au g u s t 2 014
Convenient, Comprehensive Heart Care
Heart Valve Clinic, Newest TAVR Technology Available at FirstHealth
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
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6
COVER STORY
Convenient, Comprehensive
Heart Care Heart Valve Clinic, Newest TAVR Technology Available at FirstHealth
a u g u s t 2 0 14
FEATURES
12
Weight Management
Educating Patients on Effective Exercise Strategies Lindsay Wojciechowski shares guidance that optimizes health and weight loss.
14
Vol. 5, Issue 5
DEPARTMENTS 9 Gastroenterology
18 UNC Research News
Making the Most of the Office Visit
Discovery May Lead to Safer Alternative to Blood Thinners
10 Practice Management Using Outsourcing Effectively
15 Duke Research News $15 Million Is to Advance Treatments for Autism, Other Brain Disorders
16 Duke Research News Technology
The Digital Age: Improved Patient Communication, Diagnosis and Treatment Tools Dr. Laura Briley explores areas in which the
New Technologies Empower Patients and Enhance Data Collection
19 UNC News $6 million Grant Awarded to Innovative Back Care Program
20 News Welcome to the Area
21 News North Carolina Medical Society Names New Employees
17 News - De Shazo Is Named North Hospital Vice President and Administrator - Wake Radiology Opens Outpatient Imaging Office in Smithfield
Internet supports the health care process. COVER PHOTO: Interventional cardiologist Steven J. Filby (left) shares leadership of the FirstHealth Valve Clinic with cardiothoracic surgeons Peter I. Ellman and Art Edgerton (not pictured).
2
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From the Editor
Specialty Care Close to Home FirstHealth Valve Clinic – this month’s cover story – is bringing new-generation cardiac and vascular care home to residents of the mid-Carolinas region. T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Here, patients are treated collaboratively by a multidisciplinary team led by a cardiovascular and thoracic (CVT) surgeon and an interventional cardiologist. The latest technology includes TAVR, transcatheter aortic valve replacement. Read on to learn more about the FirstHealth health care team and the specialized diagnostic and treatment services provided.
Also in this issue, dermatologist Laura Briley reflects on digital technology’s role in creating patients that are more engaged in their health care and how it has enhanced diagnosis and treatment, especially in her specialty. Gastroenterologist Douglas Drossman offers valuable self-management counseling guidelines that can improve outcomes. Nurse practitioner Lindsay Wojciechowski discusses exercise as a weight management strategy and the benefits of interval and strength training.
Consultant Margie Satinsky sheds light on the importance of outsourcing, especially when specialized expertise within a medical practice is lacking in areas like billing and collections, information technology support, human resources and compliance.
Contributors in The Triangle Physician are bringing their messages home, so to speak, straight to their intended target: the more than 9,000 physicians, physician assistants, nurse practitioners and office administrators and staffers throughout eastern North Carolina. Cover story and advertising costs are competitive. Columns offering medical insight and articles on medical and practice news run at no cost, space permitting.
One of this country’s greatest medical communities is in your backyard. For more information about making a direct connection with these referral sources, contact me at heidi@trianglephysician.com.
With gratitude for all you do,
Heidi Ketler Editor
4
The Triangle Physician
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Laura D. Briley, M.D. Douglas Drossman, M.D. Margie Satinsky, M.B.A. Lindsay Wojciechowski Creative Director Joseph Dally jdally@newdallydesign.com
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Cover Story
Convenient, Comprehensive
Heart Care
Heart Valve Clinic, Newest TAVR Technology Available at FirstHealth Comprehensive treatment for patients with
ing or intervention, FirstHealth offers the
Ellman. “Many patients with severe aortic
heart valve disease, including the transcath-
added benefit of local convenience. “Most
stenosis who were thought to be too high-
eter valve replacement, is now available
patients and their families prefer to avoid
risk for conventional surgery did not have
in the mid-Carolinas region at FirstHealth
the traffic of the larger cities, if at all pos-
any viable options in the past. These pa-
Moore Regional Hospital in Pinehurst. Pa-
sible,” says Dr. Filby. “Also, families have the
tients were basically left to be treated with
tients with suspected valve disorders can
convenience of going home at night if their
medicine alone. TAVR has given us an op-
be referred to the FirstHealth Valve Clinic,
loved one is hospitalized, or FirstHealth of-
tion for these historically hopeless patients
which is led by interventional cardiologist
fers the Clara McLean Hospitality House on
who likely would have died from their aortic
Steven J. Filby, M.D., and cardiothoracic
the hospital campus for those families who
valve disease.”
surgeons Peter I. Ellman, M.D., and Art Edg-
have traveled from farther distances. In ei-
erton, M.D.
ther case, families can be part of the recov-
TAVR uses a small catheter that gets striated
ery process.”
over a wire that is then inserted either transfemorally or transapically. This catheter
The FirstHealth Valve Clinic offers a collaborative, multidisciplinary approach to
Newest Technology
goes across the aortic valve, and the bal-
treating valve disease focused on delivering
One of the newest valve treatments on the
loon on which the valve is seated is inflated,
the best treatment plan for each individual
market is now available at FirstHealth. TAVR
expanding and pushing the patient’s valve
patient. Valve disorders that may be appro-
— transcatheter aortic valve replacement —
to the side. The new valve springs open, the
priate for referral to the clinic include aortic
is indicated for patients who are surgically
balloon deflates, and the new valve begins
stenosis, pulmonary stenosis, mitral ste-
high-risk and would not be able to tolerate
to function. Inpatient recovery is typically
nosis and mitral regurgitation. Treatments
traditional open-heart aortic valve replace-
three to four days.
range from observation and medical man-
ment. “We’ve had great success with the TAVR so
agement to surgical interventions.
far,” says Dr. Filby. “Patients who have come “The FirstHealth Valve Clinic is a ‘one-stop
in wheelchair-bound because of shortness
shopping’ model, whereby the patient has a
of breath are up and walking in just a few
dual appointment with both a CVT surgeon
days. Also, in addition to TAVR, there are
and an interventional cardiologist,” says Dr.
more exciting developments on the horizon
Filby. “After seeing the patient and review-
for valve treatment, and we look forward to
ing the diagnostics, the physicians confer
offering them here at FirstHealth.”
privately and return to the patient with an
Transcatheter heart valve device used in transcatheter aortic valve replacement (TAVR) procedures.
As an interventional fellow at the Cleveland
sicians’ experience and skill sets, and gets
“TAVR is a catheter-based aortic valve re-
Trial, a seminal 2010 study that demonstrated
away from one physician making treatment
placement that doesn’t require the use
TAVR’s benefits for United States patients.
recommendations based solely on his own
of the cardiovascular bypass pump, and
skills.”
it’s truly revolutionary in what it can of-
Reid Heart Center
fer patients who are prohibitively risky for
FirstHealth leads the region in advanced
conventional open-heart surgery,” says Dr.
heart care, and that tradition continues with
individualized treatment plan. This multidisciplinary model incorporates both phy-
When valve patients require extensive test-
6
The Triangle Physician
Clinic, Dr. Filby was part of the PARTNER
the Reid Heart Center. All heart services
his medical degree from the University of
fellowship at UNC Hospital in Chapel Hill;
are offered in the state-of-the art heart cen-
Pennsylvania. He completed his residency
and a two-year interventional cardiovascu-
ter, which includes unique operating rooms
in general surgery at the University of Vir-
lar and endovascular fellowship at Ohio’s
that allow cardiologists and heart surgeons
ginia and his cardiothoracic training in
renowned Cleveland Clinic Foundation.
to work together at the same time.
Gainesville at the University of Florida. He
Dr. Filby is board certified in internal medi-
is certified by the American Board of Sur-
cine, cardiovascular disease and interven-
gery and the American Board of Thoracic
tional cardiology, and is board eligible in
Surgery.
vascular medicine.
