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Raleigh Radiology, this month’s cover story, is a widely known and respected specialty practice dedicated to quality. Did you know the group also works to be the lowest-cost radiology practice serving the region as well? In this month’s article, Raleigh Radiology showcases advances in the treatment of vascular insufficiency and varicose veins. Read on and you’ll learn that the practice performs a diverse range of interventional services that offer an alternative to hospital-based procedures. It’s a winning formula, as Raleigh Radiology’s growth demonstrates.
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Eric D. Challgren, M.D. Marni Jameson Margie Satinsky, M.B.A. Michael J. Thomas, M.D., Ph.D. Creative Director Joseph Dally jdally@newdallydesign.com
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disease. Dermatologist Eric Challgren discusses pediatric medicine and the unique complications that must be overcome in being an effective provider. Practice management consultant Margie Satinsky recommends annual practice assessments to gauge vitality and set sights on sustaining it. Congratulations to the Association of Independent Doctors, which is hosting its first annual meeting Nov. 5 in Orlando. Thank you to our advertisers and contributors for making our magazine a part of your marketing mix. You’re certainly part of our winning formula, and based on what you tell us, your investment in The Triangle Physician is producing great returns for you as well. Here’s to continued delivery of medical community news and information to the more than 9,000 medical professionals throughout the Raleigh-Durham region. With gratitude for all you do,
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The Triangle Physician
Table of Contents
6
COVER STORY
Raleigh Radiology
Leading the Way in the Future of Imaging and Patient-Centric Excellence june 2016
Vol. 7, Issue 6
FEATURES
10
Practice Management
Check Your Practice Pulse Annually by Doing a Practice Assessment Consultant Margie Satinsky encourages a regular check up for
DEPARTMENTS 12 PHYSICIAN ADOCACY Independence in Action 2016: Independent Doctors to Unite at First Annual AID Meeting Nov. 5
14 COMMUNITY RESPONSE Down Syndrome Achievement Center Opens in Raleigh
practices, done either by office staff or contracted out.
11
15 DUKE RESEARH NEWS Bioengineered Blood Vessel Appears Safe for Dialysis Patients
Dermatology
Pediatric Care Is More Than Skin Deep Dermatologist Eric Challgren discusses the impact of dermatologic conditions on the patient and caregiver and strategies for care.
16 NEWS
- Welcome to the Area
- “Breakthrough� Status Expedites Research on Poliovirus Therapy
On the Cover: Interventional radiologist Jason Harris, M.D., performs a sphenopalatine ganglion block (SPG) procedure to treat chronic migraines.
june 2016
5
Cover Story
Raleigh Radiology
Leading the Way in the Future of Imaging and Patient-Centric Excellence Raleigh Radiology is among the Triangle’s
In July Raleigh Radiology will welcome
Venous
most consistent for offering affordable,
Jamie Doster, M.D., a vascular and
dysfunctional valves that normally keep
quality imaging interpreted by high-
interventional
began
the blood moving in one direction toward
caliber, subspecialty-trained radiologists.
her undergraduate pursuits at Florida
the heart. As the valves fail, gravity causes
This combination is driving the non-stop
State University and attended medical
blood to pool within the superficial veins
growth of this Research Triangle Park
school at Florida State University College
of the legs, resulting in the thickening and
imaging favorite.
of Medicine. Currently, Dr. Doster is
bulging typical of varicosities.
radiologist
who
insufficiency
results
from
completing her fellowship in vascular and Raleigh Radiology continues to meet the
interventional radiology at the University
The condition is usually progressive and
needs of both patients and their referring
of Virginia in Charlottesville.
worsens with time. In later stages, venous insufficiency can lead to skin discoloration
physicians by adding the most advanced
and even difficult-to-treat skin ulcers.
modalities to its comprehensive host of
Venous Insufficiency and
imaging services. Currently, its staff of 25
Varicose Veins
radiologists represents a combined 450
The focus of this article is on Raleigh
Varicose veins, therefore, are much more
years of experience. Each physician has
Radiology’s vascular and interventional
than a cosmetic issue. There is a serious
subspecialized training from some of the
services to treat lower-extremity venous
medical basis. A significant number of
nation’s most prestigious institutions.
insufficiency and varicose veins.
patients with varicose veins also suffer
Raleigh
interventional
These services were expanded in 2009
aching leg pain, fatigue, itching and
radiologists are led by Jason Harris, M.D.,
with the launch of the Vascular and
swelling, all of which typically increase as
section chief of vascular and interventional
Interventional Clinic at its Blue Ridge Road
the day progresses.
services. The current team of vascular and
facility. Increased awareness and demand
interventional radiologists also includes
necessitated expansion to a second
Enhanced Treatment Using
Raleigh
location in Cary that opened in 2013.
Minimally Invasive Alternatives
from other symptoms that may include Radiology
Radiology
President
Satish
Historically treatment of varicose veins
Mathan, M.D., along with Andrew Weber, M.D., and Mark Knelson, M.D.
to
involved major surgery and a lengthy
advancing the science of vascular and
recovery. Today minimally invasive laser
interventional radiology, which means also
applications have transformed treatment,
offering minimally invasive therapeutic
so it is now often an in-office procedure,
options that are highly effective. As a
with greatly reduced recovery time.
