From the Director
First of all, congratulations to Randy and Mindy Heffelfinger and JARs Carling Ursem and Scott Evans who busted their butts riding the MS 150 this weekend. Be sure to congratulate them if you see them, they will be the ones walking slowly or limping around the halls. Other kudos go to our very own Shelia Gainey for planning a fantastic happy hour at Piazza Italia to welcome the 4th year med students applying in medicine or prelim years to the official start of the recruitment season. We had a great time and many of you, including SARS Lisa Vann, Nikki Storms and Matt Chung (and JAR Jen Chung) explained to the students why Duke is the best place to train. I couldn’t agree more.
Also congratulations to our Appleseed award winners….
Interns: Dr. Laura Caputo, M.D., Dr. Kevin Shah, M.D., Dr. Carling Ursem, M.D., Dr. Brian Miller, M.D.
Residents: Dr. Edward Coverstone, M.D., Dr. Leon Cannizzaro, Dr. Daniel Fox, M.D., Dr. Priyesh Patel, M.D., Dr. John Roberts, M.D., Dr. Adia Ross, M.D., Dr. Tara Spector, M.D., r. Coral Day, M.D.
Also selected for contributions on Medicine and Pediatrics were Ann Marie Navar Boggan and Jordan Awerbach, and also Nora Dennis for Medicine and Psychiatry
Other kudos come from SAR Blake Cameron regarding intern Nina Beri, who managed a very sick patient at the VA with skill above what is expected in early September, from Cards attending Zubin Eapin about intern Ben Lloyd just generally being awesome on CAD and to our SARS Kevin Parrott, Callie Coombs, Bonike Oloruntoba and John Stanifer for “sitting up front” during JAR Jim Gentry’s really cool chairs conference (sure, let’s send the sample to Sweden! why not?). also thanks to all for a fantastic EM- IM conference, including SAR Charlie McCormicks discussion of alcohol withdrawal. This new conference is one of our best, so be sure to keep your calendar open whenever there is an EM-IM noon conference. Similarly, thanks George Cheely and Ryan Schulties for starting off our M and M grand rounds with a tour de force conference!
Get ready for turkey bowl practice, chief night out with SARs (night out with interns and with JARs in the planning phases!) and global health rotation applications!
This weeks pubmed from the program goes to SAR Denise Duan-Porter: Lee, G., Duan-Porter, W.D., Metjian, A. Acquired, non-amyloid related Factor X deficiency: Review of the literature. (2012) Haemophilia. 18:655-663…
Have a great week
What Did I Read This Week (Jeffrey Clarke, MD)
Increased Survival with Enzalutamide in Prostate Cancer after Chemotherapy (AFFIRM). NEJM Aug 15, 2012 Epub
Importance (in my opinion): Although historically viewed as an ‘androgen independent’ lethal disease, metastatic castrate resistant prostate cancer (CRPC) in the past decade has been proven to be dependent (at least in part) on the androgen receptor axis. Enzalutamide (previously MDV3100) is one of a number of recent novel agents, including abiraterone (a CYP17 inhibitor), which target androgen synthesis/signaling and have demonstrated tremendous efficacy in improving survival in patients with CRPC. Specifically, enzulutamide is a small-molecule, pure androgen receptor antagonist which inhibits ligand binding and subsequent nuclear translocation. Since the announcement of the early termination of the AFFIRM study last year, the official results of this trial have been eagerly anticipated. Given the publication of this article 2 weeks ago and the subsequent FDA announcement of its approval last week making national headlines, a review of the AFFIRM results seems quite timely and fitting this week.
Design: Phase 3, double-blind, placebo-controlled trial, of 1199 men with castration-resistant prostate cancer after chemotherapy (docetaxel) stratified according to the ECOG performance-status score and pain intensity, and randomly assigned in a 2:1 ratio, to receive oral enzalutamide at a dose of 160 mg per day (800 patients) or placebo (399 patients). The primary end point was overall survival.