John F. Krahnert Jr., M.D., Cardiovas-
Peter L. Duffy, M.D., F.A.C.C.,
two or more procedures combined
cular Thoracic Surgeon, FirstHealth
Interventional Cardiologist,
in one visit
Cardiovascular & Thoracic Center
FirstHealth Cardiology Services-
• 57 private rooms
The founder of FirstHealth of the Carolinas’
Pinehurst
• Cardiac catheterization
heart surgery program, Dr. Krahnert gradu-
Dr. Duffy graduated from Lafayette College
• Bedside registration
ated from Wake Forest University with a
in Easton, Pa., and earned his M.D. from
• The region’s most advanced electro-
B.A. in biology and earned his M.D. from
New York Medical College in Valhalla, N.Y.
the Bowman Gray School of Medicine in
He received his master in medical manage-
Features of Reid Heart Center include: • Six operating rooms with advanced technology • Two multi-use operating rooms for
physiology equipment and procedures
Winston-Salem. He completed both his in-
ment degree from Carnegie Mellon Univer-
Reid Heart Center Team
ternship and residency at the University of
sity. He completed his internship and resi-
Art Edgerton, M.D., Cardiovascular
Kentucky Medical Center, as well as a fel-
dency at St. Vincent’s Hospital and Medical
& Thoracic Surgeon, FirstHealth
lowship in cardiovascular and thoracic. He
Center in New York, N.Y., and then did a
Cardiovascular & Thoracic Center
is certified by the American Board of Sur-
fellowship in cardiology at Georgetown
Dr. Edgerton earned his bachelor’s degree
gery and the American Board of Thoracic
University and the Veterans Administration
in chemistry from Wake Forest University
Surgery and serves as chief medical officer
Medical Center in Washington, D.C. He
and his medical degree from the Bowman
for FirstHealth of the Carolinas.
is board certified by the American Board of Internal Medicine in Internal Medicine,
Gray (now Wake Forest) School of Medicine. He completed his general surgery
Steven J. Filby, M.D., Structural,
Cardiovascular Diseases and Intervention-
residency and a fellowship in cardiotho-
Peripheral & Coronary Interventional
al Cardiology. He is a Fellow of the Ameri-
racic surgery at Wake Forest University
Cardiologist, FirstHealth Cardiology
can College of Cardiology and the Society
Baptist Medical Center. He is certified by
Services-Reid Heart Center
of Cardiac Angiography and Intervention.
the American Board of Thoracic Surgery.
Dr. Filby graduated from Harvard University with a B.A. in biological anthropology
Peter J. Vassallo, M.D., F.A.C.C.,
Peter I. Ellman, M.D., Cardiovascular &
before earning his M.D. from Louisiana
Cardiologist, FirstHealth Cardiology
Thoracic Surgeon, FirstHealth Cardio-
State University Medical School. He com-
Services-Pinehurst
vascular & Thoracic Center
pleted an internship and residency in inter-
Dr. Vassallo graduated from Fordham Univer-
Dr. Ellman attended Dartmouth College,
nal medicine at Stanford University Hospi-
sity in Bronx, N.Y., and earned his M.D. from
where he majored in English. He earned
tal in Palo Alto, Calif.; a general cardiology
Universidad del Noreste School of Medicine.
The FirstHealth Heart Team (from left): Cardiologist Debbie Wright-Thomasson, M.D.; interventional cardiologist Peter L. Duffy, M.D.; cardiothoracic surgeon Art Edgerton, M.D.; cardiologist ‘Jide G. Lawal, M.D.; electrophysiologist Mark D. Landers, M.D.; cardiothoracic surgeon John F. Krahnert Jr., M.D.; cardiothoracic surgeon Peter I. Ellman, M.D.; cardiologist David J. Shin, M.D.; cardiologist Peter J. Vasallo, M.D.; cardiologist H. Allen Strunk, D.O.; and interventional cardiologist Steven J. Filby, M.D.
august 2014
7
He completed his internship, residency and
Va. He completed his internship and resi-
Md., and a medical degree from Tulane
a cardiology fellowship at Bridgeport Hospi-
dency, as chief resident, in the University
University School of Medicine in New
tal at Yale University School of Medicine in
of Connecticut Medicine Program. He then
Orleans, La. He did his internship and
Bridgeport, Conn. He is board certified in
completed a fellowship in cardiology and
residency in internal medicine at Tulane,
internal medicine, cardiovascular diseases
electrophysiology at the University of Colo-
where he also completed a fellowship in
and nuclear cardiology. He is a fellow of the
rado Health Sciences Center in Denver. Dr.
cardiology. He is board certified in inter-
American College of Cardiology.
Landers is board certified in internal medi-
nal medicine, cardiovascular diseases and
cine, cardiovascular diseases and clinical
nuclear cardiology. He is a fellow of the
H. Allen Strunk, D.O., F.A.C.C.,
cardiac electrophysiology. He is a fellow of
American College of Cardiology.
Cardiologist, FirstHealth Cardiology
the American College of Cardiology and a
Services-Pinehurst
member of the Heart Rhythm Society.
Debbie Wright-Thomasson, M.D., F.A.C.C., Cardiologist, FirstHealth
Dr. Strunk graduated from Gettysburg College in Gettysburg, Pa., and earned his D.O.
â&#x20AC;&#x2122;Jide G. Lawal, M.D., F.A.C.C.,
Cardiology Services-Hoke
from Philadelphia College of Osteopathic
Cardiologist, FirstHealth Cardiology
Dr. Wright-Thomasson earned a B.S. de-
Medicine. He completed his internship
Services-Rockingham
gree in home economics from Texas Tech
and residency at Youngstown Hospital As-
Dr. Lawal graduated from the University of
University in Lubbock; an M.S. degree in
sociation in Youngstown, Pa., and Harris-
Lagos, Lagos, Nigeria, where he also earned
nutrition from Texas Womenâ&#x20AC;&#x2122;s University
burg Hospital in Harrisburg, Pa. He then
his M.D. He completed his internship, resi-
in Denton; and her medical degree from
completed a fellowship in cardiology at
dency and cardiology fellowship at Colum-
the University of Texas Medical Branch
Allegheny General Hospital in Pittsburgh,
bia University College of Physicians and
in Galveston. She completed her intern-
Pa. Dr. Strunk is board certified in internal
Surgeons at Harlem Hospital Center, New
ship with the University of Texas Medical
medicine and cardiovascular diseases. He
York, N.Y. Dr. Lawal is board certified in
Branch, John Sealy Hospitals, in Galveston,
is a fellow of the American College of Car-
internal medicine, cardiovascular diseases
and her residency in internal medicine
diology.
and nuclear cardiology. He is a fellow of the
with Texas Tech University Health Sciences
American College of Cardiology.
Center, University Medical Center in Lubbock. She is board certified in cardiology,
Mark D. Landers, M.D., F.A.C.C., Electrophysiologist, FirstHealth
David J. Shin, M.D., F.A.C.C.,
Cardiology Services-Pinehurst
Cardiologist, FirstHealth Cardiology
Dr. Landers graduated from Utah State
Services-Rockingham
University, and earned his M.D. from East-
Dr. Shin earned a B.A. in chemistry from
ern Virginia Medical School in Norfolk,
Johns Hopkins University in Baltimore,
nuclear cardiology and echocardiography.
Reid Heart Center, the FirstHealth Cardiac and Vascular Institute at Moore Regional Hospital, features the next generation of cardiac and vascular care.
8
The Triangle Physician
Gastroenterology
Making the Most of the Office Visit By Douglas A. Drossman, M.D.
Patients with chronic illnesses have a
Step 5: Know your rights…
better chance of reaching improved
• To be treated with respect.
health outcomes when they understand
• To ask questions and voice your
the role of self-management. Physicians
opinions.
can help their patients adopt a greater
• To disagree as well as agree.
self-management role by offering some
• To say “no” without guilt.
practical guidance during the clinic visit. Step 6: Recognize and accept I have found that the following 10 steps
emotions.
lead to better outcomes for my patients
• Mind and body are connected.
with functional gastrointestinal and believe
• Strong emotion affects pain, for better
they can improve the clinical experience for all providers and their patients.
or worse. • By acknowledging and dealing with your emotions you can reduce stress
Step 1: Accept.
and decrease the pain.
