j u LY / a u g u s t
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UNC Center for Heart & Vascular Care Trial Begins on Promising Therapy for Treatment-Resistant Hypertension
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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Contents
COVER STORY
6
UNC Center for Heart & Vascular Care
Trial Begins on Promising Therapy for Treatment-Resistant Hypertension j u ly / a u g u s t
2012
Vol. 3, Issue 7
FEATURES
9
Your Financial RX
Transparency in 401(k) Plans Paul Pittman urges practice administrators to brief employees about new federal disclosure rules now in effect.
10
DEPARTMENTS 11 Practice Administration
12 UNC News
- Award Recognizes Hospitals’ Higher Standard of Care for Heart Attack - Antibodies Reverse Type 1 Diabetes in New Immunotherapy Study
14 UNC News
New Network Name Reflects Wider Reach
15 Duke News
Information Technology
Health Care IT: Consider Your Infrastructure Options
$139 Million Grant Funds Discovery of HIV/AIDS Vaccine Immunogens
16 Duke News
Drug Fails to Curb Heart Bypass Complications, but Surgery Gets Safer
17 Durham Regional Hospital News
The Value of Media Relations
Paul Brown supports why media relations is an essential
18 Rex News
practice marketing and referral tool in this age of information. COVER PHOTO: Members of the Symplicity HTN-3 study team at UNC Heart & Vascular (left to right): Ankit Patel, M.D., Alan L. Hinderliter, M.D., Romulo Colindres, M.D., M.S.P.H., Cassie Ramm, RN, BSN, George A. “Rick” Stouffer III, M.D., Deanna Ravenscraft, and Xuming Dai, M.D. Photo by Jacoby Photography.
2
The Triangle Physician
Upcoming Events
Epicenter Designation Recognizes Robotic Surgery Expertise Venture Capital Firm Invests in Aerial BioPharma Research
19 News
Affiliate AHA Board Leaders Named
20 News
Welcome to the Area
JOHNSTON MEDIC AL CENTER Clayton A Healthier tomorrow begins today
JOHNSTON MEDIC AL CENTER Clayton
A H e a lt h i e r tom or r o w b e g i n s today
From the Editor
From the Editor
Symplicity’s Potential 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
The Symplicity HTN-3 clinical trial offers hope for an estimated six million Americans with treatment-resistant hypertension. The University of North Carolina Center for Heart & Vascular Care, in collaboration with the UNC Kidney Center and the Department of Family Medicine – and key physicians who are engaged in the trial are featured in this
Editor Heidi Ketler, APR
heidi@trianglephysician.com
month’s The Triangle Physician. Under investigation is the Symplicity™ renal denervation system, a minimally invasive, catheter-based procedure that has been used successfully outside of the United States to deactivate the nerves to the kidneys. It is the largest randomized, controlled and blinded study of its kind, expected to randomize approximately 530 patients across 90 trial sites throughout the U.S. Based on the evidence to date, there is a great deal of confidence that results of the six-month study will confirm its safety and effectiveness. Ultimately, the procedure could
Contributing Editors Larry B. Goldstein, M.D., F.A.A.N., F.A.H.A. Andrea S. Lukes, M.D., M.H.Sc Paul C. Peterson, M.D., F.A.C.E.P. Paul J. Pittman, C.F.P. Alfonso Torquati, M.D., M.S.C.I., F.A.C.S. Maryan Binkley Photography Mark Jacoby Creative Director Joseph Dally
mark@jacobyphoto.com
jdally@newdallydesign.com
lead to a reduction in the incidence of cardiovascular events.
Advertising Sales Info@trianglephysiciancom
Also in this issue, several contributors offer their practice-enhancing expertise. David
News and Columns Please send to info@trianglephysician.com
Sturdivant shares his insight into the expanding options for information technology. Paul Brown makes the case for media relations as a tool for strengthening referrals. Certified financial planner Paul Pittman discusses a new law that requires increased transparency of 401(k) plans.
The Triangle Physician is published by: New Dally Design Subscription Rates: $48.00 per year $6.95 per issue
Your news and insight is always welcome. Visit The Triangle Physician editorial calendar on page 14 and plan to contribute to focused issues. Consider also the value of advertising. Delivered to more than 9,000 physicians, physician assistants, nurse practitioners, office administrators and staff, The Triangle Physician is simply the best way to reach the Triangle medical community. With gratitude for all you do,
Heidi Ketler Editor
Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.
4
The Triangle Physician
Cover
UNC Center for Heart & Vascular Care
Trial Begins on Promising Therapy for Treatment-Resistant Hypertension By Heidi Ketler
The long-awaited trial to test renal denervation as a therapy for treatment-resistant hypertension in the United States is now under way at the University of North Carolina-Chapel Hill. Physician scientists from the UNC Center for Heart & Vascular Care, in collaboration with colleagues from the UNC Kidney Center and the Department of Family Medicine, are participating in the Symplicity HTN-3 trial. Renal denervation is a minimally invasive, catheter-based procedure, in which a tiny device is threaded into the arteries to
deactivate the nerves to the kidneys using low radio-frequency energy. Treatmentresistant hypertension is defined as blood pressure that remains elevated (greater than 140/90 mm Hg) despite treatment with three or more antihypertensive medications, including a diuretic. Symplicity HTN-3 is designed to evaluate the safety and effectiveness of Medtronic Incorporated’s Symplicity™ renal denervation system in select patients with treatment-resistant hypertension. It is the largest randomized, controlled and blind-
Symplicity HTN-3 investigators George A. “Rick” Stouffer III, M.D. Romulo Colindres, M.D., M.S.P.H., and Alan L. Hinderliter, M.D. stand in the newly renovated UNC Catheterization Lab.
6
The Triangle Physician
ed study of its kind, expected to randomize approximately 530 patients across 90 trial sites throughout the U.S. The current trial builds on the knowledge gained in Symplicity HTN-2, a study conducted in Australia, New Zealand and Europe and published in The Lancet in 2010. Symplicity HTN-2 was a multicenter, prospective, randomized trial of 106 patients who had a blood pressure of 160 mm Hg or more despite taking three or more antihypertensive medications. The patients were randomly assigned to undergo renal denervation or placebo. Blood pressure medications were maintained in both groups. Six months later, blood pressure measurements in the renal denervation group were reduced by 32/12 mm Hg, whereas there was no change in the control group. At six months, 84 percent of patients who underwent renal denervation had a reduction in systolic blood pressure of 10 mm Hg or more, compared with 35 percent of controls (p<0·0001). There were no serious procedure-related or device-related complications and occurrence of adverse events did not differ between groups. Medtronic’s Symplicity™ renal denervation system was the first to receive approval in Europe in April 2010 and has been commercially available in parts of Europe, Asia, Africa, Australia and the Americas. Worldwide, it has been used successfully in nearly 5,000 patients with refractory hypertension. The U.S. Food and Drug Administration granted Medtronic approval for the protocol for Symplicity HTN-3, the company’s U.S. clinical trial of the Symplicity™ renal denervation system for treatment resistant
hypertension, in August 2011. The Symplicity™ renal denervation system is not approved by the FDA for commercial distribution in the U.S. The impact of a safe and effective therapy for treatment-resistant hypertension in the U.S. may be profound, considering the extent of the disease and its associated health risks. Treatment-resistant hypertension affects nearly six million Americans and 100 million people worldwide, and puts them at an increased risk of cardiovascular events. This is of particular interest among physicians in North Carolina, a state that lies in the “stroke belt,” a region of the U.S. with an especially high prevalence of hypertension. “I think this could be one of the most promising novel therapies for treatmentresistant hypertension that’s ever come our way. It holds real promise,” says Alan L. Hinderliter, M.D., a cardiologist with the UNC Center Heart & Vascular Care. Dr. Hinderliter is a hypertension specialist and is responsible for overseeing patient selection and managing the patients’ care after the renal denervation procedure.
