From the Director
Hi everyone!
Continued happy Doctoberfest! The weather is feeling more like fall - nothing like a nice cold, rainy turkey bowl practice. Good thing we are all (almost!) vaccinated against the flu! If you haven't - run, don't walk, to employee health!
Lots of nice kudos headed my way regarding you all- congrats to
Aaron Mitchell and Scharles Konadu on their gold stars and also
Lauren Prats on her outstanding work in the CCU (from
Sunil Rao). I'm sure there's a lot more....post about your colleagues on the Wall ofFame!
Also thanks to everyone who has been answering the daily trivia. More to come this week.
On Thursday, many of the program leadership are headed to the program directors meeting in Phoenix. We will definately learn more about milestones (the new evaluation system). Lok for your chance to participate - an email will becoming from Bill Hargett and I to tell you how!
Finally, I am so happy about the participation in 3 good things (3GT!)....it can seem a little silly, but it's highly addictive and I've certainly been looking forward to posting each night and reading what is on the message board. If you haven't started, it's still not too late.
This weekends pubmed from the program goes to SAR
Carrie Horney!
Am J Emerg Med. 2012 Jan;30(1):135-42. Epub 2011 Jan 8.
Health care utilization before and after an outpatient ED visit in older people.
Horney C,
Schmader K,
Sanders LL,
Heflin M,
Ragsdale L,
McConnell E,
Hocker M,
Hastings SN.
Have a great week - and, of course, happy Doctoberfest!
Aimee
QI Corner (by Jon Bae, MD)
Three Good Things: This week the program launched a program wide 3 Good Things initiative. This online resiliency experience will go through 10/14/2012. We have 80+ residents participating. And it's not too late to sign up at the link below. Keep your eyes peeled to medhub and email for daily 3 Good Things from your program leaders.
http://bit.ly/3goodthings
Flu Blitz: We are 88% of the way to 100% vaccination. Only 16 residents are unaccounted for! Check out these graphs for current performance through 10-5.
Last year, it took us through December to get to 100% so we are doing great.
Special shout out to Kerby Society for making it to 100% first although Kempner and Smith are neck and neck for 2nd place.
PGY 1 and 2 are neck and neck for first class to 100% while PGY3 a distant third. Don't call it a comeback, but there is still time SARs!
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
Medicine Residency Balanced Scorecard: Please check out the new residency program balanced scorecard for fiscal period 2 (August). We have added the HCAPHS measures and the readmission rates for medicine resident heavy floors to coincide with the GME Incentive Program targets. This is posted in Sharepoint as well.
Resident Ballanced Score Card - Aug 2012
Medicine Residency Patient Safety and Quality Council:
Get your Quality On in the Medicine Residency Library on October 10th at 5pm. We will have
dancing monkeys** at this month's meeting. Come check 'em out!
**Loratadine to be provided for those with pet allergies
What Did I Read This Week (by Jason Webb, MD)
Context: Despite advances in the treatment of major depression more than one-third of patients fail to respond to conventional antidepressant medication. One proposed pathophysiologic mechanism hypothesized to contribute to depression has been inflammation. Inflammatory biomarkers have been shown to be reliably elevated in depressed patients and have been associated with decreased likelihood of response to therapy with conventional antidepressants.
Objective/Design/Outcomes: Double blind, placebo-controlled, RCT, at an Emory University outpatient infusion center. Treatment was with three infusions of infliximab (5mg/kg) (n=30) or placebo (n=30) at baseline and weeks 2 and 6, with a 12 week follow-up. Patients were assessed at baseline for elevations of biomarkers of hs-CRP, TNF. Outcome measures were response to the 17-tem Hamilton Scale for Depression (HAM-D) with treatment response defined as a decrease of 50% from baseline during the study period, or remission defined as a HAM-D score less than 7 at the treatment end (weeks 12). hs-CRP and TNF markers were followed throughout the course of therapy as well.
Patients: Ages 25-60 years who were on a consistent antidepressant regimen for at least 4 weeks. No change in antidepressant medications was allowed during the course of treatment. Patients had to suffer from moderate resistance to therapy for major depression. Patients were excluded who were at risk for adverse effects of anti-TNF therapy, a presence of psychotic disorder or psychosis, or history of substance abuse.