Results: The study was stopped after a planned interim analysis at the time of 520 deaths. The median overall survival was 18.4 months (95% confidence interval [CI], 17.3 to not yet reached) in the enzalutamide group versus 13.6 months (95% CI, 11.3 to 15.8) in the placebo group (hazard ratio for death in the enzalutamide group, 0.63; 95% CI, 0.53 to 0.75; P<0.001). The superiority of enzalutamide over placebo was shown with respect to all secondary end points: the proportion of patients with a reduction in the prostate-specific antigen (PSA) level by 50% or more (54% vs. 2%, P<0.001), the soft-tissue response rate (29% vs. 4%, P<0.001), the quality-of-life response rate (43% vs. 18%, P<0.001), the time to PSA progression (8.3 vs. 3.0 months; hazard ratio, 0.25; P<0.001), radiographic progression-free survival (8.3 vs. 2.9 months; hazard ratio, 0.40; P<0.001), and the time to the first skeletal-related event (16.7 vs. 13.3 months; hazard ratio, 0.69; P<0.001). Rates of fatigue, diarrhea, and hot flashes were higher in the enzalutamide group. Seizures were reported in five patients (0.6%) receiving enzalutamide.
(My) Conclusions: Enzalutamide is now a well-tolated treatment option for men with advanced prostate cancer which provides a very meaningful improvement in survival, as well as a number of secondary outcomes including disease progression and quality of life. Importantly, it also provides further confirmation that CRPC is indeed an androgen sensitive disease process and targeting the androgen receptor axis is an important avenue for further exploitation. Ongoing studies are examining the role of enzalutamide pre-docetaxel (PREVAIL) in CRPC as well as with localized disease. Additionally, identifying biomarkers to predict response to androgen-directed therapies in CRPC will be important moving forward.
From the Chief Residents
|14-Sep-12||Infectious Disease-2||Dr. Naggie/Joyce/Costa||Hep C Diagnostic|
|Monday||9/10||PFT interpretation||Neil MacIntyre||12:00||Chick-fil-A||2002|
|Tuesday||9/11||Hem/Onc Emergencies||Richard Reidel||12:00||Dominos||2002|
|Wednesday||9/12||Electrolyte Abnormalities||Dave Butterly||12:00||The Picnic Basket||2002|
|Thursday||9/13||Worst practices in hospital medicine||Dan Kaplan||12:00||Papa John’s||2002|
|Friday||9/14||Chair’s Conference||Chiefs||12:00||Jersey Mike’s||2002|
When ordering labs, remember to use v58.69 as a diagnosis for BMP for HTN, or any other monitoring while on long term meds, just as you did on the paper encounter form
CC the attending when you are putting in the follow-up..on the same “page” of the encounter
From the Residency Office
Now Accepting Applications for Global Health Elective Rotations
The Hubert-Yeargan Center for Global Health (HYC) is now accepting applications for Global Health Elective Rotations for July 2013 and March 2014. Application is open to residents from the Department of Medicine (PGY 2), Pediatrics (PGY 2), Med-Peds (PGY 3), and Med-Psych (PGY 4).
Application materials are attached and can also be found at http://dukeglobalhealth.org/education-and-training/global-health-elective-rotation.
Respiratory Fit Testing Schedule for September 2012.
Fit Testing/ T-Dap Vaccination/ TB Skin Testing will be available at Duke North Room 4000C. (Fourth Floor beside service elevator). Please refer to the attached schedule. Resp Fit Testing-T-Dap-TB Skin Testing Flyer Sept 2012
Duke Information Security and the Duke Compliance Office
The contents of the memo are familiar to you because of the online modules we complete every year, but it’s worth highlighting a few key points:
- Help us stay in compliance for encryption of every Duke-owned laptop. Our IT staff can assist with configuring your new purchases.
- Mobile devices, flash drives, external hard drives need to be kept secure, too. Please ask our IT staff if you have questions.
- E-mail with sensitive information really requires use of secure messaging. Both Lotus Notes and Outlook have this option.
- Remember to use the HIPAA privacy statement for fax management (the text is in the attached memo)
- Data storage off-site, for example, “DropBox” is not secure.
- Options for Survey tools used in research: Duke endorses RedCap or survey development via Steve Wilfong in DHTS
If you have specific questions regarding IT compliance, please contact the DHTS Help Desk at (919) 684-2243 or https://www.dunk.duke.edu/secure/submit/index.htm.
HIPAA is the law and effects our entire enterprise, our contracted vendors, and each of us personally. Thank you for keeping secure systems a priority.
Vice Chair for Administration
Dates to Add to Your Calendars /Contact Information/Opportunities
Sept 19-20 Flu Shot BLITZ 8831_FLU_Clinic_Template_Final
Oct 25 Recruiting Kick Off Event