Resistant Hypertension and the Sympathetic Nervous System Only about 50 percent of people with hypertension in the United States have controlled blood pressure. The others are either unaware of their condition, are not receiving or not adhering to treatment or have treatment-resistant hypertension, as conventionally defined. The latter may be about 10 percent of the hypertensive population, according to Romulo Colindres, M.D., M.S.P.H., a nephrologist and hypertension specialist with the UNC Kidney Center. Dr. Colindres, whose patients frequently have hypertension that is difficult to control, is actively involved in identifying and evaluating possible study participants and providing follow up of randomized subjects. Despite focused efforts and the introduction of multiple new therapies, the percentage of patients with hypertension that is resistant to treatment has increased in the last 20 years. According to Dr. Colindres, that can be attributed to, in some
Dr. Rick Stouffer evaluates a renal angiogram with UNC interventional cardiology fellows Ankit Patel, M.D. and Xuming Dai, M.D.
degree, isolated systolic hypertension that often occurs after age 60 and responds poorly to medication. He also cites the rise of obesity and the difficulty losing the necessary weight. While, the onset of hypertension has been correlated with several factors, including genetics, aging, diet and lifestyle, the reasons why hypertension in some patients is difficult to control are complex and not fully understood. Research has shown that hyperactivity of the sympathetic nervous system (SNS) plays a role in sustained hypertension. The SNS connects the brain, heart, blood vessels and kidneys, each of which are important factors in the regulation of blood pressure. Hyperactivation of the SNS can increase heart rate and heart contractility, promote renin release and salt and water retention in the kidney and cause vasoconstriction of the blood vessels, all of which contribute to rising blood pressure. Patients with hypertension are strongly advised to make behavioral and dietary changes, such as losing weight, exercising, reducing sodium intake, consuming a diet rich in fruits, vegetables and low-fat dairy products and moderating alcohol intake. Many will require medications for adequate blood pressure control. If these treatments are ineffective, additional measures, including investigational interventional therapies, such as percutaneous disruption of the sympathetic nerves, may be recommended.
UNC Study Gets Under Way Patient enrollment in the Symplicity HTN-3 study began in September 2011. Inclusion criteria include an office systolic blood pressure greater than 160 mm Hg despite treatment with three or more medications (including a diuretic), an estimated GFR (glomerular filtration rate) greater than 45 ml/min/1.73 m2 and no history of Type 1 diabetes. The primary endpoints of the study are the change in blood pressure from baseline to six months following randomization and incidence of major adverse events. Each study participant is randomized in a 2:1 ratio to receive either renal denervation and treatment with antihypertensive medications or treatment with antihypertensive medications alone for six months. The trial is blinded, so only the proceduralist knows who is assigned to the control group and who is assigned to the treatment group. All study participants are closely monitored throughout the Symplicity HTN-3 study. Patients in the control group may have the option to receive renal denervation treatment six months following randomization. George A. “Rick” Stouffer III, M.D., an interventional cardiologist with the UNC Center for Heart & Vascular Care, is the study proceduralist, who performs the Symplicity™ renal denervation procedure. The Symplicity™ renal denervation system consists of a proprietary generaJuly/august 2012
7
of catheter-based kidney denervation and will provide insight into the effects of this therapy on end-organ manifestations of hypertension. It will be of particular interest to assess effects of the denervation on nocturnal blood pressure.” Dr. Hinderliter emphasizes that the renal denervation should not be viewed as a cure for hypertension. “Lifestyle changes and medications will remain the cornerstones of therapy for patients with high blood pressure. However, in those with refractory hypertension, renal denervation may improve blood pressure control and reduce the number of medications required, lessening the risk of side effects and the associated costs.” Symplicity HTN-3 study nurse Cassie Ramm, RN, BSN views a study patient’s aortogram.
tor and a flexible catheter. The catheter is threaded up through the femoral artery in the upper thigh into the renal artery near each kidney. Once in place, the tip of the catheter delivers low-power, radio-frequency (RF) energy according to a proprietary algorithm to modulate the surrounding sympathetic nerves. After energy delivery in multiple locations along each artery, the Symplicity™ catheter is removed. There is no permanent implant. “The minimally invasive procedure may be a significant improvement over the surgical sympathectomy of the 1940s,” a procedure that achieved blood pressure control through disruption of the sympathetic nerves, but came with the risks of major surgery and generalized anatonomic dysfunction, says Dr. Stouffer. “It was a major operation, with a long list of side effects, and patients were in the hospital for two to four weeks. It was performed on selected individuals with severe hypertension and worked, in large part, lowering blood pressure and increasing longevity for many patients.” The procedure became obsolete with the emergence of drugs in the 1960s to treat hypertension by relaxing blood vessels or reducing blood volume. However, medications can be expensive, need to be taken on a regular basis and come with side effects that include fatigue and depression. “Now, we have come full circle, and we’re able to selectively interrupt the sym-
8
The Triangle Physician
pathetic nervous system communication within the kidney, with a much more userfriendly, catheter-based procedure that takes about 20 minutes per kidney, with essentially no recovery time. We recommend light activity for a few days to let the small incision in the leg heal, and after that, it’s full speed ahead,” says Dr. Stouffer. “In clinical studies, the safety profile of this procedure looks very good,” says Dr. Hinderliter. “The adverse effects have primarily been minor problems at the access site. We have not seen a compromise of kidney function or significant injury to the renal arteries.” “One caution is that we only have data indicating how patients will do for about three years. However, as best we can tell, there aren’t complications that develop years out from the procedure,” Dr. Hinderliter says.
Hope for the Future Encouraged by the findings from earlier studies, the UNC researchers are excited about what the Symplicity HTN-3 study might reveal in a larger, blinded trial of U.S. patients. “There is great interest in this novel treatment by all physicians who treat hypertension and understand the limitations of our current therapies,” says Dr. Colindres. “This clinical trial will increase our experience with the efficacy and safety
Trial Resources For more information about the Symplicity HTN-3 trial at UNC, referring physicians and patients may call the study nurse, Cassie Ramm, R.N., B.S.N., at (919) 843-1610 or send an e-mail to Cassandra_ Ramm@med.unc.edu. The summary inclusion and exclusion criteria available online at www.clinicaltrials.gov can help guide physicians in referring the proper patients for this study. For more information about the Symplicity HTN-3 study, visit www.symplifybptrial.com.
Comprehensive Care Clinical trials are among the many aspects of care offered by hypertension specialists at the UNC Center for Heart & Vascular Care and the UNC Kidney Center. In the hypertension clinics, physicians, pharmacists and other professionals collaborate to evaluate and develop comprehensive treatment plans for patients with difficult to treat high blood pressure, suspected secondary hypertension or hypertension associated with target organ damage using a full range of diagnostic and therapeutic services. Treatment-resistant hypertension often requires additional attention and a coordinated effort between primary care doctors and hypertension specialists. To make a referral to the UNC Center for Heart & Vascular Care, call (919) 966-7244 or send a fax to (919) 966-7322. To make a referral to the UNC Kidney Center, call (919) 966-4615.