Raleigh
Radiology
is
dedicated
result, more patients are being referred for such conditions as venous insufficiency
Treatment for venous insufficiency may
and varicose veins.
involve techniques for eliminating the greater saphenous vein. As the primary
Venous insufficiency affects an estimated
superficial vein in the leg, dysfunction
50 percent of men and women 50 and
within this vein most often results in
older and 15-25 percent of all adults. The
varicosities and other symptoms.
most common risk factors are age, family Neuroradiologist Jamie Doster, M.D., is joining Raleigh Radiology in July.
6
The Triangle Physician
history, female gender and, especially,
Surgical vein stripping or ligation of
pregnancy.
the saphenous vein often resulted in
Interventional Radiologist Mark Knelson, M.D., performs a procedure to treat varicose veins.
significant trauma to the leg. It required
all of which Raleigh Radiology offers at its
More Outpatient
general anesthesia and weeks or even
clinic.
Interventional Services Radiologists
months of recovery.
at
Raleigh
Radiology’s
Guidance Using Advanced Vascular
Vascular and Interventional Clinics in
As a minimally invasive alternative, in-
Ultrasound Technology
Blue Ridge and Cary consult for a range of
terventional radiologists are now able to
Patients begin their treatment at the
interventional procedures outside of the
employ endovascular ablation. Through a
Vascular and Interventional Clinic by
hospital setting.
small puncture near the knee, they access
giving their clinical history and getting
and ablate the entire length of the greater
a physical exam. Usually the next step is
Consultations
saphenous vein. Ultrasound guidance pro-
ultrasound.
embolization (UFE), pelvic congestion
for
uterine
fibroid
syndrome, kyphoplasty, endovenous laser
vides direct visualization. Vascular ultrasound plays a key role in
therapy, sclerotherapy, therapeutic and
The same-day procedure performed in an
the diagnosis and the treatment of lower-
diagnostic paracentesis, thermal ablations,
office setting has a low risk of complica-
extremity venous insufficiency. Long a
PICC
tions. It requires only a local anesthetic
part of Raleigh Radiology’s interventional
catheter) lines and port placements,
and is followed by quick recovery time.
practice, vascular ultrasound enables the
checks and removals are often performed
physician to confirm valve dysfunction,
in
Given the proven effectiveness of venous
to determine if the patient is a candidate
that require pre-imaging (i.e., magnetic
ablation, most insurance companies cover
for laser therapy and to map the lower-
resonance imaging of the pelvis for UFE
minimally invasive treatments when they
extremity venous anatomy to establish the
or of the spine for kyphoplasty) can be
follow failed conservative therapy and
precise sources of venous insufficiency.
performed in the same visit for patient
(peripherally
office.
In
inserted
addition,
central
consultations
convenience, also making scheduling
medical necessity for symptom relief. Of Raleigh Radiology’s seven locations
easier for referring physicians and for
All immediate postoperative care is
throughout Wake and Johnston Counties,
patients.
handled through the clinic. Physicians
six offer the most affordable vascular
follow up with patients to ensure proper
ultrasound studies, which are performed
The newest vascular and interventional
recovery and perform further management
by registered vascular technologists. A
services offered in the outpatient setting
of their varicose disease if necessary.
fellowship-trained, subspecialized vascular
include spenopalatine ganglion block
Adjuvant therapies might include ablation,
and interventional radiologist reads every
(SPG) and intravenous catheter (IVC)
ambulatory phlebectomy or sclerotherapy,
study.
filter placements and removals. All are
june 2016
7
preformed on the C-Arm at the Vascular
Missouri School of Medicine in Kansas City
Raleigh
Radiology’s
radiologists
and
and Interventional Clinic in Cary.
and is completing his fellowship at Duke
technologists have taken the Alliance for
University Medical Center.
Radiation Safety in Pediatric Imaging’s “Pledge to Image Gently.” In so doing,
Expansion of Peter Tanpitukpongse, M.D., will join Ra-
they follow all guidelines and methods to
Raleigh Radiology is welcoming two new
leigh Radiology in October. Dr. Tanpituk-
reduce radiation doses during pediatric
physicians who are subspecialized in
pongse completed his undergraduate
medical imaging exams. In support of the
neuroradiology.
education at Johns Hopkins University
Radiation Safety in Adult Medical Imaging
and attended medical school at New York
campaign, Raleigh Radiology also pledges
University. He completed his neuroradiol-
to “Image Wisely,” using the lowest
ogy fellowship at Duke University Medical
radiation dose possible for adult patients.
Neuroradiology Services
Center. Raleigh Radiology is also currently seeking accreditation
Excellence in Quality Radiology
is
committed
to
providing the latest technology and maintaining
the
the
Intersocietal
Accreditation Commission for the Blue
Patient-Focused Care Raleigh
from
highest
Ridge and Cary Vascular and Interventional Clinics.
professional Committed to excellence in patient care,
standards.
convenience and affordability, Raleigh Its facilities are accredited by the American
Radiology is a leader in paving the way
Neuroradiologist Mustafa Khan, M.D., is joining Raleigh Radiology in July.
College of Radiology (ACR). The practice
for advanced radiologic treatments in the
observes
Quality
community. Practice leaders, medical
Mustafa Khan, M.D., will join the practice
Standards Act (MQSA) and is designated
staff and technologists are proud of this
in July. He earned his undergraduate and
as a computed tomography lung cancer
commitment to quality and the value of
doctoral degrees from the University of
screening center.
their services to the Triangle.
the
Mammography
Interventional Radiologist and Raleigh Radiology President Satish Mathan, M.D., treats spider veins using sclerotherapy.
