november 2010
University Orthopaedics and Sports Medicine Is Home Team Advantage in Johnston County
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
Also in This Issue
Alzheimers Disease Medical Science Works on Advances
Endometrial Ablation
Beyond Imagination. Working in partnership with physicians for over 50 years to bring the benefits of biomedical technology to patients around the world.
ADVANCES IN ONCOLOGY
What makes her happy? Change, collaboration, and her patients. Duke cancer specialist Hope Uronis, MD, thrives on person-to-person contact and bringing knowledge from bench to bedside. Why did you go into medicine?
Science has always attracted me, but I realized early on that I would not be happy at a bench in the lab. I needed more person-to-person interaction. I chose medical oncology as a specialty because it’s a field with a great deal of research potential and one that is always changing. Oncology also allows me to develop relationships with patients and their families as they travel along the continuum from diagnosis to definitive treatment and surveillance or disease progression and palliative care. What is unique about working at Duke?
I knew Duke was special the day I interviewed for my internal medicine residency. There was a feeling that everyone was excited to be here and to be taking care of patients. All members of the Duke community—from physicians to nurses to support staff—collaborate to make sure that our patients get the best care possible. Can you give an example of that collaboration and how it provides for better patient care?
Duke provides multidisciplinary care in a coordinated fashion so that patients traveling long distances are often able to see all members of the treatment team—from medical oncology to radiation oncology to surgical oncology—on the same day. This is convenient for the patient but also ensures communication regarding treatment plans in real time. What have been the significant advances in oncology recently?
Oncology has seen many changes in recent years as we learn more about disease biology and how to direct our therapies. We are moving from traditional cytotoxic chemotherapy to agents that target specific pathways known to be important in the growth and spread of cancer. This started with the introduction of the anti-VEGF agent bevacizumab, but has now expanded to include more and more novel agents. We are also learning more about how to use new techniques such as microarray to better characterize tumors. This will hopefully allow for more individualized, or personalized, treatment plans.
dukehealth.org/cancer
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Contents
COVER STORY
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PHOTO BY JIM SHAW
University Orthopaedics and Sports Medicine Is Home Team Advantage in Johnston County
FEATURES
10
Neurology
Medical Science Works on Advances in Alzheimer’s Disease Dr. Patricia Naslund holds hope for some current clinical trials and new therapies.
november
2 0 1 0 VO L U ME 1 I S S U E 1 0
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DEPARTMENTS 9 Insurance
Neurology
Alzheimer’s Demands Greater Diagnostic Precision Dr. Daniel Kaufer’s notes the shortcomings of current diagnosis and treatment.
We Dodged a Bullet Again
14 Women’s Health
ndometrial Ablation Is Effective E End to Heavy Periods
16 Practice Management
ight-Sizing Your Medical Office R Staff: Part II
18 News
elcome to the Area, Upcoming W Events, Clinical Trials and More
19 Hospital News
ex forms physician network R with UNC and opens new Holly Springs facility
20 Ob/Gyn News
COVER PHOTO: Dr. Richard Alioto and Dr. Mark Moriarty in the lobby of Johnston Health Center in Smithfield. PHOTO BY JIM SHAW
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onors and Awards, Board H Appointment, Blog Entries and Presentations
JOHNSTON HE ALTH
From the Editor
Three cheers for sports medicine! University Orthopaedics and Sports Medicine – this month’s cover story – is continuing a tradition of caring for a community’s athletes that dates back to ancient Greece. However, history indicates that physician involvement in not only treating, but preventing, injury was not widely practiced in modern society until well into the 20th century. Only during the 1928 Olympics was a small committee formed with the task of organizing the International Congress of Sports Medicine. Since then, the involvement of physicians in more than just the treatment of sports injuries has increased. Still, team physicians in high school sports are viewed as a luxury, which means the Johnston County schools covered by University Orthopaedics and Sports Medicine have a lot going for them. Now, if only there was some sort of physical training or lifestyle adaptations that could prevent or delay Alzheimer’s disease. Hopefully, our understanding of this debilitating degenerative disease that threatens untold numbers of elderly now and in the future is just within the grasp of medical science and great breakthroughs are imminent. Helping us understand the basics of Alzheimer’s disease in this issue of The Triangle Physician are Drs. Daniel Kaufer and Patricia Naslund. On the women’s health front, Dr. Andrea Lukes discusses some effective treatments for heavy menstruation. The challenge for physicians is to establish a trusting relationship that will help them discuss with the female patient the existence of this problem and her choices for improved quality of life. Our business management experts are back to share practical insights on working smarter, not harder. John Reidelbach concludes his two-part series on staffing. Mike Riddick expresses our collective relief that this hurricane season was less active than predicted and cautions that now is the time to prepare for next season. High fives go out to UNC obstetrics and gynecology for accomplishments and commendations, and Rex Healthcare for the opening of its newest facility, Rex Primary Care of Holly Springs. Finally, a reminder to consider The Triangle Physician in your marketing mix. Every month, the magazine is delivered to more than 8,000 medical professionals in private practices, health care systems and hospitals in Alamance, Chatham, Durham, Granville, Harnett, Johnston, Lee, Moore, Nash, Orange, Person, Sampson, Vance, Wake, Warren, Wayne and Wilson Counties. It’s a reach that our advertisers cheer about. As always our gratitude for all you do!
Heidi Ketler Editor
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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
Editor Heidi Ketler, APR
heidi@trianglephysician.com
Contributing Editors Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G; Daniel Kaufer, M.D.; Patricia Naslund, M.D.; John Reidelbach; and Mike Riddick Photography Jim Shaw Photography jimshawphoto@earthlink.net Creative Director Joseph Dally
jdally@newdallydesign.com
Advertising Sales Carolyn Walters carolyn@trianglephysician.com News and Columns Please send to info@trianglephysician.com
The Triangle Physician is published by New Dally Design 9611 Ravenscroft Ln NW, Concord, NC 28027
Subscription Rates: $48.00 per year $6.95 per issue 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. Opinion expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. However, 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.
On the Cover
University Orthopaedics and Sports Medicine Is Home Team Advantage in Johnston County By Heidi Ketler
It’s game time and the Clayton Comets charge the field, determined to make big plays. The Greater Neuse River 4A conference is tough, with the likes of Garner, ranked 23rd in the state. Always a source of confidence for Clayton Athletic Coach Gary Fowler and his players is the sideline presence of team physician and orthopedic surgeon Richard Alioto, M.D., of University Orthopaedics and Sports Medicine. Dr. Mark Moriarty, M.D., also of University Orthopaedics and Sports Medicine, has teamed up with the all-new Corinth-Holders High School. He has been triaging and treating injuries during the Pirate’s initial junior varsity football schedule, after which many players will return for their first full varsity season in 2011-2012. Formerly, Dr. Moriarty was team physician for West Johnston High School.
All-told, University Orthopaedics and Sports Medicine has athletes of every variety, level and age throughout Johnston County covered. “Our sports medicine practice is balanced between the younger high school athlete on the field and those we see in the office – the 45-year-old weekend warrior with the degenerative meniscus tear and the 65-year-old tennis player who needs a knee replacement, “ says Dr. Moriarty.
“Although, we relish the opportunity to practice sports medicine, we pride ourselves in our ability to take care of a multitude of orthopedic issues,” says Dr. Alioto.
