From the Director
ACC Tourney aside, what a phenomenal week for the program! We are so excited about the fantastic match – the Medicine, Med Psych, Med Peds and Prelim classes are a group of outstanding individuals and we are confident that they will carry on the tradition of Duke Medicine! I can't thank you all enough (residents, faculty and the Med Res Office) for your efforts during recruitment. Thank you for being the reason that we are the best program in the country (in the best department in the country!). The post match party at
Dr. Klotman's was very fun and thanks for taking the time to celebrate with all of us!
Also, another thank you to the Intern Class for my new Duke Med T-shirt, and to
Nick Rohrhoff and Ryan Huey for representing at Grand Rounds. Very very humbling.
Other great news from this week..
Kevin Trulock did an awesome job speaking at Grand Rounds, and we listened to two great SAR talks from
Brett Goodwin and Kevin Riggs. Carter Davis, Lynn Bowlby and the DOC staff led an excellent
Schwartz Rounds, and we had a tremendous number of great cases at report…
Murat Arcasoy sends his kudos to
Alex Fanaroff for DRH AM Report case of mucormycosis (although, save the fungal cases for me, please!), and
Kelly Han rocked a case of gout at the VA (uncommon presentations of common diseases are more common than the zebras!),
Alyson McGhan taught us about Q fever and
Alex Clarke was pretty quick to pick up on cardiac tamponade as the cause of
Wassim Shatila's patient's progressive dyspnea with edema and clear chest exam.
We absolutely ROCKED the
QI symposium this week — the Med Res program and the Division of Hospital Medicine took home almost every prize available. Congratulations to
Jon Bae, George Cheeley, Ryan Schulties, and the rest of the QI team for fantastic effort.
In MiniCex Madness, we logged 17 MiniCex's last week! This is a great effort — congratulations to
Lindsay Anderson 
as our weekly winner. Much thanks to the ambulatory docs, the GM docs and also Krish Patel for helping out in the effort. Keep going for two more weeks — we have several house staff who now have 5 MiniCex's for the year…very close to the goal of 6 per resident!
Our pubmed from the program this week goes to SAR
Ivan Harnden for his poster accepted to Digestive Diseases Week!
Endoscopic mucosal resection of duodenal carcinoid tumors: a single tertiary care center experience, Ivan P Harnden, Robert G Walker, Brian L Balmadrid, Jorge V Obando, Paul S Jowell, Rebecca A Burbridge.
Have a great week…next week's updates will be coming to you from Barcelona!!
Aimee
QI Corner (submitted by Jon Bae, MD)
GME Performance Incentive Program:
Here is the latest period results for the GME Performance Incentive Program.
We remain on pace to achieve target on 2 of 4 measures which translates to an additional $400 in your paycheck in June.
If interested in getting involved, please contact George Cheely or Jon Bae.
GME Incentive Plan FY2013P7
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What Did I Read This Week
(submitted by Aimee Zaas, MD)
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What Did I Read (besides the match list!)…..When looking for what to report on this week, I looked at the NEJM because I was originally planning to write about this article… The 2011 Duty-Hour Requirements — A Survey of Residency Program Directors Brian C. Drolet, M.D., Mamoona T. Khokhar, M.D., and Staci A. Fischer, M.D.;
N Engl J Med 2013; 368:694-697February 21, 2013DOI: 10.1056/NEJMp1214483
However, I saw the new TOC, and wanted to read this article instead "Dabigatran and Postmarketing Reports of Bleeding" by Southworth, Reichman and Unger. In yesterday's New York Times ( a really great place to begin your scientific reading..), there was an article about post marketing surveillance. The writers of the NYT piece were commenting on the following article in a journal that typically does not make my weekly reading list…The Journal of the American Medical Informatics Association. The article in question is "Web Scale Pharmacovigilance: listening to signals from the crowd" by RW White, et al, and can be found at
http://jamia.bmj.com/content/early/2013/02/05/amiajnl-2012-001482.full.pdf+html.
Why did I read any of this? 1) It's novel and interesting 2) there are many new ways to get data, and the definition of data, data quality, research, and information is evolving as the information landscape equalizes such that consumers can get medical information from many sources as quickly as doctors (or nurses or pharmacists or other health professionals) can, AND we should be paying attention to how the web and the growing electronic health record capabilities change how we gather evidence for our treatments.
So, in the JAMIA article, researchers from Columbia, Stanford and Microsoft conducted a large scale web search log (e.g google) study to evaluate drug drug interactions, specifically with pravastatin and paroxetine. They knew that googleFLU was very successful in tracking the flu epidemics (e.g. Look for flu in areas where a lot of searches are about flu like symptoms), and thought that people might do searches about their medications if they were experiencing side effects. They also know that most physicians don't use the adverse event database to report, so this system is important but may underregognize problems. They chose pravastatin and paroxetine as there were some burgeoning signals in the FDA adverse event reporting system that these two drugs together might cause hyperglycemia, and some additional data review and mouse models confirmed this as a possibility.
