From the Director
Hey everyone! Hope you all had a great week. Vacation was excellent, and I am looking forward to catching up on all that happened while I was away. We have our summer celebration on Friday night, so I hope to see you all there. Progress is being made on our house construction, so we are gearing up to plan the first party at our home as well. I hear that Dr. Joe Rogers hosted a fantastic Cardiology Interest Group meeting at Alivia’s last week – great attendance and great conversation! Thanks Dr. Rogers
Lots of kudos to go out this week – to Sipa Yankey, Luke Cerbin and Rebecca Donald from Emily Barnes (7100 RN) for fantastic communication with patients and staff during CAD nights, to Megan Dupuis and Lakshmi Krishnan for outstanding cross-cover care at the VA (from Myles Nickolich), to Team Blue 3 at the VA (Div Patel and Betty Jiang) for hosting a birthday party for a patient, and to Chris Hostler, Adam Barnett and Ashley Naughton for treating a patient to a steak dinner at the end of a very long hospital stay. Also kudos to our SARs for their SAR talks last week (sorry to miss!) - Steph Giattino, Eric Pollack, Cece Zhang and Jessie Seidelman.
The PSQC met last week – if you are interested in being involved but were unable to make the meeting, please contact your QI Chief Lindsay Boole!
We have an upcoming Social Action Council meeting on 8/26 at 6 pm in the Med Res Library…looking forward to having great attendance and to moving forward on our initiatives to GET INVOLVED in our community.
Please watch your email for an ANONYMOUS survey sent on behalf of the APDIM (Association for Program Directors in Medicine) President (and former Duke Resident!) Lia Logio. She is currently the PD at Weill-Cornell and is interested in residency life in 2015. Please take the time to fill this out – we were among 15 programs selected to receive the survey.
This week’s Pubmed from the Program goes to Julia Xu who just had her work from medical school published in the American Journal of Tropical Medicine and Hygiene. Congrats, Julia! "G6PD Deficiency in an HIV Clinic Setting in the Dominican Republic” Julia Z. Xu,* Richard O. Francis, Leonel E. Lerebours Nadal, Maryam Shirazi, VaidehiJobanputra, Eldad A. Hod, Jeffrey S. Jhang, Brie A. Stotler, Steven L. Spitalnik, and Stephen W. Nicholas. Published online August 3, 2015; doi:10.4269/ajtmh.14-0295.
Have a great week!
Aimee
What did I read this week?
Submitted by Dr. Jennifer Rymer
The literature has been full of exciting papers addressing our use of anticoagulation and antiplatelet therapies.
Many of you use dabigatran (Pradaxa) for stroke prevention in patients with non-valvular atrial fibrillation. When initiating this medication, we must always counsel our patients regarding the potential risks of major bleeding events given the lack of FDA-approved reversal agents for NOACs. Recently, the interim analysis from RE-VERSE AD was published in NEJM (citation listed below). This represents a phase III study of intravenous idarucizumab, a monoclonal antibody fragment with high affinity for dabigatran, with the plan to enroll a total of 300 patients from 400 centers in 38 countries (Duke is one of the sites). RE-VERSE AD is a prospective cohort study without a control group, as you can imagine that randomizing patients experiencing a major bleeding event to a “placebo” would have potential ethical issues.
The interim analysis was based on 90 patients, divided into two groups. The first group included patients who were deemed by a physician to have a life-threatening bleed, and the second group were patients who needed urgent surgery within 8 hours, necessitating reversal of dabigatran. The primary endpoint was the maximum percentage reversal as determined by measurement of dilute thrombin time and ecarin clotting time at different time points after idarucizumab initiation.
Of note, there were 22 patients (from both groups) for which dilute thrombin time and/or ecarin clotting time were already normal prior to administration of the drug (remember: enrollment into the study did not require evidence of laboratory clotting derangement). Within an hour of administration, dilute thrombin time and ecarin clotting time were normalized in roughly 90% of both groups. For those patients ingroup B who underwent surgical procedure, 92% were noted to have normal hemostasis intraoperatively. Hopefully, other potential reversal agents for the other NOACs will be studied as well. Keep in mind though that idarucizumab is not FDA approved yet.