PHOTO BY BRYAN REGAN PHOTOGRAPHY
The Smithfield-Selma Spartans receive medical support from University Orthopaedics and
Sport Medicine physician assistant Courtney Jordan. In addition, the medical team is in close contact with the athletic trainers and coaches for North Johnston and Princeton high schools, whenever a need arises.
“Although, we relish the opportunity to practice sports medicine, we pride ourselves in our ability to take care of a multitude of orthopedic issues.” – Richard “Rick” J. Alioto, M.D. The general orthopedic range of services includes: joint replacement, fracture care, reconstructive procedures, shoulder care, carpel tunnel surgery, and a variety of arthroscopic procedures. Customer service is a key element of the practice philosophy and every staff member buys in to it, says Dr. Alioto. There are nine full-time staff members, including practice manager Wendy R. Gatewood. “I am proud of the staff we’ve put together and the stability that Wendy Gatewood brings,” says Dr. Alioto. Wendy Bass, a certified X-ray technician, has been with the practice since Day 1. “She exemplifies the camaraderie within the office, which translates into seamless continuity of care and great customer service for the patients,” says Dr. Alioto. “Everyone knows their role and that our patients come first. Loyalty to our practice and our patients are the things we appreciate most,” Dr. Alioto.
Dr. Alioto and Misty Baker, CMA, apply a cast to a very cooperative four year old, Kaleigh Spence.
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A COMMUNITY SPORTS MEDICINE PRACTICE IS BORN Dr. Alioto’s days as a team physician began during a sports medicine fellowship at the University of Missouri with the NFL Kansas City Chiefs. That was back in 1994-1995,
Dr. Alioto was practicing in Pittsburgh, Pa., in 1997, when Duke University Medical Center recruited him to open a community practice in Smithfield, N.C. He hung the University Orthopaedics and Sports Medicine shingle in 1998 in Smithfield and the practice has kept pace with the fastest-growing county in North Carolina. Its affiliation with Duke University and Johnston Memorial gave it immediate acceptance within the community, Dr. Alioto says. “Growth in Johnston County is inevitable,” he says. “Johnston Memorial Hospital is well positioned for the growth and so University Orthopaedics and Sports Medicine will continue to be.” A second office opened in Clayton on Hwy. 70 (business) in 2002.
“Our sports medicine practice is balanced between the younger high school athlete on the field and those we see in the office – the 45-year-old weekend warrior with the degenerative meniscus tear and the 65-yearold tennis player who needs a knee replacement.” – Mark Moriarty, M.D. BATTLE FIELD TO THE PLAYING FIELD Dr. Moriarty was a medical student at Georgetown University School of Medicine when he joined the U.S. Air Force for a health professions scholarship. After graduating, he served three years of active duty as a major at MacDill Air Force Base in Tampa, Fla. “It was just like a sports medicine fellowship, with young people – 18 to 25 year olds – getting classic sports injuries – dislocated shoulders and torn knee cartilage – while exercising, says Dr. Moriarty. “Unlike civilian practice, it becomes the injured soldier’s job to get
well and return to full duty. This made for motivated recovery.” Afterward, Dr. Moriarty joined a private orthopedics and sports medicine practice in Cocoa Beach, Fla. Eighteen months later, the United States led Operation Desert Storm against Iraq and Dr. Moriarty was reactivated to six months of active duty. At Lackland Air Force Base in San Antonio, Texas, he treated returning troops with sports-like injuries. Then Dr. Moriarty moved his practice to North Carolina. Seeking opportunities in community sports medicine, he responded to one that University Orthopaedics and Sports Medicine was advertising. “The military provides an orthopedic training experience on par with the best civilian training programs anywhere,” says Dr. Alioto. THE ART AND SCIENCE OF SPORTS MEDICINE From the hulking linebacker to the lean runner, each sport is uniquely susceptible to certain injuries. An understanding of the biomechanics involved is more likely to result in accurate diagnosis, so focus can shift from treatment to recovery and the safe return to the sport. Perhaps the most exciting advances in orthopedic medicine are in this arena.
Dr. Moriarty recalls distance runner Jonathan Wood. In 2004, the Smithfield Selma High School junior collided with the opposing goalie at a soccer match and suffered a transverse distal tibial shaft fracture, with marginal displacement, which required intramedullary nail fixation. This was performed with a lightweight titanium rod, which would remain in Jonathan’s leg. “A remarkable patient eager to get back to sports, his determination led to a remarkable recovery,” says Dr. Moriarty. Due to his injury, Jonathan ended up leaving the soccer field and running marathons instead. He also inspired his father to run with him. “It was after he devoted his energies to running that he attained his highest level of achievement by winning several marathons side by side with his father.” A year ago, Dr. Alioto operated on Olympic hopeful, West Johnston High School graduate and swim team champ Sarah Henry. She had come to him with a torn anterior cruciate ligament and meniscus, an injury she sustained while playing Frisbee on Mother’s Day weekend 2009. Dr. Alioto performed ACL reconstructive surgery and gave Sarah a 95 percent chance of full recovery. Today, Sarah is a student and PHOTO BY BRYAN REGAN PHOTOGRAPHY
when the Chiefs had a dynamic team, with quarterback Joe Montana and running back Marcus Allen.
Dr. Moriarty, with medical assistant Beth Beasley, applies a brace to a patient while X-ray tech Laura Whalen observes.
NOVEMBER 2010
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University Orthopaedics has a great team! Top Row from left to right - Deborah Cramer, Laura Whalen, Courtney Jordan PA-C, Christy Spence, Wendy Gatewood. Bottom Row - Wendy Bass, Misty Baker, Jennifer Wood, Amy Evans, Beth Beasley.
swim team standout at Texas A&M, with time trials that beat those before her injury, and her sights are locked on the 2012 and 2016 Olympics. “In today’s sports world, it’s a return to the pre-injury level of function that you’re after.” Also important to Sarah’s recovery, says Dr. Alioto, is work ethic. “With ACL surgeries, 50 percent of the ball game is how committed the athlete is to the rehabilitation process. A non-motivated patient can make even the best surgeon look bad.” Boosting her chances of a full recovery, Sarah was given platelet-rich plasma (PRP) therapy, an injection of her own platelets into the injured area to over-stimulate the healing and repair process. Though platelets are best known for their role in initiating blood clots, they also contain growth factors. “PRP is the latest innovation in orthopedics that we’re exploring right now. But it will be years before that approach is proven – or not,” says Dr. Alioto. “It’s in no way harmful and we suspect it’s going to have many different uses.” Clinical trials are being conducted in multiple places with multiple different types of surgery and non-surgery, for everything
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from treatment of tennis elbow to rotator cuff tendonitis, cartilage and disc regeneration. HOME TEAM ADVANTAGE So far this season, Clayton football injuries have included everything from broken fingers and minor bruises to ACLs and torn muscles, according to Clayton Athletic Director Fowler. Christy Schoolcraft, athletic trainer, and health, physical education and sports medicine teacher at Corinth-Holders, reports sprains and strains, a couple of fractures and just one concussion. Head injury is always a big concern, says Dr. Moriarty, and that requires pulling out the athlete for a week or two until symptoms are cleared. “There is a great deal of interest in that lately, and finally, there are regulations in place that require the presence of a physician or first responder during games,” he says. “The problem with a concussion occurs when the athlete continues playing, risking a second head injury. This can result in permanent injury or death. So it’s critically important to recognize the signs of concussion immediately on the field.” For the injured athlete, the team physicians provide continuity of care that lasts through
recovery, which usually requires great determination on the part of the athlete. “Rick reinforces that and it helps,” says Coach Fowler. Courtney Jordan puts into practice her specialized background as an orthopedic physician’s assistant, directing protocol for specific sports. Dr. Moriarty also credits University Orthopaedics’ network of physical therapists who attend high school games and help with patient recovery. “We have a great physical therapy team, whose goal is to return the athlete to play as soon as possible. This, combined with minimally invasive arthroscopic surgery techniques also returns players to the field sooner. We minimize softtissue damage by employing these minimally invasive techniques. We keep exposure small and do what we can arthroscopically to violate as little muscle, tendon and bone as possible.” Drs. Alioto and Moriarty are looking forward to adding new providers to help keep pace with the growth of the county. Duke University Health System and Johnston Health Center support and share in the excitement of the group’s expansion. For more information, call the practice at (919) 989-6535.