8
The Triangle Physician
Endocrinology
Focus on Graves’ Disease By Michael J. Thomas, M.D., Ph.D.
Graves’ disease (also known as toxic
symptoms typically start to improve within
diffuse goiter) is the most common cause
two to four weeks of starting therapy.
of hyperthyroidism. It is an autoimmune
Thyroid
disorder
affects
enzymes are typically monitored every six
the thyroid, causing hyperthyroidism.
to eight weeks and, then less frequently, as
Occasionally
of
they stabilize. Most patients with Graves’
cases), the eyes are affected (Graves’
disease should be treated with anti-thyroid
ophthalmopathy)
uncommonly,
drugs for at least 12-18 months, as the dose
(about two percent) the skin is affected
is slowly tapered. If the patient remains
(Graves’
that
nearly (about
always 30
and,
percent
function
tests
and
hepatic
e.g.
pretibial
euthyroid on low-doses of antithyroid
disease
occurs
drugs, then the medication is eventually
most commonly in young adults, with a
held, in order to see if their Graves’ disease
female:male ratio of about 5:1.
has gone into remission.
The hallmark of this disease is the presence
Common side effects of antithyroid
of a thyroid-stimulating antibody, which
medications include rash/hives, muscle
binds to the thyrotrophin (TSH) receptor,
aches, headaches and nausea. These
causing the thyroid gland to increase
symptoms occur about 2 percent of the
production of thyroid hormone. Like other
time. Less common but more serious
autoimmune diseases, Graves’ disease can
side effects include liver and kidney
wax and wane, or go into remission. This
damage. The most serious side effect is
may have implications on how to approach
agranulocytosis, occurring in about 1 out
therapeutic intervention.
of 300 patients on antithyroid medications.
dermopathy,
myxedema).
Graves’
Dr. Michael Thomas graduated from the School of Medicine at West Virginia University in Morgantown, with medical and doctorate degrees in pharmacology and toxicology. He completed post-graduate medical training at Barnes Hospital at Washington University in St. Louis, including his internship, residency and fellowship in endocrinology. Dr. Thomas established Carolina Endocrine, P.A., in the summer of 2005. He was previously a faculty member in endocrinology/medicine at Washington University, the University of Iowa and the University of North Carolina at Chapel Hill. Dr. Thomas is board certified in internal medicine and endocrinology and is licensed to perform endocrine nuclear medicine procedures and therapies at Carolina Endocrine. He is a fellow of the American College of Endocrinology and has completed Endocrine Certification in Neck Ultrasound.
Patients should be advised to discontinue Physical findings include clinical signs and
medication and contact their medical
particularly children and pregnant women.
symptoms of hyperthyroidism. The thyroid
provider if symptoms of high fever or sore
Women of childbearing age should avoid
gland is usually enlarged, and may have a
throat develop and have a complete blood
pregnancy for six months. Patients who
thyroid bruit or, less commonly, a palpable
count evaluated for white blood count and
have Graves’ ophthalmopathy should be
thyroid thrill. Other stigmata of Graves’ eye
neutrophil count.
seen in consultation by an ophthalmologist, since there is controversy as to whether
disease include proptosis/exophthalmos, lid lag or dysconjugate gaze. Diagnosis is
Radioiodine therapy (I-131) has been
radioiodine treatment exacerbates the eye
often made by the measurement of serum
effectively used to treat hyperthyroidism
condition.
thyrotrophin receptor antibody (TRAb) or
for the past 70 years. It involves the
thyroid-stimulating immunoglobulin (TSI).
administration of a radioiodine pill, which
Surgery is another option for treating
Alternatively, a radioiodine uptake (RAIU)
slowly causes the thyroid gland to recede
hyperthyroidism. It is usually employed
measurement is often increased, reflecting
in size and function.
when the patient has an extremely large goiter or in uncommon circumstances
a marked increase in iodine metabolism by the thyroid gland. A thyroid nuclear
The main disadvantage to radioiodine is
during
medicine scan may show homogeneous
the development of hypothyroidism, which
drugs
uptake throughout the thyroid gland.
usually requires life-long thyroid hormone
radioiodine therapy is not possible.
replacement. When advising radioiodine it
Drawbacks to surgery include post-
Antithyroid medications are medications
is important to consider the social situation
surgical hypothyroidism and a small risk
that block thyroid hormone production.
of the patients, who will need to follow
for developing injury to the recurrent
They include methimazole (Tapazole)
some safety precautions after treatment,
laryngeal
including minimizing exposure to others,
hypoparathyroidism.
and propylthiouracil (PTU). Hyperthyroid
pregnancy might
not
nerve
when be
and
antithyroid
tolerated
and
post-surgical
june 2016
9
Practice Management
Check Your Practice Pulse Annually by Doing a Practice Assessment By Margie Satinsky, M.B.A.
When is the last time you stepped back
practice assessment, it makes more sense
and objectively assessed all aspects of
to engage someone outside the practice.
your medical practice? If you are like
Outsiders can be more objective than in-
most busy physicians who are managing
siders. They don’t need to worry about of-
increased patient loads and day-to-day
fice hierarchy and politics or the potential
operations, you haven’t made that effort
impact of the assessment project on their
recently.
jobs. Insiders are more candid with someone who is outside the organization than
What Is a Practice Assessment
they are with a colleague or co-worker.
and Why Do It?