• Accept that your symptoms are there. • Learn all you can about your condition and its management. • Knowledge is therapeutic.
Step 7: Relax. • Stress lowers pain threshold and increases symptoms. • Relaxation helps reclaim control over
Step 2: Get involved. • Take an active role. • Develop with your doctor a partnership in the care. • Understand your doctor’s recommendations and maintain an
one’s body and reduces pain. • Relaxation options to consider: - Deep breathing - Relaxation response - Hypnosis - Yoga and meditation
open dialog. Step 8: Exercise… Step 3: Set priorities.
• Diverts attention from your symptoms.
• Look beyond your symptoms to the
• Increases one’s sense of control in life.
things that are important in your life.
important.
• Share your thoughts and feelings with
• With these steps your symptoms are no • Focus on abilities not disabilities.
• Set goals within your power to
• You will then see you can live a more
manageable steps • Take the time to enjoy the success of reaching your goals
your provider. • Talk and interact with family and
Step 4: Set realistic goals. accomplish
Drossman Gastroenterology P.L.L.C. (www.drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.
Step 10: Reach out. Step 9: Refocus. longer the center of your life.
• Break a larger goal into small
Dr. Drossman is president of the Rome Foundation (www.theromefoundation. org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www.drossmancenter.com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patientprovider relationship.
• Helps you feel better about yourself.
• Do what is important. • Eliminate or reduce what is not
Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment.
normal life.
friends in healthy ways. • Support others and seek support from them as well.
For more information about patient self-management, patients and providers, alike, can benefit from visiting the following blog on our practice website: http://drossmancenter.com/suffering-chronic-gi-symptoms-heres-make-doctor-visit
JULY 2014
9
Practice Management
Using Outsourcing
Effectively By Margie Satinsky
You know how medicine works. You
actual reimbursement; the numbers don’t
provide patient care in the areas in which
always match.
Margie Satinsky is president of Satinsky Consulting, L.L.C., a Durham consulting firm that specializes in medical practice management. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century.
you are trained and board certified, and you refer patients to your colleagues when
If you outsource some or all of your
in your collections. Outsourcing billing and
they need care that you can’t provide.
managed
collections could be an attractive solution.
care
work,
ask
potential
consultants about their experience in The same principle applies to practice
North Carolina. Many consultants prefer to
When you talk with vendors that provide
management. As the job of managing a
work on all of your managed care contracts
billing and collections services, ask about
medical practice increases in complexity, it
simultaneously, rather than one at a time.
company ownership, structure, history and
makes sense to determine what’s best done
We prefer that approach, as it provides
long-term goals. Seek examples of results
internally and what might be outsourced to
a broad picture of the entire landscape,
with current clients.
an external professional with expertise that
offering opportunities for leverage. Given your financial situation, what one-
you lack. Select a consultant who will let go of
time savings and long-term results are
Let’s talk about two topics: what functions
the reins, teaching someone in your
projected for your practice? How does the
are often outsourced and how to select a
practice what to do in the future so you
vendor service new accounts, and who will
consultant or vendor. Practices commonly
can eventually do the work yourself.
be your service representative? Will the
outsource the functions of managed
Most consultants charge a fixed rate for a
vendor clean up accounts that are older
care, billing and collections, information
specific number of contract re-negotiations
than 90 days and, if so, will there be an
technology support, human resources and
or an hourly rate. An incentive-based
extra charge for the service? Is the vendor
compliance.
consulting fee that is tied to increases in
available and willing to meet regularly with
reimbursement is theoretically appealing
your practice so that you can identify and
Managed Care
but difficult to implement, because most
correct operational issues?
An external consultant with managed care
practices are not informed on the current
experience can help you review contracts
reimbursement by code and by plan.
Most billing and collections vendors charge a percentage of revenue collected or a flat
that you have in place and verify your current rates of reimbursement. You should
Billing and Collections
monthly fee. Be sure to ask about start-up
already know that insurers don’t knock on
Obtaining managed care contracts that
costs, such as license fees, hardware and
the door offering higher rates; you have to
offer favorable reimbursement doesn’t
network connections. Finally, ask what
ask for better reimbursement and justify
guarantee that the entire revenue cycle
software the vendor uses. If you have
your request with documentation of quality
management process in your office will
already purchased an integrated practice
or other features.
work smoothly. The methodology by
management/electronic health records
which you capture patient demographic
system from a vendor that offers outsourced
Experienced consultants know how each
information, verify insurance coverage,
billing and collections at an additional
plan pays (e.g., percentage of Medicare
code, submit claims, monitor denials and
charge, it may make sense to purchase that
Resource Based Relative Value Scale –
collect all impact the revenue that you
additional service from the same vendor
RBRVS – and/or proprietary fee schedule)
ultimately receive.
rather than choosing a different vendor that uses different software.
and can negotiate increases in your reimbursement. They can review contract
Staffing issues also can have a negative
language and other plan materials to
impact on your bottom line. For example,
Information Technology
ensure there are no hidden bombshells.
if you have frequent staff turnover, your
Successful practice management in the
They can also guide you in developing
accounts receivable statistics may not meet
21st century depends on your ability to
systems for comparing expected with
industry standards, and you may fall behind
select and use a practice management
10
The Triangle Physician
system, electronic health record system
experienced in that aspect of medical
themselves at great risk.
practice management. Consultants other
and an interactive website linked to a You should have a formal compliance plan
than legal counsel can help you with
that addresses Medicare and Medicaid
operational issues, such as policies and
Many small practices lack the internal
issues, and you should also be compliant
procedures. Most attorneys and other
expertise
maintain
with other relevant rules and regulations
consultants charge an hourly rate.
information technology (IT) applications.
such as OSHA, CLIA and HIPAA Privacy
My own IT support vendor ranks closely
and Security. With respect to HIPAA, the
Remember, you don’t have to do everything
behind my family in importance. When
Omnibus Final Rule that went into effect
internally. If the increasing complexity
my system is having problems, my family
in 2013 changed some of the original
of medical practice management feels
drops to second place!
requirements, so make sure you are up to
overwhelming, investigate the outsourcing
date.
option, keeping in mind that your external
patient portal.
to
select
and
partners will work best with internal
Check the experience and stability of the support vendor that you select. How does
The
the vendor recruit and train staff, and are
compliance plan is an attorney who is
best
resource
for
creating
a
support and guidance.
they certified? How does the IT support vendor charge for services (hourly or monthly rate, special “after hours” rate), and what’s the method for prioritizing requests for assistance? Human Resources Your employees are your most important assets.
Recruiting,
hiring,
firing,
supervising, training, performing regular evaluations, making sure you comply with state and federal law, reviewing your benefit package and upgrading your salary scales are some of the tasks that you should be doing on a regular basis. You have three options for outsourcing. You can ask an external consultant to do one or more of these tasks. You can also ask a single vendor to help with multiple human resource tasks in what is called business process outsourcing (BPO). You can also partner with a professional employer organization (PEO). With the PEO option, your employees are actually on the payroll of the PEO and you “lease” them back. Compliance If managed care ranks first as the aspect of practice management that physicians hate, compliance ranks a close second. Believe it or not, some practices don’t pay any attention to compliance at all, putting Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
august 2014
11
Weight Management
Educating Patients on Effective Exercise Strategies By Lindsay Wojciechowski
Health care professionals nationwide are
• An equivalent mix of moderate and
struggling to manage the overwhelming
vigorous-intensity aerobic activity and
epidemic of obesity. Within an ever-chang-
muscle strengthening as mentioned
ing health care system, providers are chal-
above.
lenged with the need to see more patients in less time, and few of us have the time
Moderate-intensity aerobic activity, de-
or the background to educate our patients
fined by the CDC (www.cdc.gov) is physi-
about effective weight-loss strategies.
cal activity done at three to 5.9 times the intensity of rest, or a 5-6 effort on a 0-10 scale
Patients have more co-morbidities than
relative to the person’s capacity. Vigorous-
ever, most of which require complex man-
intensity exercise is defined as a 7-8 effort.
agement and significant patient education. Many of these co-morbidities are directly
Working Up to Aerobic Activity
or indirectly related to obesity.