Your Financial Rx
Transparency in
401(k) Plans This news just in: Transparency in your
the years. Employers need to plan and think about
401(k) plan. For years, employer-sponsored 401(k)
how employees will react to these changes,
plan participants have received statements
and how to inform them responsibly to
that include account balances and changes
minimize the surprise. Plan sponsors have
in values since the prior period. In most
a duty to evaluate the fees to determine
cases, fees paid from their account were
whether they are reasonable and in the
not mentioned.
best interest of the employees. If uncertain
Plan sponsors, service providers and
whether the fees are reasonable, your
participants faced big changes in 2012,
organization might need to benchmark
starting July 1. That’s when the United
them against what other providers charge.
By Paul J. Pittman, C.F.P.
Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and paul.pittman@ pcgnc.com. Send an e-mail to receive Mr. Pittman’s Weekly Market Commentary.
States Department of Labor required
“In the 401(k) world, benchmarking
mutual funds and plan administrators to
measures a plan against other plans with
disclose details about the fees they charge
the same characteristics in terms of assets,
employees with 401(k) plans. The long-
cash flow, number of participants, number
running a retirement plan in the long run,”
awaited disclosures cover both direct and
of
account
says Jeff Zobell, vice president of Alliance
indirect compensation that administrators
balance, fees (both stated and unstated)
Benefit Group - Rocky Mountain. “Not only
receive – the latter of which often slides
and much more,” says Steven E. Parmelee,
are the fee disclosure regulations requiring
under the radar.
president of Westport Benefits Group.
more active oversight by both participants
non-participants,
average
plan
By 1990, 401(k) plans held about $900
and plan sponsors, they are changing
participants directly. Plans must furnish
billion in assets; by 2011, the figure had
the focus of the conversation to that of
their first set of fee disclosures to
swelled to $4.3 trillion.
retirement
A
second
change
involves
preparedness.
Participants
participants by Aug. 30 – 60 days after
“The Department of Labor believes that
and plan sponsors will have access to
the July 1 effective date. In addition, fees
fee disclosure will help reduce the costs of
better programs and products because
and by
expenses
paid
of these lower costs and a
participants
must
higher account balance at retirement,” he says.
appear on the quarterly fees
Transparency is good
incurred in July through
for employers, participants
September)
be
and the 401(k) industry.
furnished no later than
If you want an unbiased,
Nov. 14.
independent professional
statement
(for to
A recent AARP survey
review of your plan by
found that 71 percent of
an accredited investment
401(k) participants think
fiduciary (AIF), contact me
they don’t pay any 401(k)
and I’ll refer you to one.
fees at all. So seeing
Without
these fees for the first
everyone else is just a
time might come as a big
salesman.
this
credential,
surprise to those who
Until next month, I wish
had no idea how much
you health, wealth and
they’ve been paying over
happiness.
July/august 2012
9
Marketing
The Value of
Media Relations By Paul V. Brown Jr.
You’re a skilled and compassionate physician.
You
have
an
health in the hands of someone they trust.
established
practice. And while you could always use
Why might a physician resist enlisting
a few more patients, it’s not like you have
media to their cause? One reason, in my
loads of free time on your hands. So why
view, is modesty. Most caregivers get into
do you need to reach out to the media for
the business simply to help people. There’s
coverage?
a natural – and laudable – tendency to want to stay in the background, to resist
It’s a smart question to ask, especially since
shouting your credentials and successes
interaction with reporters and bloggers
from the housetops. But the business
may require you to develop a few new
side of medicine requires marketing your
skills, and since hiring a media relations
services and experience.
or public relations company is another business expense.
Paul V. Brown Jr. founded PB Media, a media relations company, in 2008, after three decades as a reporter, bureau chief, editor and editorial writer at big and small newspapers in North Carolina. His list of clients includes government agencies, politicians and nonprofit groups, as well physician practices. He can be reached at (919) 698-7871 or at paul@pbmediacompany.com.
as the has-been practice tomorrow. Surely good, competent physicians will get word-of-mouth patient referrals. Their
Health is a person’s most valuable asset, and most people would rather put their health in the hands of someone they trust.
names (and reputations) will reach the ears of referring physicians. But that’s rarely enough in this digital age, with information flooding your customers from the Internet, smart phones, niche publications and traditional media. You probably know of
But in today’s constantly changing and
Then there are the issues of cost and time.
“reforming” medical market, practices do
Media relations can be expensive. Big
well to set themselves apart in the eyes of
public relations firms command the biggest
patients, referring physicians and hospital
fees. But smaller shops and consultants
and insurance concerns. Otherwise, they
who offer media relations specifically
risk being overshadowed by a practice
(instead of the full array of public relations
across town.
services) often are more affordable.
How important is it to get your name and
Busy doctors don’t have the time to sit for
expertise into the public consciousness –
interviews or write op-ed pieces. A good
coverage on TV news spots, a mention in
media relations expert does the advance
blogs and a quote in newspaper stories?
work needed to minimize a client’s time
Well, ask yourself why hospitals have large,
away from patients.
costly public relations departments. Or why the American College of Rheumatology
The fact is, unless your practice is bursting
devoted an entire session to developing
out of its examining rooms and will stay
media relationships at its annual meeting
that way, you will need the public to know
last year (and a session on marketing).
that you exist and are good at what you do. Advances in your field and changes in the
Health is a person’s most valuable asset,
larger medical landscape are constant. A
and most people would rather put their
cutting-edge practice today may be viewed
10
The Triangle Physician
cases where a patient didn’t receive the best care because they were attracted to a doctor in your field with less expertise – but much greater visibility. What can media relations get you? Well, what do you want? It may be to attract more patients, to establish your practice, to position yourself as a primary expert in your field, to present your uniqueness compared to your competition. All of these aims are sound and can be accomplished through an effective outreach plan. Indeed, you’ll first want to decide your specific aim or aims for media, and then make sure your media relations consultant tailors your campaign to achieve those aims. As a practitioner, you want to interact with your patients. As a business person, you’ll want to interact with the media.
Information Technology
Health Care IT Consider Your Infrastructure Options By David M. Sturdivant
Health care information technology that
A traditional approach to upgrading in-
enables the collaborative sharing of infor-
volves purchasing hardware and software
mation has quickly evolved into a corner-
every three to five years, installing locally
stone for delivering quality patient care,
within an office facility and allocating tech-
while remaining competitive in a rapidly
nical support resources via an internal IT
changing market.
staff or a third-party provider for ongoing management.
Complex issues surface when investing in a new system or upgrading an existing
Automation burdens don’t end with the
one. While electronic health record (EHR)
system components, however. Significant
software features are the focus of extensive
changes in employee culture, operational
evaluation, many other components of
workflow and patient care processes must
health care information technology (HIT)
be addressed along with system installa-
should not be overlooked during the se-
tion, training and customization.
lection process to yield a reliable, secure system.
Meaningful use continues to make regulatory compliance a moving target, further
The quality of a technology infrastructure
taxing an environment that is already
– software, systems and services – relates
resource constrained. Given the current
directly to managing risk that is associated
market dynamics of rising expenses and
with the privacy and security of patient
declining income streams, solutions must
data. Infrastructure has become a key fac-
be affordable and fit within capital and op-
tor in delivering clinical applications to
erating budget constraints.