Results: No significant differences were found between the groups at baseline. Overall no differences in change in HAD-D scores over time were found between the treatment group and placebo (P=.92). However, there was a significant effect of time, with HAD-D scores significantly decreasing from baseline, in both infliximab and placebo-treated groups. Interestingly, when the baseline hs-CRP concentration was modeled there was a significant interaction among treatment, time, and hs-CRP concentration (P=0.01). Patients with a baseline hs-CRP concentration greater than 5mg/L were found to exhibit a greater decrease in HAM-D scores compared to placebo patients, however placebo was superior for participants with a baseline hs-CRP concentration of 5mg/L or less. The symptom subsets that were more responsive to infliximab than placebo included anhedonia, psychomotor retardation, depressed mood, psychic anxiety, and suicidal ideation. Baseline concentrations of TNF and its soluble receptors were significantly higher in infliximab-treated responders vs. nonresponders (
P < .05), and infliximab-treated responders exhibited significantly greater decreases in hs-CRP from baseline to week 12 compared with placebo-treated responders (
P < .01). The number of patients needed to be treated with infliximab in order to have one or more responder (NNT) for participants with hs-CRP concentration greater than 5mg/L was 3.45. No statistically significant differences were found between groups for adverse events/outcomes.
Limitations: The study was underpowered to adequately test the possibility that infliximab would only show superiority to placebo in participant with an elevated baseline hs-CRP. Thus future studies seem warranted to focus on patients with elevated baseline inflammatory biomarkers using infliximab. In addition, the follow-up period was short and may have obviated the capacity to detect effects between an interaction of conventional antidepressants and TNF antagonism. The high rate of placebo response also reduced the power to
Conclusions: Infliximab did not show overall superiority to placebo on depressive symptom outcome, suggesting that blockade of peripheral TNF (infliximab does not cross the blood-brain-barrier) is not effective as a generalized strategy for treatment resistant depression. However, an association was observed between elevations in baseline inflammatory biomarker hs-CRP and subsequent response to infliximab. Taken together, the data suggest that there is a subgroup of treatment resistant depression patients who have increased inflammation (elevated hs-CRP), and respond to peripheral cytokine antagonism and not placebo. The study is a step in the right direction for a proof-of-concept that might lead to more personalized treatments of major depression in populations with responsiveness to immune-targeted therapy.
[hr]
From the Chief Residents
Grand Rounds
| Date |
Division |
Speaker |
| 12-Oct-12 |
Cardiology-1 |
Dr. Manesh Patel |
| 19-Oct-12 |
Pulmonology-2 |
Dr. Patricia Lugar |
| 26-Oct-12 |
Gastroenterology-1 |
Dr. Joanne Wilson |
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
Room |
| Monday |
10/8 |
Palliative Care Medicine |
Tony Galanos |
12:00 |
Saladelia |
2002 |
| Tuesday |
10/9 |
TB diagnosis and management |
Jason Stout |
12:00 |
Sushi |
2002 |
| Wednesday |
10/10 |
PWIM |
Karen Barnard |
12:00 |
Chick-fil-A |
2002 |
| Thursday |
10/11 |
Ambulatory Townhall - 2002, 8253, 1700B(hallway to south) |
|
12:00 |
Papa John's |
2003 |
| Friday |
10/12 |
Chair's Conference |
Chiefs |
12:00 |
Jimmy John's |
2002 |
Turkey Bowl Practice
Time to suit up and get ready for the game - in case you somehow missed the "trash" that is all ready circulating.
Time and place for practice remains unchanged: Sunday @ 330 at Forest Hills Park.
[divider]
From the Residency Office
Doctober Fest is Here:
The
Wall of Fame: We have seen a lot of activity on the "wall" . Stop by to explore the postings and to take a few minutes to add your own notables. What to post? Anything that you would like to recognize as a “job well done” by one of your peers. If you can’t stop by the office, email your “note” to Lauren
lauren.dincher@duke.edu and she will post it for you. At the end of the month, we will choose one of the notes randomly and the person who was honored will receive a prize.
Name the Gnome: Last week to add your suggestions to the list posted on the Wall of Fame. We have had some "incredulous" suggestions, but there is still room for a few more. Next week the voting beings.