After you determine that the patient is medically clear to exercise, obese adults
Currently in North Carolina, 64.9 percent of
not currently exercising should start by
adults are overweight (body mass index,
building their capacity to do work.
Lindsay A. Wojciechowski is a nurse practitioner and consultant to the Women’s Wellness Clinic and the Carolina Women’s Research and Wellness Center (CWRWC). She has worked as a clinical nurse practitioner for Triangle Family Practice at Duke University Medical Center since 2006. She also has taught courses at the Duke University School of Nursing. Ms. Wojciechowski’s focus is on women’s health and family medicine, and she also is the lead medical writer for the Women’s Wellness Clinic.
by periods of rest. Interval training is more effective than long, steady cardio exercise,
or BMI, greater than or equal to 25) and 27.8 percent are obese (BMI greater than
Matthew Alegre, an experienced certi-
because it results in greater weight loss
or equal to 30).
fied strength and conditioning specialist
(specifically lower overall fat percentage),
(CSCS) and BioSignature practitioner in
while retaining/gaining lean muscle mass.
Effective weight management requires a
Chapel Hill (www.carpediemstrong.com),
Increased muscle mass leads to more
proper diet, behavioral modification and
advises walking at approximately 60 per-
long-term energy expenditure, facilitating
physical activity. This article addresses
cent of maximum heart rate three to four
further weight loss.
how providers can help guide weight loss
times a week (for a total of 150 minutes).
through exercise, especially for those pa-
Exercise
tients frustrated with their lack of weight
After three weeks, the patient has accli-
(EPOC) – the “after-burn,” or the calories
post-oxygen
consumption
loss from their exercise plan.
mated to this exercise and should switch
expended (above resting level) after exer-
to a higher intensity pace (80 percent of
cise – is greater in those doing short, in-
The Centers for Disease Control and Pre-
the maximum heart rate for 20 minutes,
tense, repetitious intervals. EPOC increas-
vention (CDC) suggests these guidelines
three to four times a week). After six to
es after most types of exercise, but the
for adults age 18-64:
eight weeks of this traditional “cardio” pro-
higher the intensity of the exercise inter-
• Two hours and 30 minutes (150
gram, few body composition changes are
vals, the greater the EPOC and the greater
minutes) of moderate-intensity aerobic
expected as the patient gains efficiency of
the post-exercise caloric burn.
activity (like brisk walking) a week
those movements. Mechanisms involved with this increased
and muscle strengthening on two or more days a week that works all major
Mathew recommends switching at this point
metabolism include lactate removal, in-
muscle groups or
to an interval-based routine for the “aerobic
creased blood circulation, ATP-PC (ad-
activity” to optimize health and weight loss.
enosine
• Seventy-five minutes of vigorous-
triphosphate-phosphocreatine
system) resynthesis and replenishment of
intensity aerobic activity every week and muscle strengthening on two or
Interval Training Is Best
oxygen stores1. In addition, patients who
more days that works all major muscle
Interval training incorporates alternating
do long-distance and constant-pace exer-
groups or
periods of high-intensity exercise followed
cises experience higher chronic inflamma-
12
The Triangle Physician
tion due to oxidative stress. This can add to
ACNE • MOHS SURGERY • SKIN CANCER • PSORIASIS • ECZEMA • DERMATITIS • ALOPECIA
already heightened inflammatory states for patients with diabetes, hypertension, etc.
Skin so
Conveniently for patients, interval training
SMOOTH Southern Dermatology & Skin Cancer Center offers diagnosis, treatment and counseling for diseases of skin, hair and nails including the most advanced therapies for prevention and early detection of skin cancer.
also takes up significantly less time than more traditional methods of exercise (2025 minutes vs. 45-50 minutes).
Southern Dermatology’s Skin Renewal Center offers state-of-the-art skin rejuvenation procedures and medical grade skin care products to make your skin as smooth as jazz. Including:
Examples of interval-training workouts: • Track workout: Sprint 400 meters followed by a four-minute rest, sprint 300 meters followed by three-minute rest,
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• Bike: 30-second sprint, followed by
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three-minute rest. Repeat for six sets. All of the above should include a two-to-
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three-minute warmup. A Mix Is Best
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Mathew is adamant that a combination of interval and strength training is ideal.
DER131_AD_Triangle Physican 1_3.indd 1
7/23/14 10:15 AM
Although not always financially possible,
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Drossman Gastroenterology PLLC a patient-centered gastroenterology practice focusing on patients with difficult to diagnose and manage functional GI and motility disorders. The office is located within the multidisciplinary health care center, Chapel Hill Doctors. Dr. Douglas Drossman is joined by physician’s assistant, Kellie Bunn, PA-C. Appointments are scheduled on Tuesday and Wednesday and most laboratory studies are available.
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a certified trainer is the best way to start the strength-training component to avoid injury. If interval workouts are done in conjunction with strength training (recommended), then one to two interval sessions per week are enough. If interval training is the only feasible form of training for your patient, three to four sessions per week is advised. This however should always be based on the patient’s ability to recover from one session to the next.
Drossman Gastroenterology
Both Andrea Lukes at the Women’s Wellness Clinic and myself strongly recommend Mathew for his knowledge and expertise. More information visit Mathew’s website (www.carpediemstrong.com) or send an e-mail (matthew@carpediemstrong.com). Reference 1 Vella, C.A., & Kravitz, L. (2004). Exercise AfterBurn: Research Update, IDEA Fitness Journal, 1(5), 42-47.
august 2014
13
Technology
The Digital Age
Improved Patient Communication, Diagnosis and Treatment Tools By Laura Briley, M.D.
These days, digital technology is used in
The Internet is an important resource for
virtually all aspects of the health profession.
practitioners when, as part of treatment plans, we need to rapidly get information
In terms of the health and care of the skin,
about interactions between certain drugs,
the Internet and digital technology, in
for example. Sophisticated digital technol-
general, have been of enormous benefit
ogy underlies many tools used in South-
both to dermatologists and the patients
ern Dermatology’s practice every day, in-
we treat. The Internet has served as a vast
cluding laser treatments for a wide range
learning resource, empowering patients
of applications, from removal of age spots
to become well informed about health
and facial veins to laser hair removal.
conditions that need attention. In fact, Southern Dermatology’s Skin RePatients will come in and tell me what
newal Center was one of the first in the
they or their child are dealing with, be-
Triangle to offer a highly effective fat-
cause they saw photos on the Internet
reduction process called CoolSculpting,
that seem to mirror the condition. After an
which, not surprisingly, relies on digital
exam, I may agree with their conclusion
technology. CoolSculpting is not meant as
and sometimes not.
a treatment for the seriously overweight, but works really well in the removal or re-
Though digital technology is sometimes
duction of “fat pockets” on the hips, above
the cause of a disease (a rash called ery-
and below the belly button and the thighs.
Dr. Laura Briley, a board-certified dermatologist at Southern Dermatology Skin Cancer Center & Skin Renewal Center in Raleigh, specializes in dermatologic surgery and cosmetic dermatology, among other specialties. She earned her bachelor of science degree from Wake Forest University and her medical degree from The Brody School of Medicine at East Carolina University. She completed her internship at Roger Williams Medical Center in Providence, R.I., and residency at The Brody School of Medicine. Dr. Briley is a member of the American Academy of Dermatology, American Medical Association and Alpha Omega Honor Society. them often. But when I tell a mom that her
thema abigne caused by heat sources, such as laptop computers, or the “cell
Digital technology is especially helpful
child has a condition she’s never heard of
phone rash” caused by nickel allergies),
with dermatology, because we have so
before, it’s very reassuring to guide her to
it has, by and large, helped patients to be
many disease conditions that are very un-
a website where she can see photos that
more proactive about their health care.
common and that most people have nev-
look just like what her daughter is deal-
It also provides valuable diagnostic and
er heard about. As a practitioner these
ing with, along with detailed information
treatment tools for physicians.
conditions may not be rare, because I see
about symptoms and treatment.
