From the Director
Hi everyone! Thanks to our ACRs for stepping it up and starting some hilarious turkey bowl smack talk! Love it.
Kudos this week to JAR
Nancy Lentz for her gold star, and also to JAR
Tyler Black for a fantastic chairs conference. Was happy to hear all the chatter from the audience - keep it up (
Jon "eponym" Stanifer, that means you!). And kudos to all at Pickett for doing well with JHaCO.
We have a very
important flu shot blitz on Wednesday. We would love to get as many of you vaccinated as possible. Remember last year was our first 100% vaccine rate for house staff. It would be great to match that!
I hear there are more stead gatherings this weekend - nice!
Pubmed from the program goes to our very own Daniella Zipkin and Larry Greenblatt
Zipkin-EBM-PrimaryCare_MSJM2012 which was recently published in the Mount Sinai Journal of Medicine . Excellent work.
Have a great week
Aimee
What Did I Read This Week (Rex Cheng, MD)
[box] Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials Parachutes - BMJ 2003; 327_1459 [/box]
Why is this article relevant? As the nation’s newest generation of healthcare providers, we place a huge importance on the role of evidence based medicine in empowering our decision making strategies for good patient care. From the complex if-then algorithms of early goal directed therapy in sepsis to the simplest baby aspirin to fend off the greasy sickle of coronary disease, no stone is left unturned. Through our careful scrutiny of
The Literature for drafting our epic medicine H/Ps and JAMA inspired critical appraisals during VA morning report, we as Duke Medicine residents have developed a discerning and practiced taste for the quality in data, much like stool laden with C. diff (you just kind of know when its there). However, there is one sinister sector of medicinal interventions that has managed to evade our evaluation for decades since its inception, the parachute industry. This article goes on to prove, if subtly, how devious the makers of parachutes are in misleading the public of the utility of their products. In fact, the efficacy of the parachute in preventing morbidity and mortality in free fall has never been studied using the standards of modern medicine.
What is already known? The parachute, as defined by “a fabric device, secured by strings to a harness worn by the participant and released (either automatically or manually)”, is the generally administered methodology for limiting the rate of descent during free fall.
Parachutes are advertised to prevent orthopedic and soft tissue trauma from the impact of one’s body against the Earth during gravitational challenge.
The evidence for parachutes as a successful intervention is
purely anecdotal from historical observations.
In addition, use of a parachute has been associated with increased morbidity and mortality compared to the general public. Conversely, even if parachutes deploy incorrectly, it does not always result in an adverse outcome.
What does this article do? This is a systematic review of all randomized control trials found using the search parameters “parachute” and “trials”. Inclusion criteria were free fall from a height greater than 100 meters (British: pronounced
mee-terz) using a parachute as previously described. Studies were excluded if they did not have control groups. Unfortunately, the authors did not find any randomized control trials that successfully compared individuals undergoing free fall with and without parachutes.
Why is this important? While there is ample anecdotal and observational evidence that links parachute use with decreased injury and death during free fall, the lack of randomized control trials is quite prohibitive. Without a good RCT, we cannot factor out bias from our observations. Society’s notions of “physics” and “common sense” leads us to conclude that subjects who fall from great heights without parachutes will suffer damage. But without extensive research with well-designed clinical trials, how do we really know that other forces aren’t at play? One could say that those who choose not to wear parachutes in free fall have psychological co-morbidities or increased non-compliance with all medical recommendations and that their parachute-donning counterparts were healthier to begin with. This “healthy cohort effect” greatly impedes our assessment of parachute efficacy, which translates to an inability to make good recommendations. Per the standards on guideline recommendations of the USPSTF, to wear parachutes for trauma prophylaxis is only supported as a level B-III recommendation. My Asian mother won’t settle for anything less than an A+, so why should we be satisfied with a weak recommendation backed by insufficient data?
We can do better - As a premier academic institution with a heavy emphasis on producing sound clinical research, we as Duke residents have a unique opportunity in this pivotal area of aerospace medicine. For the academic year of July 2013- July 2014, I will be recruiting for my very first clinical trial, titled
Parachutes to Effectively Rule Out Death and Crash-related Trauma, Year-Long (PTERODACTYL). To effectively power this study, I will need about 180 healthy medicine residents to be subjected to freefall from a height of about 10,000 ft. To rule out any sort of bias, residents will be randomized to receive either a parachute or the truly useless placebo: a backpack full of OSH nursing notes. All subjects and study administrators will be blinded to rule out bias. Primary outcomes measured will be survival as well as the incidence of orthopedic and soft tissue trauma. Statistical analysis will be performed using SAS (Cary, NC). We can all agree that death would be a pretty awful outcome for healthy volunteers. To make things fair and to ensure we have adequate staffing, survivors will have to work both Christmas AND New Years.
