From the Director
And another AMAZING holiday party in the books! Thank you Dr. Klotman and Donna Salvo for hosting and planning a spectacular party. And also to our fearless leaders, Armando, Chris, Jenn and Lindsay for Oscar-worthy OSCE’s and Grammy contender style singing. Also to our very very good sports Dr. Corey, Marc Samsky, Jon Buggey, Sipa Yankey, Zach Wegermann and Jenny Van Kirk.
Thank you to all who contributed to the Toy Drive for the Department of Medicine and to Eric Fountain who delivered our toys to Toys for Tots. Also thank you to all who are participating in the DOC holiday gift drive as well.
Lots of kudos this week – to Rajiv Agarwal and Jon Hansen for great patient care at the VA, to Zach Wegermann from Taylor Bazemore for being a huge help on VA Cards consults (I’m told that no one knew that it was Zach covering for Taylor), to Azalea Kim from Lindsay and Lish for her excellent Grand Rounds presentation, to AJ Blood and Jackie Bolwell from Mike Sketch for excellent work on CAD, to Paul Riordan (along with Drs. McNeill and Zipkin) for great teaching and patient care at the DOC from Leah Machen, to Ryan Orgel for an amazing CHair’s conference, to Manisha Bhattacharya from Jan Dillard at the DOC for an excellent home visit, and to Sipa Yankey, Marc Samsky, Kahli Zeitlow, Pascale Khairallah and Megan Dupuis for My Take last week.
Get ready for the holiday break – since when did it almost become 2016? Be on the lookout for your SCHEDULE REQUEST FORMS, due after the break. Embedded in the forms are the Clin Epi applications for interested rising JARs (and rising MP3’s and MedPsych 4’s), as well as the ACR nomination forms. This year, EVERYONE will be able to suggest up to 3 people (including yourself if you are an eligible rising SAR) to be considered for ACR. THIS IS NOT A VOTE, but a way to put yourself or others up for consideration. Once we get the list, we look at sites that people prefer and put together next year’s ACR team by February. As a reminder, those going abroad are not eligible for ACR.
This week’s pubmed from the program goes to Eric Yoder for his letter to the editor in Academic MedicineAcademic Medicine:December 2015 - Volume 90 - Issue 12 - p 1585doi: 10.1097/ACM.0000000000000964
Galanos AN and Yoder E. “Promoting Palliative Care”
We also have a second pubmed from the program for Li-Wen Huang for her upcoming abstract at the Tandem BMT meeting - Efficacy of Autologous Stem Cell Transplantation in Older Multiple Myeloma Patients
Li-Wen Huang, Wendi Bacon, Constance Cirrincione, Bercedis Peterson, Gwynn Long, David Rizzieri, Mitchell Horwitz, Keith Sullivan, Kelly Corbet, Nelson Chao, Cristina Gasparetto, Sascha Tuchman
HAVE A GREAT WEEK!
This is the last Med Res News of 2015! Look for us again in 2016!!
Aimee
What did I read this week?
Submitted by: Daniella Zipkin, MD
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
The SPRINT Research Group, N Engl J Med 2015; 373:2175-2178
The JNC-VIII hypertension guidelines which were published in 2013 recommended a treatment goal below 150/90 for adults over age 60 (Grade A, strong recommendation) and a goal below 140/90 for all others, including those with diabetes or kidney disease (Grade E, expert opinion). Recently, the SPRINT trial has been making big news in primary care and will likely have a major impact on practice patterns, calling JNC-VIII recommendations into question. The features of the SPRINT trial merit closer attention!
- Population: Age >50, SBP 130-180, and increased cardiovascular risk defined by CVD, CKD, Framingham CVD risk >15%, or age over 75. Excluded diabetes and history of stroke.
- Intervention: Systolic target <140 vs. <120, stratified by site (there were 102 clinical sites). Study personnel and participants were not blinded. Outcome adjudicators were blinded. Encouraged thiazides, CCB, ARB, beta blockers for CAD, but didn’t mandate choices.
- Primary outcome: Composite of MI, ACS, stroke, acute CHF, or death from CVD.
- Follow-up maximum of 6 years, planned median f/u 5 years.
- Power based on expected event rate of 2.2% per year, planned to reduce it by 20% (to approx. 1.8%). Needed 9250 participants for 88% power.
RESULTS:
- 9361 enrolled. 28% were over 75 years of age, 28% CKD, 20% CVD
- Stopped early at 3.26 years.
- Primary outcome occurred in 6.8% of controls, 5.2% of intervention. ARR 1.6% at 3 years. This gap would likely have been a little smaller if they had continued to five years, based on what we know of trials stopped early carrying inflated event rates.