Also, check out the latest editions of JACC, where Connie Hess (recent fellow and attending at Duke), Tracy Wang, and Eric Peterson published results outcomes when using triple therapy in post-MI patients with afib. There is a lot of ongoing research surrounding the question of what we should do with patients who have had an MI and have afib, requiring DAPT and anticoagulation for afib. Many of you are familiar with WOEST, which randomized patients on warfarin to either warfarin with clopidogrel or warfarin plus DAPT. A recent observational study in JACC demonstrated no difference in MACE when comparing patients on triple therapy with those on DAPT alone. Stayed tuned for the results of RESIDUAL PCI (DAPT with dabigatran vs triple therapy with warfarin) and PIONEER AF-PCI (various strategies using rivaroxaban with recently stented PCI patients).
Many of our questions regarding how to use NOACs, how to reverse them, and how to combine them with anti-platelet therapy will likely be further elucidated in the next few years.
N Engl J Med 2015;373:511-20.
JACC (Journal of the American College of Cardiology), 2015-08-11, Volume 66, Issue 6, Pages 616-627
CLINIC CORNER
Submitted by: Dr. Sharon Rubin
Pickett Road is happy to announce its Tier 1 status. We have great staff and good teamwork to help take care of patients! We are proud to recognize Dr. Jeff Clough's article in July JAMA
Clough JD, Richman BD, Glickman SW. Outlook for Alternative Payment Models in Fee-for-Service Medicare. JAMA. doi:10.1001/jama.2015.8047.
We are continuing to add more staff and implement new programs. We Daniel Pennington, CMA and Lawyette Terrell, CMA who started August 10, 2015. These two staff members have been hired specifically to help out with resident clinic.
We continue to forge ahead with Transforming primary care. Our rooming nurses have been calling patients the day ahead to confirm appointments and start medicine reconciliation. Our rooming nurses will be starting to tee up labs, medications, vaccines that are needed for our patients in anticipation of their doctor visits.
Mini cex is going strong here. We are almost through our first phase and plan to have at least 1 mini cex done on all Pickett Road residents by the end of August.
Pickett Road is planning to send a team to the Triangle Heart Walk on September 27, 2015. This is a walk to benefit heart disease research.
We have started a new initiative to showcase our residents. Starting with the intern class, we have their pictures and biographies on the Duke Primary Care website along with interviews so patients can view their video and pick Pickett Road as their primary care clinic.
Sincerely Sharon Rubin
From the Chief Residents
Grand Rounds
Friday, August 21- M&M, Dr. Lindsay Boole
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 8/17/15 | SAR Emergency Series: DVT/PE - Management of Thrombophilias |
Bhavana Singh |
12:00/2002 | Domino's |
| 8/18/15 | SAR Emergency Series: Inpatient Insulin Management |
Jessica Morris |
12:00 | Mediterra |
| 8/19/15 | Antibiotic Stewardship |
Deverick Anderson |
12:00/2002 | China King |
| 8/20/15 | IM-ED Combined Conference: Palliative Care in the ER |
Robin Turner |
12:00 | Subway |
| 8/21/15 | Chair's Conference | Chiefs | 12:00 | Picnic Basket |
From the Residency Office
Global Health-Internal Medicine Residency Program Recruiting Eligible Candidates
Internal Medicine Residents who have successfully completed PGY1 are eligible to apply for the Duke Global Health Residency, an extended residency that leads to a Master of Science in Global Health and a total of nine months providing clinical care and conducting mentored research at a Duke University international partner site.
Please visit our website for an in-depth description of the core curriculum including rotations, global health competencies, and program requirements as well as application instructions:www.dukeglobalhealth.org
Watch current global health resident John Stanifer, MD, discuss his decision to pursue global health training at Duke:
Send all application materials electronically to sarah.brittingham@duke.edu.
Applications accepted on a rolling basis until October 1, 2015. Offers will be made in November.
STEAD TREAD 2015!
Wanted to take a second to invite you all to come support the Stead Tread, the Kempner Stead Society's annual charity event, which benefits Lincoln. It was a blast this year, and since we're due for some good weather this year, I'm sure it will be even better this time around.
