. The survey is web-based and asks questions about your program and level, about how you use EBM in clinical care, and about EBM in your program.
The major benefit of participation in these surveys is that your input will be used when designing new educational opportunities in evidence-based medicine across GME programs. We hope that this study will facilitate creation of relevant and engaging educational online modules and/or in person classes to support EBM. Individual responses will not be matched to their email addresses or other identifying information, and every effort will be made to preserve confidentiality.
Completion of the survey indicates implied consent to participate. Your participation is voluntary. If you wish to decline, simply do not fill in the survey. There are no negative consequences to your employment or education if you refuse to participate in this survey. Please contact this study’s Principal Investigator at mitchell.heflin@duke.edu, the study coordinator at megan.vonisenburg@duke.edu, or the Duke IRB at (919) 668-5111 with any questions or concerns.
https://redcap.dtmi.duke.edu/redcap/surveys/?s=xaFWhT
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