Partipants were taken from millions of web users who consented to a microsoft browser add on that tracked all searches they performed in 2010. These logs were queried for searches related to the two above mentioned drugs and symptoms relatable to hyperglycemia. They analyzed 82 million drug, symptom and condition queries from 6 million web surfers. Using a disproportionality analysis, they found that users were more likely to search for terms related to hyperglycemia symptoms if they were searching on both pravastatin and paroxetine than either drug alone. They then compared to true positives (known drug-drug interactions that cause hyperglycemia) and true negatives (drug drug interactions thought to be very unlikely to cause hyperglycemia). These analyses confirmed that this type of analysis was likely to yield good information.
Authors conclude that this type of study of health related behaviors is a complement to more traditional sources of data for pharmacovigilance, and is not likely subjected to some of the biases that come with provider driven adverse event reporting.
In this context, I was interested in the dabigatran article. These authors chose a different tack…they are refuting the idea that dabigatran is associated with worse bleeding related adverse events than warfarin, although the AERS may indicate that dabigatran IS worse than we would predict from the clinical trial data, and is worse than warfarin.
First, I had to check out where the authors were from. They are FDA employees, so should not have bias towards the pharma company that makes dabigatran.
They make the point that we are seeing an increased "signal" of reports about bleeding with dabigatran vs warfarin in the public reporting systems because dabigatran is a new drug (whereas warfarin is not) and new drugs always get more reports, AND physicians etc are more aware of reporting now than they would have been when warfarin was introduced. ( the "Weber effect").
To decide whether the large number of bleeding reports related to dabigatran were related to a true increase in risk, OR a bias towards reporting, they queried insurance claim data from FDA sentinal database for reports of bleeding related to warfarin and dabigatran. They found similar rates for the two drugs during the reporting period. This database uses medical record data instead of physician/health care worker reports. Thus, despite acknowledged limitations, they conclude that "stimulated reporting" is the main reason for the disparity in dabigatran bleeding rates vs warfarin bleeding rates shown in post marketing analysis.
So…good information on how informatics is changing the landscape of medicine, plus some compare and contrast of FDA based adverse drug event reporting data! And if you have a chance, I would encourage you to read the duty hours piece as well.
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From the Chief Residents
Grand Rounds
| Date |
Division |
Speaker |
Title |
| 22-Mar |
Geriatrics-2 |
Dr. Heather Whitson |
Multi-Morbidity |
Noon Conference
| Date |
Topic |
Lecturer |
Vendor |
| 3/18 |
Vasculitis Overview |
Nancy Allen |
The Picnic Basket |
| 3/19 |
Med-Peds Conference: long-term survivors of malignancy |
Philip Rosoff |
Sushi |
| 3/20 |
Gallops |
ACRs |
Rudinos |
| 3/21 |
SAR talks |
Charlie McCormick, Ryan Nipp |
Dominos |
| 3/22 |
Chair's Conference |
Chiefs |
Chik-fil-A |
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From the Residency Office
We are excited to welcome an absolutely amazing class of new interns to Duke. Just in case you have not had a chance to check out the various postings, here they are.
Attachments:
2012-13 Uniform Allotment
Deadline for ordering your 2012-13 uniform allotment is March 31, 2013. If you have not yet ordered your labcoats/scrubs, you must go to the bookstore and place your order by the end of the month.
Trainees continuing in your current program or transferring to a new program within Duke in 2013 will have the opportunity to place a one-time order for new labcoats, for the 2013-14 academic year, beginning on July 1, 2013 thru December 31, 2013.
Contact Information/Opportunities
Nevada Internist
Northeastern Colorado Internist
Utah Internist
Upcoming Dates and Events
- March 17 - 23: Operation Medicine Drop http://www.ncdoi.com/osfm/SafeKids/sk_OperationMedicineDrop.asp
- March 25, 2013; 1:00 PM - 2:30 PM ED: A Survivor's Journey: Understanding the Health Impact of Abuse and Paths to Promote Wellness; For more information, go to website
- March 25-28: BLS Blitz (registration: blsblitz )
- March 29: Faculty Resident Research Grant Application Deadline
- April 19: Residency Program Pictures (rain date May 10)
- April 28: 2nd Annual Stead Tread
- June 4: Resident Research Conference, Searle Center
- June 8: SAR Dinner, Hope Valley Country Club
Useful links