Outsiders also have the advantage of offer-
A practice assessment is an objective eval-
ing the practice practical suggestions that
uation of the current status of a medical
may have been effective in other similar
practice. A thorough practice assessment
situations.
focuses on organization and management,
Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She has helped many physicians start new practices, assess the wisdom of affiliating with a larger health care system and improve their current practices. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century. For more information, visit www. satinskyconsulting.com.
financial management, marketing (includ-
2. Designate an internal point person.
ing Website), information technology (in-
Effective practice assessments combine
cluding software systems, hardware and IT
good questions and recommendations
support), quality measurement, human re-
developed by the external consultant with
sources and compliance (HIPAA and oth-
thoughtful input by the practice. An inter-
4. Design and execute the game plan
er government regulations) and the way in
nal point person can smooth the way. In
for the assessment. We recommend a
which all of these areas impact workflow.
a private practice environment, the physi-
face-to-face meeting to begin the fact-find-
cian owner is usually the most appropri-
ing process. Once the consultant has ba-
Well-run practices conduct a practice as-
ate person to serve as the liaison with the
sic knowledge about the way in which the
sessment every year. They use the findings
external consultant.
practice works and some of the perceived issues, he/she can develop a draft custom-
to identify aspects of practice management that work well and those that need
3. Solicit input from many people.
ized list of questions to share with practice
improvement. The assessment may be
Maximize the number of clinical and ad-
leaders in order to obtain their input.
used as the first step in a formal strategic-
ministrative staff that provides input to the
planning process. The first practice assess-
assessment questions. Different people
After the assessment questions have been
ment takes the most amount of time. Sub-
have different perspectives on each issue,
finalized, solicit input from all or selected
sequent efforts require less time and effort.
and the goal is to solicit as much informa-
clinical and administrative staff and pos-
tion as possible. Inevitably, some of the in-
sibly from patients. For workforce mem-
Suggested Steps
formation will conflict; everyone has his/
bers, we like to send an electronic version
1. Seek external expertise. Although it’s
her own opinion on a given situation and
description of the project and the assess-
possible to designate an internal member
remedial action. Many practices solicit
ment questions, offering each person the
of the practice as the individual who is
information from patients as well as from
opportunity to read the information prior
responsible for designing and executing a
workforce members.
to the all-important face-to-face interview.
10
The Triangle Physician
Dermatology A candid and confidential one-on-one
responded to the assessment questions,
suggestions, postponing the development
conversation reveals far more than a com-
combine the answers, respecting confi-
of a strategic plan until a later date.
puter-generated survey. With respect to
dentiality and preserving the anonymity of
patient input, effective tools are small fo-
the responses.
Consider the first independent practice assessment as a baseline. Repeat the pro-
cus groups, brief online surveys and, less Use Assessment Results
cess again within a year, taking the oppor-
The assessment may be used as the founda-
tunity to note progress and items still to be
5. Combine the results of the assess-
tion for a formal strategic plan. Or the prac-
addressed.
ment questions. After everyone has
tice may decide to act on particular urgent
frequently, one-on-one interviews.
Pediatric Care Is More Than Skin Deep By Eric D. Challgren, M.D.
A
dermatologists
treating
pediatric
immediate
psychological
impact
on
patients must overcome a unique set of
children who will have to undergo multiple
complications when treating children.
uncomfortable treatments. If a child comes
Even innocuous skin conditions on a child
in once and experiences pain, she will
can have a massive impact on his or her
likely begin to resist future treatments. As
wellbeing.
a result, the treatment process can become much harder for both the parents and the
While all health care includes significant
doctor.
emotional aspects, it is particularly important in dermatology to consider the self-
Of course, there is no easy way to prepare
confidence and self-perception of patients.
a patient for discomfort and even pain. So a
This is because skin carries with it a unique
doctor must try to maintain the trust of the
set of psychological aspects.
patient and accompanying caretakers. That means having an honest dialogue – even if
Our skin is inextricably connected to how
the patient is a child – on what to expect.
people perceive us and how we perceive ourselves. It even goes beyond the patients
Today, a doctor’s responsibility when
themselves, such as parents, who are
treating children goes beyond proper
concerned about the health (and perceived
diagnosis and prescription. It not only
health) of their children.
involves designing treatment plans, but
Dr. Eric Challgren graduated from North Carolina State University with a bachelor of science degree in chemical engineering. He earned his medical degree from the Medical College of Ohio and completed his internal medicine internship at Medical College of Ohio and dermatology residency at the Medical College of Wisconsin. Dr. Challgren is a fellow of the American Society for Mohs Surgery and a member of the American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Society of Pediatric Dermatolgy, American Academy of Dermatology, American Medical Association, North Carolina Medical Association. Areas of special interest include Mohs surgery, pediatric dermatology, dermatologic surgery, cosmetic dermatology and skin cancer.
proposing them and effectively educating For example, parents of children with
parents
successful
As a result, being a dermatologist treating
neonatal acne have to deal with feelings
continuation outside of the doctor’s office.
or
caretakers
on
children can be both intimidating and
of guilt and insecurities about the future,
When treating teenagers, tenable solutions
rewarding. It involves recognition of the
compounded by glances from other parents.
will include methods to help them accept,
deep-seated emotional lives of both children
Although the acne will most likely clear up
actively participate in and remember
and parents. The rewards are the thanks
on its own, a doctor must navigate between
treatments.
we get for our work – even if it sometimes
the physical and psychological wellbeing of
isn’t until five years down the road – when
patients and family. Deciding on treatments
There is a lot at stake when we talk
parents return for their own treatments and
can quickly become complex.
about pediatric dermatology. Children’s
tell us that coming here was one of the best
confidence is perhaps the single largest
things they ever did for their child.
