From the Director
It’s the final third of the year, and this is where time really starts flying. SARS, please make sure you are completed with your procedures. If you are not, please talk to me or the chiefs ASAP to figure out how you are going to meet the ABIM requirements. Madi will also be sending out an email to schedule exit interviews with me before you graduate. This is also a requirement, so take a look at the sign ups and pick an available time that works for you. If you are leaving Duke, remember you should not moonlight in June because you won’t have a way of getting paid.
Rising JAR and rising SAR schedules went out on Friday. Questions? Talk to me, your advisor or the chiefs. New intern schedules are being built this week, and soon we will be able to let the rising JARs know who will be coming for shadow day to their service and ultimately take their pagers!
Current JARs, most of you have met with me regarding fellowship/career planning. If you haven’t scheduled your meeting yet, please do so ASAP! If you don’t have your CV and Personal statement ready, that is ok for now, but our goal is to have your paperwork all ready by June 1 so that all you are doing in June is chasing down your letter writers.
Kudos this week to Eric Gutgluek from Andy Mumm for helping out at the DOC, to Taylor Bazemore from Jenn Rymer for helping out this weekend, to Juan Sanchez for a fantastic chair’s conference, and to Adva Eisenberg for getting the diagnosis.
One of the suggestions from the residency council was to hold class retreats. We are happy to announce that the current interns will have a retreat on May 31 (afternoon) and the current JARs will have a retreat on June 1 (afternoon). This is replacing our prior “How to Be A JAR” and “How to Be a SAR” events, and will focus on career development activities and have breakout groups also for class selected program improvement projects. More to follow.
This week’s pubmed from the program goes to former resident Howard Lee (we had a fun visit from him this week!) and current Duke ACR Bassem Matta … Lee TH, Matta B, King BD, Hodges MR, Tillmann HL, Patel K. MicroRNA-122 Associates with Serum APOB but not Liver Fibrosis Markers in CHC Genotype 1 Infection. J Med Virol. 2015 Oct;87(10):1722-6.
Have a great week
Aimee
What Did I Read This Week?
Submitted by Armando Bedoya, MD
HOPE-3 TRIALS
Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease
- April 2, 2016DOI: 10.1056/NEJMoa1600175
Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease
- April 2, 2016DOI: 10.1056/NEJMoa1600176
Blood-Pressure and Cholesterol Lowering in Persons without Cardiovascular Disease
- April 2, 2016DOI: 10.1056/NEJMoa1600177
The Heart Outcomes Prevention Evaluation (HOPE-3) Trials were recently published in the New England Journal of Medicine. In a trial spanning six continents, 21 countries, and 12,705 patients it’s results were placed on the front page of major news websites including CNN, BBC, and the Associated Press e.g. I have no doubt that some of you will have patients coming to to your primary care clinics with questions.
The purpose of the trial was to evaluate whether a cholesterol lowering drug, rosuvastatin, and a combination blood pressure lowering pill, candesartan/hydrochlorothiazide, used alone or together can reduce the risk of heart attacks, stroke and their sequelae in people without known heart disease and at average risk.
The study design was a large, simple, multi-center, randomized, placebo-controlled trial evaluating the effects of lipid modification and blood pressure lowering with rosuvastatin and a combination of candesartan/hydrochlorothiazide and their combination. In a 2×2 factorial design, each participant received daily rosuvastatin (10 mg) or placebo, plus daily candesartan/hydrochlorothiazide (16 mg/12.5 mg) or placebo. Funding was from AstraZeneca, which makes Crestor (rosuvastatin).
There were two co-primary outcomes: the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke (the composite of these events plus resuscitated cardiac arrest, heart failure, or revascularization. The secondary outcome was the composite of events comprising the second co-primary outcome plus angina with evidence of ischemia.
Participants were eligible if they (age, ≥65 for women, and ≥55 for men) were without known cardiovascular (CV) disease who were considered to be at intermediate risk by virtue of meeting at least one inclusion criterion: Elevated waist–hip ratio, HDL cholesterol level <39 mg/dL (men) or <50 mg/dL (women), current or recent smoking, prediabetes or diet-controlled diabetes, premature coronary disease in first-degree relatives, or early renal dysfunction. Most participants had at least two risk factors.