Insurance
We Dodged a Bullet… Again
Mike Riddick is president of Riddick Insurance Group Inc., an independent insurance agency in Raleigh. For 10 years, he has been helping professionals protect their assets through insurance and financial planning. Riddick Insurance Group specializes in property, casualty, liability and life insurance planning for small business owners. Mr. Riddick can be reached at (919) 870-1910 or mike@riddickinsurancegroup.com.
By Mike Riddick
November is here, and again for the 10th year in a row central North Carolina has dodged a bullet. The bullet I’m referencing is a major hurricane. The National Weather Service, insurance carriers and many local residents all thought our area was way overdue for a major storm, and today it still is. I even wrote some editorials on how to prepare your office from hurricane disaster.
and have no idea if they truly have enough coverage to rebuild their home as is, not to mention enough coverage if there was some kind of spike in construction costs. Many home insurance policies use complicated terms like 100 percent replacement cost, full replacement cost, etc., yet have a cap on how much the carrier will pay for replacement of your home.
Now that we seem to be in the clear, I’d like to address one other important issue that has come up a lot this year in my office. The issue is replacement value on your home insurance. Many of my clients are professionals who live in large homes. What
Today some insurance carriers are offering a true full replacement cost. What I mean when I say this is that as long as the home was originally insured for the correct replacement value, the carrier will rebuild the home with no dollar limitation in the
If you haven’t had a review with your agent in a while, or more importantly have never spoken with your agent since the original writing of the policy, schedule a coverage review. would happen if a major storm hit our area and massive destruction occurred? Would the replacement cost of your home go up? Would materials go up? Would they double, triple or quadruple in price? Ask folks who experienced Hurricane Katrina, or folks who’ve lived in coastal Florida for many years. The answer is simple. When a major storm strikes a heavily populated area, supply and demand causes material and labor costs to increase dramatically. Many of our customers have not looked at their home insurance policies in many years
event of a covered peril. Customers who obtain this kind of policy can often find that the cost of this policy is extremely affordable and very competitive with the pricing of similar carriers who cap replacement coverage. If you haven’t had a review with your agent in a while, or more importantly have never spoken with your agent since the original writing of the policy, schedule a coverage review. This is a great opportunity to make sure you are well protected before next summer arrives and hurricane season is here again.
NOVEMBER 2010
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Neurology
Medical Science Works on Advances in
Alzheimer’s Disease By Dr. Patricia Naslund
Alzheimer’s disease is the most common form of dementia, affecting 5.3 million people in the United States, most of whom are elderly. Alzheimer’s disease is a progressive illness marked by prominent and early memory deficits. The first characterization of the illness by Alois Alzheimer in 1901 described a typical patient with progressive memory loss, aphasia and delusions. The most common initial complaint is memory impairment, although as the disease progresses, other cognitive domains are affected, including judgment, social functioning and behavior. The eventual course is relentless. Ultimately, Alzheimer’s disease (AD) is a fatal illness, with the average patient living about eight years after diagnosis. Who Develops Alzheimer’s Disease? Currently in the United States, Alzheimer’s disease affects 5.3 million people. AD is the most common form of dementia, and preferentially affects the elderly. Age is the most important risk factor for AD; the incidence of AD doubles every five years after the age of 65. The second most important risk factor for development of AD is genetics. Twenty-five percent of patients with AD have two or more family members affected. Several genetic markers for AD have been identified, including apolipoprotein E4 (ApoE4). ApoE4 is one allele of the gene coding for a protein involved with cholesterol transport. A person with one copy of ApoE4 doubles his or her risk of AD, while having two copies of ApoE4 increases the risk by between five and 15 times. Several other risk factors for developing AD have been identified. Previous head injury, particularly with prolonged loss of consciousness or repeated head injury, increases the odds of developing AD. Vascular disease, obesity, insulin resistance, obstructive sleep apnea and hyperlipidemia also have been shown to increase the risk of AD. Several other factors may actually decrease the risk of developing AD. These include physical exercise, social
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Dr. Patricia Naslund is a neurologist with Raleigh Neurology Associates. A Connecticut native, she received her undergraduate degree in 1990 and her medical degree in 1994 from Duke University. She completed her residency at Washington University in St. Louis in 1998. She then completed a fellowship in electromyography with additional training in neuromuscular disease in 1999 at Washington University. Board certified in neurology and electrodiagnostic medicine, Dr. Naslund specializes in peripheral neuropathy. She is a member of the American Association of Neuromuscular and Electrodiagnostic Medicine, the Alpha Omega Alpha Honor Medical Society, Sigma Xi Scientific Research Society and the American Academy of Neurology. Dr. Naslund has been practicing in Raleigh since 1999 and joined Raleigh Neurology in 2001. She and her husband have two children and they enjoy spending time outdoors.
approved by the Food and Drug Administration to treat the cognitive decline in AD. Cholinesterase inhibitors (donepezil, galantamine and rivastigmine) all have similar therapeutic effect, which is a modest reduction in the progression of AD symptoms compared to placebo. Memantine, an NMDA (n-methyl d-aspartate) receptor antagonist, also treats the cognitive decline in AD with mild improvement seen in AD symptoms. Clinical trials of vitamins including vitamin E and ginko biloba have shown mixed results.
A medical food, Axona, has been approved recently as a dietary supplement and has shown modest benefit. Treatment of behavioral symptoms is problematic. Atypical antipsychotics are used commonly, although the FDA recently issued a black-box warning because of increased mortality in this patient population. Numerous clinical trials are in progress. Newer therapies may prove to be more effective in halting or even reversing progression of AD.
activities, moderate alcohol use and eating foods high in unsaturated fat. How is Alzheimer’s Disease Diagnosed? Although definitive diagnosis can be confirmed only by autopsy, the clinical diagnosis of AD can be made by obtaining a history and ruling out other conditions. Both the patient and a close friend or family should be interviewed. The typical history is a slow progression of memory problems, often difficulty with names of people or trouble finding words. Other symptoms include misplacing objects, becoming lost or disoriented, difficulty following sequences, agitation or delusions. Screening mental status testing may be relatively normal early in the clinical course or may show deficits of memory, language or constructional praxis (i.e. drawing a clock face). The American Academy of Neurology guidelines recommend screening for B12 deficiency, hypothyroidism, depression and intracranial abnormalities with a noncontrast CT or MRI. How is Alzheimer’s Disease Treated? Currently, several medications have been Womens Wellness half vertical.indd 1
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NOVEMBER 2010
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Neurology
Alzheimer’s Demands Greater Diagnostic Precision By Daniel Kaufer, M.D.