Doctors also must consider the more
factor for success.
june 2016
11
Physician Advocacy
Independence in Action 2016 Independent Doctors to Unite at First Annual AID Meeting Nov. 5 By Marni Jameson
One of the most common questions doctors
Disney Swan & Dolphin Resorts in Orlando.
ask me when they join the Association of Independent Doctors is “Do you have an
While the one-day event is open to all doctors
annual meeting?”
interested in preserving their independence, AID members will enjoy a discounted
Up until now the answer has been, “We plan
registration rate.
to – someday.” Some day, when we’re bigger and have more members, have a solid core
AID was established in April 2013 to create a
of sponsors and are well-enough established.
voice for independent doctors who did not
Marni Jameson is the executive director of the Association of Independent Doctors. You may reach her at (407) 571-9316 or marni@aid-us.org. Visit www.aid-us.org for more information.
want to be acquired by a hospital, but who Well, I am delighted to announce, someday
felt alone in their fight for autonomy. Since
the Center for Hospital Finance and Manage-
has come. Our three-year-old association will
then the national non-profit has grown to
ment, Dr. Anderson is a leading authority on
host its first member meeting, Independence
represent nearly 1,000 members in 14 states
health care payment reform. He will discuss
in Action 2016, Saturday, Nov. 5, at the Walt
coast to coast.
how price decisions made by physicians and hospitals influence profits, revenue and qualNow these far-flung mem-
ity of care. He also will examine the charac-
bers, from Maine to Los
teristics that allow doctors and hospitals to
Angeles, can meet other
have the greatest bargaining power, reveal
like-minded doctors, while
who is most likely to use the power to their
hearing
nationally
advantage and how, and reasons behind his
recognized speakers who
findings that nonprofit hospitals are actually
will share their insights into
among the nation’s most profitable.
from
the future of independent practices, dynamics in the marketplace and survival tactics. Here are some of the renowned speakers who will be presenting at Independence in Action 2016. Gerard Anderson, Ph.D. Follow the Money
12
The Triangle Physician
Richard Gunderman, M.D. The Case for Autonomy Professor of radiology, pediatrics, medical education, philosophy, liberal arts and philanthropy and vice-chair of the radiology department at Indiana University, Dr. Gunderman is also a contributing writer to The Atlantic, where his views as both a philosopher and physician are relevant and profound. At AID’s conference, Dr. Gunderman will make the case for doctor independence with his trademark grace,
A professor of health pol-
humanity, authority and reason. He will
icy and management at
address some of the many thought-provoking
Bloomberg School of Pub-
questions he has tackled for The Atlantic:
lic Health, John Hopkins
Should doctors work for hospitals? Should
University, and director of
hospitals make a profit or a difference? Do
Physician Advocacy drugstore clinics hurt or hinder the doctorpatient relationship? And why physicians are burning out at a young age? Michael Reilly, M.D. Games Hospitals Play Orthopedic surgeon and whistle blower,
MOHS MICROGRAPHIC SURGERY • EXCISIONAL SURGERY • CRYOSURGERY
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Dr. Reilly is the force behind the secondlargest hospital false-claims settlement in United States history. The case Michael T. Reilly, MD vs Broward Health culminated in a landmark $70 million Stark law settlement last year. In his talk, Dr. Reilly will share his 12-year journey as he battled the ninth largest health care system in the country –
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law violations and false claims, attorney Wilbanks has championed cases that have resulted in more than $2 billion in settlements being returned to the U.S. Department of the Treasury. Sharing lessons learned from fighting fraudulent claims on behalf of the American taxpayer, Mr. Wilbanks will discuss recent settlements he’s won, how these cases impact providers and the scope and potential impact of current cases. He also will discuss the vital and courageous role of the whistle blower. If you’re an independent doctor and care about staying that way, you don’t want to miss this conference. To take advantage of early bird rates, sign up before Aug. 15 at www.aid-us.org/conference. • Member registration before Aug. 15 – $100; after Aug 15 – $175 • Non-member registration before Aug. 15 – $150; after Aug 15 – $225 Join AID today and save.
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13
Community Response
Down Syndrome Achievement Center Opens in Raleigh Syndrome
The Triangle community was invited to
Achievement Center is celebrating the
participate in tours showcasing playhouse
opening of its 31st United States location,
programs. Fun activities included a
at 2887 Jones Franklin Road in Raleigh.
bounce house, music and a performance
GiGi’s
Playhouse,
Down
by the Alpha Athletics special-needs cheer team.
GiGi’s
Playhouse,
Down
Syndrome
Achievement Centers offer free educational and therapeutic programming to in-
“Our
dividuals of all ages with Down syndrome,
to change the way people view Down
program
participants
their families and the community. The pro-
syndrome through their amazing self-
grams focus on skill development in the
confidence
and
areas of education, social skills, speech
Playhouse
founder
and language skills, fine- and gross-motor
Nancy, mother of GiGi, opened the first
Nancy and GiGi were special guests at the
development and job training.
playhouse in Hoffman Estates, Ill., in 2003.
