Weekly Updates - September 5, 2011 - Week 11

By heffe004@dhe.duke.edu

The Internal Medicine Residency newsletter is posted each week to share important news, announcements and updates about the residency program. Please contact Randy Heffelfinger or Emily Strollo with corrections, contributions and suggestions.

From the Director

Happy Labor Day! Especially to those residents who happen to be on ambulatory this week….. Hard to believe that ERAS opened up on September 1st – at last count on Friday we had almost 1,000 applicants for next year’s intern class! Dave Butterly and I have started reviewing applications, and there are some pretty impressive people who will be coming through to interview. We are very excited to show off the great things going on in the program, and particularly excited to have the applicants meet our incredible interns and residents. This week, another thank you to James Tulsky and Mike Felker, our Gen Med Stead Attendings. Upcoming Stead attendings are Peter Ubel and Chet Patel. More turkey bowl trash talk continues, with Duke taking the early lead in funny photoshop emails, although the picture that VA ACR Ed Coverstone photoshopped of DRH Chief Resident Juliessa Pavon line dancing in geriatrics clinic was pretty good. First practice was this weekend, and I haven’t heard of any injuries yet. Resident report continues with outstanding cases, including a perplexing case of cranial nerve palsies presented by SAR George Cheely, and chronic thromboembolic pulmonary HTN presented by SAR Lauren Gratian. Diagnostician of the Week goes to SAR Dan Fox for deducing that SAR Vashaili Patel’s chair’s conference case of a patient with non-Hodgkin’s lymphoma and malabsorption was really that of a pirate. The crickets were definitely silenced by Dan (who, in all seriousness, does a fantastic job during report and case conference) and fellow SARS Ryan Schulteis, Priyesh Patel as well as JAR Ann-Marie Navvar Boggan (who did say the diagnosis was lymphoma with ichthyosis, not Jack Sparrow coming to the Duke ED), plus the many others who spoke up during conference. Thanks everyone for making it a great discussion, and to Dr. Leslie Dodd from Pathology for joining the discussion. During the week, SARS (and future endocrinologists!) Carly Kelley and Lauren Gratian were also spotted with many medical students, endocrine fellows and faculty members at the first Medical Student journal club, hosted by Dr. Diana McNeill. Low carb desserts were shared over a discussion of key articles in endocrinology. Duke housestaff will be returning from Global Health rotations this week…we are excited to hear about their life-changing adventures abroad. Praise is already arriving for MedPsych SAR (and future VA Chief Resident) Jason Webb. Team Leader John Lawrence sends this comment, “Jason Webb and the palliative care group here ( IU Chair of Palliative Care and Indiana Hospice leaders) went to Kampala last week for the pan African Palliative Care meetings (400 attendees) … the palliative care group is going out in a similar fashion to the remote villages and nurses are getting morphine to individuals in dreadful shape and in great need. Noble work. …He has given his "all" to this experience, has been the model for all future residents who come here. He has been, will be, a superb ambassador for our program and he wants to come back. He has "set the bar" very high for future residents. He will tell you that his experience here has changed his life. What a fine young man!” We are proud of you, Jason. Pubmed from the program goes to Duke housestaff and ID fellowship alum (and current faculty member) Tom Holland for his editorial with Vance Fowler in Journal of Infectious Diseases “Vancomycin Minimum Inhibitory Concentration and Outcome in Patients with Staphylococcus aureus Bacteremia: Pearl or Pellet?” Keep sending me the titles of your published articles and abstracts so we can recognize you in Weekly Updates! Don’t forget to mark your calendars for Sept 27 at 5:30 PM in the Faculty Lounge – “Leader’s Board” with Dr. Victor Dzau. All are welcome to attend. SARs, SAR significant others and faculty, please join us on Oct 11 at 7:30 pm for Evening Rounds with Ann Lore. The first CPC (Clinico-pathologic conference) is right around the corner! SAR Talal Dahhan will be sure to stump us all with a medical mystery….Sept 20, 7pm at 604 W Morgan. Have a great week! Aimee

 What I Read This Week “WIRTW” (by Sarah Rivelli 9-4-11)

