Weekly Updates: August 26, 2013

By admin3

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Happy end of block 2, interns! Hard to believe how fast time goes. We've had a great week in the program, with Jon Bae and the Quality Team receiving an NC ACP grant to support Share point and also a similar grant went to Tim Mercer and Jane Trinh! We have 8 posters accepted at Clinical Science Day as well. Exceptional! Kudos to Marc Samsky from the endocrine team for outstanding work. It has been fun watching the interns and residents teaching our new MSIIs - spotted has been ED intern Andrew Iannuzi, night resident Ben Lloyd, and also Myles Nickolich. I know the rest of you are teaching as well! This week we have our second JAR dinner - looking forward to seeing 5 of you at Mateo. Dr Klotman starts her SAR mentoring lunches as well. While I shamelessly stole the JAR dinner idea from my good friend Harry Hollander at UCSF, I'm not aware if any other chairs who do lunch with small groups of residents - please sign up if you haven't yet! This week's pubmed from the program goes to Jenn Rymer who will be presenting the GME incentive program at the national AAMC meeting! Congrats to Jenn and coauthors George Cheely and Jon Bae. Have a great week! Aimee

QI Corner (submitted by Joel Boggan, MD)

New Patient-Centered Business Cards The new patient-centered business cards have arrived!  Please pick them up in the Med Res office this week.  Your business cards are primarily geared towards inpatient care, but your clinics will have stickers to place on the back for outpatient use.  We encourage you to use your cards on both inpatient wards and outpatient clinics.  On the examples, please note there are places where you can help fill out information to tell patients who you are, what your role is, and who else might be taking care of them in the hospital . . . slide 1 Slide 5Slide 4                             Patient Safety Noon Conference A big thank you to Luke Chen who presented on Infection Control procedures at Duke on Wednesday.  Hopefully, you're inspired to wash hands, use (and ask for) the contact stethoscopes, and wash your white coats! August QI Champs A special congratulations to our first QI champs of this academic year:  Jonathan Hansen, Stephanie Giattino, and Jessica Seidelman, who were our first people to sign up to be Hand Hygiene Ward Champions.  You'll be hearing updates from all of us through the year as we work toward our 91% hand hygiene goal on the 7th, 8th, and 9th floors. Follow Us on Twitter - @DukeMarines - Duke Chief Resident Updates - @JonBae01 - QI and Patient Safety (general news and program updates) - @DukeDOMQuality - Duke DOM Quality Updates - @bcg4duke - Maestrocare and health informatics [box]

What Did I Read This Week

 Submitted by Krish Patel, MD

Long-Term Survival of Participants in the Prostate Cancer Prevention Trial. N Engl J Med 2013; 369:603-610