- HR 0.75; 95% CI 0.64-0.89; benefit seen within the first year
- Rate of serious adverse events was 4.7% in intervention and 2.5% in control, defined as hypotension, syncope, electrolyte abnormalities, AKI.
Zipkin’s Bottom Line: This study has methodologic features that make it easier to find a difference between groups, such as composite outcomes, lack of blinding, and stopping early. Also, there was a near doubling of serious adverse events. However, the impact of aggressive blood pressure lowering in this high risk population that included patients with CKD is compelling and will change practice. Whether we really need to aim for systolic of 120 is unclear – keep in mind that in a less controlled setting out in the world, this will invariably result in even higher adverse event rate. But it’s fair to say we should move our goals down from the 140-150 range of JNC-VII!!
QI CORNER
A huge thank you to Azalea Kim for her excellent case presentation at Grand Rounds on Friday. Thanks also to Damien Earl, Dr. Rivelli, Dr. Graffagnino, Yvonne Spurney, MJ Stillwagon, and the very engaged audience for a great discussion. Our next Grand Rounds M&M will be in March--please pass along any interesting cases to me or Lish.
Thanks to all who have had input on the paging culture project! Look for a survey in your inbox soon and respond so that your voice can be heard about what YOU want from a better paging culture. Also, we're excited to announce that 4300 will be piloting a new text paging format in January. We'll give those of you on gen med in January a run-down when you start.
In the meantime, we hope you can all join us THIS Thursday at noon conference for a great talk on high value prescribing from our own Lish Clark. See you there!
CLINIC CORNER
Happy Holidays from Pickett Road.
We are having our own toy drive for our chosen charity the Durham Rescue Mission. We are collecting new and unwrapped toys until December 18th (in case anyone misses the DOM Toys for Tots drive deadline of 12/14/15). The Durham Rescue Mission very much appreciated our over 6 bags of non perishable goods and turkey coupons donated to their local shelter. I am sure even if the toys are gently used they will take the donation.
We are happy to announce our new nurse manager Christine Pace will be joining us 12/28/15. We have two new nurses and CMA's coming by next year. Transforming Primary Care has been on hold with staff moving up but we are still on target to continue with the strides we have taken so far.
We will have all the residents on Ambulatory coming for morning report in combination with Duke Internal medicine Grand Rounds on Tuesday December 15th at 7:30am. The topic is focusing on communication with challenging patients. Bagels will be provided. Please come and learn this important skill.
We will be celebrating our Pickett Road Holiday Party on Thursday December 17th. We have chosen non traditional meals this year (fried chicken for Thanksgiving) and BBQ for the Winter holidays. We hope our residents in clinic will be able to join us.
Thank you!
Sincerely
Sharon Rubin, MD, FACP
Assistant Professor, Duke University Medical Center
Residency Director at Pickett Road
Internal Medicine
From the Chief Residents
Grand Rounds
Friday, December 18 - Nephrology, Dr. Susan Gurley
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 12/14/15 |
Recruitment day-Lunch w/ Applicants |
|
12:00 | Nosh |
| 12/15/15 | MedPeds Recruitment-Lunch with Applicants | 12:00 | Saladelia | |
| 12/16/15 |
Influeza Management |
Cameron Wolfe |
12:00 | Domino's |
| 12/17/15 |
QI Patient Safety Noon Conference |
12:00 |
China King | |
| 12/18/15 |
Chair's Conference -11:30 Lunch with Applicants follows |
Chiefs | 12:15 | Pipers in the Park |
From the Residency Office
Annual Toys for Tots Holiday Toy Drive - Huge Success!
THANK YOU to everyone who donated!! This year, we delivered well over 100 new toys to the Toys for Tots organization. An extra "Thank You" to Jesse Tucker for collecting them at the Holiday Party, and Eric Fountain for making the trek to Raleigh today to deliver them!!
Deadline for ordering your 2015 Labcoat – December 31, 2015
All trainees that have continued in their current training programs for academic year 2015-16 (currently in 2nd year of the same program or above) are able to order one new GME provided labcoat per year. If you have not ordered your new coat this year, the deadline for ordering is quickly approaching (December, 31, 2015). To order, you will need your email address (exactly as listed in MedHub). Go to https://shopgmeuniforms.dukestores.duke.edu to place your order.
NOTE: If you are a first time user OR don’t know your password, click on the “Attention First Time Users“ link and you will receive one. If you have any trouble logging into the system, please contact the GME Office at dukegme@dm.duke.edu.
