From the Director
Hi everyone!
Heading back from the program directors meeting - also represented were clerkship directors and program administrators. Duke had a great showing, with seminars presented by
Bill Hargett, Saumil Chudgar, Murat Arcasoy, Jane Gagliardi, Steve Bergin, Diana McNeill and I. We all learned a lot and look forward to bringing some great ideas back to you.
Even though I was away, I heard some kudos about Intern
Hal Boutte from his teammate on CAD for making a diagnosis that required some dedicated work and time. I'm sure there's more, so send them my way!
Love the
gnome antics! Didn't see gnome land security at the airport, so guess he hasn't escaped!
This weeks Pubmed from the program goes to
Callie Coombs, whose abstract for poster presentation has been accepted to be preseented at the 2012 Annual Meeting of the American Society of Hematology in Atlanta, Georgia. Title: The Relationship Between Socioeconomic Status and Clinical Outcomes in African Americans with Chronic Lymphocytic Leukemia.
Have a great week and happy Doctoberfest, week 3.
QI Corner (by Jon Bae, MD)
Flu Blitz: Incredible, and thank you to everyone who has gone out of their way to ramp up our numbers. We are 95%, just a few short of our goal of 100% vaccination. Even more important is that we will be in a much better position to take care of our patients and each other as the flu season really kicks in.
For the final few hold outs, vaccines are offered for free through employee health in Duke South. You can get vaccinated at your clinic, DRH, VA, or even the hospital wards as well. If you have already been vaccinated, particularly if not at Duke North, make sure you fill out the online form through employee health (link below).
http://www.safety.duke.edu/EOHW/FLU/FluSurvey.aspx
Here are the most recent graphs by Stead Society and Class"
What Did I
Read This Week (by Sarah Rivelli , MD)
We know that melatonin levels are low in delirium and in dementia which confers risk for developing delirium. This study examines the efficacy of low dose exogenous melatonin in preventing delirium. The design was a randomized, double-blinded, placebo-controlled trial. Patients were aged 65 years or older and admitted to inpatient general medicine in a tertiary care hospital in Canada.
Patients received either 0.5 mg of melatonin or placebo every night for 14 days or until discharge. The dose of melatonin used is considered physiologic and would serve to simply restore levels to normal. The primary outcome measure was the occurrence of delirium as determined by Confusion Assessment Method (CAM) criteria. There were 12 and 11 patients in the placebo and melatonin arms, respectively, that did not complete the study. There were no significant differences between the placebo and melatonin groups at baseline.
Melatonin was associated with a lower risk of delirium (12.0% vs. 31.0%, p<0.014). The odds ratio (OR), adjusted for dementia and comorbidities potentially associated with delirium, was 0.19 (95% CI [0.06–0.62]). There were 9 patients in the placebo and 5 in the melatonin groups that screened positive for delirium at the time of enrollment. When these patients were excluded from the analysis, the melatonin group still had a lower risk of delirium compared to placebo (19.2% in the placebo group and 3.6% in the melatonin group, p<0.02), or a relative risk reduction of 0.19. The absolute risk reduction was 15.6% and number needed to treat to prevent one case of delirium was 6.4.
This study provides provocative, though limited evidence, for physiologic dose melatonin as a preventive agent for delirium among the elderly. Limitations include that the outcome measure was the CAM, which is only a screening tool for delirium and cases were not confirmed with further clinical testing. However, raters were blinded to the intervention and inter-rater reliability was reportedly high.
Will this change my practice? It might. I do currently use supraphysiologic doses of melatonin in delirium, but haven’t used it as a preventive agent. I think I’ll need more evidence prior to recommending that all elders admitted to Gen Med get low dose melatonin. If you are considering ordering melatonin, note that it is not currently on formulary and can only be ordered as a miscellaneous medication.
[hr]
From the Chief Residents
Grand Rounds
| 19-Oct-12 |
Stead/Alumni |
Dr. Whyte |
Media & Health Messages |
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
Room |
| Monday |
10/15 |
CXR/Chest CT conference |
Phil Goodman |
12:00 |
The Picnic Basket |
2002 |
| Tuesday |
10/16 |
Schwartz Rounds |
Lynn O'Neill |
12:00 |
Saladelia |
2002 |
| Wednesday |
10/17 |
IM-ED Combined Conference |
|
12:00 |
Jersey Mike's |
2002 |
| Thursday |
10/18 |
Optho for the internist |
Kelly Muir |
12:00 |
Sushi |
2001 |
| Friday |
10/19 |
Chair's Conference |
Chiefs |
12:00 |
Rudinos |
2002 |
Turkey Bowl Practice
Time and place for practice each week: Sunday @ 330 at Forest Hills Park.
AMPATH Grand Rounds: Building Innovative Academic Global Health Partnerships in Western Kenya – October 23rd
The Academic Model Providing Access to Healthcare (AMPATH) Consortium was initially established by Indiana University as a strategic global health partnership between North American Universities, Moi University, and Moi Teaching and Referral Hospital in Kenya. AMPATH’s mission of care, research, and education is embraced by institutions worldwide, who partner with the Moi Hospital and University, allowing the Kenyan leaders to draw upon the resources and talents of North American academic health institutions to tackle the challenges of disease and poverty.