14
The Triangle Physician
Duke Research News
$15 Million Is to Advance Treatments for Autism, Other Brain Disorders Duke Medicine has been awarded a
Medicine. “With the foundation’s help, we
Cord blood cells are collected without risk
$15 million grant to support an innovative
hope to give untold numbers of people
to the mother or baby from the placenta,
research program that explores the use of
with autism and related disorders hope for
which is otherwise discarded as medical
umbilical cord blood cells to treat autism,
a better outcome.”
waste after a baby is born. After collection,
stroke, cerebral palsy and related brain dis-
the cells can be frozen and stored for fu-
orders.
ture use in blood stem cell transplantation or cellular therapies.
The award from The Marcus Foundation, an Atlanta-based phil-
Dr. Kurtzberg’s previous research has
anthropic organization, will fund
shown that cord blood cells can reduce
the first two years of a planned
inflammation and signal normal cells to
five-year, $41 million project by
repair damage in areas of the brain affected
Joanne Kurtzberg, M.D., chief
by inherited pediatric brain diseases. A
scientific and medical officer of
recently published Duke study indicates
Duke’s Robertson Cell and Trans-
that treating children with their own cord
lational Therapy Program; and
blood cells can have similarly beneficial
Geraldine Dawson, Ph.D., director
results in cases of hypoxic ischemic
of the Duke Center for Autism Diagnosis and Treatment.
Geraldine Dawson, Ph.D., (left) and Joanne Kurtzberg, M.D.
encephalopathy.
There are approximately two million peo-
Building on those research results, the
Dr. Kurtzberg and Dr. Dawson hope to de-
ple in the United States with autism spec-
new study will try to determine whether
velop cell-based therapies that can poten-
trum disorder, a group of conditions affect-
cord blood cells will have the same effect
tially restore brain function in people with
ing social communication and behavior.
in cases of autism and stroke. Using meth-
the disorders for which there currently are
Stroke kills an average of nearly 130,000 in
ods developed by Dr. Dawson, the study
no cures. If successful, the study could
the United States every year, while cerebral
will examine whether the therapy not only
identify therapies for further evaluation in
palsy currently affects an estimated 764,000
improves behavioral outcomes in children
clinical trials to potentially decrease dis-
children and young adults.
and adults with autism, but also reshapes the patterns of brain activity.
abilities and improve the quality of life for millions of children and adults.
The initial phase of the program – a preliminary trial involving 20 pediatric sub-
Dr. Kurtzberg and Dr. Dawson also will
The project will consist of a series of clini-
jects with autism using their own banked
explore the key question of whether the
cal trials using umbilical cord blood cells
cord blood – is already under way. It will
beneficial effects of cord blood can be
to treat a total of 390 children and adults
conclude with Phase II trials using donated
achieved by treating patients with donated
with autism, 100 children with cerebral
cord blood in children with autism and ce-
cord blood rather than only with their own
palsy and 90 adults with stroke. Based on
rebral palsy and adults with stroke.
banked blood cells. If that is found to be true, it could make cord blood treatment
previous research, Dr. Kurtzberg and Dr. Dawson hypothesize that cord blood may
“The whole program has enormous po-
available to the largest numbers of patients
promote repair of dysfunctional or dam-
tential,” said Dr. Kurtzberg, who is also
in need.
aged areas of the brain.
director of the Pediatric Blood and Marrow Transplant Program and the Carolinas
“We all wanted to have a treatment that, if
“Funding for this type of research is very
Cord Blood Bank. “Autism, stroke and ce-
it’s effective, would be accessible to every-
scarce, so the only way we can truly make
rebral palsy are all neurologic conditions
one,” said Dr. Dawson, who was the found-
progress is with support from private phil-
that impair function and quality of life for
ing director of the University of Washing-
anthropic organizations like The Marcus
these children and adults. If we can make
ton Autism Center and then chief science
Foundation,” said Nancy Andrews, M.D.,
that better, it will have a huge personal and
officer at Autism Speaks before joining the
Ph.D., dean of Duke University School of
societal impact.”
Duke faculty in August 2013.
august 2014
15
Duke Research News organization in 2005.
Established by Bernie Marcus, the co-
pies to bear on disorders without existing
founder of The Home Depot, The Marcus
treatments, and that are unlikely to receive
Foundation has a long-established inter-
funding from traditional sources, such as
Families interested in enrolling a child in
est in autism, stroke, cerebral palsy and
the National Institutes of Health.
the study should contact Duke via e-mail to cordbloodtherapyinfo@dm.duke.edu or
other neurological conditions, and in stem cell research. It focuses on biomedical re-
Mr. Marcus also opened the Marcus Autism
search projects that are close to clinical
Center in Atlanta in 1991 and donated the
application, which may bring novel thera-
funds to start the Autism Speaks advocacy
(844) 800-CORD/(844) 800-2673.
New Technologies Empower Patients and Enhance Data Collection The changing dynamic of health studies
perspective that big data and comparative
With the increasing availability and popular-
driven by “big data” research projects will
effectiveness research have the potential to
ity of wearable monitoring devices that track
empower patients to become active par-
greatly enhance the health of both individual
such outcomes as heart rate, blood pressure
ticipants who provide real-time information
patients and whole populations.
and blood sugar levels, patients are now able to be active participants in their daily health
such as symptoms, side effects and clinical outcomes, according to researchers at Duke
They argue that using new ways of acquir-
needs, while also adding to the broader data
Medicine.
ing and aggregating data directly from clini-
collection.
cal care offers an alternative to randomized The analysis, published in the July issue of
controlled trials, which are currently the gold
The researchers noted that this new reliance
Health Affairs, lays out a new paradigm for
standard of medical studies, particularly for
on patient-driven data is already being incor-
health research, particularly comparative
new therapies.
porated into studies funded by the PatientCentered Outcomes Research Institute, the
effectiveness studies that are designed to assess which therapies work best in routine
“Generalizing data from these trials to larger,
clinical practice.
more heterogeneous populations to deter-
NIH Collaboratory and many others.
mine treatment effectiveness can be prob-
“The value of engaging with patients to gen-
Fueled by new technologies – including
lematic,” Dr. Abernethy said. “Further, it takes
erate the information needed to provide care
electronic health records and monitoring
years – often more than a decade – for a trial
that is truly patient-centered and individual-
devices that people can wear as clothing or
to progress from the idea stage to actionable
ized will benefit society as a whole,” Dr. Ab-
accessories – health studies are now poised
information, and cost and complexity mean
ernethy said. “With this kind of information,
to integrate data from a much larger pool of
that some important questions go unan-
health care and health care research can be
information. The new data is immediate and
swered.”
truly patient-centric.”
terial, but also clinical information that can
Dr. Abernethy said electronic health records
In addition to Dr. Abernethy, the paper’s au-
improve the patient’s care in the short term.
provide a huge volume of information from a
thors include Lynn Howie, Bradford Hirsch
much wider and diverse pool of participants
and Tracie Locklear.
actionable, providing not only research ma-
“When linked to the rest of the available elec-
than has typically been available. The clini-
tronic data, patient-generated health data
cal information can be used for research to
Dr. Abernethy reports research funding from
completes the big-data picture of real peo-
improve care for current patients as well as
the National Institutes of Health, Agency for
ple’s needs, life beyond the health care sys-
future patients.