With more than 20 years in the information technology industry, David Sturdivant is a senior executive with mindSHIFT Technologie Inc. of Morrisville. He is responsible for defining market direction and driving growth for mindSHIFT’s health care business unit. mindSHIFT is one of the largest IT outsourcing and cloud managedservices providers, serving small and midsize businesses for more than 10 years. By combining the resources of a national IT services organization with local customer assistance, mindSHIFT is able to provide small to midsize businesses with highly secure data availability and reliable, hometown support. mindSHIFT Technologies is an independent Best Buy business-to-business services company, employing a staff of more than 600 people who support more than 5,700 clients. Learn more at www.mindshift. com. Mr. Sturdivant may be reached by calling (919) 459-1151 or sending an e-mail to david. sturdivant@mindshift.com.
device of choice (i.e. iPad) and relying on
physicians; it provides the foundation from which they will operate into the future. De-
So given all these challenges, what’s the
secure access from any location is compel-
cisions made regarding the architecture
good news? New requirements have pro-
ling. Service interruptions that threaten pa-
and management of these systems will
duced more solution choices for HIT.
tient care, operations and risk of financial penalties are minimized.
have a direct impact on efficiency of operations, regulatory compliance, data security
For example, cloud computing solves
and the ability to adapt to ever-changing
many obstacles and enables organizations
The benefits of more technology architec-
requirements.
to subscribe to service capacity they need
ture choices are clear: secure, highly avail-
on-demand, without the time, costs and
able resources and reliable computing ca-
Health care providers are not immune to
resources required to deploy and maintain
pacity to support critical software and data.
common barriers when adopting new
a traditional solution. Migrating to a cloud
Clinical systems and PHI (protected health
technology. For example, the financial in-
platform allows access to a “utility” of a
information) remains secure within a cen-
vestment is significant. In addition to the
shared pool of configurable computing
tralized platform, protected from threats,
cost associated with EHR software, old
resources.
breaches and viruses. Scalability and efficiency is drastically improved. Updated
technology must be upgraded to prepare for EHR. Many face forklift upgrades of sys-
Networks, servers, storage, software appli-
choices and solutions in HIT will likely
tems that are dated, having been in produc-
cations and related services can be rapidly
pave the way to a more successful adop-
tion for 10 to 15 years.
provisioned and readied for use in a frac-
tion of EHR and ultimately improve the
tion of the time. Selecting your own mobile
quality of patient care.
July/august 2012
11
UNC News
Award Recognizes Hospitals’ Higher Standard of Care for Heart Attack UNC Hospitals recently qualified for the
“We are extremely proud of the UNC team
Hospitals that earn the Mission: Lifeline
Gold Level Performance Achievement
of interventional cardiologists, emergency
Gold Performance Achievement Award
Award from the American Heart Associa-
department physicians, coronary inten-
have demonstrated for 24 consecutive
tion’s 2012 Mission: Lifeline program. The
sive care unit nurses, staff in the cardiac
months that at least 85 percent of eligible
award recognizes UNC Hospitals’ commit-
catheterization laboratory, performance
STEMI patients (without contraindica-
ment and success in implementing a high-
improvement staff and emergency medi-
tions) are treated within specific time-
er standard of care for heart attack patients
cal services personnel who earned this
frames upon entering the hospital and
that effectively improves the survival and
award through teamwork and their dedica-
discharged following the American Heart
care of STEMI (ST Elevation Myocardial
tion to saving lives,” said Cam Patterson,
Association’s recommended treatment
Infarction) patients.
M.D., physician-in-chief of the UNC Center
guidelines.
for Heart & Vascular Care and chief of the Every year, almost 250,000 people experi-
UNC Division of Cardiology.
“UNC Hospitals is dedicated to making our cardiac unit among the best in the
ence the STEMI type of heart attack – the deadliest type of heart attack. Unfortu-
Hospitals involved in Mission: Lifeline
country, and the American Heart As-
nately, a significant number don’t receive
strive to improve care in both acute treat-
sociation’s Mission: Lifeline program is
prompt reperfusion therapy, which is criti-
ment measures and discharge measures.
helping us accomplish that by making it
cal in restoring blood flow. Mission: Life-
Systems of care are developed that close
easier for our professionals to improve the
line seeks to save lives by closing the gaps
the gap of timely access to appropriate,
outcomes of our cardiac patients,” said
that separate STEMI patients from timely
lifesaving treatments. Before they are dis-
George A. “Rick” Stouffer, M.D., director of
access to appropriate treatments. Mission:
charged, patients are started on aggressive
the UNC Cardiac Catheterization Labora-
Lifeline is focusing on improving the sys-
risk-reduction therapies, such as choles-
tories and Interventional Cardiology. “We
tem of care for these patients and at the
terol-lowering drugs, aspirin, ACE inhibi-
are pleased to be recognized for our dedi-
same time improving care for all heart at-
tors and beta-blockers, in the hospital and
cation and achievements in cardiac care.”
tack patients.
receive smoking cessation counseling.
Antibodies Reverse Type 1 Diabetes in New Immunotherapy Study Scientists at the University of North Caro-
insulin-dependent diabetes mellitus, is an
munotherapies also exists to treat Type 1
lina School of Medicine have used injec-
autoimmune disease in which the body’s
diabetes in people already living with the
tions of antibodies to rapidly reverse the
own immune T cells target and destroy in-
disease.
onset of Type I diabetes in mice genetical-
sulin-producing beta cells in the pancreas. “Clinically, there have been some promis-
ly bred to develop the disease. Moreover, just two injections maintained disease re-
The immune system consists of T cells
ing results using so-called depleting anti-
mission indefinitely without harming the
that are required for maintaining immunity
bodies in recently diagnosed Type 1 dia-
immune system.
against different bacterial and viral patho-
betic patients, but the disease process is
gens. In people who develop Type 1 dia-
blocked for only a short period of time,”
The findings, published in the June 29 is-
betes, “autoreactive” T cells that actively
Dr. Tisch said. “These antibodies don’t
sue of Diabetes, suggest for the first time
destroy beta cells are not kept in check, as
discriminate between T cells normally
that using a short course of immunothera-
they are in healthy people.
required for maintaining immunity to disease-causing pathogens and the autoreac-
py may be of value for reversing the onset of Type I diabetes in recently diagnosed
Senior study author Roland Tisch, Ph.D.,
tive T cells. Therefore, T cells involved in
people, according to a press advisory.
professor of microbiology and immunol-
maintaining normal immune function are
This form of diabetes, formerly known as
ogy at UNC, said a need for effective im-
also going to be depleted.
12
The Triangle Physician
UNC News “You’re getting some efficacy from immu-
The researchers also found an increase
UNC study coauthors with Dr. Tisch are
notherapy, but it’s only transient, it doesn’t
in the numbers of “immune regulatory” T
first-author Zuoan Li (now at the University
reverse the disease, and there are various
cells. In the healthy individual, these regu-
of Iowa), Ramiro Diz, Aaron Martin, Yves
complications associated with the use of
latory T cells block autoimmunity, Dr. Tisch
Maurice Morillon, Douglas E. Kline (now
these depleting antibodies.”
explained. “They protect us from the auto-
at the University of Chicago), Li Li (now at
reactive cells that all of us have. And that’s
Harvard Medical School) and Bo Wang.
Dr. Tisch said his UNC lab has been study-
why most of us don’t develop autoimmune
ing the use of certain “non-depleting anti-
diseases, such as Type 1 diabetes.”
