From the Director
Hey everyone! One week done of the new year. So far, everyone is doing great. The Duke night JARs have admitted a record number of patients, and by all reports, are even still smiling in the morning. Same goes for the rest of the teams at Duke, DRH and the VA. Thanks guys for your hard work. I've even spotted our new interns, like
Jim Lefler, teaching med students! Also nice work by SAR
Rex Cheng for earning a gold star for patient care.
Maestropalooza was a huge success - look for details from
Lynn Bowlby, Alex Cho and Adia Ross on who participated and how many charts were entered. Thanks for putting in some extra time to make the maestro roll out a smooth one.
Have a great week! Aimee
Pubmed from the Program this week goes to JAR
Bronwen Garner whose abstract was accepted for an oral presentation at ID Week 2012 (a combined meeting of the Infectious Diseases Society of America, The Society for Healthcare Epidemiology of America and the Interscience Conference on Antimicrobial Agents and Chemotherapy). Bronwen's work is titled "When a Classic Respiratory Virus of Children Affects Big People: Descriptive Comparisons of Clinical Features and Outcomes among Adult and Pediatric Patients infected with Human Metapneumovirus" and
co-authors are ID fellow (and former Duke Resident)
Sarah Lewis and ID attending
Luke Chen. 
What Did I Read This Week (by Lynn Bowlby, MD)
[box]
Thrombotic Stoke and Myocardial Infarction with Hormonal Contraception, NEJM June 14, 2012 366:24, pp2257-2266[/box]
At the DOC we take care of many women’s health needs. Pregnancy prevention or planning is an important area that we address at as many visits as possible.
Recently we have had several patients where choosing which method was the priority. This recent NEJM article addressed risks of the various hormonal contraception options, including OCP, patch, and IUD.
This was an open cohort study of Danish women, from 1995-2009. End points of thrombotic events were searched for in the National Register of Patients, along with their contraception use. 1.6 million women were followed, the relative number of events was small.
The results?
Interestingly, higher education level in the woman was associated with a marked reduction in thrombosis risk. Those with DM, HTN or hyperlipidemia had a x2 risk of clot.
In this review, the type of progestersone in the OCP had only a minor effect on risk. Smoking did increase risk of clot.
Age was the major risk—increasing risk of CVA x20 and MI x100 with increased age. Different estrogen doses in OCP only had a very small effect. Ethinyl estradiol at 30-40 mcg 1.3-2.3 x increased risk of clot, while 20 mcg is 0.9-1.7x risk as compared to a non user.
The conclusion of the study?
Among 10,000 women with desogestral/ ethinyl estradiol at 20 mcg, at one year 2 will have arterial clot, 6.8 with venous clot.
And at the DOC? It certainly confirms the risk of age, as well as comorbid issues like DM in risk of CVA and MI. I won’t be as concerned about clot with those women who struggle with the irregular bleeding of the 20 mcg pill and want to go up to the 30 mcg option. The type of progesterone won’t be as much of a concern with this new data.
[hr]
From the Chief Residents
Grand Rounds
| Date |
Division |
Speaker |
Title |
| 13-Jul-12 |
LMSA |
Dr. Calles |
Hypoglycemia |
Noon Conference
| Date |
Topic |
Lecturer |
Time |
Vendor |
Room |
| 7/9 |
Diabetic/Endocrine Emergencies |
Diana McNeill |
12:00 |
Chick-fil-A |
2002 |
| 7/10 |
Acute Renal Failure |
John Middleton |
12:00 |
Dominos |
2002 |
| 7/11 |
Cirrhosis |
Andrew Muir |
12:00 |
Moe's |
2002 |
| 7/12 |
Antibiotic Stewardship |
Dev Anderson |
12:00 |
Sushi |
2002 |
| 7/13 |
Chair's Conference |
Chiefs |
12:00 |
Rudinos |
2002 |
Pull List
If you are looking for the pull list, please note that it can be found on MedHub under the Resource Documents section
[divider]
From the Residency Office
Noon Conference/Grand Rounds Recordings
If you missed a conference - or grand rounds - you can still catch all of the action. The Residency Program posts recordings of both noon conferences and grand rounds on MedHub. If you have viewed these in the past - and possibly found the format a little cumbersome - you will find the newest release to be an AWESOME improvement.
How to find them? Log onto MedHub, go to your calendar, and click on the icon below the conference you would like to view. This will open a window with the conference details - including an internet link to the recording. Click on the link and the recording opens - including audio, video of speaker, and the complete slide set. We normally upload the link to the recordings within 2 days - and many times the same day.
Maestro Countdown! 11 days to go live!! July 18 (from Drs Bowlby and Phelps!!)
Tips for the week:
Abstraction of Problem lists and PMH are being done now at both sites. That is the only activity we can do in the live system.
Go to the Duke Maestro web site—just google—and see short helpful videos.
No more paper encounters or printing of paper notes after July 17!!
Meetings with Dr Zaas and Events (by Erin Payne)
We are looking forward to having everyone all together July 27
th for our first "event" of the year! Rumor has it that there might even be a food truck making an appearance! Don’t forget to rsvp.
For those who are still in need of scheduling an advising meeting with Dr. Zaas, my office is the first on the right as you are walking towards 8100, room # 8241 Feel free to stop by or email me to make appointments. Sheila Gainey and I share an office and are always happy to see you!
List Serve – Health Care Policy and Reform (from Aaron Mitchell)
If you are interested in getting a ~1x weekly email with news, research, and analysis pertaining to health care policy and reform, and have not all ready been added to the list serve – or would like to find out more - please send your email address to:
aaron.mitchell@duke.edu
Those Testy "COMPLIANCE MODULES"
This is the time of year when you will find that your compliance module certifications start to expire. How will you know? Check your "URGENT TASK" bar on MedHub - and please, don't wait to take action till after they expire. Why? We have to scramble to confirm that they have been completed, or we are required to remove you from service (meaning that someone else needs to be pulled to cover your service).
If you are required to update your respiratory fit testing, T-DAP vaccination, or TB skin testing, refer to the following attachment listing dates and times when these are available in Duke North.
Resp Fit Testing-T-Dap-TB Skin Testing Flyer July 2012
Dates to Add to Your Calendars
July 27 Residency Program Summer Celebration at the Zaas's
Useful links