Healthcare Research and Quality, PatientCentered Outcomes Research Institute,
tem, and how changes in health and health care lead to meaningful changes in people’s
Electronic health records can also be aug-
DARA Bioscience, GlaxoSmithKline, Cel-
lives,” said senior author Amy P. Abernethy,
mented with patient-driven data, with real-
gene, Helsinn, Dendreon, and Pfizer. At the
M.D., Ph.D., professor of medicine and direc-
time reporting directly to the health record
time of this press release, Dr. Abernethy will
tor of the Center for Learning Health Care at
during a clinical visit or via the patient’s per-
be employed by Flatiron Health Inc., in addi-
Duke.
sonal input of symptoms, side effects, quality
tion to Duke University. She is on the board
of life assessments and other factors.
of directors for athenahealth Inc. A full list of
Dr. Abernethy and colleagues advance the
16
The Triangle Physician
disclosures is provided in the publication.
News
De Shazo Is Named North Hospital Vice President and Administrator Sheri De Shazo, M.B.A., M.H.A., R.N.,
“We are very pleased to welcome
the newly-completed Piedmont Newnan
has been named vice president and
Sheri to the WakeMed team. She is an
Hospital. She then worked closely with
administrator of WakeMed North Hospital,
innovative thinker with a strong history
physicians, staff and other leaders to build
effective Aug. 11.
of relationship-building with physicians,
relationships with the community while
nursing and hospital staff and other health
overseeing all clinical, nursing, ancillary
She brings 20-plus years’ experience
care professionals, as well as business and
and support services.
in health care management, including
community organizations,” said Donald
previous roles as hospital administrator
Gintzig, WakeMed president and chief
Prior to Piedmont, Ms. De Shazo was the
and chief nursing executive.
executive officer. “As we look forward to
chief operating officer and chief nursing
providing exceptional women’s services
executive
In her new role, Ms. De Shazo will be
to northern Wake County and surrounding
Systems’ Kings Mountain Hospital in
involved in all major operational and
communities, we are fortunate to have
Cleveland County, N.C.
management
found an administrator with these skills
decisions
as
WakeMed
prepares for the Mother’s Day 2015 opening
along with a proven track record.”
for
Carolinas
HealthCare
Ms. De Shazo, who is Lean Six Sigma Green-
of North Hospital, a 61-bed acute care
belt certified, earned a master’s in health care
hospital with a focus on women’s specialty
Ms. De Shazo comes to WakeMed from
administration and a master’s in business
services. In addition, she is responsible for
Piedmont Health Care, where she served
administration from Pfeiffer University in
overall operational leadership, including
as the chief clinical officer and vice
Charlotte, N.C. She also holds a bachelor’s in
administration, clinical outcomes and
president of administration for Piedmont
nursing from Winston-Salem State University
financial performance.
Newnan Hospital in Newnan, Ga. In
and an associate’s in nursing from Bluefield
2012, she helped open and establish
State College in Bluefield, W. Va.
Wake Radiology Opens Outpatient Imaging Office in Smithfield Wake Radiology opened a new
One in eight women in the
outpatient imaging office in
United
Smithfield that offers screening
invasive
mammograms.
mammograms are considered
States breast
will
develop
cancer,
and
the best way to detect breast the
cancer early when it is most
Smithfield community for 25
treatable. The American Cancer
years while running the radiology
Society
department at Johnston Memorial
mammograms
Hospital until 2010.
starting at age 40.
Wake
Radiology
served
A
“Wake Radiology has a long
recommends
Wake
for
annual women
Radiology
press
history in Smithfield, and we’re excited
to make it as convenient as possible for
advisory reports that a mammography
to continue serving this community,”
women to have a mammogram.”
appointment
only
lasts
30
minutes
from check-in to exam completion. To
said Lyndon K. Jordan III, M.D., Wake Radiology’s president and managing
The office, located behind Carolina
schedule a screening mammogram at
partner and a Smithfield native. “We know
Premium Outlets at 218 Venture Drive, is
Wake Radiology’s Smithfield office, call
that the best protection against breast
open Monday through Friday from 8 a.m.
(919) 232-4700 or visit www.wakerad.com.
cancer is early detection, and we want
to 4:30 p.m.
august 2014
17
UNC Research News
Discovery May Lead to Safer Alternative to Blood Thinners For the first time, scientists at the University of North Carolina School of Medicine have shown that eliminating the enzyme factor XIII reduces the number of red blood cells trapped in a clot, resulting in a 50 percent reduction in the size of the clot.
bolism. DVT often occurs during periods of restricted movement, such as prolonged sitting common during a long trip. Also, pregnancy, cancer, genetics, certain kinds of injuries, surgeries and medications can raise the risk of developing DVT.
The finding, featured July 2 in the Journal of Clinical Investigation, has major implications for people at high risk of deep vein thrombosis (DVT), a condition that – together with its deadly cousin pulmonary embolism – affects 300,000 to 600,000 people in the United States every year. Between 60,000 and 100,000 people die from these conditions every year in the United States, according to the Centers for Disease Control and Prevention.
Many patients at high risk for developing clots regularly take blood-thinning drugs, such as warfarin, which stifles the body’s ability to make fibrin – the fibrous protein that binds a clot together. But these drugs can raise the risk of excessive bleeding, can cause side effects and aren’t appropriate for all patients.
“If we can develop a treatment that exploits this discovery to reduce the size of blood clots, it would represent a whole new approach to treating thrombosis that’s different from anyAlisa Wolberg, Ph.D. thing else on the market,” said Alisa Wolberg, Ph.D., associate professor of pathology and laboratory medicine and senior author of the JCI paper. “We think reducing factor XIII activity could be helpful to a large number of people, perhaps including some who cannot take existing ‘blood-thinning’ medications.”
“What’s needed is a drug that reduces the risk of forming large clots but still allows you to form a clot when you need one to stanch bleeding,” Dr. Wolberg said. “The biological pathway we’ve discovered may make it possible to strike that balance.” In experiments using mice and human blood, the researchers examined the role of a protein called factor XIII in clot formation. To their surprise, they found that mice incapable of producing factor XIII formed clots that were half the size of the clots produced by normal mice.
“That difference in itself was extremely striking,” said Maria Aleman, Ph.D., first author of the JCI paper and a graduate student in Dr. Wolberg’s lab at the time of the study. Maria Aleman, Ph.D. “Then, the second surprise was discovering that the size difference was actually due to a reduced number of red blood cells in the clot. Since no previous studies had suggested that it was possible to manipulate the number of red blood cells, we knew we had found something new.” Factor XIII appears to play a crucial role in helping the fibrin matrix keep its integrity during clot formation. Normally, the fibrin matrix forms a strong mesh in and around the clot, trapping red blood cells within. Without factor XIII, some red blood cells are squeezed out, resulting in a much smaller clot. Unlike existing drugs that reduce the formation of fibrin, a drug that reduces factor
The ability for blood to clot is crucial to our health; by stanching bleeding long enough to allow healing, clots keep us from bleeding to death from injuries. But in the wrong circumstances, clots can pose a significant health hazards. In patients with DVT, clots that form inside blood vessels, usually in the legs, obstruct the flow of blood, leading to pain and swelling while raising the risk of pulmonary em-
18
The Triangle Physician
At left, a normal blood clot. At right, a blood clot in which factor XIII activation is reduced. As a result of reducing factor XIII activity, red blood cells are not retained in the clot, making the clot 50 percent smaller.
UNC News At left, a normal blood clot. At right, a blood clot in which factor XIII activation is reduced. As a result of reducing factor XIII activity, red blood cells are not retained in the clot, making the clot 50 percent smaller.
sacrificing the ability to produce small, beneficial clots.
XIII could potentially cut the body’s ability to produce large, dangerous clots without
Dr. Aleman, who earned an Impact Award from the UNC Graduate School for her research, is now a postdoctoral research associate at UNC’s Center for Environmental Medicine, Asthma, and Lung Biology. Additional UNC co-authors of the JCI paper include graduate student James Byrnes;
postdoctoral fellow Jian-Guo Wang, Ph.D.; and Nigel Mackman, Ph.D., the John Parker Professor of Medicine. Authors from other institutions include graduate student Reginald Tran of Emory; Wilbur Lam, Ph.D., from the Georgia Institute of Technology; Jorge Di Paola, M.D., from the University of Colorado at Denver; and Jay Degen, Ph.D., and Matthew Flick, Ph.D., both from the Cincinnati Children’s Hospital Medical Center. The study was funded by the National Institutes of Health and the American Heart Association.
