Research

Amir K. Jaffer, M.D. is involved in several clinical trials looking at many of the new anti-coagulants, specifically new oral anticoagulants. These anticoagulants would ultimately replace some of the older agents (such as warfarin) and other medications (such as heparin) that are used often in hospitals today.

Dr. Jaffer is a steering committee member of the division’s first randomized clinical trial set for October 2008. He will study how patients already on warfarin therapy (specifically those who have a common type of arrhythmia known as atrial fibrillation) should be managed at the time of surgery. This first of-its kind, $25 million randomized clinical trial, called “Bridge”, is being supported by the National Institutes of Health and will be  performed in conjunction with Duke Clinical Research Institute.

In addition, there are 4 industry-sponsored protocols that involve oral anticoagulants.

• ·          Efficacy of an oral medication in patients with severe symptomatic deep-vein thrombosis and/or pulmonary embolism prevention.
• ·         An oral administration evaluating the extension of this once-daily medication in the long term prevention of recurrent symptomatic deep vein thrombosis or pulmonary embolism.
• ·         An oral medication evaluating the efficacy of  rivaroxaban compared to subcutaneous enoxaparin in patients who have been hospitalized for a medical illness.
• ·         A multi-center study of the safety and efficacy of apixaban for prophylaxis of venous thromboembolism in acutely ill medical patients during and following hospitalization.

Dr. Efren C. Manjarrez, assistant professor of clinical medicine and director of clinical operations, has undertaken a project that involves the interest in internal medicine residents who are pursuing the hospital medicine residency track in internal medicine. It is an anonymous on-line survey that queries the residents experience in current instruction in several core areas of hospital medicine and how well they have mastered those areas. Another study on the horizon that Dr. Manjarrez is spear-heading is the effect of the hospitalist model of care at the Sylvester Comprehensive Cancer Center. This study will examine the hospitalist’s co-management of the patient with other medical specialties.

Dr. Joshua Lenchus, assistant professor of clinical medicine for the Division of Hospital Medicine is also a sub-investigator working collaboratively with Dr. Jaffer on the Bristol-Myers Squibb sponsored clinical trail. In addition, Dr. Lenchus has two IRB approved protocols. The first is team-based crisis management, which involves re-creating a crisis scenario. The goal is to improve efficiency and communication. The second protocol involves procedural instruction. Dr. Lenchus designed a curriculum used to formally teach invasive bedside procedures in a standardized format. Curricular data has been presented at 3 national meetings, demonstrating significant improvement post-intervention. A recent abstract based on this study, accepted at the 4^th national meeting, demonstrated a decreased incidence of complications by those who have participated in the course compared to previously published data.