Food - More to come later in the month, but we heard the pretzels and "beer" were a great hit.
Stead Groups - What You May Not Know:
This week we are honoring the
Rankin Stead Society, which is chaired by
Steve Crowley, MD.
Rankin was a native of Mooresville, NC. He received his MD from U of Maryland in 1901, and then did postgraduate work at Johns Hopkins. He became a professor of pathology at Wake Forest College and was Dean of their School of Medicine (2yr school) 1905-9. He gained prominence in research studying hookworm in NC, leading to his appointment as secretary of the NC State Board of Health, acting as the state’s first full-time health officer.
He retired from the state board in 1925 (after 16 years) at which time NC had more counties with full-time public health officers than any other state. He was therefore “recognized as the nation’s outstanding state public health officer.” Upon leaving the state board, he became head of the Hospital and Orphans Section of the Duke Endowment. He remained a trustee of this organization for 40 years. This Section was “the most innovative and progressive aspect of the foundation’s otherwise traditional approach to charity, providing nonprofit hospitals in NC and SC with a dollar/day for every bed occupied by an indigent patient, regardless of race. This organization also provided grants for rural communities to build their own nonprofit hospitals and convert private, for-profit hospitals into locally owned and operated community hospitals. He was a good friend of Wilburt Davison, the first Dean of Medicine at Duke, and had approved Davison’s appointment. Davison considered Rankin the one person “to whom he was more indebted than anyone else.” “Rankin had helped Davison plan and open DUMC in 1930 and had proved indispensable as an advisor to the young dean in the meantime.” Rankin’s… involvement with the Committee on the Costs of Medical Care (an AMA committee) were critical in shaping the early years of Duke’s new hospital and medical school, in addition to laying the groundwork for the public health system in the United States. Under Rankin’s leadership, the Duke Endowment led DUMC to accept all this Committee’s suggestions such that DUMC became a critical caregiver for indigent patients across the region. Between 1930-32, days of care delivered increased from 14887 to 67672, with DUMC and the Endowment covering any expenses not handled by the original dollar/day transfer. DUMC also implemented tenet 5 of the Committee’s recommendations accepting 30 1
st year medical students in the fall of 1930. Rankin and Davison also worked together to produce the “first statewide hospital insurance plan in the world,” called the Hospital Care Association.
Our Stead group has taken the name Rankin in part because the physicians in our group, following Dr. Rankin’s example, aspire to be
civic-minded and attentive to the betterment of public health. With this in mind, the Rankin group in the spring of 2012 prepared and
served a dinner at the Ronald McDonald House for those boarding parents of critically ill children receiving inpatient treatment at DUMC. For this fall of 2012, the Rankin group is currently
planning a canned good drive to provide food for the needy during the holiday season.
Our first social outing is rapidly approaching –
Trivia Night at the Carolina Ale House (3911 Durham-Chapel Hill Boulevard, Durham) on
Wednesday, October 10, at 7PM or whenever each Rankinite can escape the hospital. The Rankin society will have a full table at Trivia Night and stands a very good chance of competing as successfully as we did during this outing last year J. We would be delighted to take on tables staffed by members of the “other” Stead societies, who may wish to pool their memberships in order to keep pace with the lightning reflexes of the Rankin Trivia Team
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
FYI: Current Global Health Pathway Resident, John Stanifer, will be presenting a case from Tanzania at next week’s Global Health Gallops, October 3
rd, 12:00pm, 2003 DN.
Please contact me at
cecelia.pezdek@duke.edu or 919-668-5976 if you have any questions.
Duke Outings List-Serv (from John V. Abraham, M.D., Emergency Medicine Resident)
- Why? Because you want to meet other residents, and you want to check out the area when you're off.
- Make plans to see a concert, go on a camping trip, check out a new restaurant, get together to watch football, etc. It's all fair game, as long as it involves escaping the hospital!
- To join, visit the link below, or send an email to jvabra@gmail.com with the email you'd like to join with.
- You will receive a confirmation email with a link to set up your email preferences.
- Once approved, you will be able to email dukeoutings@googlegroups.com to reach the entire group.