I subscribe to Evidence Updates (props to Larry Greenblatt for that tip) and it just so happened that this week I was sent a study relevant to the noon conference I was preparing for DOM on alcohol dependence and withdrawal: [box]   McQueen J, Howe TE, Allan L, Mains D, Hardy V. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database of Systematic Reviews 2011, Issue 8. [/box] Type of study: Systematic review of 14 studies and meta-analysis of 4 studies. Inclusion criteria: prospective RCTs . Population: adults admitted to general inpatient hospitals for any reason other than alcohol tx who consumed above safe weekly amounts. Intervention: brief intervention (mostly single session, 15-30min) consisting of counseling about patient’s drinking based on motivation enhancement and summarized under the acronym FRAMES (feedback, responsibility, advice, menu of options, empathy and self-efficacy). Control: no intervention, usual care. Outcomes: Self reported alcohol consumption, blood or saliva alcohol levels, deaths, hospital readmission rates. Results: Brief intervention lead to a reduction in alcohol consumption at 6 months, there was no significant difference at 1 year. There were significantly fewer deaths at 6 and 12 months (RR 0.42 [95% CI 0.19-0.94]; RR 0.60 [95% CI 0.40-0.91]) among the group receiving the intervention, however, there was no significant difference for hospital readmissions. Bottom Line: We need to understand more about the ideal intervention, including content, length and number of sessions, but this study suggests that a little bit of counseling about alcohol use in the medical setting can have significant impact. [divider]

From the Chief Residents

Grand Rounds

 
Date September 9, 2011 Learning Objectives:
Title

"Management of asthma:     from inhalers to   bronchoscopic     thermoplasty"

 Following this activity, learners should be able to:       1.  Discuss the pathophysiology of asthma    2.  Learn about the current treatment approach to asthma  3.  Discuss the challenges of severe and persistent asthma    4.  Learn about a novel bronchoscopic treatment in asthma: bronchial thermoplasty
Speaker(s): Momen M. Wahidi, MD, MBAMonica Kraft, MD  

 

Noon Conference

 

Date

Topic

Lecturer

Time

Vendor

9/5

 LABOR DAY  

NA

 

9/6

 Electrolyte Disturbances David Butterly

12:00

Dominos

9/7

 Delirium Sarah Rivelli

12:00

Saladelia

9/8

 Fungal ID Aimee Zaas

12:00

Chick-fil-A
 

From the Residency Office

Dates to Add to Your Calendars

Looking ahead, dates to keep in mind: Sept 20 – CPC @ 604 W Morgan (RSVP to follow) Sept 27  - Leader Board @ 5:30 PM in the Faculty Lounge Sept 27 - Duke Mass Vaccination Exercise Dec 10 – DOM Holiday Party Feb 24 – Charity Auction (Contact Tian or Ann Marie to participate) June 13 –Resident Research Event, 5-7pm

Duke Medicine wide effort to vaccinate all health care works September 27.

Duke will have a Mass Vaccination Exercise to kickoff the 2011 Healthcare Worker Vaccination Campaign The goal is to get 100% of all health care workers vaccinated in 24 hour period This exercise will test DUHS mass vaccination/drug distribution plans which would be used during an epidemic, pandemic, or emergency event such as an explosion at Sharon Harris Nuclear Plant. Residents/fellows can receive at Duke Hospital, DRH and Duke South clinics (as they're working in clinical areas) Residents, at VA can come to cafeteria or Employee Occupational Health and Wellness Duke South Clinics.

Employee Heath - September Services

Fit Testing/ T-Dap Vaccination/ TB Skin Testing will be again be available for your employees in September. We do not have many days scheduled at North due to Staffing the Flu Program.    Resp Fit Testing-T-Dap-TB Skin Testing Flyer Sept 2011 Also available: Color Vision, Flu Shots, TB Skin Testing (T-Dap) vaccine (Diphtheria, Tetanus, Pertussis) Required for all employees working with Children 18 months of age or younger.  Location - 4th floor room 4000C.  This Room is beside the private patient elevator behind the main circle elevators on the 4th floor).   Feel free to call us in room 4000C- at 681-7185 or at Employee Health at 684-3136 Option 2 or Rita Oakes 681-0513, if you have questions.      

Opportunities

Consistent with prior requests we will post in this section links to job postings that are received by our office. Hospitalist Opportunities - Internal Medicine CHS IM Opportunities Flyer Aug 2011  

Useful links

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