Some additional information:
Please access the Stead Tread 2015 website (http://www.steadtread.org) for additional information, to securely register ($25), or make a donation
Race date/time: Saturday, September 12th, 2015 at 10:00AM (registration from 8:45-9:45)
Race location: American Tobacco Trail, starting at Solite Park on Fayetteville Road in Durham (https://www.google.com/maps/place/Solite+Park/)
Race beneficiary: Lincoln Community Health Center (and all Lincoln patients walk/run for free)
Your $25 registration fee includes an official Stead Tread 2015 T-shirt – shirts are going fast, so register ASAP to reserve your size!
Participants are welcome to run or walk, and strollers are permitted - kids under 12 walk/run for free (but should be registered by their parent/guardian)
In case you cannot make the race this year, donations can be made securely through our website
Thank you for considering supporting the Stead Tread – we really hope to see you there this year. For any questions, please contact us through our website (http://www.steadtread.org), via e-mail at steadtread5K@gmail.com, or by replying directly to me (Matt Crowley, M.D. <matthew.crowley@dm.duke.edu>).
SARs
Please know there is an excellent opportunity to hone your interviewing skills. Dr. Kathryn Pollak who is a communication coach and faculty member in the SoM will provide 4 1-hour sessions from which you can choose. In the session, Dr. Pollak will cover tips to finesse interviewing skills as well and give some a chance to role play. She also will be available for practice for their interviews in September and October.
The four sessions will be held the following dates and times:
Tuesday, August 18th: 4:00 to 5:00pm
Wednesday, August 26th: 12:00 to 12:00pm
Thursday, August 27th: 4:00 to 5:00pm
Each session will be 10 people or less, that way it’s more personalized. Please let me know as soon as possible which session you would like to sign up for. This is a very valuable tool being offered!
Book Club
Every few months, the Department of Internal Medicine Book Club joins together residents, fellows, and attendings to discuss the humanistic side of medicine through reading. Please join us for our first event of this academic year on Tuesday, September 8th from 5:30 - 7:30 pm in the Faculty Lounge! This time we're reading Changing the Culture of Academic Medicine by Linda Pololi, which tackles the changing roles of women and minorities in medicine and what ground is still left to cover.
The best news: all are welcome to attend, and thanks to help from the Program for Women in Internal Medicine and the Trent Memorial Foundation, this year books are free to ALL participants who RSVP (while supplies last)! Food and drinks will be provided.
For more questions or to RSVP, please email laura.caputo@duke.edu to reserve a spot now! We're looking forward to seeing you all there!
Thank you!
Laura M. Caputo, MD
Hospital Medicine, Durham VA Medical Center
The poster session reception and competition is scheduled for 6:00 PM to 7:30 PM CDT on Thursday, October 22nd, 2015 in New Orleans, LA at the Roosevelt Hotel.
Submission details/guidelines for quality-innovations-research abstracts and clinical vignettes are attached in a document as well as pasted below the body of this message. Please note that all accepted abstracts/vignettes will be considered for online publication in The Ochsner Journal following the conference.
Please visit our website for further details at:
http://www.southernhospitalmedicine.org/?page_id=43
The submission deadline to be considered for acceptance is 11:59 PM CDT on Sunday, August 23rd, 2015.
Authors will be notified of acceptance status by Tuesday, September 15th, 2015.
Presenting Author’s Availability: The presenting author (preferably the primary author) must be available to present his or her work at the Southern Hospital Medicine Conference on Thursday, October 22nd, 2015 in New Orleans, LA. Authors will be responsible for any associated costs including travel, meeting registration, and poster preparation.
Please note that registration for the conference is NOT REQUIRED for those authors who are accepted for and only attend the poster presentation and competition, but registration is highly encouraged and required for those who attend the main conference and/or pre-courses.
Prizes will be awarded for the top presenters at the competition in both categories and all presenters will receive a certificate of participation.
Please email all submissions and questions to: southernhospitalmed@gmail.com
If you feel you have received this message in error and/or are no longer the acting program director, please email southernhospitalmed@gmail.com to be removed from this list and/or forward this message to the appropriate current program director.
Good luck,
Dustin T. Smith, MD
Chair, Southern Hospital Medicine Conference Poster Session
Upcoming Dates and Events
August 21 - Housestaff Welcome Event
September 12 - Stead Tread
Useful links
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
http://www.ad001.info/blasts/CKS/CKS15_05431/CKS15_05431.html