$6 million Grant Awarded to Innovative Back Care Program The University of North Carolina School of Medicine has been selected by the Centers for Medicare and Medicaid Innovation Center for a $6 million prospective award for its Better Back Care program.
guidelines and is subject to overuse of diagnostic imaging, injections and surgery,” said Brian A. Casazza, M.D., director of the UNC Hospitals Spine Center and program director for Better Back Care.
UNC is one of only 39 awardees nationally, and its Better Back Care program is the only spine program to be chosen among the second-round winners of the Health Care Innovation Awards. UNC’s Better Back Care program creates a new model of care for patients with back pain that is designed to improve the patient’s experience and outcomes, reduce the cost of care and deliver an innovative method of financing care , according to a UNC press advisory.
The Better Back Care program will create a medical neighborhood linking approximately 60 primary care providers with the UNC spine program, an existing multidisciplinary team of 10 specialty providers employing evidence-based, patient-centered approaches. This medical neighborhood will adopt evidence-based, coordinated care of demonstrated effectiveness for patients with new-onset low back pain through guideline adherence, patient education and shared decision making, improved access to care and care coordination. Nursepatient navigators will ensure patients receive the right care at the right time.
“Back pain is common, debilitating and expensive, and its contribution to poor patient outcomes and increasing health system expenditure has grown Brian A. Casazza, M.D. rapidly in the last decade alone. Treatment for back pain often does not follow evidence-based
“The UNC Hospitals Spine Center provides Amy Shaheen, M.D. back care that is patient-centered, high quality and cost effective. With this $6 million award, we will
be able to expand this approach to the patients of 60 top primary care physicians in the Triangle. The impact to patients, their families and the North Carolina economy of spine disease can’t be understated. This is a terrific opportunity to improve care of patients suffering from back pain,” said Matthew G. Ewend, M.D., chair of neurosurgery in the UNC School of Medicine. “We know the primary care providers in our area provide excellent care for many conditions,” said Amy Shaheen, M.D. “This award will allow us to demonstrate that high quality and high value can be delivered seamlessly all the way from the primary care office to the subspecialist office when needed.” The Better Back Care program will be directed by Drs. Casazza and Shaheen, an associate professor in the UNC School of Medicine. It was developed with support from UNC Health Care and UNC School of Medicine Center for Innovation. Collaborators for the program include the Cecil G. Sheps Center for Health Services Research, Blue Cross and Blue Shield of North Carolina, the North Carolina Area Health Education Centers Program and Community Care of North Carolina. august 2014
19
News Welcome to the Area
Physicians
Clarissa Jonas Diamantidis, M.D.
Tanya Tabassum Khan, M.D.
Matthew Allan Popa, M.D.
Lee Michael James, D.O.
Internal Medicine - Nephrology
Facial Plastic Surgery; Ophthalmology
Orthopedic Surgery, Adult Reconstructive
Duke University Division of Internal Medicine Durham
Duke University Eye Center Durham
Central Carolina Orthopaedic Associates, PLLC Sanford
Physical Medicine and Rehabilitation
UNC Hospitals Chapel Hill Gina Elyse Miller, D.O. Family Medicine; Family Practice
Cbell University Jerry M. Wallace School of Osteopathic Medicine Lillington Keren Aviva Bashan, M.D. Surgery - Surgical Critical Care
UNC Hospitals Chapel Hill Andre Barranda Bautista, M.D. Diagnostic Radiology; Diagnostic Ultrasound; Interventional and Vascular Radiology
Duke University Hospitals Durham Thomas George Caranasos, M.D. Abdominal Surgery; Cardiovascular Surgery; Critical Care Surgery; General Surgery; Thoracic Surgery
UNC Division of Cardiothoracic Surgery Chapel Hill Jacquelyn Sara Carr, M.D. Abdominal Surgery; Colon and Rectal Surgery; Critical Care Surgery; General Surgery; Pediatric Surgery; Plastic and Reconstructive Surgery; Surgical Oncology; Thoracic Surgery; Vascular Surgery
UNC Hospitals Chapel Hill Danny George Cheriyan, M.D. Durham Anika Shannel Cherry, M.D.
Mary Claire Kimmel, M.D. Mary Adel Elmasri, M.D.
Psychiatry
Lauren Prats Porras, M.D.
Internal Medicine; Pulmonary Disease and Critical Care,
UNC Department of Psychiatry Chapel Hill
Internal Medicine; Sports Medicine
Duke University Durham Samuel Jarrod Francis, M.D. Emergency Medicine
Duke University Hospitals Durham Bronwen Halstead Nussloch Garner, M.D. Internal Medicine
Duke University Hospitals Durham Jonathan Andrew Gehlbach, M.D. Critical Care Pediatrics; Pediatrics
Duke Medical Center Durham Daniel Tyler Goodberry, M.D. Emergency Medicine
Sandhills Emergency Physicians Southern Pines Paige Josephine Halvorson, M.D.
Andrew Brian Kleinberg, M.D. Pediatrics
Jeffers, Mann and Artman Pediatrics Raleigh Sarah Christine Leeper, M.D. Emergency Medicine
UNC Hospitals Chapel Hill Elmer Philip Lehman IV, M.D. Cardiovascular Disease, Internal Medicine
Duke University Hospitals Durham Amy Amenawon-Ohen Mauritz, M.D. Anesthesiology
Duke University Hospitals Durham
Audrey Elaine Herrin Metz, M.D.
Christopher Gale Hauck, M.D. Infectious Diseases, Internal Medicine
Duke University Durham
UNC Hospitals Chapel Hill
Kunal Mitra, M.D.
Internal Medicine
Pediatrics Child Neurology; Pediatrics
Duke University Hospitals Durham
Encompass Womenâ&#x20AC;&#x2122;s Care Burlington
Duke University Hospitals Durham
Jason Robert Mock, M.D.
Matthew Harmon Collins, M.D.
Heath Christopher High, M.D.
Pulmonary Disease and Critical Care, Internal Medicine
Infectious Diseases, Internal Medicine
Critical Care-Internal Medicine
UNC Infectious Diseases Clinic Chapel Hill
CaroMont Health Gastonia
UNC Division of Pulmonary Diseases and Critical Care Medicine Chapel Hill
Michelle Suzanne Collins, M.D.
Christine Jeanne Horton, M.D.
Ann Marie Gonzalez Munoz, M.D.
Angiography and; Interventional Radiology; Body Imaging; Diagnostic Radiology; Diagnostic Roentgenology Radiology; Diagnostic Ultrasound; Musculoskeletal Radiology; Neuroradiology; Nuclear Imaging and Therapy; Nuclear Radiology; Pediatric Radiology
Gynecology; Obstetrics and Gynecology
Ophthalmology
Wake Ophthalmology Cary Kareem Charles Cooper, M.D. Family Medicine; Hospitalist
Wayne Memorial Hospital Goldsboro Anna Vergun Cuomo, M.D. Orthopedic Surgery, Pediatric
UNC Orthopedics Chapel Hill Claire Gordon Dakik, M.D. Anesthesiology; Surgery (general)
Duke University Hospitals Durham
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The Triangle Physician
Anesthesiology - P.A.in Medicine
UNC Hospitals Chapel Hill
Raleigh
Tammy Hall Jenkins, M.D. Raleigh
Neurological Surgery, Critical Care; Neurology with Special Qualifications in Child Neurology
Christa Lynn Jillard, M.D.