Support for research came from the National Institute of Diabetes and Digestive
bodies.” These bind to particular proteins known as CD4 and CD8 expressed by all
“We’ve demonstrated that the use of non-
and Kidney Diseases, part of the National
T cells. Just as the name implies, when
depleting antibodies is very robust. We’re
Institutes of Health; and from the Juvenile
these non-depleting antibodies selectively
now generating and plan to test antibodies
Diabetes Research Foundation.
bind to CD4 and CD8, they don’t destroy
that are specific for the human version of
the T cells; the overall numbers of T cells
the CD4 and CD8 molecules.”
are unaffected. With this in mind Dr. Tisch wanted to determine whether these non-depleting antibodies could have a therapeutic effect in the non-obese diabetic, or NOD mouse, an excellent model for human Type 1 diabetes. The answer is yes. In some of the recently diagnosed NOD mice, blood sugar levels returned to normal within 48 hours of treatment. Within five days, about 80 percent of the animals had undergone diabetes remission, reversal of clinical diabetes. “The protective effect is very rapid, and once established, is long term,” he said. “We followed the animals in excess of 400 days after the two antibody treatments, and the majority remained free of diabetes. And although the antibodies are cleared from within the animals in two to three weeks after treatment, the protective effect persists.” The study showed that beta cells in the NOD mice had been rescued from ongoing autoimmune destruction. In looking for the mechanism to explain how the therapy worked, the researchers found that the antibodies had a very selective effect on T cells that mediated beta cell destruction. After treatment, “all the T cells that we would normally see in the pancreas or in tissues associated with the pancreas had been purged,” said Dr. Tisch. This despite the fact that the numbers of T cells found in other tissues and blood were unaffected.
Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
July/august 2012
13
UNC News
New Network Name Reflects Wider Reach Triangle Physician Network has become
cians more time to focus on prevention,
The new name and logo come with a
UNC Physicians Network, reflecting a broad-
wellness and improving patient satisfaction
new website at www.uncpn.com. Designed
er reach throughout North Carolina.
and outcomes. To achieve these goals, the
as a resource for patients, it offers information on physicians, practices and more.
The new UNC Physicians Network
practices coordinate with UNC Hospitals
(UNCPN) name represents 34 practices
in Chapel Hill, Rex Hospital in Raleigh,
and more than 150 providers affiliated with
Chatham Hospital in Siler City and other
UNC Health Care, including Rex Health-
facilities to give patients access to robust
care, UNC Hospitals, UNC Physicians and
specialty care services. UNC Physicians
Associates and Chatham Hospital.
Network practices also work closely with
The name change “reflects the enlarging geographic breadth of our community
the specialty physicians of Rex Healthcare and UNC Physicians and Associates.
physician network beyond just the Trian-
The changes will not affect day-to-day
gle,” said Dr. Allen Daugird, president of
operations, and patients won’t see any-
UNC Physicians Network. “The change is
thing different beyond the new name, ac-
also part of an evolving system-wide brand-
cording to the advisory.
ing strategy for UNC Health Care.”
“We look forward to enhancing the
According to a press advisory, the
lives and health of patients in more com-
framework gives member physician prac-
munities across North Carolina,” said Dr.
tices the operational support to provide
Robert Gianforcaro, executive medical di-
high-quality patient care that allows physi-
rector of UNC Physicians Network.
The Triangle Physician 2012 Editorial Calendar September Sports Medicine Physical Therapy
October Breast Cancer Reconstructive Surgery
November Urology Robotic Surgery
December
Pain Management
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The Triangle Physician
Duke News
$139 Million Grant Funds Discovery of HIV/AIDS Vaccine Immunogens A large federal grant awarded to Duke University will fund a highly focused program to discover how to induce the precise immune factors needed for effective vaccines against HIV. Barton Haynes, M.D., will be the director of the seven-year grant for the Duke Center for HIV/AIDS Vaccine ImmunologyImmunogen Discovery (CHAVI-ID). Dr. Haynes previously led the original Center for HIV/AIDS Vaccine Immunology (CHAVI) consortium, the grant which ended in June. For its role in the new CHAVI-ID program, Duke received $19.9 million for the first year beginning in July, according to the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). Scripps Research Institute was also selected as a second center to receive CHAVI-ID grant funding. The CHAVI-ID initiative overall may receive as much as $186 million or more over seven years. Duke may receive more than $139 million in total over the same time period. “Duke is deeply honored to be selected again, as we now build on all the progress made in the initial CHAVI grant and now focus the effort on design of immunogens capable of preventing HIV transmission and protecting people worldwide,” said Victor J. Dzau, M.D., chancellor for health affairs and chief executive officer of Duke University Health System. NIAID originally established CHAVI in response to recommendations of the Global HIV Vaccine Enterprise, a virtual consortium endorsed by world leaders at a G-8 summit in June 2004. “We were privileged to have the CHAVI grant over the past seven years, and the work in this consortium helped us understand what needed to be done to make a successful AIDS vaccine,” said Dr. Haynes, who is also director of the Duke Human Vaccine Institute and the Frederic M. Hanes professor of medicine and immunology.
“The CHAVI-Immunogen Discovery grant will be used to learn how to do what we need to do.” The CHAVI-ID grant now will focus on projects that are critical to creating the most effective vaccines for prevention, Dr. Haynes said. Members of the Duke CHAVI-ID Scientific Leadership Group and their participating institutions who submitted the grant with Dr. Haynes are Andrew McMichael of Oxford University, United Kingdom; George Shaw, University of Pennsylvania; Bette Korber of Los Alamos National Laboratory; Garnett Kelsoe at Duke; and Joseph Sodroski and the late Norman Letvin of Harvard University. The Duke-led work will largely concentrate on inducing broadly neutralizing antibodies that can prevent HIV-1 infection, as well as on generating protective T cell and innate immune system responses. A major strategy will be to evaluate maturation pathways of broad neutralizing antibodies when they do arise, which happens rarely. The scientists will use these pathways as roadmaps for candidate vaccines to stimulate protective antibody responses. “Today’s grant reaffirms our nation’s commitment to HIV/AIDS research and
However much you value wildlife conservation in North Carolina,
underscores the Triangle’s prominent role in this groundbreaking science,” said Rep. David Price of North Carolina’s 4th District. “This award brings much hard work to fruition and is a testament to the quality of researchers and research programs at Duke. It is particularly exciting to focus on vaccine development, which may put us on a path to eradication of this devastating disease.” Dr. Haynes is an internationally recognized leader in vaccine development, basic T and B cell immunology and retrovirus research. He has studied HIV for more than 22 years. Approximately 34 million people are living with HIV/AIDS globally, and the rate of new HIV infections continues to exceed 7,100 per day, according to 2010 data from the Joint United Nations Program on HIV/ AIDS. In the United States, more than a million people are living with HIV/AIDS and about 21 percent are unaware of their infection. Although AIDS drugs have extended the lives of many in wealthy nations, according to global health experts, an effective HIV vaccine would be a valuable addition to the comprehensive prevention strategies needed to stop the spread of HIV everywhere.
DEC NC
11
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July/august 2012
15
Duke News
Drug Fails to Curb Heart Bypass Complications, but Surgery Gets Safer A drug designed to shield the heart
from changes that occur to tissue starved
sicker patients are now undergoing car-
from injury during bypass surgery failed
of oxygen during the surgery, when blood
diac surgery with very good results.”
to reduce deaths, strokes and other seri-
vessels are clamped to establish the grafts.
Dr. Newman also said that support
ous events among patients at high risk of
This period of oxygen deprivation triggers
for publication of a negative study by the
complications, according to a large, pro-
inflammation and cell death once blood
sponsor, Merck, and by the publisher
spective study led by researchers at Duke
flow is restored.
JAMA, is an important step in defining the
University Medical Center.
Earlier evidence from smaller studies
appropriate therapy for heart surgery patients going forward.
But the international study also pro-
suggested acadesine, given before, during
duced a surprising silver lining. As re-
and after surgery, could offer protection
In addition to Dr. Newman, study au-
ported in the July 11 issue of the Journal
by easing some of the inflammatory re-
thors include: Robert A. Harrington, Jen-
of the American Medical Association, the
sponses that kill cells. Most of those stud-
nifer A. White and Tammy L. Reece of
researchers discovered that complica-
ies occurred before 1997, however, when
Duke; T. Bruce Ferguson of East Carolina
tions among bypass surgery patients were
the rate of serious complications was 10
Heart Institute; Giuseppe Ambrosio of the
far less frequent than previously reported.
percent or greater.