[hr]
From the Chief Residents
Grand Rounds
| Date |
Division |
Speaker |
| 21-Sep-12 |
Nephrology |
Dr. Michelle Winn |
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
Room |
| Monday |
9/17 |
Board Review |
ACRs |
12:00 |
Saladelia |
2002 |
| Tuesday |
9/18 |
Med-Peds Conference: Influenza |
Cameron Wolfe |
12:00 |
Moe's |
2002 |
| Wednesday |
9/19 |
QI/Patient Safety Conference |
Jon Bae |
12:00 |
Jimmy John's |
2002 |
| Thursday |
9/20 |
Schwartz Rounds |
Lynn O'Neill |
12:00 |
Sushi |
2002 |
| Friday |
9/21 |
Chair's Conference |
Chiefs |
12:00 |
Rudinos |
2002 |
Maestro Tips:
To get a trend for a lab value, or vital signs you can put in for example .lastweight3 which will bring up the last three weights recorded. So far this works with all vital signs (blood pressure, heart rate), and various lab values such as hgb a1c, hct, and white blood cell.
Amarndo Gedoya, MD
Internal Medicine Representation in DUHS Committees (from Philip Lehman, MD)
I have the esteemed pleasure of announcing to you the many residents in internal medicine and our combined programs who will be representing our program through one of 11 committees at DUHS this year. They are as follows:
| Hany Elmariah- Ethics |
| Chris Hostler- Infection Control |
| Amanda Elliott- IRB |
| Jennifer Rymer- Duke University Safety
Andrea Shaw- Infection Control
Monica Tang- Library
Natasha Cunningham- Ethics
Gregory Brown- Medication Safety |
The Influenza Vaccine Blitz Begins!!
Our goal is 100% participation!
From Sept. 19-28, you can get your flu shot on Duke Hospital’s first floor outside of 1700A (in the connector hallway where the Mars Gallery display cases are located) at the times noted below. Bring your valid Duke ID.
Kick-Off DayMass Vaccination Drill* Wednesday, Sept. 19, 7:30 a.m. - 3:30 p.m. and 4:30 p.m.-9:00 p.m.
Thursday, Sept. 20: 7:30 a.m.-3:30 p.m.
Friday, Sept. 21 7:30 a.m.-3:30 p.m.
Monday, Sept. 24 7:30 a.m.-3:30 p.m.
Tuesday, Sept. 25 7:30 a.m.-3:30 p.m.
Wednesday, Sept. 26 7:30 a.m.-3:30 p.m.
For a full vaccination calendar, which includes listings for off-site locations, visit: http://intranet.dukemedicine.org/influenza/
[divider]
From the Residency Office
Now Accepting Applications for Global Health Elective Rotations
Developing the next generation of globally educated, socially responsible healthcare professionals dedicated to improving the health of disadvantaged populations. 
The Hubert-Yeargan Center for Global Health (HYC) is now accepting applications for Global Health Elective Rotations for July 2013 and March 2014. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4). Access the application form and FAQ at
http://dukeglobalhealth.org/education-and-training/global-health-elective-rotation.
Application deadline is October 5, 2012. Interviews will be held between October 8 and November 7. We encourage you to speak with past participants to get a better idea of what daily life is like on the wards of your top sites. For more information, contact Tara Pemble, Program Coordinator at
tara.pemble@duke.edu or 668-8352.
AMPATH Consortia Meeting
Duke University is a member of the AMPATH Consortium. This year we are hosting the AMPATH Consortium meeting on Duke campus on October 22-24, 2012. The fact sheet link below highlights much of the work that our faculty have been doing in Kenya.
If you are interested in learning more about collaborating with our academic partners working in Kenya, we hope that you will join us for several activities taking place over the course of this meeting. If you plan to attend, please register
http://dukeglobalhealth.org/node/149
Monday, October 22: 6:30 – 8:00PM, Meet & Greet - Cocktails/Appetizers - Location: David Thomas Center
Tuesday, October 23: 2:00 – 4:00PM, Breakout Sessions by Clinical Specialty - Location: David Thomas Center
5:00 – 7:00PM, Grand Rounds followed by reception– Location: Duke North, Room 2002
“Building Innovative Academic Global Health Partnerships in Western Kenya” presented by Dr. Joseph Mamlin, Professor Emeritus of Medicine, School of Medicine, Indiana University
Fact Sheet:
Fact Sheet AMPATH
To All JAR's Regarding USMLE Step 3
Per the recommendation of the GME office, we advise you to plan to take the USMLE Step 3 exam no later than January 1, 2013. It typically takes 8-10 weeks from the testing date for scores to be returned, and this would give you the opportunity to take it again in March if needed and still have final scores in by the end of the year. Please let the chiefs and Laura know your test dates so we can adjust the schedule. As a reminder, we will not be able to execute your PGY Level 3 contracts until your USMLE Step 3 scores are received.
