From the Director
Another strong week in the books! We have a new member of the Duke family .. Julia Cupp and Justin Morrow welcomed Arissa last week! Congratulations! And the fellowship applications are uploaded…interviews are already rolling in!
It was so fun to have the first JAR dinner this year with John Musgrove, Bill McManigle, Anubha Agarwal, Julia Xu and Coco Fraiche. Looking forward to the upcoming dinner in August as well as several more nights out, including Kerby night at the Durham Bulls and the Warren Trivia Night. Our program-wide Summer Celebration will be held at the end of August – please check your email for an invitation from Madi.
There are two fantastic opportunities coming up to give back to our community. Sue Woods and Haley Peterson have been working with Dr. Klotman and Dr. Ann Reed (Chair of Pediatrics) to develop a volunteer opportunity at the Samaritan Health Center, and our Social Action Council (led by Dinushika Mohottige, Jake Feigal, and Jenny Van Kirk) has just sent out a survey regarding an evening opportunity at Lincoln Community Health Center. Please respond to Dr. Woods by Friday if you are interested in Samaritan, and respond to Dinushika’s survey ASAP if you are interested in the Lincoln opportunity.
Kudos this week to the CCU crew of Ann Weaver, Lauren Collins and Brian Andonian – Lauren sent me a note about her amazing co-JARs, and Cory Miller let me know that they were all doing an amazing job. Also to Coco Fraiche and Lauren Ring for helping out on Oncology during the weekend, and to Vedran Oruc for a fantastic chair’s conference. Our SAR talks this week were excellent, including Andy Mumm, Emily Ray, Amanda Verma and Bassem Matta. Also congratulations to Eric Fountain for getting a gold star from a patient.
This week’s pubmed from the program goes to Dinushika Mohottige…Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.Austin CA1, Mohottige D2, Sudore RL3, Smith AK3, Hanson LC4.JAMA Intern Med. 2015 Jul 1;175(7):1213-21. doi: 10.1001/jamainternmed.2015.1679.
Welcome Arissa Morrow!
What did I read this week?
Submitted by Sharon Rubin, MD
Immunogenicity and Safety of 9 Valent HPV vaccine. Journal of Pediatrics. doi: 10.1542/peds.2014-3745) Pierre Van Damme, MD, PhDa et al.
As this month’s theme is Immunizations, I wanted to highlight a new vaccine that is available.
In the US, ~12,000 women will develop cervical cancer every year, and ~ 4,000 women die from cervical cancer. Gardasil-9 can prevent most of these cancers. HPV infection usually comes from sexual contact, and most people will become infected at some point in their life. About 14 million Americans get infected every year. Many infections resolve and not cause serious problems. But thousands of women and men will develop cancer and diseases from HPV.
In this study, 3066 boys (age 9-15) and girls/women (9-26) received a 3 dose regimen 0, 2,6 months. Their blood was checked with anti HPV assays (antibody testing) at day 1 and month 7, serology’s, antibodies 99%. Persistence of antibodies was demonstrated at 2.5 years after dose 3. The major side effect was injection site reactions, headache and pyrexia. The one data that I would have liked is to see if the pap smears were observed(less ASCUS/LGSIL). The only follow up was checking immunogenicity. With the 10% chance, women still need to be screen for pap smears. We also do not know how long the protection will last, perhaps patients will need a booster. There is hope the dose regimen can be decreased to 2 doses and results to come.
On December 10, 2014 the FDA approved the Gardasil 9 (6, 11, 16, 18, 31, 33, 45, 52, 58) vaccine. This vaccine covers more than quadravalent Gardasil (6,11,16,18) or bivalent Cervarix (16,18 . The Gardasil protection of 16,18 protect 70% cervical cancer, 80% of anal cancers, 60% of vaginal cancers, 40% of vulvar cancer and the 6,11 protect 90% genital warts. The new Gardasil 9 vaccine protects 90% of cervical cancer and still provides protection against genital warts. The schedule is still the same 0,1-2, 6 months. If a patient starts on the Gardasil 4, the other 2 remaining vaccines can be given as Gardasil 9. Eventually clinics should be phasing out the Gardasil 4. The Gardasil 9 will provide protection against other cancers cause by HPV such as vulva/vagina/penis/anus and throat cancer. The US Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (AICP) recommends the vaccine for both boys and girls ages 11 and 12; females 13-26 and males 13-21 who have not been vaccinated.
Pap smear screening has decreased cervical cancer tremendously. This vaccine will help as well to eradicate these cancers for patients in the future.
Clinic Corner
Greeting PRIME team,
PRIME staff is looking forward to another great year. Please take some time and find your new interns on your team and say Hello and set up team meetings with your attending and your team.
Regarding changes to our team names, sorry for the change but hopefully all of us will get used to our new clinic names soon. If you have any questions please do not hesitate to contact me.
Remember exit interviews are really important so nurses can provide vital teaching to our patients, go over instructions and spend time completing reminders and administering vaccines. Please try to avoid “exit by provider” unless a patient needs to leave or there truly is nothing that needs to reviewed with the patient.
Remember also that all appointment times are at the 15 and 45 minute mark for vitals and nurse check in and that your time with the provider starts at the hour and half hour. Clinic starts at 8:30 for residents in the morning and 1:00 pm for the afternoon, you are welcome to see patients early if they are ready but you do not need to leave morning report or noon conference.
Thanks again and Welcome New Interns!
From the Chief Residents
Grand Rounds
Friday, July 24th- Dr. Jennifer Cousar, Invited Speaker
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 7/20/15 | SAR Emergency Series: Biliary Tract Emergencies |
Yi Qin |
12:00/MedRes | Nosh |
| 7/21/15 | SAR Emergency Series: Hypertensive Emergency/Urgency |
Brittany Dixon |
12:00/MedRes | Domino's |
| 7/22/15 | SAR Emergency Series: Altered Mental Status |
Melanie Goebel |
12:00/MedRes | Cosmic Cantina |
| 7/23/15 | SAR Emergency Series: Perioperative Risk Assessment |
Jonathan Hansen |
12:00/MedRes | Subway |
| 7/24/15 | Chair's Conference | Chiefs | 12:00/MedRes | Surprise! |
From the Residency Office
Get Involved 2015!
As we start another academic year, we remind you of all of the opportunities the program and Duke Medicine offer for you to get involved and give back to to our community. Please see the brochure linked at the end of this post for more information!
Duke Partners Club
We are a group of significant others (spouses/fiancés/partners, etc) of residents and fellows in the many different specialties at Duke. Our group offers several monthly activities such as book club, dinners, movies, playgroup, and most simply, a community for those sharing similar experiences during this exciting time in our partners' careers.
This year, GME invited us to participate in orientation with a info-table allowing us to share details about our group. Knowing that information received at orientation doesn't always make it home, please see the information available for download at the end of this post!
Certification in Language Translation Services
If you speak a language other than English fluently and would like to be certified as a medical translator in order to inform/consent patients, please contact The Duke International Patient Center (919) 681-3007
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:
Monday, August 17th: 12:00 noon to 1:00pm
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!
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
Ambulatory curriculum wiki
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
CAH Primary Care Bulletin 2014.pdf
Decatur Primary Care CHIC Bulletin.pdf
PC Beardstown Bulletin.pdf