ALL LABCOAT ORDERS MUST BE PLACED BEFORE DECEMBER 31, 2015.
Hematology Division Newsletter
Please note that we will now include a copy of the Hematology Division Newsletter, published monthly, at the end of this post - check it out!
ACLT Applications Now Being Accepted!
Ambulatory Care Leadership Track (ACLT) Applications Due December 31, 2015:
Calling all interns who may be interested in either general internal medicine or a subspecialty where your focus will be ambulatory medicine, please consider applying to the ACLT. It’s a foundation for careers in general medicine leadership, primary care, academic ambulatory subspecialties, research, or education. Program highlights:
- Three blocks of ambulatory medicine throughout JAR and SAR years, with dedicated didactic time following four key themes:
- Clinical: Expanded clinical options in fields inside and outside of medicine: sports medicine, ENT, ophtho, dermatology, obesity medicine, as well as all medicine subspecialties. Maximum 4 weeks in any one medicine subspecialty (plus subspecialty continuity clinic), minimum 4 weeks general medicine ambulatory, over a total of 24 weeks.
- Teaching: Curricula in teaching and opportunities to teach in small group as a SAR
- Scholarship: Support for preparing and presenting scholarship, ambulatory journal club
- Advocacy and health policy: seminars given by faculty in government relations and health policy throughout the year, and an advocacy trip in the spring to both Washington DC and Raleigh, NC, alternating year.
Please fill out the application linked at the end of this post and submit to Armando Bedoya and Dani Zipkin before the end of the year!
Duke Narrative Writing Project
Dear Medical Trainees,
We invite you to participate in the inaugural Duke Narrative Medicine Project.
This initiative includes a special Medicine Grand Rounds by invited speaker Anna Reisman, MD from Yale School of Medicine (Director of Yale Internal Medicine Residency Writers' Workshop) as well as a one-day workshop focused on honing the craft of writing.
Duke medical students, residents, and fellows across all departments are invited to submit narrative or reflective writing samples in advance of a one-day workshop in which participants will engage in critical and constructive feedback of each other's writing.
The writing workshop will be moderated by Dr. Anna Reisman as well as Duke faculty members who will work with you to prepare your narrative writing pieces for publication.
Please see the attached flyer as well as the application link below for additional details.
Duke Narrative Medicine Project: Writing Workshop
Saturday, February 6th 2016
Duke Medicine Pavilion
Pre-workshop dinner February 5th, 2016
Application details:
https://duke.qualtrics.com/SE/?SID=SV_2fUx5jKrPKf9ZhH
Application deadline:
Rolling submissions until January 15th 2016
Please contact DukeNarrativeMedicine@duke.edu with any questions!
Sincerely,
Duke Narrative Medicine Project Team
Amy L Jones, Dinushika Mohottige, Lakshmi Krishnan, Anubha Agarwal
General Medicine Health Services Research Fellowship at Duke (Attention SARS!)
Health services research (HSR) is multi-disciplinary and focuses on the impact of systems of care, access, cost, quality, behavior and other factors on health care outcomes. We have a very robust network of support and outstanding faculty in HSR at Duke. Here is an introduction to our fellowship, courtesy of David Edelman. The application cycle begins in January!
The Division of General Internal Medicine collaborates with the Center for Health Services Research in Primary Care in the Durham VA Medical Center to offer fellowships for MD and PhD scholars with an interest in training in clinical or health services research. The fellowship is ordinarily a two year program, though three year fellowships may be available to certain candidates. Training grants are funded by the VA Office of Academic Affairs (OAA). We have trained more than 100 fellows in our 30-year history, including many leaders in Health Services Research and many of our core faculty in General Internal Medicine.
The primary goal of the post-doctoral fellowships is for fellows to perform high-quality, mentored clinical or health services research working closely with a mentor from the Division of General Internal Medicine. MD fellows ordinarily obtain a Masters in Clinical Research from Duke’s CRTP program, with tuition paid by the fellowship. All fellows also participate in a Faculty/Fellow Development Seminar Series, a set of weekly, one-hour discussions addressing a variety of career development topics. Stipend is at the appropriate PGY level.
Senior Residents wishing to apply for July 2016 should contact Dr. David Edelman, Fellowship Director (David.Edelman@duke.edu) no later than Friday, January 9 to express interest. Written application will be due February 1 with interviews competed by the 3rd week in February and applicants notified of their status by March 1.
Click the link for more info:
http://www.durham.hsrd.research.va.gov/MD_fellowship.asp.
Or, contact David Edelman, MD, Fellowship Director (david.edelman@duke.edu).
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
March 2 - JAR Networking Event
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