MKSAP - Available to Loan
Dr. Alex Wong (Cardiology) was kind enough to donate a hard-copy of MKSAP 16 Part A to our office. We will make them available to residents to borrow as needed. Each book will be available on a check-out basis and can be kept for a maximum of 2 weeks. We ask that you only check out one book at a time. Please see
Jen Averitt in the MedRes office if you are interested in borrowing any of these materials.
Schwartz Center Rounds
Schwartz Center Rounds is a monthly interdisciplinary conference that offers clinicians a regularly scheduled time during their fast-paced work lives to openly and honestly discuss social and emotional issues that arise in caring for patients. An initiative of the Schwartz Center for Compassionate Healthcare, the rounds take place at 250 sites in the U.S. and U.K. including many of Duke’s peer institutions (Massachusetts General Hospital, Brigham & Women’s, Vanderbilt, Mount Sinai, Emory, Cleveland Clinic and UNC-Chapel Hill).
We are excited to be bringing this program to Duke and hope many of you will join us!
Schwartz Center Rounds: Topic: “When Everything is Too Much”
Thursday, September 20; Noon – 1 p.m. Duke North 2001
Lunch provided
Moonlighting Residents (logging duty hours)
Reminder that the GME office links duty hours with hours submitted for TSMA payment. Please be sure to LOG your moonlighting hours as “internal moonlighting”, and to also abide by duty hours rules (24+4 maximum, 80 hours per week maximum, 8 hours minimum off between shifts, 1 day off in 7),
or they can’t pay you for moonlighting. This policy was announced late last year by the GME office and is now in effect.
Project Homeless Connect (from Julia Gamble, NP)
Project Homeless Connect is a one day, one-stop event that brings together services (among other things housing, benefits, healthcare, and haircuts) and people who are in need. It takes place at the
Durham Bulls ballpark from 10-4 pm on October 11. Last year the Lincoln Community Health Center Healthcare for the Homeless Clinic and Duke's Internal Medicine Department provided health consultations to 25 people in need. A sign up sheet will be posted in the Med Res Office for those who are able to help provide coverage.
CareerMD Career Fair in Chapel Hill
Residents and fellows are invited to attend the CareerMD Career Fair to enjoy a complimentary buffet dinner, including a vegetarian option, while networking with prospective employers from leading healthcare organizations and practice groups. The event takes place at the Sheraton Chapel Hill. Residents and fellows may arrive any time from 5:00 PM and 9:00 PM on Tuesday, September 18, 2012. Spouses and significant others are welcome, too. Additional details are available on our website at
www.CareerMD.com/ChapelHill.
Any resident or fellow who would like to attend is asked to respond by clicking any of the RSVP links below or by emailing
charles.howell@careermd.com.
Charles Howell, CareerMD, 41 East 11th Street, New York, NY 10003
Educational Debt Management Consultations
If you have not yet had the opportunity to register for either a one-on-one consultation or the large group session with Mr. Paul Garrard, a nationally known expert in student loans and educational debt management and a frequent presenter at Duke, please take a moment and do so.
Large Group Session: Wednesday, September 26, 2012 at 5:30 p.m. in Duke North, Room 2001. If you would like to attend this large-group session, please register using the following link:
https://www.surveymonkey.com/s/7WL6Z2L
One-on-one Consultations will be held in the GME Conference room located at Duke South, Green Zone, room M147 on Wed., Sept. 26 from 8:00 a.m. - 5:00 p.m. AND Thurs., Sept 27 from 8:00 a.m. to 12:00 p.m. Consultations will be in 30 minute increments. To schedule your consultation, please click here<
https://instant-scheduling.com/sch.php?kn=820794&typId=30298&step=2>. Mr. Garrard will contact you prior to your appointment with information on what you need to bring to the appointment.
More Information<
https://gme.duke.edu/about-gme/news/student-loan-assistance-one-one-consultations-mr-paul-garrard>
Dates to Add to Your Calendars /Contact Information/Opportunities
Sept 19-20 Flu Shot BLITZ
8831_FLU_Clinic_Template_Final
Oct 25 Recruiting Kick Off Event
December 1 DoM Holiday Party
Opportunities
IM for NY 935B
Useful links
The Hubert-Yeargan Center for Global Health (HYC) is now accepting applications for Global Health Elective Rotations for July 2013 and March 2014. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4). Access the application form and FAQ at http://dukeglobalhealth.org/education-and-training/global-health-elective-rotation.
Application deadline is October 5, 2012. Interviews will be held between October 8 and November 7. We encourage you to speak with past participants to get a better idea of what daily life is like on the wards of your top sites. For more information, contact Tara Pemble, Program Coordinator at tara.pemble@duke.edu or 668-8352.