UNC School of Medicine Chapel Hill
Kim Jiramongkolchai, M.D. Ophthalmology
Duke University Hospitals Durham Joici Job, M.D. Radiology
Duke Medical Center Durham Yubin Kang, M.D. Hematology, Internal Medicine; Internal Medicine; Medical Oncology
Duke University Hospitals Durham
Joseph Harran Rabinowitz, M.D. Family Medicine; Family Practice
Sanford Medical Group Sanford Samina Saadia Raja, M.D. Psychiatry; Psychiatry, Geriatric
Duke University Hospitals Durham Taher Reza Kermanshahi, M.D. Pathology
Lucas Brandon Romine, M.D.
Ophthalmology
Duke University Hospitals Durham
Duke Medical Center Durham
WakeMed Raleigh
Pradeep Mettu, M.D.
Tammy Lynn Hennika, M.D.
Michael Wilder Compton, M.D.
General Surgery; Surgical Critical Care
Marlboro Chesterfield Pathology Pinehurst
Obstetrics and Gynecology; Oncology; Urogynecology
Abdominal Surgery; Colon and Rectal Surgery; General Surgery; Surgical Oncology
Crystal Michaela Pressley, M.D.
Duke University Hospitals Durham
Obstetrics and Gynecologic Surgery; Obstetrics and Gynecology
Duke University Hospitals Durham
UNC Chapel-Hill Department of Family Medicine Chapel Hill
Casey Olm-Shipman, M.D.
David Isaias Ortiz Melo, M.D. Internal Medicine - Nephrology
Duke University Hospitals Durham Sumir Suresh P.A.tel, M.D. Diagnostic Radiology; Diagnostic Roentgenology Radiology; General Practice; Neuroradiology; Nuclear Medicine; Nuclear Radiology
Duke University Hospitals Durham Joanna Kristine Pearson, M.D. Psychiatry
HRC Chapel Hill
Orthopedic - Surgery of the Hand; Orthopedic Sports Medicine; Adult Reconstructive; Musculoskeletal Oncology; Orthopedic Surgery, Pediatric; Orthopedic Surgery, Trauma; Orthopedic, Ankle Foot; Orthopedic, Hand Surgery
Triangle Orthopedic Associates Durham Elizabeth Marie Ross, M.D. Anesthesiology
UNC Anesthesiology Chapel Hill Stevie Michelle Rowe, M.D. Neonatal-Perinatal Medicine; Pediatrics
Duke Medical Center Durham Jessica Marian Furr Saricicek, M.D. Hospitalist; Pediatric Critical Care Medicine; Pediatric Emergency Medicine; Pediatrics
Duke University Hospitals Durham Jay Christopher Sellers, M.D. Infectious Diseases, Internal Medicine
Raleigh Infectious Disease Associates Raleigh Asad Ali Shah, M.D. Abdominal Surgery; Cardiovascular Surgery; Colon and Rectal Surgery; Critical Care Surgery; General Surgery; Surgery; Thoracic Cardiovascular Surgery; Thoracic Surgery
Duke University Hospitals Durham Neil Devendra Shah, M.D. Gastroenterology, Internal Medicine; General Practice; General Preventive Medicine; Internal Medicine
UNC Department of Gastroenterology Chapel Hill Christine Shieh, M.D. Ophthalmology
Duke Eye Center Durham
News Rahul Prasad Sinha, M.D.
Laura Ann Vickers, M.D.
Warren Umandap Everett, P.A.
Pediatrics
Ophthalmology
Emergency Medicine
Duke University Hospitals Durham Anthony Derek Sung, M.D. Internal Medicine; Hematology/Oncology
Duke University Hospital Durham
Duke University Eye Center Durham
Maria Parham Medical Center Henderson
Joseph Lane Wilson, M.D.
Allison Courtney Gilboy, P.A.
Family Medicine; Family Practice
UNC Hospitals Chapel Hill
Duke Radiology Durham Elizabeth O’Toole Tegins, M.D. Ophthalmology
Raleigh Lindsay Gossage Terrell, M.D. Pediatric - Allergy/Immunology; Pediatric Critical Care Medicine; Pediatric Dermatology; Pediatric Emergency Medicine; Pediatric Rehabilitation Medicine; Pediatric Transplant Hepatology; Pediatrics; Pediatrics - Child Abuse Pediatrics
Duke University Hospitals Durham
Stephen Roy Todd, P.A. Orthopedic Surgery
Family Medicine
Cary
Durham VA Medical Center Durham
Thu Anh Le, P.A.
Erin Elizabeth Woody, P.A.
Emergency Medicine; Urgent Care
Ronak Kiran Talati, M.D. Radiology
Erik Svensen Stubberud, P.A. Duke University Health System Durham
Physician Assistants John Francis Cassidy, P.A. Addiction Psychiatry; Child and Adolescent Psychiatry; Child Psychiatry; Child/ Adolescent Psychiatry; Geriatric Psychiatry; Psychiatry; Psychosomatic Medicine
Thoracic Cardiovascular Surgery
Wake Med Raleigh
Duke University Hospital Durham
Christian Paul Marocco, P.A. Emergency Medicine
Orthopaedic Specialists of North Carolina Raleigh
Carolina Partners in Mental Health Raleigh
Jessica Danielle Stevens, P.A.
Danielle DiLorenzo, P.A.
Orthopaedic Specialists of North Carolina Raleigh
Critical Care Surgery
Raleigh
Cecilia Zebedeo, P.A. Durham
General Practice; Orthopedic Sports Medicine
North Carolina Medical Society Names New Employees North Carolina Medical Society (NCMS) reports the following staff additions: Kristina “Tina” Natt och Dag is the new director of the Kanof Institute for Physician Leadership at the NCMS Foundation. Ms. Dag has a doctorate in workforce and human resource education from North Carolina State University and a master’s degree in human rights from Lund’s University in Lund, Sweden. She has been working in training and development in the corporate and non-profit sectors for the past two decades, working with leaders at all levels around the world. Denna Suko is the new deputy director of specialty society, meeting and education services, supporting 10 state medical societies and one county medical society contracting with the NCMS for management services. A veteran association man-
ager, Ms. Suko brings more than 15 years of experience to the job, including positions with FirstPoint Management Resources, the American Academy of Ophthalmology, the National Association of Letter Carriers and the National Committee for an Effective Congress. Ms. Suko holds a master’s degree in political science from American University and a bachelor’s degree from Indiana University of Pennsylvania. Jennifer Gasperini is the new director of health policy. Ms. Gasperini served most recently as the senior government affairs representative for the Medical Group Managers Association in Washington, D.C., focusing on federal legislative and regulatory issues pertaining to physician payment and quality. She also worked as a senior account executive at Ketchum, a D.C. public relations firm, with government clients, such as the Center for Medicare and Medicaid Services. She holds a bachelor’s degree in journalism with a minor in political science from Pennsylvania State University and a master’s degree in
legislative affairs from George Washington University. The North Carolina Medical Society represents approximately 12,500 physicians and physician assistants across the state. Founded in 1849, the society seeks to promote access to quality health care for in North Carolina and champions initiatives that seek to improve quality of care and promote patient safety.
2014 Editorial Calendar September Bariatrics Neonatology October Cancer in women Wound management November Urology ADHD December Otorhinolaryngology Pain management august 2014
21
SCREENING MAMMOGRAPHY. NOW IN SMITHFIELD.
THE BEST PROTECTION IS EARLY DETECTION. For 25 years, we served Smithfield from Johnston Memorial Hospital. Now we’re back. In a new location. And we bring with us more than 60 years as the region’s premier provider of outpatient imaging. We also bring screening mammography to your community. And, because early detection is what it’s all about, access and scheduling couldn’t be easier. What’s more, the appointment itself is just 30 minutes from check-in to exam completion. So there’s never been a better time (or place) for a checkup.
At your request, Wake Radiology can easily obtain your most recent mammogram from other practices.
TO LEARN MORE, CALL 919-232-4700 OR VISIT WAKERAD.COM.
Wake Radiology | 218 Venture Dr. Smithfield, NC Behind the Carolina Premium Outlets Hours: Monday-Friday 8:00am-4:30pm Appointments: 919-232-4700 | wakerad.com