[divider]
From the Residency Office
DoctoberFest is Here:
The
Wall of Fame: If the following picture is not familiar, you obviously have not stopped by the office often enough to dip your hand into the basket of treats. The wall has taken shape - make sure to NOT miss the following:
Sign Ups for Interview Dinners: The venues and sign up sheets for the month of November are posted and filling up quickly.
3GT (Three Good Things): The leadership team is posting their 3GT's on the wall for all to see
Recognition: Check out the postings and add yours to the growing color scheme of residents who are simply saying thanks for doing an awesome job.
Name the Gnome: The voting has started and will remain open this week. Use the following link to enter your vote (or start a write in campaign) (
https://www.surveymonkey.com/s/Name_the_MedRes_Gnome). The final "selection" will be posted in Updates on
Sunday evening. And if you missed it, Mr. Gnome is happy to have survived ITE's earlier this week.
Food - BIG conference again this Tues, with box lunches. Should be amazing to see 150 boxes stacked up outside 2002. More to come later in the month as we approach Halloween.
Stead Groups - What You May Not Know:
This week we are honoring the
Kempner Stead Society, which is
chaired by
Matt Crowley, MD.
Our Society is named for
Dr. Walter Kempner. Dr. Kempner was born in 1903 in Germany, which he reportedly left to escape Nazi persecution. He came to Duke in 1934 as a member of the Department of Medicine. Dr. Kempner was probably the biggest researcher at Duke during the hospital’s early period – he was a nephrologist and invented the Rice Diet Program (which exists to this day) to treat severe hypertension and congestive heart failure, all at a time where there was no effective treatment for these. According to Dr. Stead himself, “patients who at that time would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.”
Dr. Kempner’s work was revolutionary for the time, and he was a nationally recognized figure – he pioneered the idea of salt restriction in dietary management of hypertension and CHF, and his work contributed heavily to the now-universal recognition of hypertension as a modifiable cause for many complications.
Dr. Kempner was also considered to be pretty controversial in many ways…like many current Kempners, he was a bit of a rebel. Per Dr. Stead, Dr. Kempner “made many enemies because he has been honest and uncompromising and has never spent a single hour of his life, except for some scientific talks on rare occasions, in any society or even in a committee meeting.” From my reading, it appears that there was also a heavy component of anti-Semitism that drove some of the establishment’s concerns about him (see “Foundations for Excellence” reference below for further details). Dr. Stead was a big fan of Dr. Kempner, once refusing to fire him when the Dean of the Medical School insisted he do so.
Despite the controversy, there seems to be a consensus that Dr. Kempner was the single most important person in helping Duke transition from a minor regional medical center to the internationally recognized place it is today. According to Dr. Jay Skylar, “Walter Kempner has had a profound influence on all those who passed through Duke Medical Center, be they faculty or student. His unique contributions to the Medical Center, to his many patients, and to medicine in general have earned him a position of great esteem among his colleagues and they have brought international recognition to Duke University Medical Center.” Needless to say, we were proud to name our Society for Dr. Kempner and are working hard to honor his legacy.
Our group has been busy over the past year. In addition to building camaraderie through multiple enjoyable social gatherings, establishing many important mentorship links, and welcoming our new interns, our residents organized and hosted a blockbuster community service event last April. Over 100 people registered for the
Stead Tread, a 5K race in Duke Forest, and we raised over $2500 for Lincoln Community Health Center. We’ve already reserved the course for Stead Tread 2013 on 4/28/13 – it’s going to be bigger and better than the last one, so get off the couch and start training. Big thanks to our Stead Tread planning team, including
Meredith Clement, Marianna Papademetriou, Marcus Ruopp, Kevin Shah, and Leah Rosenberg.
References:
- Campbell WE. Foundations for excellence: 75 years of Duke Medicine. Durham, NC; Duke University Medical Center Library Publishing: 2006.
- Skylar JS. Walter Kempner: a biographical note. Arch Intern Med. 1974;133(5):752-5.
- Stead EA Jr. Walter Kempner: a perspective. Arch Intern Med. 1974;133(5):756-7.
- www.ricediet.com/page/view/rice_diet_founder_dr._walter_kempner, Accessed October 9, 2012
Developing Academic Leaders in Global Health
The Global Health Residency Pathway offers Duke internal medicine residents the opportunity to broaden their training to address health disparities in a resource-poor setting.
We are currently soliciting applications from Internal Medicine Residents for enrollment in July 2013. Application deadline is November 1, 2012.
Please see attached flyer for eligibility and application process. You can also visit us on the
Global Health Residency Pathway website.
2012 Global Health Medicine flyer
Please contact me at
cecelia.pezdek@duke.edu or 919-668-5976 if you have any questions.
