From the Director
Hi everyone! Hard to believe it's a week before the holidays. Thanks to everyone for your hard work for the first half of this year. Kudos to our outgoing ACRs -
Sam Horr, Tara Weiselberg and Ann Marie Navar Boggan. Great leadership and teaching! Also kudos to
Ashley Whyte for helping a fellow intern, and to
Chris Merrick and
Aparna Swaminathan from their gen med SAAR. Notably, the hospital has been very busy and I am so happy to see the teamwork and positive attitudes from all. Great SAR talks from
Adia and Hassan as well as chair''s conference from
Matt Summers.
Look for an email from
Meredith Clement about a new volunteer opportunity, and also last call for the gift drive. We have stepped up our community involvement 500% in the past couple years - amazing work!
This weeks pubmed from the program goes to MSIV
Marc Samsky for his upcoming article in JACC. Nice work, Mark.
Wishing you a very happy holiday!
Aimee
Research Awards (by Murat Arcasoy, MD)
We congratulate two Duke SARs who were acknowledged as the
2012 recipients of the American Society of Hematology (ASH) Trainee Research Award during the 54th annual ASH meeting December 8-11, 2012 in Atlanta:
Catherine (Callie) Coombs, MD, MS and Wei (Denise) Duan-Porter, MD, PhD
[caption id="attachment_9280" align="alignleft" width="100"]
Denise Duan-Porter, MD, PhD[/caption]
[caption id="attachment_9281" align="alignright" width="100"]
Callie Coombs, MD, MS[/caption]
Callie and Denise are among only 17 residents nationwide who have received this prestigious award. The new name for this award moving forward is "ASH Hematology Opportunities for the Next-Generation of Research Scientists Award (HONORS)". The 2013 applications are due on February 29, 2013.
We also congratulate Callie Coombs and Hany Elmariah (JAR) for their poster presentations at ASH 2012 this week ! Among thousands of abstracts submitted, there is a highly selective process for the best scientific work presented as a poster !
Congratulations Callie and Hany!
Callie Coombs, MD, MS
The Relationship Between Socioeconomic Status and Clinical Outcomes in African Americans with Chronic Lymphocytic Leukemia Abstract 3912. Mentor Dr. Mark Lanasa
Hany Elmariah, MD
Clinical Characteristics Associated with Survival in Adult Sickle Cell Disease. Abstract 3229. Mentor: Dr. Marilyn Telen
What Did I Read This Week (by Sarah Rivelli, MD )
[box] Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease. Results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study. J Blumenthal, PhD et al, JACC Vol. 60, No. 12, 2012 September 18, 2012:1053–63 [/box]
Why did I read this? We were seeing a patient with admitted for an MI who was depressed and the question came up, if we treat their depression, will they have better cardiac outcomes?
Background: We know that depression is associated with increased risk of developing CAD, is common among CAD patients and is associated with more than double the risk for mortality and cardiac events after MI and unstable angina. This has led the AHA to advise that patients with CAD be screened for depression. However, it’s unclear if screening leads to any benefit, and which treatments are most effective in this patient population. In fact, there are only a few RCTs looking at depression treatment in patients with CAD and CHF and some pharmacological interventions have actually not been significantly better than placebo in improving depression.
Exercise has been shown to reduce depressive symptoms and might improve not only depression, but cardiovascular risk among patients with CAD. This study looked at the impact of exercise on depression and some biomarkers of cardiovascular risk, including heart rate variability (HRV), low baroreflex sensitivity (BRS), impaired endothelial function, increased platelet activation and inflammation.
This study was conducted at Duke, led by
Jim Blumenthal, PhD, of Medical Psychology. All patients had depressive symptoms, but only 40% met criteria for major depression. 284 patients met initial criteria and 101 were randomized. Patients were randomized to exercise, sertraline or placebo for a treatment period of 4 months in a 2:2:1 ratio. The exercise intervention was 3 supervised aerobic sessions per week with 30 minutes at 70-85% maximal heart rate.
Patients in the exercise arm achieved significantly lower depression scores than sertraline or placebo and exercise was also the most effective in reducing symptoms among those with major depression. Not surprisingly, exercisers had significantly improved peak oxygen consumption. Significantly more patients remitted their depression in the exercise arm as well.
Biomarkers: Both sertraline and exercise lead to increased HRV; however there was no improvement in BRS, nor chronic inflammation markers compared to placebo. Endothelial function did not appear improved, which is at odds with prior studies of exercise. More sexual dysfunction was reported in the sertraline arm of the study.
Comment: This study was relatively small and was likely underpowered to detect differences for all of the biomarkers, it was positive for the primary endpoints. Study volunteers were highly educated and may not be representative of all patient with CAD and depression. Exercise was supervised in a group setting, so social support may have contributed to its benefit. The dose of sertraline was low (median 50mg) and may not have been high enough for maximal effect. Lastly, patients were only moderately depressed and most did not meet criteria for major depression, thus it is unknown if this intervention would be effective with more severely depressed patients.
