WIN OF THE WEEK: ANOTHER TWO-PARTER

As we wind down the academic year here at IMRESPDX.COM, we are excited to bring you another two-parter WIN from this past week!

First up, we have:

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A number of residents have organized a Landmark Trials Journal Club that takes place at a residents home! This monthly feature that is topic-based where they come together to learn about and discuss relevant landmark trials is becoming popular, now with subspeciality fellows attending to share their wisdom and experience! While they are great at organizing these groups and top-notch budding clinician-educator-researchers in training, they aren’t great photographers, so we will have to make do with the above tweet…

Next up, WIN #2 goes to:

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GUIDE DOGS NOON CONFERENCE!!!

Last week, Dr. Algranati’s incredible wife, Emily, who is a trained Guide Dog Mobility Instructor, came to deliver an important conference on the different types of service animals. She brought along a colleague and his guide-dog, Forli! See the attached document for more information about the content delivered during this great lecture. (Thanks to Samora for a guest appearance as well!)

Congrats to all! Here’s to another wonderful week full of wins!

WIN OF THE WEEK: DR. DHALIWAL COMES TO VISIT!

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This week, Dr. Gurpreet Dhaliwal came to visit OHSU as part of the Noble Wiley Jones lectureship. Dr. Dhaliwal is a well-known clinician-educator who primarily works at the San Francisco VA. He is an expert diagnostician whose grand rounds covered strategies on honing- and truly approaching excellence- in clinical learning.

Famed for his "Stump the Chump" style lectures, he also entertained our residency program during a session where he was presented a series of local thorny diagnostic challenges. Navigating these tricky cases, he treated us to a masterclass in diagnostic reasoning.

Thanks Dr. Dhaliwal!

Cold Hands, Warm... Differential?

Last week, Dr. Derrick Tao presented a case of an elderly woman who presented with subacute progressive discoloration of her fingertips after cold exposure. Raynaud’s phenomenon, obviously. But wait! It lasted for several weeks and she also had tender ulcers and splinter hemorrhages! Hmmmm… After a long and extensive infectious and rheumatologic work-up, she was diagnosed with chilblains!

Wait a minute, chil-what? Chilblains, or pernio, is cold-induced damage to the capillary beds in the skin causing erythema, pruritus, inflammation, and even tissue damage. It is a benign condition in and of itself, but can be associated with more serious diagnoses. It is treated with – you guessed it –gloves! It is often confused with Raynaud’s, and a patient may have both simultaneously, but the key difference is that Raynaud’s phenomenon is typically acute and readily reversible vasospasm (lasting minutes), whereas pernio involves more prolonged vasospasm causing chronic tissue changes (lasting weeks). You should not have skin lesions (ulcers, nodules) with Raynaud’s alone.

Thanks to Derrick and the Clinical Problem Solvers for this great discussion and diagram of alarm features of Raynaud’s and the differential that results.

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When’s the last time you examined your patient’s nails on admission? We ended report with a little manicure time - see below for a fun review of different nail changes and disease associations!

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WIN OF THE WEEK: BINGO!!!

Congratulations to our illustrious BINGO winners - Team VA GM3! They completed the following for their win: learning a joke from a patient, senior resident gives 2+ chalk talks in a week, whole team goes outside together, learn something personal about your social worker, and complete a discharge without a pharmacist paging you. Not to mention petting a therapy dog for bonus warm fuzzies!

Congratulations to our illustrious BINGO winners - Team VA GM3! They completed the following for their win: learning a joke from a patient, senior resident gives 2+ chalk talks in a week, whole team goes outside together, learn something personal about your social worker, and complete a discharge without a pharmacist paging you. Not to mention petting a therapy dog for bonus warm fuzzies!

And our runner ups - Team VA GM1! Coming in a close second place with: complete a med rec with >25 meds, visit the VA Canteen or Natural Food Store, all residents on the team attend at least 3 noon conferences/reports, intern goes home early, and admitting and discharging the same patient within 24h!  Thanks to all the ward/ICU teams for playing along and adding a little spice to an otherwise wet and mundane week in the hospital!

And our runner ups - Team VA GM1! Coming in a close second place with: complete a med rec with >25 meds, visit the VA Canteen or Natural Food Store, all residents on the team attend at least 3 noon conferences/reports, intern goes home early, and admitting and discharging the same patient within 24h!

Thanks to all the ward/ICU teams for playing along and adding a little spice to an otherwise wet and mundane week in the hospital!

WIN OF THE WEEK: UPDATES FROM PVAMC!

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Every week, this blog (IMRESPDX.COM) delivers to you content as fresh as a Mount Hood morning in February...

Today, the premiere Internal Medicine blog of the Pacific Northwest is proud to share with you news of the latest changes that relate to our cherished VA Medical Center!!!

Recently, the onus of placing beneficiary travel orders and observation admission orders have been lifted from the residents. Anyone who has tried to navigate this labyrinth of an order set can appreciate how big of a time saver this is.

In addition, a new buffer period for late call admissions has been implemented-- now admissions after 6:15 PM can be admitted by the night float team, allowing the late call teams to have a more predictable schedule.

Our VA Chief Resident position for Quality and Safety is now open for the 2020-2021 year! Please contact Dr. DiVeronica for more information about this fantastic opportunity.

Finally, we received word that the VA canteen now employs a SUSHI CHEF! We have not tried this ourselves, but please leave your reviews in the comments below or email a review to medchiefs@ohsu.edu for the sake of our entire readership!

Until Next Week, and Go Blazers!!!!

WIN OF THE WEEK: LINDA'S BACK!!!

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Dr. Peng returned from her monthlong rotation in Thailand this past week, regaling us with stories of her time there both as a clinician and a researcher:

” It was a wonderful trip. I spent time with clinical researchers looking at a large dataset they have on patients with dengue fever. In addition to research, I had a very interesting clinical experience at a couple different hospitals and also had the opportunity to talk to many clinicians, including world-renowned dengue clinicians.”