ACP Call for Abstracts for the 2013 Chapter Scientific Meeting
The North Carolina Chapter is excited to announce the Call for Abstracts for the 2013 Chapter Scientific Meeting, taking place February 8-9 at the Washington Duke Inn and Golf Club in Durham, NC.
This competition is open only to Associate and Medical Student members of the ACP North Carolina Chapter. First authors must be Medical Students or Associate-level members of ACP or have made official application for membership in order to enter this competition. There will be no exceptions to this requirement. If you have not joined ACP (medical students join for free; associates should contact their residency program directors), please visit
ACP Online to find out more and apply.
Each abstract will undergo careful review and will be ranked for scientific merit, originality, proper presentation, and clinical application. To view ACP's guidelines and tips on preparing an abstract, click
here. The deadline for submitting entries is
Saturday, December 15, 2012 at midnight.
Abstracts can be submitted electronically online only. To electronically submit an abstract, visit the
Online Abstract Submission Form.
AAIM Offers AJM to Residents in 2013! Sign Up by November 16
AAIM is extending the offer for internal medicine and medicine-pediatrics residents to sign up to receive a complimentary e-subscription to
The American Journal of Medicine in 2013!
How? Just
complete the online form by November 16, 2012. The subscription starts in January.
Dates to Add to Your Calendars /Contact Information/Opportunities
October 19 "Doctoberfest" Wine tasting with the Klotmans
Oct 25 Recruiting Kick Off Event (Tylers)
December 1 DoM Holiday Party
Opportunities
Useful links
The Wall of Fame: If the following picture is not familiar, you obviously have not stopped by the office often enough to dip your hand into the basket of treats. The wall has taken shape - make sure to NOT miss the following:
Sign Ups for Interview Dinners: The venues and sign up sheets for the month of November are posted and filling up quickly.
3GT (Three Good Things): The leadership team is posting their 3GT's on the wall for all to see
Recognition: Check out the postings and add yours to the growing color scheme of residents who are simply saying thanks for doing an awesome job.
Name the Gnome: The voting has started and will remain open this week. Use the following link to enter your vote (or start a write in campaign) (https://www.surveymonkey.com/s/Name_the_MedRes_Gnome). The final "selection" will be posted in Updates on 
Sunday evening. And if you missed it, Mr. Gnome is happy to have survived ITE's earlier this week.
Food - BIG conference again this Tues, with box lunches. Should be amazing to see 150 boxes stacked up outside 2002. More to come later in the month as we approach Halloween.
chaired by Matt Crowley, MD.
Our Society is named for Dr. Walter Kempner. Dr. Kempner was born in 1903 in Germany, which he reportedly left to escape Nazi persecution. He came to Duke in 1934 as a member of the Department of Medicine. Dr. Kempner was probably the biggest researcher at Duke during the hospital’s early period – he was a nephrologist and invented the Rice Diet Program (which exists to this day) to treat severe hypertension and congestive heart failure, all at a time where there was no effective treatment for these. According to Dr. Stead himself, “patients who at that time would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.” 
Dr. Kempner’s work was revolutionary for the time, and he was a nationally recognized figure – he pioneered the idea of salt restriction in dietary management of hypertension and CHF, and his work contributed heavily to the now-universal recognition of hypertension as a modifiable cause for many complications.
Dr. Kempner was also considered to be pretty controversial in many ways…like many current Kempners, he was a bit of a rebel. Per Dr. Stead, Dr. Kempner “made many enemies because he has been honest and uncompromising and has never spent a single hour of his life, except for some scientific talks on rare occasions, in any society or even in a committee meeting.” From my reading, it appears that there was also a heavy component of anti-Semitism that drove some of the establishment’s concerns about him (see “Foundations for Excellence” reference below for further details). Dr. Stead was a big fan of Dr. Kempner, once refusing to fire him when the Dean of the Medical School insisted he do so.
Despite the controversy, there seems to be a consensus that Dr. Kempner was the single most important person in helping Duke transition from a minor regional medical center to the internationally recognized place it is today. According to Dr. Jay Skylar, “Walter Kempner has had a profound influence on all those who passed through Duke Medical Center, be they faculty or student. His unique contributions to the Medical Center, to his many patients, and to medicine in general have earned him a position of great esteem among his colleagues and they have brought international recognition to Duke University Medical Center.” Needless to say, we were proud to name our Society for Dr. Kempner and are working hard to honor his legacy.
Our group has been busy over the past year. In addition to building camaraderie through multiple enjoyable social gatherings, establishing many important mentorship links, and welcoming our new interns, our residents organized and hosted a blockbuster community service event last April. Over 100 people registered for the Stead Tread, a 5K race in Duke Forest, and we raised over $2500 for Lincoln Community Health Center. We’ve already reserved the course for Stead Tread 2013 on 4/28/13 – it’s going to be bigger and better than the last one, so get off the couch and start training. Big thanks to our Stead Tread planning team, including Meredith Clement, Marianna Papademetriou, Marcus Ruopp, Kevin Shah, and Leah Rosenberg.
References: