From the Director
Can’t believe it! New chiefs officially started TODAY! A huge thank you to our outgoing chiefs Nilesh Patel, Coral Giovacchini, Bonike Olorontoba and Aaron Mitchell. Coral had a AMAZING Grand Rounds on Friday, and Bonike gets to welcome our new interns this coming Friday with her (sure to be amazing) Grand Rounds. Also thanks to our outgoing ACRs Venu Reddy, Katie Broderick-Forsgren (and stand-ins Angela Lowenstern and John Wagener), and Sneha Vakamudi.
Welcome to Jenn Rymer, Chris Hostler, Armando Bedoya and Lindsay Boole. Today started off with a great prank (just ask Armando), so all signs point to an outstanding year ahead. Also welcome to our new ACRs for July-August – Sarah Goldstein, Marc Samsky and Matt Atkins.
Other kudos this week go to our Appleseed Teaching Award winners: Interns: Lauren Collins, Tim Hinohara, Jenny Van Kirk, Zach Wegermann and JAR/SARs: Adam Banks, Katie Broderick-Forsgren, Hal Boutte, Kedar Kirtane, Venu Reddy, Aparna Swaminathan, and Kevin Trulock. Also kudos to our VA teaching award winner Joel Boggan, and nominees Ryan Schulteis, Ken Schmader, and Laura Caputo, as well as our Stead Teaching Award nominees Howard Rockman, Larry Greenblatt, and Ken Schmader, with congratulations to our winner Tom Bashore.
Other congratulations to Mike Woodworth and Kate Russell (Peds) on your engagement!
If you missed Lish Clark’s awesome QI/PS wrap up conference last week, we highlighted all the topics and closure from this year’s resident M and M conferences as well as reminded you all that $400 extra will be in your upcoming paychecks for meeting TWO GME INCENTIVE TARGETS! Congratulations on reducing ED consult time and meeting the mark for RL solutions reporting. These were directly under YOUR control, and you did it!
New interns will be arriving for GME orientation on Wednesday, and then will be here on Friday for our IM orientation. Get ready for the Tom Holland Lecture on Friday, and also for NEW INTERN shadow day on Saturday! Look for your email from me regarding your shadow intern, and let me know if you have any questions.
This week’s pubmed from the program goes to our amazing QI team working with Jacob Doll on the CAD handoff process – Jon Buggey, Joanne Wyrembak and Jessie Seidelman: Buggey J, Doll J, Wyrembak J, Seidelman J, Ward C. Evaluation of Written Materials for Patient Handoffs on an Inpatient Cardiology Service. 2015 American Heart Association Quality of Care and Outcomes Research Scientific Sessions, Baltimore, MD
We are looking forward to an amazing year coming up! Another thanks to our outgoing SARs for being tremendous contributors to the Duke IM legacy.
Aimee
What did I read this week?
(Submitted by: Sharon Rubin, MD)
What I read this week 6/16/15.
Efficacy and safety of alirocumab in reducing lipids and cardiovascular events.
N Engl J Med. 2015 Apr 16;372(16):1489-99. doi: 10.1056/NEJMoa1501031. Epub 2015 Mar 15.
Robinson JG, Farnier M, Krempf M, Bergeron J, Luc G, Averna M, Stroes ES, Langslet G, Raal FJ, El Shahawy M, Koren MJ, Lepor NE, Lorenzato C, Pordy R, Chaudhari U, Kastelein JJ; ODYSSEY LONG TERM Investigators.
6/14/15 my patient asks if she is a candidate for alirocumab (Praluent) from Sanofi SA and Regeneron Pharmaceuticals, which the FDA approved that day. She has chronic life long whole body tendonitis and cannot tolerate any of the statins. I asked her to wait while I reviewed the evidence for use.
What is Alirocumab? It is a monoclonal antibody that inhibits proprotien covertase subtilisin-kexin type 9 (PCSK9) that reduces LDL levels in patients receiving statin therapy. (Odyssey Long term Trial) They looked at 2341 patients (320 sites in 27 countries Africa, Europe, N/S America)with high risk for cardiovascular events with LDL of >70 + on statins at max tolerated dose or w or w/o other lipid lowering therapy for 4 weeks before screening. Patients were randomly assigned to receive alirocumab 150 mg or placebo 1 ml subq injection every 2 weeks for 78 weeks. The primary end point was %change LDL from baseline to week 24. Results showed at 34 weeks the alirocumab group had 62% change in LDL and was consistent over 78 weeks compared to placebo. Reported side effects were injection site reactions, myalgia, neurocognitive events and ophthalmologic events. Only in post hoc analysis the rate of cardiovascular events was lower compared to placebo.
This brings up many questions. The ODYSSEY OUTCOMEs has a larger patient population 18,000 and the end points set not just to LDL reduction but cardiovascular reduction over 5 years. This is similar to zetia or even bisphosphonates, where is the end point of LDL or DEXA appropriate when really the cardiovascular and decreased fractures are the more important end points. Stains already have a side effects of myalgia and memory disorders, getting patients to take an injection will be difficult to add. Where does this medication fit in the new AHA/ACC/ATPIV guidelines? This is adjunctive therapy not stand alone.
Take home point, I am waiting for more studies and evidence and the experts to process this in guidelines. I advised my patient wait at least 6 months to a year for “phase 4” of the drug roll out in case there are side effects not seen in the small number of 2341 patients or it is pulled from the market. I see the FDA indication as add on not stand alone medication for lowering LDL.
From the Chief Residents
Grand Rounds
Fri., June 26: Dr Omobonike Oloruntoba, Chief Resident
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 6/22/15 | Fun Lunch | N/A | 12:00 | Saladelia |
| 6/23/15 | Basics of Echocardiography | Anna Lisa Crowley | 12:00 | Domino's |
| 6/24/15 | Common Curbside: Psychiatry | Amy Newhouse/Jacob Feigal | 12:00 | Cosmic |
| 6/25/15 | PEAC Study Hall | Chiefs | 12:00 | Subway |
| 6/26/15 | Tom Holland Lecture | Marc Samsky | 12:00/2002 | Chick-Fil-A |
From the Residency Office
Please Welcome the New Members to our MedRes Team!
Please join us in welcoming our newest team members - Madi Smith, who has taken over for Erin Payne as our Recruitment Coordinator and Assistant to Dr. Zaas, and Tia Williams, who has been with us as a temporary staff assistant for a few months and will now join us as a permanent staff member! Come by and say "Hi" when you have a chance!
First Annual Summerfest
The Duke Medical Alumni Association is delighted to host this year’s First Annual Summerfest, an event for all Duke residents and their families. We want to welcome Duke’s newest house staff and celebrate with all residents that they are part of the Duke medical alumni family.
Book Club Event
Hello, residents!
Congratulations on being so close to the end of another year! We have one more Dept. of Medicine book club event scheduled before this academic year comes to a close, and would love to see as many of our residents there as possible! This time we’ll be reading The Immortal Life of Henrietta Lacks by Rebecca Skloot, a tremendously popular read that highlights important issues in medicine like access to care, informed consent, and more.
The event will be held on Monday, June 22nd, from 7-9 pm in the Searle Center Faculty Lounge. As always, we have a limited supply of FREE BOOKS to the first residents to RSVP, and there will be plenty of wine and food to go around. Please email laura.caputo@duke.edu if you would like to attend! We can’t wait to see you all there!
Thank you!
Laura M. Caputo, MD
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
June 26 - Dr. Bonike Oloruntoba, Chief Resident Grand Rounds
June 27 - Intern Shadow Day
June 26 - Intern Orientation
August 21 - Housestaff Welcome Event
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
South Georgia (See attachment below)