We should effectively treat depression in patients with CAD in its own right, but we are less clear of the impact of interventions on cardiac outcomes. It does seem that 90 minutes per week of exercise can have significant benefits in improving depression, we need to know more about its impact on improving biomarkers or mitigating the elevated risk of negative CAD outcomes.
QI Corner (by Jon Bae, MD)
Our First Quality Champion
Please congratulate intern
Joe Broggan on being recognized as our first residency program Quality Champion. Quality Champions will be honored periodically by our program as individuals who go above and beyond the call of duty to improve the quality of our health system or to keep our patients safe. Joe received this award for his insightful participation in an SRS review and his willingness to share his experience during noon conference so that we all may learn from him. Thank you to Joe and be sure to check out his new lapel bling.
Who will be the next Quality Champion? One of you! If there is someone you want us to consider, please forward Ryan, George, or Jon their good deed.
Quality and Safety Noon Conference Thank You
Thank you to
Evan Frasure and the Department of Pharmacy for their presentation on medication reconciliation at this month's Quality and Safety Noon Conference. His slides have been posted to our Sharepoint website for those interested. Stay tuned for our next QI conference (1/30/2013) when we rock in the new year with
Luke Chen reviewing hospital based epidemiology and infection control. Bring your purell!
Medicine Residency Balance Scorecard Update
The period 4 (AKA October) update of our scorecard has been posted to our Sharepoint site. Be sure to check it out!
Medicine Residency Patient Safety and Quality Council Update
Our next meeting is Wed 12/19 5PM in med res library. George has promised dancing pigs. We also will be discussing outside hospital transfers in follow-up to last week's M&M. All welcome!
From the Chief Residents
Grand Rounds
| Date |
Division |
Speaker |
| 21-Dec-12 |
Oncology-2 |
Dr. Jon Gockerman |
Noon Conference
| Date |
Topic |
Lecturer |
Time |
Vendor |
| 12/17 |
INTERVIEW |
|
12:00 |
Panera |
| 12/18 |
SAR talks |
Dale Okorodudu, Sima Hodavance |
12:00 |
Bullock's BBQ |
| 12/19 |
Hyperthyroidism/Hypothyroidism |
Tracy Setji |
12:00 |
Moe's |
| 12/20 |
SAR talks |
Jen Chen, Denise Duan-Porter |
12:00 |
Domino's |
| 12/21 |
INTERVIEW |
|
12:00 |
Nosh |
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From the Residency Office
Electronic W-2 Opt Out Election
As the second phase of the Electronic W-2 Initiative, we are pleased to announce that all
active Duke employees will now have the opportunity to discontinue receipt of the paper W-2 forms and receive the electronic version only. You may initiate this process by logging in through the Duke@Work portal (the same method used for the pay statements) using the link provided, and clicking on the top row to highlight the election to make any necessary changes.
https://work.duke.edu/irj/portal/W2OnlineElection
This election period is available December 10, 2012 through January 9, 2013 at 5:00pm. Once the election to discontinue paper is invoked, this will apply to W-2 forms for calendar year 2012 and all future years or until the employee elects to revert back to paper using the same tool.
Some key benefits of this election are included below:
- Electronic W-2 Forms are available online 24 hours per day, 7 days per week.
- Enhanced security since the online form is accessed using the net ID and password in the Duke@Work Portal.
- Supports the Duke Sustainability initiative
No action is necessary for staff members who elect to continue receipt of paper W-2 forms.
The dates for the distribution of both electronic and paper W-2 forms are included below.
Friday, January 18, 2013 – Electronic W-2 Forms for calendar year 2012 will be available using Duke@Work. Email notifications including a link to the online form will be distributed to all active employees receiving a W-2 form. For those employees who do not have an email address but have earnings for calendar year 2012, the online form will be available through the MyInfo tab under the MyPay section of
Duke@Work.
Friday, January 25, 2013 – Paper W-2 forms will be distributed to departmental Payroll Representatives for biweekly and monthly employees. Additional communications on this process will be distributed by Corporate Payroll Services during the week of January 21, 2013.
Recruiting Dinners and Tour Guide
If you haven't done so already, PLEASE sign up for a Recruitment Dinner and/or to be a Tour Guide on a Recruitment day! The links to sign up for both are below!
http://www.signupgenius.com/go/60B084FAEAE2CA13-december
http://www.signupgenius.com/go/60B084FAEAE2CA13-december1
Note: The MedRes office will be closed (no admin staff on duty) December 24 - January 1, 2013
Contact Information/Opportunities
Useful links
