Internal Medicine Residency News, July 18, 2016

July 18, 2016

From the Director

Hope everyone is doing well! So far, the first two weeks of the year have been off to a fantastic start. It has been great to see the noon conference room packed to STANDING ROOM ONLY (although we hate to have people standing, the attendance is fantastic). We will be moving back downstairs in August when 2002 is back in operation. The SAR talks have been outstanding (See kudos below!), as have the pre-conference ‘gallops’ presented by Caroline Sloan. Looking forward to more of these throughout the year.

Kudos this week goes to our SAR talk presenters Kara Wegermann, Christine Bates, Adam Barnett and Taylor Bazemore as well as our outstanding chair’s conference presentation of chronic eosinophilic pneumonia by Annie Reihman. Linda Koshy set up Dr. Granger for his learning filled grand rounds on anticoagulation in atrial fibrillation. If you missed grand rounds, this one is ABSOLUTELY worth watching on the CME portal. Other kudos this week come from Gen Med SARs Jenny Van Kirk, Rachel Hu, Peter Hu, Christine Bates and Kavisha Singh to the Duke Night Residents Ankeet Bhatt, Landon Brown, Jeremy Cypen, Dan Maselli and Hari Ramalingam for outstanding work, great patient care and excellent AM presentations. As I just finished two weeks of Duke Gen Med, I can attest that they deserve so many compliments for their patient care and teamwork over the first two weeks of the year.

Thank you to all who are logging hours on a daily basis. This information is VERY helpful to us as we look at rotations and ways to improve.

Keep in mind the following upcoming events:

Professional Development Noon Conference Day – FRIDAY JULY 29th! Interns will meet with Dr. Galanos for a chance to debrief the first month of intern year. JARs will meet with outstanding faculty members and former Duke IM Chief Resdients and Fellows Susanna Naggie and Heather Whitson to talk about mentorship in residency and SARs will meet with a panel of senior fellows to talk about interview skills. Rooms TBD for each group
Summer Celebration – join us at my house on FRIDAY JULY 29th for the annual IM Residency Summer Celebration! Significant others, kids welcome.

Welcome to the #dukefamily to Avery Mumm, and congratulations to the proud parents Azalea Kim and Andy Mumm (Duke IM Class of 2016, and current Palliative Care Fellow). We can’t wait to meet him, and of course assign him to be on some sort of residency committee.

SARs, our communications specialist Dr. Kat Pollak will be offering small group interview practice sessions in the Med Res Library

Madi will be sending around a sign up sheet for the following times:

Aug 2: 5:00
Aug 24: 5:00
Aug 25: 8:00
Aug 29: 8:00

Have a great week

Aimee

What Did I Read This Week?

Annals of Internal Medicine Vol 164 No 12, 21 June 2016

Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: US Preventive Services Task Force (USPSTF) Recommendation Statement

At the DOC, like many general medicine clinics, use of ASA for prevention is inconsistent. This update of the 2009 recc. of the USPSTF with 5 new studies and commissioned systematic reviews , will greatly help to provide evidence based guidance for this important prevention strategy.

Cardiovascular disease and colon cancer are major causes of death in the US. In 2011, > ½ of all deaths were caused by heart disease, cancer or stroke.

The USPSTF used the widely used 2013 calculator from the ACC/AHA to predict 10 yr risk.

Primary risk factors include older age, male, race/ethnicity, abnormal lipids, HTN, DM and smoking.

The recommendations applies to adults at increased CVD risk ( nonfatal MI, CHD death, and fatal or nonfatal stroke) and average CRC (colorectal cancer) risl.

ASA reduces risk for CVD in adults aged 50 to 69 yrs . Amount of benefit varies by age and 10 yr CVD risk.

It also reduces CRC risk after 5 to 10 yrs of use.

Harms are GI bleed and hemorrhagic stroke.

GI bleeding is the most common serious harm of ASA use.

Major GI bleeding increased by 58% in ASA users.

GI bleed risk is 2-3 x greater in pts with h/o GI ulcer, and x2 greater in men as compared to women.

GI bleed risk increases with age.

No evidence that enteric coated ASA or buffered formulations are safer.

Hemorrhagic stroke is a rare risk.

Trials showed a 33% increase in hem. Stroke.

The USPSFT used a microsimulation model to develop one table which shows risks of ASA use , stratified by age and gender.

Life-years and quality life-years were the metrics followed.

The greatest net benefit was found in pts aged 50-59 whose 10 yr CVD risk is > 10%.

Pts aged 60-69 may benefit from ASA use, but the net benefit is smaller.

CVD risks vs benefits of ASA is an individual decision as well.

Optimal dose of ASA for prevention of CVD risk is not known. Various doses inc. 75-100 mg/day and 100 and 325 mg qod have been studies.

Dose of 81 mg/ day is as effective as higher doses and most common dose in the US.

Benefits in those < 50 yr old is limited, likely due to the lower risk for CVD risk.

Evidence in using in those > 70 yrs is limited.

Nearly 40% of US adults > 50 yrs use ASA for primary or secondary prevention of CVD.

The decision to start or continue ASA is complex.

The balance of benefits and harms considers 4 main factors: risk for bleeding, preferences abouto ASA, baseline CVD risk, and age.

CVD preventions benefit begins within the first 5 yrs, while the CRC prevention takes at least 5-10 years of daily use to show a benefit.

Research needs—no data on the difference with various ethnic groups, how PPI use may change risk, CRC screening and dosing strategies.

A tool that considers CVD risk and GI bleeding is needed.