Earlier diagnosis and intervention before widespread devastation of vulnerable brain regions occurs is a common-sense therapeutic approach that will require increasing research effort and greater diagnostic precision. Alzheimer’s disease and other dementias threaten individuals and families with functional disability and loss of independence, high levels of caregiver stress and rising health care costs. Lacking the palpable onset of a stroke or heart attack, or the tangible invasiveness (and as yet, potential curability) of many forms of cancer, degenerative dementias are insidious chronic diseases that are laborious to diagnosis, difficult to manage and demand greater attention. In North Carolina, the estimated number of individuals with dementia will double over the next 20 years, affecting more than 250,000 individuals and their families. Most of these individuals will be aged 65 years and older, retired and on fixed incomes. In particular, the number of individuals over age 80 years with dementia will increase dramatically. Conversely, many individuals younger than 65 years old will be stricken by less common, but equally devastating dementias such as Frontotemporal Degeneration (FTD). Many others will experience dementia either before or after the onset of Parkinsonian motor signs, reflecting a spectrum of Lewy body dementia (LBD) that lies at the intersection of Alzheimer’s and Parkinson’s disease. A recently defined syndrome of mild cognitive impairment (MCI), referring to cognitive decline in short-term memory that does not otherwise affect daily functional
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abilities, is present in 10-15 percent of individuals over age 65 years and carries a 50 percent risk of progressing to dementia over a five-year period. Diagnosis At present, there are no clinical diagnostic tests for Alzheimer’s disease or other dementias, but recent research advances are bringing us closer. The Alzheimer’s Disease Neuroimaging Initiative (ADNI), a large study jointly funded by the government and private industry, has identified ptential diagnostic biomarkers
based on structural and functional brain imaging and spinal fluid measures of abnormal proteins. These biomarkers will become more widely integrated into clinical practice after appropriate validation studies. An important current focus is to identify patients with MCI, who have biomarkers of Alzheimer’s and test potential therapies that may prevent or delay full-blown dementia. Delaying the onset of Alzheimer’s by even five years would decrease its prevalence by about 50 percent. By contrast, developing drugs to slow disease progression, which is the primary current focus of Alzheimer’s therapeutic drug
Dr. Daniel Kaufer is associate professor in neurology and director of the University of North Carolina at Chapel Hill Memory Disorders Program. He completed undergraduate and medical school studies at the University of Wisconsin-Madison. He completed a neurology residency at the University of Pittsburgh and fellowship training in behavioral and geriatric neurology at the University of California at Los Angeles. He is board certified in neurology, and in behavioral neurology and neuropsychiatry. Dr. Kaufer completed a Merck-American Federation for Aging Research fellowship in geriatric clinical pharmacology and received the Augustus Rose Fellowship of the John Douglas French Alzheimer’s Foundation. Current affiliations outside UNC include memberships on the board of directors for Alzheimer’s North Carolina; the Scientific Advisory Council, Lewy Body Dementia Association; and the Social, Behavioral and Diversity working group of the national Alzheimer’s Association. He is also a fellow of the American Academy of Neurology and the American Neuropsychiatric Association, and immediate past-president of the Society for Behavioral and Cognitive Neurology. Dr. Kaufer and Dr. Philip Sloane co-direct the Carolina Alzheimer’s Network (CAN), an initiative funded by The Duke Endowment, whose primary goals are to train primary care physicians throughout North Carolina to become more proficient in diagnosing and treating Alzheimer’s disease and related dementias.
development, would actually increase the prevalence of the disease, shifting toward milder illness and more outpatient management. Although some Alzheimer’s biomarker tests are now commercially available, their utility is limited by the absence of disease-modifying therapy. Evidence is accumulating that exercise, challenging cognitive activity and certain dietary patterns may significantly reduce the risk
of Alzheimer’s disease, although definitive data are lacking. Treatment Therapeutic development in Alzheimer’s disease and other dementias is in a transitional period. Neurotransmitter-based approaches to date have been moderately beneficial in alleviating cognitive symptoms and slowing the progression of functional disability, but are only palliative. Strategies aimed at reducing the excess accumulation of amyloid and tau proteins that are the hallmarks of Alzheimer’s disease offer the prospect of modifying the underlying disease processes and ultimately slowing the course of neurodegenerative decline. Results to date with amyloid-targeted agents have been disappointing, but ongoing studies may prove otherwise. Earlier diagnosis and intervention before widespread devastation of vulnerable brain regions occurs is a commonsense therapeutic approach that will require increasing effort and greater diagnostic precision. Different protein pathologies associated with various degenerative dementias will need to have disease-specific biomarkers identified and validated in collaborative studies similar to ADNI that are just getting under way for FTD and LBD. With a concerted effort, the current state of diagnosis by exclusion and palliative treatments will gradually give way to geneticallyinformed molecular diagnostic and therapeutic strategies that target specific-disease processes associated with Alzheimer’s and other degenerative dementias.
NOVEMBER 2010
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Women’s Health
Endometrial Ablation Is Effective End to Heavy Periods By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G
We encourage health care providers to recognize the importance of heavy periods and to educate their patients on the high satisfaction rates of endometrial ablations. Approximately 1 in 4 women complain of heavy periods. Heavy periods are defined as a condition that “interferes with the woman’s physical, social, emotional and/ or material quality of life2.” Women with heavy periods often avoid activities that they would otherwise perform, including physical (cleaning, playing with children), work (increased days of missed work) and social activities (going out with friends, family events). Some women feel embarrassed to bring up this problem to their provider, and too often providers don’t ask women about the heaviness of their periods. A simple and highly effective treatment for heavy periods is the endometrial ablation. At the Women’s Wellness Clinic, our initial approach to management of heavy periods is to determine the cause. Important to determining the cause of heavy periods is taking a thorough history and physical, blood work (complete metabolic panel, ferritin level, potential thyroid levels, potential evaluation for bleeding disorders) and a pelvic ultrasound. Ideally, treatment options then target the reason for heavy periods. For instance, if there are uterine fibroids, then understanding the location and potential respectability or removal of these fibroids is important. After determination of cause, the choice of treatment is important. We
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individualize treatment – each woman is different. Endometrial ablations are simple treatments that we perform within our office at the Women’s Wellness Clinic. On average, these treatments take 15 minutes. Although we still perform some ablations at Davis Ambulatory Surgical Center, the majority are
done within the comfort of our office. This is advantageous for many reasons, including convenience and cost. One impressive statistic is the high satisfaction with endometrial ablations. Patient satisfaction for an endometrial ablation is between 86 percent to 96 percent1. This high satisfaction is double the satisfaction of hormonal options.