- Check out the Group site for links to local events: https://groups.google.com/d/forum/dukeoutings
Fit Testing/ T-Dap Vaccination/ TB Skin Testing
If you need to have this done - here is the list of access points for the month of October
Resp Fit Testing-T-Dap-TB Skin Testing Flyer Oct 2012
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
GIM Opportunity at Emory Healthcare in Atlanta GA
Job Desc Hospitalist fin
GIM Opportunity at Emory Healthcare in Atlanta GA
Useful links
Last year, it took us through December to get to 100% so we are doing great.
Special shout out to Kerby Society for making it to 100% first although Kempner and Smith are neck and neck for 2nd place.
PGY 1 and 2 are neck and neck for first class to 100% while PGY3 a distant third. Don't call it a comeback, but there is still time SARs!
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
Medicine Residency Balanced Scorecard: Please check out the new residency program balanced scorecard for fiscal period 2 (August). We have added the HCAPHS measures and the readmission rates for medicine resident heavy floors to coincide with the GME Incentive Program targets. This is posted in Sharepoint as well.
Resident Ballanced Score Card - Aug 2012
The Wall of Fame: We have seen a lot of activity on the "wall" . Stop by to explore the postings and to take a few minutes to add your own notables. What to post? Anything that you would like to recognize as a “job well done” by one of your peers. If you can’t stop by the office, email your “note” to Lauren lauren.dincher@duke.edu and she will post it for you. At the end of the month, we will choose one of the notes randomly and the person who was honored will receive a prize.
Name the Gnome: Last week to add your suggestions to the list posted on the Wall of Fame. We have had some "incredulous" suggestions, but there is still room for a few more. Next week the voting beings.
Food - More to come later in the month, but we heard the pretzels and "beer" were a great hit.
He retired from the state board in 1925 (after 16 years) at which time NC had more counties with full-time public health officers than any other state. He was therefore “recognized as the nation’s outstanding state public health officer.” Upon leaving the state board, he became head of the Hospital and Orphans Section of the Duke Endowment. He remained a trustee of this organization for 40 years. This Section was “the most innovative and progressive aspect of the foundation’s otherwise traditional approach to charity, providing nonprofit hospitals in NC and SC with a dollar/day for every bed occupied by an indigent patient, regardless of race. This organization also provided grants for rural communities to build their own nonprofit hospitals and convert private, for-profit hospitals into locally owned and operated community hospitals. He was a good friend of Wilburt Davison, the first Dean of Medicine at Duke, and had approved Davison’s appointment. Davison considered Rankin the one person “to whom he was more indebted than anyone else.” “Rankin had helped Davison plan and open DUMC in 1930 and had proved indispensable as an advisor to the young dean in the meantime.” Rankin’s… involvement with the Committee on the Costs of Medical Care (an AMA committee) were critical in shaping the early years of Duke’s new hospital and medical school, in addition to laying the groundwork for the public health system in the United States. Under Rankin’s leadership, the Duke Endowment led DUMC to accept all this Committee’s suggestions such that DUMC became a critical caregiver for indigent patients across the region. Between 1930-32, days of care delivered increased from 14887 to 67672, with DUMC and the Endowment covering any expenses not handled by the original dollar/day transfer. DUMC also implemented tenet 5 of the Committee’s recommendations accepting 30 1st year medical students in the fall of 1930. Rankin and Davison also worked together to produce the “first statewide hospital insurance plan in the world,” called the Hospital Care Association.
Our Stead group has taken the name Rankin in part because the physicians in our group, following Dr. Rankin’s example, aspire to be civic-minded and attentive to the betterment of public health. With this in mind, the Rankin group in the spring of 2012 prepared and served a dinner at the Ronald McDonald House for those boarding parents of critically ill children receiving inpatient treatment at DUMC. For this fall of 2012, the Rankin group is currently planning a canned good drive to provide food for the needy during the holiday season.
Our first social outing is rapidly approaching – Trivia Night at the Carolina Ale House (3911 Durham-Chapel Hill Boulevard, Durham) on Wednesday, October 10, at 7PM or whenever each Rankinite can escape the hospital. The Rankin society will have a full table at Trivia Night and stands a very good chance of competing as successfully as we did during this outing last year J. We would be delighted to take on tables staffed by members of the “other” Stead societies, who may wish to pool their memberships in order to keep pace with the lightning reflexes of the Rankin Trivia Team