June 18 Raleigh grand opening.
skills,”
continue
says
Nancy
GiGi’s Gianni.
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in Mental HealthCare, PLLC
(919) 314-0381 • (877) 712-7168 www.carolinapartners.com Fast Appointments • In-Network With Most Insurance Plans 14
The Triangle Physician
Lucia Romano from Chapel Hill and Matthew Schwab from Holly Springs both will benefit from the programs at GiGi’s
Countless volunteers worked to make the new GiGi’s Playhouse possible. To donate and/or volunteer, send an e-mail to: cmoore@gigisplayhouse.org.
CME Courses Ahead Duke Urologic Surgery presents “DUKE TUESDAY IN UROLOGY”: Morris Center for Urologic Research Lectureship presented by Samir Taneja, MD July 12, 2016 1–5 p.m. Searle Conference Ctr. in the Seeley G. Mudd Bldg., Duke Medical Ctr. Durham, NC http://urology.surgery.duke.edu/ Duke Urologic Surgery presents “DUKE TUESDAY IN UROLOGY”: John E. Dees Lectureship presented by Margaret Pearle, MD , PhD Nov. 1, 2016 1–5 p.m. Searle Conference Ctr. in the Seeley G. Mudd Bldg., Duke Medical Ctr. Durham, NC http://urology.surgery.duke.edu/ DUKE UROLOGIC ASSEMBLY & DUKE UROLOGIC CANCER SYMPOSIUM: March 9 – 12, 2017, JW Marriott Grande Lakes, Orlando, FL http://urology.surgery.duke.edu/
Duke Research News
Bioengineered Blood Vessel Appears Safe for Dialysis Patients Bioengineered blood vessels developed by researchers at Duke
principals of Humacyte Inc., which supported the clinical trial.
University, Yale University and the tissue-engineering company Humacyte appear to be both safe and more durable than
To create the vessels, the researchers first isolated vascular cells
commonly used synthetic versions in patients undergoing kidney
from human donors and grew them in tissue culture. They then
dialysis, the researchers report.
placed the cells on a degradable scaffold shaped like a blood vessel. As the tissue grew, it was bathed in nutrients and stretched
The findings, published May 12 in The Lancet, resulted from a
to acquire the physical properties of real blood vessels.
Phase 2 study among 60 patients with kidney failure who required dialysis, which often necessitates a synthetic graft when the
“After that process, which takes eight weeks, the scaffold degrades
patient’s own blood vessel degrades from frequent needle sticks.
and what we have left is engineered tissue that we have grown from scratch,” Dr. Niklason said. The final step was to wash away the cells with a special solution. The remaining “de-cellularized” tissue retains the structure of the vessel but none of the components that would cause tissue rejection. One year after implantation, the bioengineered vessels appeared to be both safe and functional, maintaining their mechanical integrity, the researchers report. The patients also showed no sign of rejection.
Duke surgeons implant a bioengineered blood vessel in a kidney dialysis patient. Credit: Shawn Rocco, Duke Health News
While there were cases of adverse events, such as clotting, the rates of those events were comparable to other dialysis grafts.
Such grafts, however, are prone to infection, clotting and other
Notably, the durability of the bioengineered vessels at one year
complications. Alternative bioengineered grafts derived from the
was 89 percent, compared to the approximately 60-percent rate of
patient, a donor or animal tissue have been shown to perform no
synthetic grafts reported in previous studies.
better than synthetics. Additionally, the researchers noted that after implantation, the The Duke and Yale research team – along with surgeons in
bioengineered vessels had been repopulated with the patient’s
Poland and the United States and scientists at Humacyte, which is
own cells, so nonliving tissue became living over time.
developing the bioengineered vessel – tested a human acellular vessel, or HAV, that is manufactured to be available to patients
“The fact that an implanted acellular tube becomes a living
on demand rather than made-to-order using an individual’s own
human tissue has implications for regenerative medicine in a very
cells.
profound way,” Dr. Lawson said.
“The bioengineered blood vessel represents a critical step in
Other study authors are Marc H. Glickman, Marek Ilzecki, Tomasz
tissue engineering,” said Jeffrey Lawson, M.D., Ph.D., professor
Jakimowicz, Andrzej Jaroszynski, Eric K. Peden, Alison J. Pilgrim,
of surgery and pathology at Duke and chief medical officer of
Heather L. Prichard, Guziewicz Malgorzata, Stanisław Przywara,
Humacyte. “Because these vessels contain no living cells, patients
Jacek Szmidt, Jakub Turek, Wojciech Witkiewicz, Norbert
have access to off-the-shelf engineered grafts that can be used
Zapotoczny and Tomasz Zubilewicz.
without any waiting period associated with tailor-made products.” The study received funding from Humacyte Inc., which performed Dr. Lawson and co-author Laura Niklason, M.D., Ph.D., professor
data collection, analysis and interpretation in consultation with
of anesthesiology and biomedical engineering at Yale, are
the authors.