There is only 1 risk prevention tool for GI bleeding, but it has not been validated.

Public comment this past fall raised questions primarily about older patients and appropriate strategies.

The evidence clearly supports 81 mg ASA use for pts age 50-59 with > 10% CVC risk and willing to take daily for at least 10 yrs.

2 great uses for the risk calculator!

QI Corner

Please join us for the first meeting of the Patient Safety and Quality Council (PSQC)!

Tuesday, July 19th at 7:00pm

(Location TBD)

This is a resident committee with resident-driven goals and projects. It's YOUR chance to get involved! We will meet monthly, usually luring you with food. As a group, we'll select projects at the beginning of the year, and then work together to follow them through.

At this first meeting, we'll eat, drink, review some of last years’ work (including discussing what is left to be done/opportunities to get involved) and brainstorm project ideas. If you want to be involved but you can't make it to the kick-off, email matt.atkins@duke.edu or alicia.clark@duke.edu with your scheduling preferences.

From the Chief Residents

Grand Rounds

Friday, July 22 - TBD

Noon Conference

Date	Topic	Lecturer	Time	Vendor
7/18/16	MKSAP GIM	Aparna	12:00	Domino's
7/19/16	SAR Lecture: Office Emergencies	Lauren Ring	12:00	Mediterra
7/20/16	EPIC Tricks and Tips	Jon O'DOnnell	12:00	Cosmic
7/21/16	Resident M & M	Alicia Clark	12:00	Bullock's
7/22/16	Chair's Conference	Ankeet Bhatt	12:00	Subway

From the Residency Office

Have You Logged Your Duty Hours??

With the start of the 2016-17 academic year, the residency program is asking all house staff to log their duty hours on a daily basis. This will allow us even closer oversight of duty hour compliance across the program. In order to use the MedHub mobile Duty Hour app, you will need to know your actual MedHub log in as it will not accept your NetID/password log in. If you have forgotten you main log in, please go to the main MedHub site, and select "Forgot my password." You will then be able to re-set it via email. Lynsey Michnowicz will be sending reminders each Wednesday to those who have not yet logged their duty hours for the week. Thank you in advance for your attention to this task!

NCSP Applications

The National Clinician Scholars Program (NCSP), a two-year research training fellowship (formerly known as the Robert Wood Johnson Foundation Clinical Scholars Program) for physicians and nurses, is now accepting applications for enrollment in July 2017. The NCSP provides mentored training in clinical, community, and health policy research, with a focus on supporting the development of change agents who will devote their careers to leading improvements in health and healthcare.

The NCSP, in partnership with the Department of Veterans Affairs, currently has training sites at the University of California at Los Angeles, University of Michigan, University of Pennsylvania, and Yale University.

Applications are due August 15th.

Medical Improv

Medical Improv Workshop being offered in the Triangle area. And it’s free!

Medical Improv is quickly gaining popularity as an innovative approach to teaching principles that are at the heart of patient centered care: Focused listening, collaboration and seeing things from another’s point of view. Medical Improv can help teach skills that will make you more present and aware during high stakes conversations with patients and colleagues. If you find yourself feeling overwhelmed by everything that’s coming at you during your time with patients, these skills can help things slow down a little so you can prioritize what’s most important and make better decisions.

This 3 hour workshop is free to all Duke Health Sciences’ students and clinicians on a first-come-first-served basis. The workshop will be capped at 15 students for more individualized attention. No observers will be allowed in these sessions. Everyone will be expected to participate. The sessions will not be recorded in any way and no grades will be given. The goal is to create a safe environment where people can play and speak freely.

These sessions will be led by Dan Sipp, a trainer for the Clinical Skills Program at Duke University School of Medicine. Dan has taught improvisation in Chicago and the Triangle for over 20 years. He’s trained with the creator of Medical Improv, Katie Watson from Northwestern University’s Feinberg School of Medicine*, and they have collaborated on projects for the University of Indiana School of Nursing. Dan is very excited to bring these sessions to medical learners in the Triangle. Duke Faculty members from The School of Medicine, Graduate Medical Education, The School of Physical Therapy and The Physician Assistant Program will be co-facilitating these and upcoming sessions.

You’re invited to register for this free workshop!

Saturday, September 24th from 10 a.m. to 1 p.m. @ Trent Semans Center for Health Education, 6th floor

To reserve your spot in the next Medical Improv Workshop please email Dan. Once he receives your email he’ll follow up with a confirmation of your spot, directions to the site and more information about the day.

Remember space is limited to 15 participants per session. We want to see you there. So sign up soon! You are also free to forward this email to friends or colleagues who you feel might be interested in this innovative training session.

*You can read more about Katie at her website. You can also read Katie’s paper on the applications for and the effectiveness of Medical Improv for clinicians at the Academic Medicine website.

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.

Next Book Club Event!

Attention, Medicine Residents!

Welcome to the new academic year, and a particularly warm welcome to our new interns! We're excited to announce that the Duke Internal Medicine book club is back! Our first event will be on Thursday, August 18th from 5:30 - 7:30 pm in the Searle Center Faculty Lounge. At the request of the residents (that's you!), our structure is changing a bit. This time we'll be reading All the Light We Cannot See by Anthony Doerr, a NYT best seller and winner of the 2015 Pulitzer Prize for Fiction. Books are available at most local book stores or online. Snacks and drinks will be provided.

If you're interested in attending, or if you have any questions, please RSVP to me at laura.caputo@duke.edu. We're looking forward to seeing you there!

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.

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/