After earning her bachelor’s degree in religion from Duke University (1988), Dr. Andrea Lukes pursued a combined medical degree and master’s degree in statistics from Duke (1994). Then, she completed her ob/gyn residency at the University of North Carolina (1998). During her 10 years on faculty at Duke University, she co-founded and served as the director of gynecology for the Women’s Hemostasis and Thombosis Clinic. She left her academic position in 2007 to begin Carolina Women’s Research and Wellness Center, and to become founder and chair of the Ob/Gyn Alliance. She and partner Amy Stanfield, M.D., F.A.C.O.G., head the Women’s Wellness Clinic, the private practice associated with CWRWC. Women’s Wellness Clinic welcomes referrals for management of heavy menstrual bleeding. Call (919) 251-9223 or visit www.cwrwc.com.
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The term ablation refers to the destruction of the endometrium, or lining of the uterus. Menstrual bleeding is predominantly an endocrine event. In other words, hormones (estrogen and progesterone) drive monthly periods, and the endometrium has a unique ability to regenerate each month. This unique ability to regenerate is one reason why hormonal treatments may often not work. The two important requirements prior to an ablation include: 1) normal endometrial sampling to rule out cancer or pre-cancer and 2) reliable birth control. Women should be finished having children before undergoing an endometrial ablation. Pregnancy after endometrial ablation is compromised in each trimester. There are more miscarriages, more preterm deliveries and more complications at the time of delivery in pregnancies that occur in women who have undergone an ablation. After childbearing, the endometrial ablation can be a great option for women.
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More information on endometrial ablations can be found on our website, www.cwrwc.com, and at www.novasure.com or www.heroption.com. We offer both the NovaSure and the Her Option. These endometrial ablation procedures differ in the way the endometrium is removed. NovaSure uses electromagnetic energy. Her Option uses cyroblation, or subzero temperatures. These leading technologies have proven efficacy and safety. They are safe, result in a quick return to normal activity and have high patient satisfaction rates. Heavy periods are common and often negatively impact a woman’s quality of life. Effective treatment options are available. We encourage health care providers to recognize the importance of heavy periods and to educate their patients on the high satisfaction rates of endometrial ablations. References 1. Sharp, Obstetrics & Gynecology, October, 2010 2. National Institute for Health and Clinical Excellence. NICE clinical guideline 44: Heavy Menstrual Bleeding. London; January 2007.
NOVEMBER 2010
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Practice Management This is the second in a two-part series.
Right-Sizing Your Medical Office Staff By John J. Reidelbach
A motivated staff raises the bar just a little higher. Morale will soar. Communication, encouragement and accountability are of paramount importance to achieving the mission and vision for the practice. While there are many employees who will leave a practice for 10 cents more per hour, good employees generally won’t leave to earn more money. Just the same, you need to be armed with salary data that will allow you to know if you are paying your employees what they are worth. You can conduct your own survey of similar practices in your area by talking to your colleagues, but national salary data is available through the North Carolina Medical Group Manager’s Association or the national Medical Group Manager’s Association amongst others. These resources are useful for obtaining general information, but you must consider that wages need to be attached to the skill set and responsibilities specific to the positions in your own practice. Cross-training goes a long way toward optimizing practice productivity. This exercise helps your staff understand how hard their peers work and how important their own job is within the framework of the organization. This also reinforces that they are a team – and that the entire organization works together toward a common goal - providing high quality patient care. Delegating responsibilities also has a tremendous impact on your ability to get the most out of your staff. If you are not delegating tasks, it will be difficult for you to know if you are right-sized. Each employee should perform at their maximum capacity. Goals and objectives should be set on an annual basis by your management team
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The Triangle Physician
and every employee should be evaluated on their anniversary to measure their productivity. There are other benchmarks that can tip your hand to staffing deficiencies such as overtime. If you suddenly find that an employee(s) is putting in more than a few extra hours per week, it is a good sign that your staffing model might need to be reevaluated. You will need to consider whether the work has increased or if production is faltering. Revenue is another important benchmark for you to consider as you work to right-size your practice. Given declining reimbursement, it may be expected that you and your staff
are working harder for less revenue. You will need to evaluate the number of both your new and established patient visits as well as the number of procedures performed if yours is a specialty practice. This will provide you with a source for determining the growth and productivity of your practice and the inherent staffing needs. More importantly, you will need to look at historical data and examine trends to stay on top of your staffing needs. Knowing how many patients you can comfortably see on a monthly basis will allow you to determine where to place new staff if there is an increase in that volume.
John Reidelbach’s career in health care spans more than 20 years and all facets of administration within physician practices, hospitals and large health care insurers. He founded Physician Advocates Inc. in 1996. Today, he assists health care entities in all aspects of practice management, operation, strategic development and implementation, education, contract negotiations, data analysis and capital funding. His credentials include degrees in engineering and education, and a master’s in business administration. Mr. Reidelbach has designed several health care management entities, including independent physician associations, physician practice management companies, management service organizations and group practices. His experience includes developing equity ownership structures, financial incentives, network administration, and information systems selection and implementation. He also has developed detailed analysis tools for health care providers and product vendors. Mr. Reidelbach can be reached in North Carolina at (919) 321-1656 or in Atlanta at (404) 664-9060; and by e-mail to info@mdpracticeadvice.com.
In order to reduce turnover, it is imperative to create an environment in which people want to work hard and take pride in their contributions to the organization. You must also provide a workplace that values its employees. One way to do that is to provide rewards and incentives for exceeding the job performance expectations you have set for your staff. Turn negatives into positives by conducting a staff satisfaction survey. Use the constructive criticism to implement changes that will bring about operational and process improvement. A motivated staff raises the bar just a little higher. Morale will soar. Communication, encouragement and accountability are of paramount importance to achieving the mission and vision for the practice. You can create a win-win by demonstrating the fact that you value your employees. Provide feedback. Understand your employees’ needs and let your employees know what you need from them. Employees need to know where they stand. Don’t keep them in the dark. There should be no surprises at the yearly review. Likewise,
when an employee resigns, conduct exit interviews so that you know if you are meeting employee expectations as well as to determine whether management is creating a great place to work and the culture you want in your practice. You can further optimize staff performance and costs by making sure that you are staying on top of the information technology that is available to create efficiencies. Make certain that you offer adequate training on all applications from your practice management (PM) system to your electronic health record (EHR) to accounting software. Providing opportunities for new skills such as becoming a certified coder fosters a climate where people are set up to succeed. Opportunities such as this enrich the work experience. Encourage your staff to be the very best that they can be. Hire the right people, provide continuous training and develop clear, concise, and measureable goals for every employee in the organization. Not only will morale improve but so will the financial picture of the practice.
• Financial strength – $2.6 billion in net admitted assets and $677 million in policyholder surplus; a Best’s Rating of A- (Excellent) • Unparalleled experience – more than three decades of service to the healthcare community • Aggressive claim defense – nearly 73% of cases closed without an indemnity payment; win rate of more than 93% for those that went to a verdict at trial • Innovative risk management – extensive risk management services and customized, practice-specific programs
THE TIME IS RIGHT TO EVALUATE PROMUTUAL GROUP To learn more about ProMutual Group, please visit www.promutualgroup.com/NC.html or call us at (888) 776-6888.
