Week in Review 4/3/15

Hi Residents,

April has arrived and with it we inch ever closer to new interns, new residents, and new fellows/attendings. Just a few critical items for today:

  • ACLS/BLS Renewal: For anyone who got their ACLS/CLS in June of 2013 (almost all pgy2s and pgy4s) your certifications are about to expire.  The hospital provides free renewal to all residents but you need to plan ahead.  Please refer to my email from last week or the website for more details.  As an FYI only 7 spots remain available in April.  These dates go fast so if you have not signed up yet, do so NOW.
  • Cancer Center Caps: As you all know the cancer center has a hard cap of 7 on the solids team and a soft cap of 20 and a hard cap of 21 on the leuks  As a result you may get a patient with cancer on the medicine teams similar as to what is done at the VA.  If however the patient has a neutropenic fever, leukemia, or getting active chemo you need to contact the cancer center attending directly.  They will assist you in determining if this patient is safe for the floor (i.e. simple neutropenic fever) or if the patient truly needs to go to the cancer center (in which case a patient currently on the cancer center must be transferred to a floor team).  These decisions can be difficult and are not to be made at a resident or fellow level.  If you are still having trouble then please contact us so that we can help by getting the CAP attending involved.
  • VA Imaging System: As you may know the VA has recently changed their imaging system.  There will no longer be a generic logon instead your logon will be the same one you use to logon to the VA computers.  We have turned on this access for many of you.  If we were unable to find your logon through the VA outlook system you would have received an email from Debra Parks requesting your windows username.  If you find that you on service and do not have access to the VA system please email me your VA windows logon (i.e. vhabalsidhus) and we will turn on your access ASAP.
  • Diabetes Modules: For all PGY 2 residents please make sure to get your diabetes modules done ASAP. Given the technical issues the due date has been changed to 5/1.  Having done this my PGY2 year I can say that these modules were intensely valuable.
  • Resident Bibliography: As we do every year we are currently compiling a list of resident publications and abstracts from this academic year.  Please make sure to send Debbie Trust this information in Pub Med format (and don’t forget to keep that CV up to date).
  • ENT: As of this week there are new pagers for the ENT service. For university you should page 9187.  For the VA you should page 6146 until 430PM and then 9187 after hours.
  • Moonlighting: May moonlighting will be released next Friday at 6PM.
  • Conference Attendance: In addition to attending conference please make sure you and your students are on time for all morning reports and noon conferences.
  • Article of the Week: Todays article is a systematic review looking at the use of metformin in patients with CKD published in JAMA in late 2014. Given the beneficial effects of metformin and its potential to reduce major adverse cardiovascular events (as seen in UKPDS and DPPT), and the fact that current guidelines restrict the use of metformin in 2.5 million Americans it becomes vitally important to reassess the data on metformin in CKD.  This article reviewed the use of metformin in patients with mild to moderate reductions in GFR.  It reported on studies that show that despite lower GFR the drug levels of metformin do not appreciably rise.  In addition the incidence of metformin induced lactic acidosis is rare <0.01% and does not change significantly with worsening GFR.  Overall the article made the following recommendations for prescribing metformin.  For more on this topic you can check out Dr. Diamantidis talk on drug safety in kidney disease from earlier this year.Metformin CKD

About Sunny

Inpatient Chief Medical Resident 2014-2015

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