University of Perugia School of Medicine;
“We expected about 10 percent of pa-
Dr. Newman and colleagues at 300
Joerg Koglin and Armando Lira of Merck
tients were at high risk for complication
sites in seven countries randomly as-
Sharp & Dohme Corp.; Nancy A. Nuss-
following coronary artery bypass graft-
signed patients to receive the trial drug
meier of SUNY Upstate Medical Univer-
ing,” said Mark F. Newman, M.D., chair-
or a harmless placebo and provided fol-
sity; Ronald G. Pearl of Stanford University
man of the Department of Anesthesiology
low up for a month. The group found that
School of Medicine; Bertram Pitt of the
at Duke and lead author of the study. “But
the drug was no better than placebo at
University of Michigan School of Medi-
the actual risk was 5 percent. What that
protecting people from complications,
cine; Andrew S. Wechsler of Drexel Uni-
means is cardiac surgery has gotten much
with 5 percent of patients having a severe
versity College of Medicine; and Richard
safer, even for high-risk patients.”
event within that month regardless of tak-
D. Weisel of University Health Network, Toronto.
Dr. Newman said surgical manage-
ing acadesine or a mock treatment. The
ment of patients undergoing coronary ar-
study, funded by the manufacturer Merck,
Several authors, including Dr. New-
tery bypass grafting (CABG) has improved
was halted early based on a prespecified
man, reported receiving grant support,
worldwide in the past decade.
interim analysis after 3,080 patients were
honoraria, consulting fees and/or travel
enrolled.
reimbursement from Schering-Plough/
The study, which began in 2009, tested a drug called acadesine in a Phase III
Still, the 5 percent complication rate
trial that was one of the largest involving
was good news, Dr Newman said. It is
a surgical procedure. The primary objec-
likely the result of improved surgical
tive was to determine whether acadesine
methods in recent years, including better
would cut the rate of complications from
anesthesia and advances in surgical and
CABG – the most common type of open
heart-lung machine management.
heart surgery in the United States. The
“A lot of things have played a part in
procedure is highly successful in restor-
the gradual improvement of outcomes
ing blood flow to the heart caused by
over the years,” Dr. Newman said. “We
blockages, but strokes, ventricular dam-
wish we had a drug that could help with
age and death can result even after suc-
ischemia/reperfusion injury – and that
cessful surgery.
remains something that would benefit pa-
One cause of complications is called
tients tremendously – but we have made
ischemia reperfusion injury, which stems
strides in other areas. As a result, older,
16
The Triangle Physician
Merck.
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
UNC News
Upcoming Events Durham Regional Hospital Unless otherwise specified, these events are at Durham Regional Hospital and registration is required. Register for these events at visiting www.durhamregional. org/events.
August 6 – Look Good Feel Better®
This free American Cancer Society seminar teaches women beauty techniques while they undergo chemotherapy and radiation treatments. Participants receive a free cosmetics kit and instruction by beauty professionals. Time: 5:30-7:30 p.m. Location: North Conference Room To register, call: (919) 470-7168
Partnering with patients and providers for a healthier community.
Meet Brigette...
Lost: 148 lbs Found: The joy of horseback riding with complete self-confidence
13 – Stroke Support Group
This group meets the second Monday of each month to educate the stroke survivor, caregiver and people in the community about stroke prevention and stroke disabilities. Time: 1-2:30 p.m. Location: Private Dining Room C
21 – Diabetes Support Group for Adults
People with diabetes and their guests meet to discusses monthly topics about managing their diabetes. It is facilitated by certified diabetes educators and sponsored by the Durham Regional Hospital Outpatient Nutrition and Diabetes Education Center and the Duke University Adult Diabetes Education Program. August’s discussion will focus on how sleep apnea and diabetes go hand in hand. The speaker is Nancy Lelle-Michel, M.S.N., C.N.S., B.C.-A.D.M., C.D.E. Time: 6-7:30 p.m. Location: Teer House 4019 N. Roxboro Road
28 – Weight Loss Surgery Support Group
This group facilitates discussion on topics related to adjustment before and after weight loss surgery. August’s topic is “Ask the Weight Loss Surgery Experts!” Time: 6-7:30 p.m. Location: Duke Center for Metabolic and Weight Loss Surgery Clinic, 407 Crutchfield St.
Joseph C. Moran, MD, FASMBS 2801 Blue Ridge Road, Suite 101 Raleigh, NC 27607
P: 919.781.0815 F: 919.781.0816
www.alasurgery.com
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July/august 2012
17
Rex News
Epicenter Designation Recognizes Robotic Surgery Expertise Rex Healthcare has been designated
surgeons from other hospitals across
a national training ground for teaching
North Carolina and the country to Rex to
surgeons how to perform hysterectomies
learn from Inge.”
and other gynecological surgeries using
surgical procedures. Intuitive Surgical’s epicenter designation is granted based on a hospital’s ex-
“Robotic surgery is the ultimate mini-
pertise, standard for excellence in patient
mally invasive surgery,” Dr. Inge said. “It’s
outcomes and dedication to teaching
The designation as an Intuitive Surgi-
faster surgery, with smaller incisions, fast-
physicians as they adopt the latest, state-
cal GYN Epicenter puts Rex in an elite
er recovery, less scarring and less pain.
of-the-art technology into their surgical
category – the only epicenter of its kind
Patients go home sooner and can get back
practices.
in North Carolina and one of only 21 na-
to their normal lives in a fraction of the
tionwide.
time that traditional surgery requires.”
the da Vinci robot.
“Other surgeons view Dr. Inge and the Rex surgical team as best in class, mostly
The Rex epicenter team will be led by
According to the press advisory, Rex
because of the successful robotic surger-
Jack R. Inge Jr., M.D., with Mid-Carolina
Healthcare is one of the busiest robotic
ies we perform on patients every day,”
Obstetrics & Gynecology and the first sur-
surgery centers in the southeast. Dr. Inge
said Jayne Byrd, Rex’s vice president of
geon to perform a robotic hysterectomy at
and other physicians have performed
surgical services. “Physicians can visit
Rex in 2008, according to a press advisory.
more than 2,250 robotic surgeries at Rex
Rex, see the teamwork and realize that
“Dr. Inge has built a reputation for ex-
since the hospital installed its first da Vin-
they can do successful robotic surgeries
cellence, and is sought out by surgeons
ci Robotic Surgical System in 2008. The
at their own hospitals.”
across the southeast to teach the latest in
latest generation of robot is used by more
For more information about robotic
robotic surgical techniques,” the advisory
than two dozen surgeons for a wide range
surgery at Rex or its da Vinci robot, visit
said. “The epicenter distinction will bring
of gynecological, urological and general
rexhealth.com/robotic-surgery.