NOVEMBER 2010
17
News Welcome to the Area
Physicians Michael Anthony Barakat, DO Emergency Medicine University of North Carolina Hospitals Chapel Hill
Nancy Christina Andersen, MD General Surgery OGME Rm 1107A, Chapel Hill
Oren Josh Becher, MD Duke university Medical Center, Durham
Dinesh Benjamin, MD
Upcoming Events Paul Joseph Mosca, MD
Amy Lynn Ford, PA
General Surgery, Surgical Oncology 3116 North Duke Street, Durham
Jeffrey Scott Grande, PA
Norris John Nolan, MD UNC Dept of Pathology, Chapel Hill
Michael Chinedu Nwude, MD
Friday, Nov. 12, 7 p.m.
Heather Pennell Park, MD
Nicole Blackwell Ray, PA
Kerr Scott Building at the NC State Fairgrounds, Raleigh To benefit the American Cancer Society. Hosted by the Red Sword Guild. Music by popular country band YARN, followed by dance band Party on the Moon. Other entertainment: bull riding, gambling, silent and live auctions, and raffles. Food and libations: fine food by top area chefs and a variety of beverages. Call (919) 782-5599.
General Surgery University of North Carolina Hospitals Chapel Hill
Gina Marie Carlotti, MD
Rod Evan Pellenberg, MD
Raleigh Emergency Medicine Associates, Raleigh
Raymond Thomas Doyle, MD Internal Medicine 1014 Terrace Wood Ct., Cary
Trace Isaiah Fender, MD Psychiatry University of North Carolina Hospitals Chapel Hill
Ashley Hawkins, M.D.
• BA, University of North Carolina at Chapel Hill • MD, Wake Forest University School of Medicine • Internship in Internal Medicine, Carolinas Medical Center •R esidency, Duke University Medical Center • F ellowship in Breast Imaging, Duke University Medical Center • Member of Raleigh Radiology staff
Melissa Allyson Hayes, MD Diagnostic Radiology Duke University Hospitals, Durham
Adam Bartlett Hill, MD Pediatrics Duke University Hospitals, Durham
Emily Oldham Jenkins, MD Internal Medicine University of North Carolina Hospitals Chapel Hill
Steve Thomas Kirk, MD Neurology Internal Medicine - Sleep Medicine Raleigh Neurology, Durham
UNC Chapel Hill, Chapel Hill
Deepika Polineni, MD Pulmonary Disease and Critical Care, Internal Medicine University of North Carolina Hospitals Chapel Hill
Ruchi Puri, MD Obstetrics and Gynecology Duke University Hospitals, Durham
Javeria Shaheen Qureshi, MD General Surgery University of North Carolina Hospitals Chapel Hill
Geoffrey David Rubin, MD Duke University Medical Center, Durham
Nathan Christopher Sheets, MD Radiation Oncology University of North Carolina Hospitals Chapel Hill
Shaun Oliver Smart, MD Neurology Duke University Hospitals, Durham
Lisa Anne Tarris, MD Emergency Medicine University of North Carolina Hospitals Chapel Hill
April Eve Welborn, MD Psychiatry University of North Carolina Hospitals Chapel Hill
Sarah Winchester, MD Pediatric Neurology Raleigh Neurology Associates, Durham
Physician Assistants Adija Danielle Bailey, PA Raleigh
Ravichand Madala, MD
Crystal Campbell, PA
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The Triangle Physician
Durham
Durham
Rm 7689, HAFS Bldg
Christa Cox, PA Raleigh
Tanya Lisette De La Cruz, PA Cary
Raleigh Roundup
Durham
Saturday, Nov. 20, 6 p.m.
Brandon Fraser Wyche, PA
Cat Angels Pet Adoptions Annual Silent Auction
Durham
Upcoming Events Saturday, Nov 6, 7:30 a.m.
Free to Breathe 5k and 1 mile walk/rally NC State’s Centennial Campus, Raleigh, NC Please join us for the 4th Annual Free to Breathe® Lung Cancer 5K Run/Walk in Raleigh. Similar events will be held in Greensboro and in Boone this year. Help raise awareness and research funding for lung cancer by joining or donating to one or all of these events!
Step Lively: A Walk for Hospice Every day, the volunteers and staff of Hospice of Wake County help make life’s last walk easier for patients, families, caregivers and bereaved members of our community. By providing solace and palliative care, hospice makes the path less lonely, less painful and less frightening. This walk honors all who have spent some part of their life’s journey with us. Proceeds will support the care and comfort extended to hospice patients in the William M. Dunlap Center for Caring. Register at http://support.hospiceofwake. org/site/PageServer Wednesday, Nov 10, 8:30 a.m. – 12:30 p.m.
End-of-Life Issues Facing Healthcare Professionals
Nell Juliet Bodani, PA
Neurology Duke University Hospitals, Durham
Chapel Hill
Saturday, Nov 6, 9 a.m. – 2 p.m.
Neurology Neuromuscular Medicine 303 Village Crossing Drive, Chapel Hill
Jessica Mai McFarlin, MD
Laurael Ann Robichaud, PA
Rebecca Marie Shelton, PA
Pediatrics 801 East Woodcroft Parkway, Durham
Psychiatry Divof Prisons NC DOC, Raleigh
Internal Medicine - Sleep Medicine Neurology Duke University Hospitals, Durham
Durham
Nicole Saint Simone Peters, MD
Michael Joseph Larson, MD
Michael Wong Lui, MD
Chinika Rene Reynolds, PA
Kristi Lynn Seward, PA
UNC Family Medicine Chapel Hill
Psychiatry, Geriatric Duke University Medical Center, Durham
Durham
Pediatric Cardiology 4 West Bridlewood Trail, Durham
Christine Elizabeth Kistler, MD
Sarah Hollingsworth Lisanby, MD
Henderson
Ijeoma Janice Mbanuzue, PA
Brent A Parnell, MD
Brian David Donoghue, MD
Kimberly Kathryn Jones, PA
PO Box 91281, Raleigh
Psychiatry Duke University Medical Center, Durham
Family Practice University of North Carolina Hospitals Chapel Hill
Raleigh
with Difficult Families” or Deb Blue’s “The Benefits and Burdens of Tube Feeding.” Cost is $14.99 or $49.99 to earn 3 CEs. Register at http://www.hospiceofwake.org/pages/5/ Calendar-of-Events/
This event is designed specifically for healthcare professionals who have patients dealing with end-of-life issues. Come for a morning of information on topics that cover the range of medical, psycho-social, spiritual, and ethical issues patients and families face at end of life. Light refreshments will be provided. PRESENTERS AND TOPICS: Deb Blue, MD, Medical Director’s keynote: “Gaps in Care: Why Do We Need End-of-Life Care?” followed by two separate breakout sessions. Session 1: choose between Susan Sovine, RN, MSN, CHPN, Clinical Team Leader’s “Pain Management in End-of-Life” or Jennifer H. Fitts, M.Div., Spiritual Care Counselor’s “Telling Stories: Spirituality at the End of Life.” Session 2: choose between Mayela C. Harris, CMSW, Social Worker’s “Dealing
N.C. State University Club, Raleigh Third annual silent auction to benefit rescued cats and kittens. Attendees can bid on more than 300 assorted items, including: jewelry, art, holiday, spa and beauty, services, pet care, house wares and more! Call (919) 828-0308.
Friday, Feb 25, 6 p.m.
