Internal Medicine Weekly News: November 25, 2013

By admin3

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone! The last practices are in, the jerseys are ordered, and the videos are getting serious...only 4 days to turkey bowl. Join us at 11 am Thursday at Old Chapel Hill field (behind Githens Middle School) for some football.  It's the 41st annual legendary Marines vs Jets! Thanks to everyone also for continued recruiting spirit! Applicants continue to talk about the camaraderie and enthusiasm that you show and the discussions in report and chairs have been excellent (thanks Deanna Baker for report and Carter Davis for chairs presentations!). Jim Gentry has been spectacular at organizing getting applicants to rounds and also thanks to Myles Nickolich, Deanna Baker, Angela Lowenstern, and Lindsay Boole for resident share. Other kudos to Phil Lehman for being a great team leader on gen med (from his interns!) and to Marcus Ruopp from the endocrine team and to Alana Lewis for her presentation at intern report.  Final kudos to the whole program for raising nearly $1000 for our thanksgiving food drive! This weeks pubmed from the program goes to alum Seth Martin for his JAMA article!  Comparison of a Novel Method vs the Friedewald Equation for Estimating Low-Density Lipoprotein Cholesterol Levels From the Standard Lipid Profile;  Seth S. Martin, MD1; Michael J. Blaha, MD, MPH1; Mohamed B. Elshazly, MD1; Peter P. Toth, MD, PhD2,3; Peter O. Kwiterovich, MD4; Roger S. Blumenthal, MD1; Steven R. Jones, MD1  JAMA. 2013;310(19):2061-2068. doi:10.1001/jama.2013.280532. Have a great week and see you at the game! Aimee [box]

What Did I Read This Week, Submitted by Lalit Verma, MD

Tamsulosin treatment for benign prostatic hyperpasia and risk of severe hypotension in men aged 40-85 years in the United States: risk window analyses using between and within patient methodology.

[/box] In our current health care environment any data that can improve quality and reduce cost is data worth mentioning.Or perhaps better said when we read articles today we should be thinking how can this information can be applied to improve care quality with minimal cost. It is through this lens I viewed the current article in which the authors retrospectively evaluated a drug that initially in theory had a better side effect profile than others in its class but still resulted in significant complications. Moreover in today's world we should be thinking how to program the latest EHRs to actively extract this data and implement simple safety solutions.Verma Background: Tamsulosin is a uroselective alpha blocker that in clinical trials has lower a rates of severe hypotension when compared to the non-selective blockers terazosin and doxazsin. It doesn’t carry the black box warning for hypotension and syncope that the less selective blockers carry. However in clinical practice it is unknown whether tamsulosin would increase the risk for hypotension requiring admission to a hospital. Method: Design - Retrospective cohort study utilizing the IMS Lifelink database which contains paid claims from 102 US healthcare plans.  Patient population - US men aged 40-85 who filled a perscription for tamsulosin or a 5-alpha reducatase inhibitor (5ARI) between Jan 2001 and June 20011 Outcomes - Hypotension requiring a hospital admission at various intervals after initiation were modeled by Cox proportional hazards model which estimated rate ratios at various intervals after initiation. Results - The incidence of hospitalization was 42.4 per 10,000 person years which was greater than 5ARIs. These rates were greater than the rates for the overall cohort (29) and for patients taking 5ARIs (31). The rate ratio was greatest at weeks 1-4 after initiation (2.12) than weeks 5-8 (1.51) and there was no significant increase in weeks 9-12. Comments: I thought the study was interesting in that took 10 years of data to quantify the increased risk for significant hypotensive events. Although the initial clinical trials for tamsulosin indicated a 12% incidence for hypotension, the trials did not suggest a need for further treatment. The study however suggests that hypotension is real world side effect that usually occurs in the first 1-4 weeks and can place a significant burden on the patient and our health care system. They authors go on to suggest that the “first dose phenomena” be taken into account when starting the drug. It is now 12 years since the first patient enrolled in the study and we are just now getting some system level data that may impact our management of patients starting on tamsulosin. Now that we can reasonable validate a first dose phenomena maybe we can program our new systems to automatically make a follow up phone call or appointment to ensure patient safety. Maybe in the future we can program our systems to start to intelligently assessing adverse events and not have to wait the full 10-12 years to recognize complications. When I think about all the pressures on and changes to our health care system I suspect that we will have to respond with innovation so that we can leverage our investments to maximize the potential for population based health and the care of our patients.  [divider] 

From the Chief Residents

 

Grand Rounds

 Grand Rounds will resume on December 6th 

Noon Conference

 
Date Topic Lecturer Vendor
11/25 INTERVIEW
11/26 Common   Outpatient HIV Management Issues Chuck   Hicks Cosmic   Cantina: B
11/27 MKSAP Turkeybowl Style - Marines vs Jets ACRs Domino's
11/28 NO   NOON CONFERENCE
11/29 NO   NOON CONFERENCE

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From the Residency Office

Dear Internal Medicine ( submitted by Thomas O. Dalton, MD, Fellow in Geriatric Medicine )

"This is a request for you to participate in a multi-institutional research study. The goal of the the research is to understand the need for further development of educational initiatives aimed at caring for hospitalized older adults. We would like to know how often internal medicine and family medicine residents are assessing common issues that arise in this patient population. To this end, we are asking you to complete an anonymous survey. The survey will take about 2 minutes. Taking part in this study is voluntary. If you would like to participate, please click on the link below and complete the survey. Please do not record you name or other identifying information on the survey form. https://redcap.dtmi.duke.edu/redcap/surveys/?s=dv2FQc If you have already completed this survey, thank you and please disregard this reminder emai Please feel free to contact me with questions Sincerely,

Thomas O. Dalton, MD,  Fellow in Geriatric Medicine

Department of Medicine

Duke University "

 

Information/Opportunities

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Upcoming Dates and Events

  • November 28:  Annual "Turkey Bowl"
  • December 14:  DoM Holiday Party
  • January 15th:  "Voices in Medicine"
 

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