From the Director
Hi - forgot it was Sunday!!!
Hope everyone is enjoying the holiday weekend! It's staying busy at work, and I am happy to report I survived my CAD night last Sunday with the unflappable
Matt Summers as my co- intern. Only a few strange looks as I presented the patients in the morning. Intern
Marianna Papademitriou has the photo evidence. We also had a great med student
journal club at Dr Klotman's house - thanks to
Chuck Hicks, Cam Wolfe, Eileen Maziarz, Brianna Norton, Jen Horan, Saumil Chudgar and Diana McNeill for faculty/fellow presence as well.
The totals are in and the charity auction raised a record $18,000, and the first annual Stead Tread raised 2500$ for Lincoln Clinic. Excellent work!
Kudos this week to intern
Armando Bedoya for helping out a family in need on 8100. also to
Karen Toribio for her SAR talk on Tuesday. Keep up the good work, everyone. Can't believe it's Block 12! Lots of exit interviews with the SARs - so impressed with all the work you have done here.
Congrats to SAR
Richard Wu on his recent wedding, and also to
Dan Pugmire (Med Peds) and his wife Julia on their new addition to the family - Davyn.
Now that Memorial Day is here…its time to get ready for summer. What better way to usher in the new season than celebrating the "tradition" of Seersucker Tuesdays. Join us as we honor the creators of Seersucker Tuesday, JARS
Phil Lehman and Jon Menachem. There's still time to hit the mall for a sale at J Crew or Jos A Bank if needed
Pubmed from the program this week is to SAR
Jon Roberts for his paper in Seminars in Dialysis with nephrologist
Uptal Patel, "Management of Coronary Artery Disease in ESRD"
Have a great week, and a special thanks to our veterans and active military families, friends and patients
Aimee
What Did I Read This Week (submitted by Suzanne Woods, MD)
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Dabigatran versus Warfarin in Patients with Atrial Fibrillation NEJM 2009; 361: 1139-1151 [/box]
I read (actually reread) this article this week in preparation for our Med-Peds journal club on May 23. Each MP class prepares a journal club and presents to our housestaff and faculty yearly. The MP2’s chose this article.
Anna, Ben, Jordan, Rebecca, Scott and Shailesh did a great job with this review and led an interactive discussion!
Abstract: This noninferiority trial randomly assigned 18,113 patients who had a-fib and a risk of stroke to receive in blinded fashion, fixed doses of dabigatran (110mg or 150 mg twice daily) or in unblinded fashion, adjusted-dose warfarin. Patients were followed for a median period of 2 years. The primary outcome was stroke or systemic embolism.
Conclusions: In pts. with a-fib, dabigatran 110mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin, as well as lower rates of major hemorrhage. Dabigatran 150mg doses were associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage.
New update: The day after journal club,
Dr. Jane Trinh found the following: Information sourced from
Cardiosource:
Title: New Oral Anticoagulants in Atrial Fibrillation and Acute Coronary Syndromes: ESC Working Group on Thrombosis—Task Force on Anticoagulants in Heart Disease Position Paper. De Caterina R, Husted S, Wallentin L, et al.
Citation: J Am Coll Cardiol 2012;59:1413-1425.
Date Posted: April 9, 2012
Authors: Perspective:
The following are 10 points to remember about this state-of-the-art paper:
1. The availability, of new treatment alternatives for stroke prevention in patients with nonvalvular atrial fibrillation is a great step forward to further improve outcomes and quality of life.
2. Compared with warfarin, these new alternatives have important advantages, with their lower risk of intracranial bleeding, no clear interactions with food, fewer interactions with medications, and no need for frequent laboratory monitoring and dose adjustments.
3. Dabigatran etexilate is a synthetic low molecular weight peptidomimetic that binds directly and reversibly to the catalytic site of thrombin.
4. Rivaroxaban, apixaban, and endoxaban are selective direct factor Xa inhibitors.
5. Based on the currently available results from the individual trials, it is clear that both the oral direct thrombin inhibitor dabigatran etexilate and the oral factor Xa inhibitors apixaban and rivaroxaban are attractive alternatives to warfarin or aspirin in patients with nonvalvular atrial fibrillation and an increased risk of stroke.
6. Apixaban 5 mg (with dose reduction to 2.5 mg in specific cases) BID is currently the best documented alternative to both warfarin and aspirin for stroke prevention in a broad population with atrial fibrillation and increased risk of stroke, based on two independent large-scale trials. Apixaban is awaiting Food and Drug Administration approval in the United States for atrial fibrillation.
7. Patients already on long-term vitamin K antagonist (VKA) treatment, with well-controlled international normalized ratio and handling VKA treatment and laboratory monitoring without problems, derive uncertain overall advantages from switching to the new oral anticoagulants, and the arguments for changing treatment in such patients appear weak.
8. There is also a need for more information on how to manage patients with bleeding because there are no specific antidotes for any of the new agents.
9. The cost of the drug at the patient level might be an obstacle to their use, although the cost-effectiveness at a societal level might be tolerable in comparison with other recently accepted novel treatments.
10. Additional trials are indicated to determine the utility of these agents in combination with antiplatelet treatments after myocardial infarction and percutaneous coronary intervention.
Author(s): Debabrata Mukherjee, M.D., F.A.C.C.
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From the Chief Residents
Grand Rounds
| Date |
Speaker |
Topic |
| 6/1/12 |
M&M |
|
| 6/8/12 |
Juliessa Pavon |
Chief Resident Grand Rounds |
| 6/15/12 |
Tony Gutierrez |
Chief Resident Grand Rounds |
| 6/22/12 |
Eileen Maziarz |
Chief Resident Grand Rounds |
Noon Conference
| Date |
Topic |
Lecturer |
Time |
Vendor |
| 5/28 |
MEMORIAL DAY |
|
12:00 |
|
| 5/29 |
SAR TALK |
Ike Ilochunwu/ Rebecca Burke |
12:00 |
Moe's |
| 5/30 |
Toxidromes |
Sarah Rivelli |
12:00 |
Chick-fil-A |
| 5/31 |
QI/Patient Safety Conference - dn2003 |
|
12:00 |
Bullock's BBQ |
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From the Residency Office
Hurricane Preparedness Week
Next week has been designated by the National Weather Service as “Hurricane Preparedness Week,” an effort to help communities be ready before a storm approaches. This year’s forecast for the Atlantic region calls for up to 12 named storms, including seven hurricanes and three major hurricanes.
If weather conditions warrant, Duke will use its DukeALERT emergency notification system to inform Duke community members of severe weather. The details for how Duke prepares for and responds to severe weather are available on the
DukeALERT website.
Resident Research Night
The Duke Internal Medicine Residency Program and the Department of Medicine would like to invite you to present a poster on Resident Research Night June 13th, 2012 at 5 - 7 pm at the SEARLE CENTER. Please see attached instructions for abstract preparation (300 words max, no figures) and for poster printing.
POSTER INSTRUCTIONS-2012
Please email abstracts to Dr. Arcasoy by June 1st if you are planning to present your work.
For poster printing, please email Jen Averitt in the MedRes office with your poster by June 6th (see Jen's email dated 5/11). Please complete the survey monkey information in Jen's email from 5/11 if you intend to display a poster(s) so we can reserve a board for you.
We encourage you to present as posters ALL scholarly activities you have been involved in:
1- Basic, clinical and translational research projects
2- Case studies
3- QI projects
Dates to Add to Your Calendars /Contact Information
- June 2 - Annual SAR Dinner (invitations only)
- June 13 –Resident Research Event, 5-7pm
- June 13 - Resident Research Night, Searle Center, from 5-7 PM
Useful links