Brides Against Breast Cancer VIP Event Sheraton Raleigh Hotel, Raleigh, NC
Clinical Trials Do you have patients with any of these problems?
Urology
Wake Urological Associates, PA Currently screening Do you have a sudden and urgent need to urinate? Do you have accidental loss of urine? If you are a male/female, 18 years of age and older you might be eligible to participate in a clinical trial study for Over Active Bladder conducted by Wake Urological Associates. For additional information and qualification criteria please call 919.782.1255 and ask for Clinical Trials Department or visit our web site www.Wakeurological.com.
Gynecology Women’s Wellness Clinic
is conducting a research study. If you are female and 12-18 years old, have regular periods, requesting birth control pills for any reason (OR you can be part of a control group that does not take any pills), You may be eligible to participate in this study. Participants under the age of 18 must have parental consent Study participants will receive at no cost: Birth control pills for 1 year, study related exams, compensation for time and travel is available. For information, please call 919-251-9223.
News Duke CME Courses November 2, 6:30 PM Advances in Cardiothoracic Surgery and Transitions in Care University Club, Durham, NC Credits Offered: AMA PRA Category 1 - 1.50
November 14, 7:30 PM 15th Annual Duke ACS Symposium Hyatt Regency Chicago Credits Offered: AMA PRA Category 1 - 2.00
November 6 - 7 The 37th Annual Postgraduate Course, The Alexander Spock Symposium Searle Center Credits Offered: AMA PRA Category 1 - 9.50
November 15 - 18 Musculoskeletal Magnetic Resonance Imaging DUMC Credits Offered: AMA PRA Category 1 28.00
November 7 - 10, 7:00 AM Comprehensive Review of Musculoskeletal MRI Hyatt Regency Maui Resort & Spa Credits Offered: AMA PRA Category 1 - 18.00
November 29 - December 1 Preceptorship in Intraoperative Transesophageal Echocardiography Duke North OR Credits Offered: AMA PRA Category 1 - 27.00
November 7 - 10, 7:30 AM Neuroradiolgy & Cardiopulmonary Imaging Orlando, FL Credits Offered: AMA PRA Category 1 - 20.00
December 2010
November 8, 6:30 AM Ultrasound Guided Regional Anesthesia Preceptorship Course DUMC Credits Offered: AMA PRA Category 1 - 20.00
January 2011 Janurary 1 - December 31 Ultrasound-Guided Regional Anesthesia Preceptorship Internet Credits Offered: AMA PRA Category 1 - 20.00 January 10 - 12 Preceptorship in Intraoperative Transesophageal Echocardiography Duke North OR Credits Offered: AMA PRA Category 1 - 27.00 January 10 - 12 Ultrasound Guided Regional Anesthesia Preceptorship DUMC Credits Offered: AMA PRA Category 1 - 20.00
December 1 - 4 Anesthesia Camp Puerto Vallarta Four Seasons Resort Punta Mita Credits Offered: AMA PRA Category 1 20.00
January 15 - 18, 8:00 a.m. Abdominal Imaging & Musculoskeletal MRI Atlantis Credits Offered: AMA PRA Category 1 - 19.00
December 9 - 11, 1:00 PM Third Annual Duke Venous Disease Meeting Location: Washington Duke Inn Credits Offered: AMA PRA Category 1 - 16.00
January 21 - 22 Atrial Fibillation & Heart Failure are Epidemic: What Does the Clinician Need to Know? Location: Umstead Hotel Cary NC Credits Offered: AMA PRA Category 1 - 9.00
November 9, 1:00 PM Duke Tuesday in Urology Searle Center Credits Offered: AMA PRA Category 1 - 5.00
January 26 - 29, 7:00 AM Anesthesia Camp Grand Cayman Ritz Carlton Resort Grand Cayman Credits Offered: AMA PRA Category 1 - 20.00 January 31 - February 2 Preceptorship in Intraoperative Transesophageal Echocardiography Duke North OR Credits Offered: AMA PRA Category 1 - 27.00
UNC-Chapel Hill CME Courses November 6, from 7:15 a.m. to 5:30 p.m. Advances in Gynecology and Pelvic Pain 2010 Conference http://www.med.unc.edu/cme/events/ advances-in-gynecology-and-pelvic-pain-2010/ view November 6, from 8:00 a.m. to 5:00 p.m. The 6th Annual UNC Conference on Eating Disorders: The Mind-Body Solution http://www.med.unc.edu/cme/events/themind-body-solution-womens-mental-healthand-wellness March 16, 8:00 a.m. to March 18, 5:00 p.m 35th Annual Internal Medicine Conference http://www.med.unc.edu/cme/events/35thannual-internal-medicine-conference
Rex Healthcare and UNC Health Care Launch Triangle Physician Network Network will provide access to more primary care and specialty physicians UNC Health Care and Rex Healthcare have announced the launch of Triangle Physician Network, LLC (TPN), a joint effort to operate a regional network of physicians to expand the system’s ability to support the evolving health care needs of the region. TPN will provide primary care and specialty physician practices the ability to coordinate with the health care system’s electronic medical records and access to operational support and specialty and sub-specialty care providers. Both current Rex and UNC Health Care practices, as well as unaffiliated private practice physicians, will be eligible to join the network. Executive Medical Director Robert Gianforcaro, D.O., will lead the new network along with TPN’s Executive Administrative Director, Bob Ricker. Both report to Allen Daugird, M.D., M.B.A., president of TPN and UNC Physicians and Associates.
“Providing health care continues to present administrative and regulatory challenges, as do opportunities to improve the physician’s ability to deliver services to patients,” explains Dr. Gianforcaro. “As a physicianled organization, TPN has providers who are active participants at many levels of this evolution. TPN will provide practice-specific support and enable physicians to focus on the practice of medicine, thereby better meeting the needs of patients and the community.” “TPN integrates clinical and operational services to allow both physicians and the UNC Health Care System to focus on what matters most — caring for our patients,” says Ricker. “We look forward to strengthening our network of care providers and fostering increased collaboration between hospitals and private practices.” TPN is a not-for-profit, wholly-owned subsidiary of UNC Health Care and will be based out of Morrisville, North Carolina.
The group expects to expand the network beyond the current 15 practices and more than 60 physicians to include regional physician practices by late 2010. Current TPN practices include: • Chapel Hill North Medical Center • Chatham Crossing Medical Center • Chatham Primary Care • Executive Health (The Carolina Clinic) • Highgate Family Medical Center • Pittsboro Family Medicine • Rex Primary Care of Holly Springs • Rex Family Practice of Knightdale • Rex Family Practice of Wakefield • Rex Senior Health Center • Rex/UNC Family Practice of Panther Creek (coming soon) • Sanford Hematology Oncology • Sanford Specialty Clinics • UNC Family Medicine at Hillsborough • University Pediatrics at Highgate For more information, visit www.tpnmd.com.
NOVEMBER 2010
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Hospital News
UNC Obstetrics and Gynecology Is in the News Honors and Awards Anne Dunlap, RN, BSN, OCN was awarded Alumna of the Year Award from The Carolina School of Nursing Alumni Association. Dr. Herbert Peterson was awarded prestigious Allan Rosenfield Award. The award is presented annually by the Society of Family Planning.