june 2016
15
News Welcome to the Area
Physicians Robert Charles Kollmorgen, DO
Orthopedic Sports Medicine; Orthopedic Surgery, Adult Reconstructive; Trauma
Duke University Medical Center Durham
Amy Hughes Radzom, DO Emergency Medicine
George Zhi Cheng, MD
Elias Joseph Jaffa, MD
Colleen Marie Moran, MD
Broncho-Esophagology; Pulmonary Disease and Critical Care
Emergency Medicine
Anesthesiology; Anesthesiology Critical Care Medicine
Duke University Medical Center Durham
Duke Univ Hospital, Div of Emergency Medicine Durham
Nicole Marie Conrad, MD
Tarannum Jaleel, MD
Patrick James Nailer, MD
Anesthesiology
Dermatology; Dermatological Immunology; Dermatology - Pediatric
Anesthesiology
UNC Hospitals Chapel Hill
Duke University Medical Center Durham
Department of Anesthesiology Durham
Duke University Hospitals Durham
Wake Emergency Physicians, PA Cary
Ryan James Cooper, MD Emergency Medicine; Internal Medicine
Nan Jiang, MD
Siddharth Devendra Sata, DO
Wake Emergency Physicians, PA Cary
Duke University Hospitals Durham
Rougemont
Anesthesiology Pain Management
Duke University Hospitals Durham
Lisa Michele Einhorn, MD
Elizabeth Ming Ju, MD
Pediatric Cardiology
Anesthesiology; Anesthesiology Critical Care Medicine
Dermatology
Noran Maged Abd El-Barry, MD Abdominal Surgery; Critical Care Surgery
101 Kildaire Road Chapel Hill
Kelly Salter Acharya, MD Abdominal Surgery; Adolescent Medicine; Clinical Genetics (MD); Gynecology/Oncology; Maternal and Fetal Medicine; Neonatal-Perinatal Medicine; Obstetrics; Gynecology Endocrinology/Infertility; Palliative Medicine
Duke University Hospitals Durham
Michael Robert Agnelli, MD Internal Medicine
First Health Physician Group Pinehurst
Laura Novack Andrews, MD Internal Medicine; Pediatrics
Carrboro Pediatrics and Internal Medicine Carrboro
Ioana Antonescu, MD Vascular Surgery
UNC Div of Vascular Surgery Chapel Hill
Jasmine Bahiya Barrow, MD Gastroenterology, Internal Medicine; Internal Medicine
4119 Bioinformatics Chapel Hill
Nishant Bhatt, MD Facial Plastic Surgery; Head and Neck Surgery; Otorhinolaryngology; Reconstructive Surgery
UNC Division of Plastic and Reconstructive Surgery Chapel Hill
Jamae Cherie Campbell, MD Psychiatry, Forensic; Psychiatry, Geriatric
IPC Raleigh
Junwei Chen, MD Anatomic and Clinical Pathology
Marlboro-Chesterfield Pathology, PC Pinehurst
16
The Triangle Physician
Duke University Hospital Durham
Hani Mohamed El-Wafi, MD
Neurology; Neuromuscular Medicine
Duke University Hospitals Durham
Matthew Scott Kelly, MD Pediatric Infectious Diseases
Jennifer Lynn Orning, MD Neurological Surgery, Critical Care; Neurological Surgery, Pediatric
Patsy Warren Park, MD Duke Children’s Heart Program Durham
Benjamin Raymond Parker, MD Orthopedic Sports Medicine; Orthopedic Surgery; Trauma
Duke University Hospitals Durham
Duke University Pediatric Infectious Diseases Durham
University of North Carolina Hospitals Chapel Hill
Jenny Feldman Eskildsen, MD
Jennifer Lynn Kemper, MD
William Harris Pechter, MD
Psychiatry
Anesthesiology; Anesthesiology Pain Management, Critical Care
University of North Carolina Hospitals Chapel Hill
David Elliot Fingerhut, MD Ophthalmology
Taylor Retina Center Raleigh
Michael Forbes, MD Neurology; Vascular Neurology
University of North Carolina Hospitals Chapel Hill
Joseph Cardwell Fuller III, MD Diagnostic Radiology; Neuroradiology
UNC School of Medicine Dept. of Radiology Chapel Hill
Tapan Niranjan Godiwala, MD Cardiology
WakeMed Raleigh Campus Heart Center Raleigh
Psychiatry; Psychiatry, Forensic
UNC Hospitals Chapel Hill
Nimisha Doshi Khanna, MD Diagnostic Radiology
Duke University Medical Center Durham
Melina Rae Kibbe, MD Surgery; Vascular Surgery
UNC Chapel Hill School of Medicine Chapel Hill
Agathoklis Konstantinidis, MD General Surgery; Surgery
Duke University Hospitals Durham
Winnie Kay Lau, MD Neurology
UNC Hospitals Chapel Hill
Kyle Nicholes Lavin, MD Hospice and Palliative Medicine; Psychiatry
Diagnostic Radiology; Radiology; Vascular and Interventional Radiology
Wake Radiology Raleigh
Eric Keil Pollak, MD Hospitalist; Internal Medicine
Hospital Medicine Durham
Anne Marie Antoinette Riether, MD Pittsboro
Chantel Springe Roedner, MD Gynecologic Surgery; Obstetrics and Gynecology
University of North Carolina Hospitals Chapel Hill
Laura Horst Rosenberger, MD Surgery
Duke University Health System Durham
Anna Lina-Karin Rosengren, MD Infectious Diseases, Internal Medicine
UNC Chapel Hill Chapel Hill
Chapel Hill
Duke Univ Medical Center Durham
Ramiro Jose Madden-Fuentes, MD
Emergency Medicine
Jennifer Nowak Hauck, MD Anesthesiology
Duke University Hospitals Durham
Duke University Hospitals Durham
Reina Maeda, MD
Yu-Pei Hu, MD Child Psychiatry; Psychiatry
Duke University Hospitals Durham
Duke University Hospitals Durham
Alisha Michelle Mavis, MD
Majda Hadziahmetovic, MD Ophthalmology
Katherine Elizabeth Husk, MD Gynecologic Surgery; Obstetrics and Gynecology; Urology