With the median follow-up of 5.6 years the key findings included:
- Compared with placebo, rosuvastatin lowered mean LDL cholesterol level by 35 mg/dL, and the antihypertensive drugs lowered mean systolic/diastolic BP by 6/3 mm Hg.
- The first co-primary outcome (CV-related death, nonfatal stroke, or nonfatal myocardial infarction [MI]) occurred significantly less frequently with rosuvastatin than with placebo (3.7% vs. 4.8%); absolute reductions were 0.3%, 0.4%, and 0.5% for CV-related death, MI, and stroke, respectively.
- Overall, candesartan/hydrochlorothiazide did not significantly lower the incidence of the first co-primary outcome compared with placebo (4.1% vs. 4.4%); however, it did lower the incidence in a subgroup with highest baseline systolic BP (>143 mm Hg; 4.8% vs. 6.5%).
- Overall, outcomes with rosuvastatin plus candesartan/hydrochlorothiazide were not significantly better than outcomes with rosuvastatin alone.
- All-cause mortality was not lowered by active therapies compared with placebo.
The HOPE-3 trial reinforces current guidelines. These results support a risk-based approach to statin use. With regards to anti-hypertensives the findings are controversial especially considering the recent SPRINT trial (keep in mind SPRINT occurred only in the US and Puerto Rico and the treatment was more aggressive than HOPE-3). In general, antihypertensive medications did not benefit this cohort; however, in a subgroup analysis of systolic blood pressure >143.5 mm Hg there was a 27% lower risk of cardiovascular events with blood-pressure–lowering therapy. The side effect profile noted a small excess of muscle pain in the rosuvastatin groups and dizziness with candesartan/hydrochlorothiazide. Since this was brought up by CNN (for some reason…), there was also noted a higher rate of cataract surgery among patients treated with statins (3.8%) compared with placebo (3.1%); however, looking at the supplementary tables on adverse events there was no statistically significant difference in the development of cataracts between the three arms. The authors note that determining whether the excess in cataracts is related to statins will require a systematic analysis on all statin trials.
QI CORNER
Rising SARs...
Do you nerd out on quality?
Does finding & fixing the root causes of M&M cases get you all excited?
Want to learn how to use big data to make patient care better?
Think about applying to be a Chief Resident for Quality and Safety!
We will be opening applications for the 2017-2018 position soon. If you think the job could be right for you, you should talk to us now! Contact me or one of our friendly local CRQS emeriti (Joel Boggan, Ryan Schulteis) to chat.
**We will be moving the April PSQC meeting to NEXT Thursday, 4/21 at 5:30pm. Mark your calendars!**
CLINIC CORNER
We celebrated Oreo Day at Pickett Road in the month of March.
We have many things planned for the month of April for Pickett Road.
It is time for Spring cleaning. We are collecting donations for the Durham Rescue Mission. All donations will be due on Friday 4/15/16. We have 2 bikes and many bags of donations so far.
We are planning Pickett Road gardens 4/23/16 10am. We will be planting a vegetable garden and variety of plants with our patients.
Duke Primary Care Pickett Road will be sending a team for the Triangle March for Babies on Saturday 4/30/16. This is a walk/run 5 K at 3005 Carrington Mill Blvd, Morrisville. Please let us know if you want to joint and walk for a great cause.
Dr. Peyser and Dr. Rubin are piloting a new program for CME. They are going over relevant questions from MKSAP #17 with the other attendings once a month. They hope to expand this opportunity to other clinics and residents in the future.