Board Appointment Marc Fritz. M.D., has been elected to the Board of Directors for the American Society for Reproductive Medicine.
From our Blog A recent study by Alison M. Stuebe, M.D., found evidence that diabetes and obesity risk alleles interact with maternal pregravid body mass index to predict gestational weight. She also was quoted about breastfeeding benefits. Catherine Matthews, M.D., offered a video showing her performing a supracervical hysterectomy and cervicosacropexy with the DaVinci Surgical System. Daniel Clarke-Pearson, M.D., was quoted in the Society of Gynecologic
Oncologists white paper announcing the latest on screening, diagnosis and management of ovarian cancer.
Presentations The following are presentations from the American Urogynecologic Society’s 31st Annual Scientific Meeting, Sept. 29 to Oct. 2, in Long Beach, Calif. Oral presentations: • Connolly AM. Roundtable discussion leader on “How to Be An Effective Mentor.” • Geller EJ, Hankins KJ, Robinson BL, Parnell BA, Dunivan GC. Equivalency of retrograde versus spontaneous fill to assess postoperative voiding dysfunction: a randomized trial. • Grimes DA. J. Marion Sims Lecture: A Proposal for Rational Development for New Gynecological Operations. • Matthews CA. Roundtable Discussion Leader: “How to Perform Three Robotic Sacrocolpopexies in One Day.” Poster or Video Presentations: • Dunivan GC, Parnell BA, Overby DW, Geller EJ. Pelvic Floor Disorders after Weight Loss Surgery - A Comparative Study of Gastric Bypass versus Banding. • Matthews CA.
Video Poster. Robotic sacrocolpopexy. • Parnell BA, Dunivan GC, Geller EJ. Long-term Outcomes after Robotic Sacral Colpopexy. • Parnell BA, Dunivan GC, Geller EJ. Pelvic Floor Function Before and After Robotic Sacrocolpopexy - One Year Outcomes. • Parnell BA, Dunivan GC, Geller EJ, Connolly A. A Novel Approach to Teaching the Pelvic Organ Prolapse Quantification (POP-Q) Exam. • Smith TM, Trowbridge E, Pastore L, Smith SC, Brennan MC, Dooley Y, Matthews CA, Ozel B, Sutkin G, Hullfish K. The Multicenter Urogynecology Study on Education. • Woodward A, Matthews CA, Gill EJ. Prospective Outcomes of Robotic Cervico- and Sacrocolpopexy for Apical Pelvic Support Defects. • Christie M.J.L. Cooksey, M.D. Poster Presentation “Presumptive Treatment of Early Abnormal Pregnancy” Association of Reproductive Health Professionals, Sep. 22-16, Atlanta, Ga.
Publications Berggren EK, Patchen L. Prevalence of Chlamydia Trachomatis and Neisseria Gonorrhoeae and Repeat Infection Among Pregnant Urban Adolescents. Sexually Transmitted Diseases 2010 Dec. Vol. 37(12) Chaudhury P, Haeri S, Horton AL, Wolfe HM, Goodnight WH. Ultrasound Prediction of Birthweight and Growth Restriction in Fetal Gastroschisis. Am J Obstet Gynecol. 2010 Oct;203(4):395.e1-5. Epub 2010 Aug 17. Geller EJ, Wu JM, Jannelli ML, Nguyen TV, Visco AG. Maternal Outcomes Associated with Planned Vaginal Versus Planned Primary Cesarean Delivery. Am J Perinatol. 2010 Oct;27(9): 675-83. Epub 2010 Mar 16. Meltzer-Brody S, Stuebe A, Dole N, Savitz D, Rubinow D, Thorp J. Elevated Corticotropin Releasing Hormone (CRH) during Pregnancy and Risk of Postpartum Depression (PPD). J Clin Endocrinol Metab. 2010 Oct 13. Patchen L, Berggren EK. Use of the Copper T380A Intrauterine Device by Adolescent Mothers: Continuation and Method Failure. J Pediatr Adolesc Gynecol. 2010 Sep 22. [Epub ahead of print]
Rex Primary Care of Holly Springs Opens Rex Primary Care of Holly Springs at Southpark Village recently opened as part of Rex Healthcare’s effort to serve its neighboring Triangle communities. The new facility will feature physicians’ offices and dedicated staff using the latest technologies and treatment options to provide a broad scope of services and quality care for patients. Patients will have the added benefits of the practice’s access to and affiliation with Rex Healthcare. The practice’s clinical team includes Mona S. Ghobrial, M.D., and Gail Little, practice manager. “Now we can be accessible for patients and families in Holly Springs and surrounding areas,” said Little. “We look forward to
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The Triangle Physician
working with our new patients and the Holly Village Walk Drive. For more information, NEWSOURCE-JUN10:Heidi 8/5/10 12:57 PM or Page 1 (919) 784-3419. visit rexhealth.com call Springs community.” Rex will host a groundbreaking ceremony Nov. 10, from 11:30 a.m. to 1 p.m. to celebrate the start of construction on its state-of-the-art campus in Holly Springs. It will feature urgent care, imaging services, a sleep lab, primary care, heart and vascular services, pediatrics and surgeons’ offices. Rex Primary Care of Holly Springs is located at 208
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CARDIOLOGY SERVICES CARDIOLOGY SERVICES
Coronary Peripheral Vascular Interventions, Wake Heart & Vascular AssociatesCoronary Smithfi Heart & Vascular AssociatesWake andand Peripheral Vascular Interventions, Heart & Vascular Associates Smithfi eldeld Heart & Vascular Associates Pacemakers/Defi brillators, Atrial Fibrillation 2076 Hwy West, Suite Berkshire Road brillators, Atrial Fibrillation 2076 NCNC Hwy 42 42 West, Suite 100100Pacemakers/Defi 910910 Berkshire Road Ablations, Echocardiography, Nuclear Cardiology, Clayton, 27520 Smithfi 27577 Ablations, Echocardiography, Nuclear Cardiology, Clayton, NCNC 27520 Smithfi eld,eld, NCNC 27577 Vascular Ultrasound, Clinical Cardiology, CT Phone: 919-359-0322 Phone: 919-989-7907 Vascular Ultrasound, Clinical Cardiology, CT Phone: 919-359-0322 Phone: 919-989-7907 Coronary Angiography, Stress Tests, Holter Coronary Angiography, Stress Tests, Holter 919-359-0326 919-989-3147 Fax:Fax: 919-359-0326 Fax:Fax: 919-989-3147 Monitoring, Cardiovascular Medicine, Monitoring, Cardiovascular Medicine, Echocardiography, Nuclear Cardiology, Cardiac Echocardiography, Nuclear Cardiology, Cardiac Catheterization Catheterization
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We Know How To Exceed Your Imaging Expectations.
Dr. William G. Way Jr. | PET·CT Specialist
Wake Radiology’s PET·CT Services are ready when you and your patients need us. Patients and caregivers can pull right up to our door, with check-in just a few steps away. Our PET suite, with its glorious picture windows, is calming, and our experienced staff inspire confidence. You’ll have results in record time, and you’ll find us readily available for physician-decision support. One-call scheduling
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makes us even more convenient—919-232-4700. Wake Radiology PET·CT Services. The future is now. If you haven’t received your PET·CT scheduling starter kit, please call us at 919-854-2190.
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