Venture Capital Firm Invests in Aerial BioPharma Research Rex Health Ventures, one of the na-
“This is precisely why we created
Aerial also is developing an early-stage
tion’s only venture capital funds managed
Rex Health Ventures and Rex Strategic
biologic to treat acute and chronic pain,
by a community, nonprofit hospital, has
Innovations: to find and support promising
a product licensed from the University
announced its first investment, a $500,000
companies with exciting products that
of North Carolina at Chapel Hill. Aerial
equity placement in Aerial BioPharma.
could improve the lives of thousands of
was started by the management team
Aerial, a Morrisville, N.C.-based com-
patients,” said Rex President David Strong.
behind Addrenex Pharmaceuticals and
pany, was formed in January 2011 by a
“We look forward to a long and successful
Neuronex, two successful Triangle-based
team of successful, veteran biopharma-
relationship with the very capable team at
start-up companies. The Aerial team
ceutical entrepreneurs. Aerial’s investiga-
Aerial.”
includes Chief Executive Officer Moise A.
tional narcolepsy treatment is currently
Rex
investment
Khayrallah, Ph.D.; President Steve Butts;
in Phase 2 clinical trials, and initial data
is part of an initial $3.8 million equity
and Gary Bream, Ph.D., executive vice
shows promise for controlling the symp-
financing, which Aerial will use for further
president of clinical affairs.
toms of the chronic, neurological sleep
clinical studies, as well as to pay for
“Partnering with Rex Health Ventures,
disorder, according to a Rex press release.
research and drug manufacturing. Other
which provides access to the resources
Health
Ventures’
In addition to providing the financial
participants in the funding round include
of a premier health care provider like Rex
investment, Rex may use its five sleep
a group of experienced angel investors
Healthcare, is a unique opportunity for a
centers across Wake County as clinical
based in Chattanooga, Tenn., led by David
company like ours,” Dr. Khayrallah said.
trial sites for future studies of Aerial’s
Adair, M.D.; and 3G Capital, led by Rakesh
“We look forward to tapping into Rex’s
narcolepsy drug.
Govindji.
network and expertise as we continue
18
The Triangle Physician
Rex News clinical work that will lead to new
of spurring health care innovation,
treatments.”
Healthcare.
improving health care delivery and
For more information, visit
Rex Health Ventures is part of the
services and fostering job creation. The
rexstrategicinnovations.com and
broader initiative known as Rex Strategic
fund was started in the spring with an
rexhealthventures.com.
Innovations
initial $10 million investment from Rex
that
has
the
mission
News
Affiliate AHA Board Leaders Named Eric D. Peterson, M.D., M.P.H., has
“We are a volunteer-led organization
leading killers. The AHA funds cutting-
been elected president of the 2012-2013
and are fortunate to have such strong
edge research, conducts lifesaving public
American Heart Association Mid-Atlantic
leadership driving our mission across
and professional educational programs
Affiliate board of directors, effective July
the affiliate,” said Jeremy Beauchamp,
and advocates to protect public health.
1. John J. Mullenholz will continue as
executive vice president of the Mid-
chairman.
Atlantic Affiliate.
The Mid-Atlantic Affiliate is one of seven affiliates that make up the national organization,
and
serves
Maryland,
Dr. Peterson is a
The American Heart Association is the
professor of medicine in
nation’s oldest and largest voluntary health
Virginia, Washington, D.C., North Carolina
the Division of Cardiology
organization dedicated to fighting heart
and South Carolina and parts of West
at Duke University Medical
disease and stroke. Its mission is to build
Virginia. To learn more or join, call (800)
Center. He is also the
healthier lives by preventing, treating and
AHA-USA1 or visit www.heart.org.
director of the Duke Clinical Research Institute. Dr. Peterson served on the American Heart Association’s (AHA) Mid-Atlantic Affiliate board between 2007 and 2010. He helped initiate the affiliate’s Mission:Lifeline Committee, has been a high-level advocate and a strong supporter of quality improvement initiatives. He also serves as president for the new Triangle, NC Metro Division AHA Board. Mr. Mullenholz practiced law with the United States
Department
Visibility defeating these diseases – two of America’s
• Get covered
• We know news people.
• We know what reporters & editors are looking for. • 30 years in the news business.
• Let potential patients, referring physicians know you’re an expert in your field. • We can even train your staff in media relations!
• We get results.
of
Justice and several firms before founding StaffWise Legal Inc., the first staffing agency for lawyers in the United States, which he opened in 1980. In March 2008, he founded Stonehouse Medical Staffing, a staffing company that specializes in placing temporary medical personnel in hospitals, assisted-living facilities, nursing homes and doctors offices. Mr. Mullenholz is past chairman and a current member of the Greater Washington Region Board of the American Heart Association.
PB Media • paul@pbmediacompany.com • 919-698-7871
July/august 2012
19
News Welcome to the Area
Physicians James Christopher Lorge, DO Orthopedic Sports Medicine, Orthopedic Surgery, Adult Reconstructive Triangle Orthopaedic Associates Durham
Yasir Abu-Omar, MD Duke University Medical Center Durham
Hassan Najeeb Albataineh, MD Neurology Duke University Hospitals, Durham
Wesam Awad Suliman Alhejily, MD Cardiology; Cardiovascular Disease, Internal Medicine Duke Medical Center, Durham
Gina Cleopatra Badescu, MD Anesthesiology Duke University Hospitals, Durham
Andrew Alan Berlowitz, MD Anesthesiology University of North Carolina Hospitals Chapel Hill
Jelena Catania, MD Infectious Diseases, Internal Medicine Duke University Hospital, Durham
Shelley Douglas Cathcart, MD Dermatology - Pediatric - Dermatology University of North Carolina at Chapel Hill Department of Dermatology Chapel Hill
Thomas Oran Dalton, MD Geriatrics, Internal Medicine Duke University Hospital, Durham
Jenny Myoung Detert, MD Pediatrics Duke University Hospitals Durham
Ryan Thomas Downey, MD Diagnostic Radiology Duke University Medical Center Durham
Ladan Espandar, MD Ophthalmology Duke Eye Center, Durham
James Alexander Feix, MD Anesthesiology Duke University Hospitals Durham
John Paul Galiote, MD Neonatal-Perinatal Medicine Duke University Medical Center Burlington
Rachel Gottron Greenberg, MD Pediatrics DUMC Pediatric Residency Program Durham
Jennifer Susan Guimbellot, MD Pediatrics; Pediatric Pulmonology Chapel Hill
Fletcher Lee Hartsell, III,MD Neurology University of North Carolina Hospitals Chapel Hill
Karen Rose Hippe, MD Rheumatology, Internal Medicine University of North Carolina Chapel Hill Chapel Hill
20
The Triangle Physician
Bradford Richard Hirsch, MD
Andrew Roper Lewis, MD
Ryan David Schulteis, MD
Hematology and Oncology, Internal Medicine Duke University Hospitals Durham
Diagnostic Radiology Duke Graduate Medical Education Durham
Internal Medicine Duke University Hospitals Durham
Lynn Jackson Howie, MD
Robert Walker McGarrah, III,MD
Yael Shiloh-Malawsky, MD
Hematology and Oncology, Internal Medicine Duke University Hospitals Durham
Cardiovascular Disease, Internal Medicine Duke University Hospitals, Durham