Sharon Rubin, MD, FACP
From the Chief Residents
Grand Rounds
Friday, April 15 - Geriatrics, Miriam Morey
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 4/11/16 |
ACGME Survey Prep |
Chiefs |
12:00 | Domino's |
| 4/12/16 |
PEAC Q&A Review |
2002/12:00 |
Mediterra |
|
| 4/13/16 |
Admissions Triage |
Winn and Nick |
12:00 | Cosmic |
| 4/14/16 |
Wellness |
Jim Lefler and Jake Feigal |
12:00 |
Chick Fil A |
| 4/15/16 |
Chair's Conference |
Chiefs | 12:00 | Nosh |
From the Residency Office
Office Hours for Dr. Zaas
Dr. Zaas will have the following office hours. Please feel free to stop by during these times and of course always feel free to reach out to her office to set up a meeting outside of these times if needed!
Monday - 3:00 p.m. to 4:00 p.m.
Thursday 10:00 a.m. to 11:00 a.m.
General Internal Medicine Career Night
General Internal Medicine Career Night
Interested in a career in General Internal Medicine?
Thinking about primary care medicine, Gen Med fellowship or hospitalist medicine?
Envision working in academics, research, Quality Improvement
or a combination?
Come to Gen Med Career Night
Tuesday May 3, 2016
6:30-8:30pm
Gen Med Resident Library
Dinner from Nosh
Come ask questions for our panelists about their path and journey:
Kevin Shah, Claire Kappa, Sharon Rubin, David Edelman, Sonal Patel, Lance Teagen, David Gallagher and Daniella Zipkin
Please RSVP to Sharon.rubin@dm.duke.edu by May 2, 2016
Please see flyer at the end of this post
Charity Auction 2016
The Internal Medicine Residency program Charity Auction, benefiting Senior PharmAssist will take place Friday, April 29th, 2016 @ 7:00 p.m. at Motorco in Durham! Tickets will go on sale in early April. We look forward to seeing you there. Please see the flyer at the end of this post!
LiveSafe Mobile App
Duke is introducing a new mobile app called LiveSafe to put a powerful safety tool in the hands of the Duke community.
The app, available as a free download from Apple and Android app stores, enables smartphone users to submit real-time tips to Duke Police, virtually “SafeWalk” friends and family while traveling, place emergency calls, and access important resources for support.
You can find more information, including instructions on how to download the free app, on the DukeALERT website: http://emergency.duke.edu/notified/livesafe.
Book Club Survey
If you haven't been to one of our events yet, please support the Dept of Medicine book club project by taking a quick moment to fill out the survey below! Your participation is totally voluntary and anonymous, and the questions only takes ~2 minutes. You may remember filling this out before -- if you have, try to use the same identifier you used last time (if you can't find it, just make up a new one).
Here's the link: https://duke.qualtrics.com/SE/?SID=SV_bfJqGFkA6HScRq5
Feel free to email Laura.Caputo@duke.edu if you have any questions. Thanks so much for your participation!
Opportunities for Wellness
Feeling down? Need to talk to someone?
All trainees at Duke have FREE access to Personal Assistance Services (PAS), which is the faculty/employee assistance program of Duke University. The staff of licensed professionals offer confidential assessment, short-term counseling, and referrals to help resolve a range of personal, work, and family problems. PAS services are available free of charge to Duke faculty and staff, and their immediate family members. An appointment to meet with a PAS counselor may be arranged by calling the PAS office at 919-416-1PAS (919-416-1727), Monday through Friday between 8:00 A.M. and 5:00 P.M. For assistance after hours, residents and fellows can call the Blood and Body Fluid Hotline (115 inside DUH, 919-684-1115 outside) for referral to behavioral health resources. Another resource is Duke Outpatient Psychiatry Referrals at (919) 684-0100 or 1-888-ASK-DUKE.
https://www.hr.duke.edu/pas/
Upcoming Dates and Events
April 29 -Charity Auction
May 20 - Resident Research Grand Rounds
May 31 - Rising JAR Retreat
June 1 - Rising SAR Retreat
June 4 - SAR Dinner
Useful links
GME Mistreatment Reporting Site
https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
http://duke.exitcareoncall.com/
Main Internal Medicine Residency website
Main Curriculum website
Department of Medicine
Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response
Opportunities
www.bidmc.org/CentersandDepartments/Departments/BIDHC
http://www.careermd.com/employers/latestbulletins.aspx