http://www.nejm.org/doi/full/10.1056/NEJMoa1215932?query=featured_home#t=article

[/box] Why I read this:  I recently learned that the Surviving Sepsis Guidelines had been updated in Feb 2013 and having not been the primary doctor in the MICU for at least 1 year, I wanted to know what was good and new.  Well after reading the 56 page manifesto and realizing that the levels of evidence for many of the new guidelines left a lot to be desired (and that I'd never WIRTW it as well as Bill Hargett!) I quickly retreated back to my oncology roots… No but really, I came across this article in this week's NEJM and was intrigued. All in all, it was a pretty interesting read as it tries to answer some important questions left open by an almost 20 year old study that investigated the use of finasteride to prevent prostate cancer back in the 1990s. Background:  In 2003, a large RCT (n=18,882) published in NEJM looked at whether finasteride 5mg daily (vs. placebo) could reduce the prevalence of prostate cancer in healthy men (median age 63.2 yrs) over a 7 year treatment period.  The take home from that study was that finasteride did indeed reduce the prevalence of prostate cancer (18.4% vs 24.4%, a relative risk reduction of 24.8%; p<0.001) but it resulted in an increase in the prevalence of high-grade prostate cancer (6.4% vs 5.1%, a relative risk increase of 25%;  p<0.001).  There was no mortality analysis reported in that study (fair I guess since mortality from prostate cancer typically occurs over 10+ years), so it was unknown what the possible benefit of reducing the overall rate of prostate cancer was versus what the harm may have been from the absolute increase in prevalence of high-grade cancers.  This study actually lead to the FDA requiring finasteride to be labelled as increasing the risk of developing high grade prostate cancer and finasteride never received approval for use in prostate cancer prevention. Results: Now, almost 10 years later, three of the authors from the original paper have published a mortality analysis from the long term (15+ years) follow of the 2003 study to try answer the question of what the ultimate harm/benefit of finasteride chemoprevention is.  A picture is worth a thousand words                       Copy of Snapshot of Med Onc Data (2) Yep, that line is as purple as Nick Rohroff's pants…Ok, they found no difference in overall survival in the study population…  So, perhaps the concerns from the original study that development of more high grade cancers would lead to harm were unfounded. Or perhaps there were increased harms but they were offset by the benefits of preventing more low grade cancers (and those people died of something else).  Unfortuntately we just don't know. The majority of the mortality data used in this follow up was largely obtained through the Social Security Death Index so there was no way to know who died of what or calculate prostate-specific mortality.  The follow up did show a lower prevalence of high grade prostate cancer than the 2003 study (3.5% vs 3.0%; p=0.05 compared to 6.4% vs 5.1%; p<0.001) and continued to show a lower overall rate of prostate cancer (10.5% vs 14.9%; p<0.001) in the finasteride group.  The authors also looked at survival by cancer grade and again found no significant difference between finasteride and placebo despite stratification by grade. What does this mean: Preventing prostate cancers with finasteride doesn't appear to affect mortality, so why even bother thinking about it? Well, I'll make a controversial suggestion: perhaps finasteride can be used to prevent certain patients from the morbidity of diagnosis and treatment of low grade prostate cancers detected by PSA/DRE screening.  It's certainly not clear that universal prostate cancer screening substantially reduces mortality (hence the USPTF recommendation against it).   Yet, it still widely occurs and results in the over diagnosis of low grade prostate cancers that are then managed/treated aggressively with potential harms and few benefits.  Could we offer finasteride prophylaxis instead of (or along with) prostate cancer screening to low risk men who still elect for screening with the goal of reducing the likelihood (and cost) of potentially unnecessary surgery and/or radiation therapy for low grade prostate cancers?  Hmm…or perhaps we should just stop screening low risk patients… Krish Patel, MD

SOM Clinical Science Day

Congratulations to the following residents who have been selected to present their work at the School of Medicine Clinical Science Day, to be held on October 18, 2013.

  • Dr Hany Elmariah
  • Dr Lindsay Anderson
  • Dr Jennifer Rymer
  • Dr Carling Ursem
  • Dr Aaron Mitchell
  • Dr Wassim Shatila
  • Dr John Stanifer
  • Dr Noah S Kalman

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From the Chief Residents

Grand Rounds

Date:  August 30, 2013 Topic:  M&M Presenters:  Dr. Kussin and Dr. Stout

Noon Conference

Date Topic Lecturer Vendor
8/26 Diagnostic   Radiology Essentials Lexie Riofrio The Picnic Basket
8/27 Approach   to the Anemic patient Murat Arcasoy Jersey Mike's
8/28 IM-ED   Combined Conference: Evidence Based Emergency Medicine David Newman The Pita Pit
8/29 Liver   Transplantation Alastair Smith Moe's
8/30 Chair's   Conference Chiefs Rudinos

 

Thanks For Helping Out (from Yevgeniya Foster)

"My wonderful friend and colleague Andrea Sitlinger is doing me a huge favor this weekend. She's covering my pull list while I go on the vacation I planned without adequately ensuring I had no other obligations. She offered to do it when no one else would, and even though she has no other weekend to switch with me.  I'd love for everyone to know how amazingly gracious she is... Thank you! Have a great day!"     [divider]