UNC Hospitals Chapel Hill
Urological Surgery; Urology
Psychiatry
Pediatric - Transplant Hepatology; Pediatric Gastroenterology
Duke University Medical Center Durham
Hirsh Sandesara, MD Wake Emergency Physicians, PA Cary
Jessica Catherine Schwartz, MD Pediatrics
Duke University Hospitals Durham
Mousumee Shah, MD Critical Care Pediatrics; Pediatrics
University of North Carolina Hospitals Chapel Hill
News Welcome to the Area Charles Colston Sims, MD
Emily Kay Sturkie, MD
Richard Ian Wilson, MD
Sally Dowd Wood, MD
Internal Medicine
Hospitalist; Internal Medicine
General Practice
Internal Medicine; Pediatrics
University of North Carolina Hospitals Chapel Hill
University of North Carolina Hospitals Chapel Hill
Raleigh
University of North Carolina Hospitals Chapel Hill
Gregory Michael Sprung, MD
Carol Logan Vincent, MD
Cardiology; Cardiovascular Disease, Internal Medicine
Internal Medicine; Pediatrics
University of North Carolina Chapel Hill
University of North Carolina Hospitals Chapel Hill
Sarah Elizabeth Stephens, MD
William Bradley Wainright, MD
Pediatrics
Ophthalmology
University of North Carolina Hospitals Chapel Hill
Duke Eye Center Durham
Lacey Elizabeth Straube, MD Anesthesiology
Eva Jayne Waller, MD Anesthesiology
UNC Hospitals Chapel Hill
UNC Hospitals Chapel Hill
In response to the Pulse Orlando shooting, Carolina Partners in Mental HealthCare, PLLC is offering pro-bono mental health and trauma response services to community members in need. Lenora Lemke, MA, LMFTA is a somatically trained therapist in one of our Durham, NC offices who has special training in working with clients to feel more integrated and settled following a trauma. Ms. Lemke is providing 3 free-of-charge sessions to folks who are feeling affected by this tragedy and in need of rapid response support. To access these services please call the Carolina Partners intake line at: 919-929-9610.
“Breakthrough” Status Expedites Research on Poliovirus Therapy The recombinant poliovi-
“Ultimately, we hope the therapy will one
the optimal-dose level, 15 are still alive
rus therapy developed at
day obtain FDA approval.”
and enrollment is ongoing. Three patients
the Preston Robert Tisch
treated early using different dosages are still
Brain Tumor Center at
Duke’s poliovirus therapy is an immuno-
alive more than 36 months after treatment.
Duke Health has been
therapy developed in the laboratory of
With current standard therapy, the median
granted
“breakthrough
Matthias Gromeier, M.D., a professor in the
survival time for people with glioblastoma
therapy designation” from the United
departments of Neurosurgery, Molecular
is 14.6 months.
States Food and Drug Administration.
Genetics and Microbiology, and Medicine
Matthias Gromeier, M.D.
at Duke University School of Medicine. The designation will expedite research into
The Duke team is moving to expand its work and open a clinical trial for children
the poliovirus therapy, but it does not mean
Using a modified form of poliovirus that
with brain tumors, which is expected to
the investigational drug has been approved
has been altered to eliminate harm, the
begin enrollment before year’s end. The
for clinical use. It is currently being tested
therapy preferentially attacks cancer cells,
researchers also have received federal
in a clinical trial for adults with advanced
which have an abundance of receptors that
grants to explore the therapy’s effect
glioblastoma brain tumors. To receive
work like magnets to attract the poliovirus.
on solid tumors. Laboratory studies are
breakthrough status, preliminary evidence
The modified poliovirus then kills the
already under way in breast cancer models.
must indicate that the treatment may offer
infected tumor cells while also igniting an
substantial improvement over available
additional immune response.
Principal researchers at Duke who have
standard therapy.
been involved in the development and A Phase I clinical trial using the therapy was
testing of the poliovirus therapy have
“Breakthrough status means that we can work
launched in 2012 to determine an optimal
founded and invested in a start-up company
with the highest levels in the FDA to develop
dose of the novel treatment among adult
to advance the research.
the most efficient clinical trial and pathway
patients with glioblastoma whose cancer had
to fully evaluate the safety and efficacy
returned after receiving traditional therapy.
of the genetically modified poliovirus for treating recurrent glioblastoma,” said Darell
Early testing found that lower doses of the
Bigner, M.D., Ph.D., director of the Preston
treatment were superior to higher doses.
Robert Tisch Brain Tumor Center at Duke.
Of 23 glioblastoma patients enrolled at
Samit Solutions has moved to a new, bigger, and better space! Please note our new physical address is: 15100 Weston Parkway, Ste 204, Cary NC 27513 june 2016
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