Wei Huang, MD
Erin Rebekah McNamara, MD
Neurology with Special Qualifications in Child Neurology University of North Carolina Hospitals Chapel Hill
Pediatric Urology, Urological Surgery Duke University Hospitals, Durham
Bryan Dorsey Smith, MD
Hawnwan Philip Moy, MD
Child and Adolescent Psychiatry; Psychiatry 106 Watertree Ln, Apex
Ophthalmology Duke University Hospitals, Durham
Susan Rachel Hupp, MD Pediatrics; Critical Care Pediatrics Duke Children’s Hospital Durham
Krystal Andrea Irizarry, MD Pediatrics Duke University Hospitals, Durham
Phillip Bryce Jones, MD
Emergency Medicine UNC Emergency Medicine Chapel Hill
Romita Mukerjee, MD
Pediatrics Duke University Medical Center Durham
Internal Medicine, Nephrology DUMC Div of Nephrology, Durham
Amy Polen Stallings, MD
Kimtuyen Ngoc Nguyen, MD
Internal Medicine; Psychiatry University of North Carolina Hospitals Chapel Hill
Pulmonary Disease and Critical Care, Critical Care-Internal Medicine University of North Carolina Hospitals Chapel Hill
Heema Kaul, MD
Daniel Esimajurono Okorodudu, MD
Ophthalmology Duke Eye Center, Durham
Endocrinology, Internal Medicine, Diabetes & Metabolism Duke University Hospitals Durham
Carly Elizabeth Kelley, MD Internal Medicine Duke University Hospitals Durham
Jacob Patrick Kelly, MD
Lauren Lee Smith, MD
Pediatric Allergy, Allergy and Immunology Duke Pediatric Allergy and Immunology Raleigh
Sally Gowen Stander, MD Anesthesiology University of North Carolina Hospitals Chapel Hill
David Sheldon Stroud, MD Hospitalist; Internal Medicine WakeMed Faculty Physicians, Raleigh
Jeffrey Ryan O’Rear, MD
Sarah Langston Thomas, MD
Radiology Duke Radiology, Durham
Diagnostic Roentgenology Radiology; Musculoskeletal Radiology; Neuradiology; Vascular and Interventional Radiology; Nuclear Medicine; Nuclear Radiology; Pediatric Radiology University of North Carolina Hospitals Chapel Hill
Internal Medicine, Critical Care Medicine, Cardiovascular Disease Duke University Cardiology Fellowship Durham
Manisha Palta, MD
Megan Gates Kemnitz, MD
Diagnostic Radiology Duke University Medical Center Durham
Irene Tintin Tung, MD
David Balis Patton, MD
Irene Zenobia Whitt, MD
Psychiatry Duke University Medical Center Durham
Internal Medicine; Rheumatology Duke Rheumatology, Durham
Alexis Lindsay Ponder, MD
Neurological Surgery, Critical Care Medicine, Vascular Neurology Duke University Hospital, Durham
Emergency Medicine, Urgent Care, Pediatric Emergency Medicine Duke University Hospitals Durham
Amantia Kennedy, MD Obstetrics and Gynecology University of North Carolina Hospitals Chapel Hill
Jared Mugabe Kiddoe, MD Psychiatry; Child Psychiatry Duke University Hospitals Durham
Soo Hyun Kim, MD Anesthesiology - Critical Care Medicine Duke University Hospitals Durham
Kelly Smith Kimple, MD Pediatrics University of North Carolina Hospitals Chapel Hill
Evan Loren Kulbacki, MD Anatomic Pathology and Clinical Pathology Duke University Hospitals Durham
Sang Il Lee, MD Pediatric Surgery Division of Pediatric Surgery, North Carolina Children’s Hospital Chapel Hill
Lindsay Hawkins Lefler, MD Pediatrics Duke Children’s Primary Care Durham
Radiation Oncology 3021 Bear Oak Lane, Cary
Arthur Arta Parsee, MD
Internal Medicine University of North Carolina Hospitals Chapel Hill
Kristen Leverett Pyrc, MD Child Psychiatry; Psychiatry University of North Carolina Hospitals Chapel Hill
Virginia Stinson Radcliff, MD Pulmonary Disease and Critical Care, Internal Medicine 1202 Spring Meadow Dr., Chapel Hill
Tiffany P. Callaway Randolph, MD Internal Medicine; Cardiology Duke University Hospitals Durham
Anshul Mocherla Rao, MD Rheumatology, Internal Medicine Wayne Heart & Internal Medicine Associates, Goldsboro
Michael Rosario-Prieto, MD Neurology; Neuromuscular Medicine Duke University Hospitals, Durham
Adia Kamali Ross, MD Internal Medicine Duke University Hospitals Durham
Ophthalmology Duke Eye Center, Durham
Julian P Yang, MD
Rupal Lakhani Yu, MD Family Medicine University of North Carolina Hospitals Chapel Hill
Joseph Charles Zola, Jr,MD Urological Surgery Granville Urology Associates Oxford
Physician Assistants Megan Kathryn Fuchs, PA 1816 Ivey Road Chapel Hill
Anne Fulbright, PA 300 Highgrove Drive, Chapel Hill
Kaylene Larissa Hood, PA Raleigh
Kenneth Scott Shedarowich, PA Emergency Medicine; General Practice; Hospitalist; Pediatric Hematology-Oncology 38 Tanglewood Drive, Southern Pines
“More than a doctor. Like a friend.”
We know it by heart.
Trust. WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it. We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.
Cardiovascular Professionals in Johnston, Wayne and Wilson Counties Mateen Akhtar, MD, FACC Benjamin G. Atkeson, MD, FACC Kevin R. Campbell, MD, FACC Randy A.S. Cooper, MD, FACC Christian Gring, MD, FACC
Matthew A. Hook, MD, FACC Eric M. Janis, MD, FACC Diane E. Morris, ACNP Ravish Sachar, MD, FACC Nyla Thompson, PA-C
Waheed Akhtar, MD, FACC Malay Agrawal, MD, FACC Sunil Chand, MD, FACC Paul Perez-Navarro, MD, FACC Joel Schneider, MD, FACC
Cardiovascular Services Echocardiography Nuclear Cardiology Interventional Cardiology Carotid Artery Interventions Cardiac Catheterization Cardiac CT Angiography and Calcium Scoring Electrophysiology and Cardiac Arrhythmias Peripheral Vascular Interventions Pacemakers / Defibrillators Stress Tests Holter Monitoring Lipid and Anti-Coagulation Clinics Vascular Ultrasounds / AAA Screening
WHV Locations in Johnston, Wayne and Wilson Counties 910 Berkshire Road Smithfield, NC 27577
2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520
2605 Forest Hills Road South West Wilson, NC 27893
2400 Wayne Memorial Drive, Suite A Goldsboro, NC 27534
Phone: 919-989-7909 Fax: 919-989-3147
Phone: 919-359-0322 Fax: 919-359-0326
Phone: 252-243-7049
Phone: (919) 736-8655 Fax: (919) 734-6999
When it comes to your cardiovascular care – We know it by heart. To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).
DIAGNOSTIC IMAGING | PEDIATRIC IMAGING | SPORTS IMAGING | NEURORADIOLOGY ADVANCED BREAST IMAGING | INTERVENTIONAL RADIOLOGY | ONCOLOGIC IMAGING
Since 1953, Wake Radiology has been a leader in diagnostic imaging in the Triangle and beyond. We bring to you and your patients the most advanced imaging technologies available, delivered with the reassurance and compassion that are at the heart of health and healing. We have 18 outpatient imaging locations throughout the Triangle—many offering studies on evenings and Saturdays, including screening mammography, CT, Ultrasound, and MRI exams. Wake Radiology’s 55 subspecialty trained radiologists diagnose injury and illness quickly, while working with you and your staff to ensure the best possible outcome. So, the next time your patients require medical imaging think of Wake Radiology, where outstanding imaging is backed by expertise, convenience, and compassion. Wake Radiology. Here when you and your patients need us. Wake Radiology is the only multi-site outpatient imaging service provider in the Triangle to receive the American College of Radiology’s designation of Breast Imaging Centers of Excellence. Scan now to request a Screening mammogram with your smartphone.
Express Scheduling 919-232-4700 | Chapel Hill Area Express Scheduling 919-942-3196 | wakerad.com
©2012 Wake Radiology. All rights reserved.
©2011 Wake Radiology. All rights reserved. Radiology saves lives.
Advanced Imaging For The Entire Family.