From the Residency Office

Med Res Comment Line

The link to the comment line, which is just one of the many ways residents can share their recommendations or concerns, can always be found in the "Useful Links" section of Weekly Updates.  One of the recent submissions was a request to offer Indian or Tai food  for lunch at noon conference.  This can be a little tricky, but we are working on the idea, and expect to try it out this fall to see how it might work. Keep watching the noon conference schedule to see when, and thanks for the recommendation.  

hyc_logo_lrg

Developing the next generation of globally educated, socially responsible healthcare professionals dedicated to improving the health of disadvantaged populations.

Accepting Applications for Global Health Elective Rotations

The Hubert-Yeargan Center for Global Health (HYC) is accepting applications for Global Health Elective Rotations for July 2014 and March 2015. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4).  Access the application form and FAQ at http://dukeglobalhealth.org/education-and-training/global-health-elective-rotation.   (Application addendum is available by request – tara.pemble@duke.edu) Application deadline is September 17, 2013. Interviews will be held in late September/early October. We encourage you to speak with past participants to get a better idea of what daily life is like on the wards of your top sites. For more information, contact Tara Pemble, Program Coordinator at tara.pemble@duke.edu or 668-8352.

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Annual Flu Vaccination - Condition of Employment at Duke University Health System

 

Trivia Night / Stead Society Overview

Results are in - and once again, Kempner Society (lead by Matt Crowley) came out on top.  Congratulations, and the word we heard is that everyone enjoyed the competition. Just in case there is still confusion as to the titles of each Stead Society (which used to be labeled A through E), we are attaching the Stead Society Overview for reference.  Each society is named after a distinguished Duke faculty member, led by a prior chief resident, and supported by a team of attendings. Stead Society overview_2013

2013.2014 HEALTH POLICY: JUST IN TIME LECTURE SERIES

Supported in part by the Chancellor's GME Innovation Fund

Thre Fuqua School of Business and the Duke University Hospital Office of Graduate Medical education have joined together for the 5th year to offer a Health Policy lecture series for Duke GME programs. Program Directors, residents and fellows are invited to participate. Physicians will benefit from an understanding of health care delivery systems, payment structures, incentives, and policy.  Increasingly, the role of the physician will be less of a clinical technician and more of a team-leader as our health care system evolves, using a more multidisciplinary & team-based model.  To this end, we are offering a program which covers topics that will allow residents and fellows to acquire a baseline understanding of our health care system. Participation addresses the ACGME competency of Systems Based Practice and provides critical knowledge to graduate physician leaders.

TOPICS INCLUDE:

  • Health Care Policy (September 19th, 2013)
  • Comparative Health Systems (October 10th, 2013)
  • MedPac Annual Report Overview: Medicare/Medicaid (November 14th, 2013)
  • Health Informatics (December 12th, 2013)
  • Quality & Pay for Performance (January 9th, 2014)
  • Healthcare Reform (February 13th, 2014)
  • Health Care Disparities (March 13th, 2014)
  • Accountable Care Organizations  (April 10th, 2014)
  • Conflicts of Interest (May 8th, 2014)

The series will kick-off with the "Health Care Reform Panel: Obama-care versus Canada Single-Payer Care"

Thursday, September 12th 

5pm – 7pm, Duke South Ampitheatre

Light refreshments will be served

For more information and to register for the panel please use the following link - https://www.surveymonkey.com/s/HealthCareReformPanel2013

Contact Information/Opportunities

Upcoming Dates and Events

  • September 17:  Application deadline for Global Health Electives
  • September 18/19:  Flu Shot Blitz
  •  October 1:  Duke’s Global Health-Internal Medicine Residency  deadline to submitt applications
  • October 18:  SoM Clinical Science Day

Useful links

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