F e b rua ry 2 014
Duke’s Multidisciplinary
Syncope and Dysautonomia Clinic Improves Outcomes
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
Dupuytren’s Contracture Vaginal Atrophy
Add a pinch of spice,
a hint of laughter,
and a correct diagnosis,
and you’ll get Robert.
Robert suffered from unexplained fainting spells. His physicians couldn’t figure out why. To find answers, they implanted a Reveal® Insertable Cardiac Monitor (ICM) to see if his spells were heart rhythm related.
(Actual size)
The Reveal ICM is a long-term heart monitor that may help you rule in or rule out an abnormal heart rhythm as the cause of unexplained fainting spells. In Robert’s case, they were, and now he has a pacemaker. Possible risks associated with the implant of a Reveal Insertable Cardiac Monitor include, but are not limited to, infection at the surgical site, device migration, erosion of the device through the skin and/or sensitivity to the device material. Results may not be typical for every patient.
Brief Statement Indications 9529 Reveal® XT and 9528 Reveal® DX Insertable Cardiac Monitors – The Reveal XT and Reveal DX Insertable Cardiac Monitors are implantable patient-activated and automatically activated monitoring systems that record subcutaneous ECG and are indicated in the following cases: • patients with clinical syndromes or situations at increased risk of cardiac arrhythmias; • patients who experience transient symptoms such as dizziness, palpitation, syncope, and chest pain, that may suggest a cardiac arrhythmia. 9539 Reveal® XT and 9538 Reveal® Patient Assistants – The Reveal XT and Reveal Patient Assistants are intended for unsupervised patient use away from a hospital or clinic. The Patient Assistant activates one or more of the data management features in the Reveal Insertable Cardiac Monitor: • To verify whether the implanted device has detected a suspected arrhythmia or device related event. (Model 9539 only); • To initiate recording of cardiac event data in the implanted device memory. Contraindications: There are no known contraindications for the implant of the Reveal XT or Reveal DX Insertable Cardiac Monitors. However, the patient’s particular medical condition may dictate whether or not a subcutaneous, chronically implanted device can be tolerated. Warnings/Precautions: 9529 Reveal XT and 9528 Reveal DX Insertable Cardiac Monitors – Patients with the Reveal XT or Reveal DX Insertable Cardiac Monitor should avoid sources of diathermy, high sources of radiation, electrosurgical cautery, external defibrillation, lithotripsy, therapeutic ultrasound and radiofrequency ablation to avoid electrical reset of the device, and/or inappropriate sensing. MRI scans should be performed only in a specified MR environment under specified conditions as described in the device manual. 9539 Reveal XT and 9538 Reveal Patient Assistants – Operation of the Model 9539 or 9538 Patient Assistant near sources of electromagnetic interference, such as cellular phones, computer monitors, etc., may adversely affect the performance of this device. Potential Complications: Potential complications include, but are not limited to, device rejection phenomena (including local tissue reaction), device migration, infection, and erosion through the skin. See the device manual for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
UC201003796 EN © Medtronic, Inc. 2009. Minneapolis, MN. All Rights Reserved. Printed in USA. 11/2009
For more information, visit www.fainting.com.
COVER STORY
6
Duke’s Multidisciplinary Syncope and Dysautonomia Clinic Improves Outcomes
F e b r u a r y 2 0 14
Vol. 5, Issue 1
FEATURES
10
Orthopedic Surgery
Update on Dupuytren’s Contracture Treatment Dr. John Erickson discusses the condition of progressive flexion deformities of the digits and its treatment.
12
Women’s Health
DEPARTMENTS 9 Gastroenterology
16 WakeMed News
Functional Abdominal Pain Syndrome
Cardiology Patient Navigator Program Focused on Reducing Readmission
14 Duke Research News Long-Term Spinal Cord Stimulation Stalls Parkinson’s Symptoms in Rats
17 UNC Research News
15 Duke News
$900,000 Grant Awarded: Unprecedented Collaboration Aims to Improve Autism Services
$25,000 Grant Helps Pediatric Oncology
18 UNC News
15 Rex News
Level I Pediatric Trauma Center Verification Is Triangle’s First
New Mobile Mammography Unit Increases Access to Preventive Care for Women
19 Community Support
A Pill for Pain with Intercourse?
16 ECU News
Krzyzewski Leads Giving Program that Encourages CommunityDriven Events
Dr. Andrea Lukes explores promising new
Cancer Specialists Join ECU Physicians
20 News
options for relief of vaginal atrophy after menopause.
Welcome to the Area
COVER PHOTO: Camille G. Frazier-Mills, M.D., M.H.S., of Duke Electrophysiology was instrumental in leading the development of the Duke Syncope and Dysautonomia Clinic.
2
The Triangle Physician
Could Your Patient’s Symptoms Be Caused By Something As Simple As A Sleep Disorder?
Fatigue - Irritability - Depression - Attention Deficit Difficulty Concentrating - Lowered Productivity Weakness - Memory Loss - Night Sweats - Drowsiness Clumsiness - Frequent Illness - Insomnia - Throat Irritation Loud Snoring - Narcolepsy - Difficulty Staying Asleep... These are all symptoms that can be produced by common sleep disorders such as sleep apnea, a condition that can be dangerous and damaging to a patient’s health. Johnston Health offers a full range of diagnostic and treatment services for all types of sleep disorders through Johnston Sleep Center. Call for more information!
Johnston Johnston Health Sleep Center Smithfield & Clayton 919-570-9715
www.johnstonhealth.org
From the Editor
Imagine The proverbial “light at the end of the tunnel” for patients with autonomic conditions is the new Duke Syncope and Dysautonomia Clinic, the cover story in this month’s The Triangle Physician. 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
At least once in our lives, many of us has “passed out” and recall – if vaguely – the symptoms before and after a syncopal event. Having experienced it once makes it even harder to imagine the hardships faced by those with recurring syncope. The feeling of isolation is one of a number of common health issues associated with dysautonomia and other autonomic disorders that are frequently aggravated by inexperienced, ineffective medical care. Patients with autonomic conditions who are referred to the Duke Syncope and Dysautonomia Clinic are diagnosed and treated using evidence-based algorithms. A multidisciplinary medical team zeroes in on the etiology of the autonomic condition and
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Douglas A. Drossman, M.D. John M. Erickson, M.D. Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Creative Director Joseph Dally jdally@newdallydesign.com
delivers individualized care that addresses any combination of symptoms present.
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So, imagine the joy that comes with regaining control of one’s life – finding something
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precious that was lost. Cost savings as a result of improved use of medical resources is another outcome of this specialized Duke clinic. As always, contributed articles by your peers offer enlightening glimpses into their specialty areas. In this issue, orthopedic surgeon John Erickson brings us up to date on current therapies for Dupuytren’s contracture. Gastroenterologist Douglas Drossman provides an overview of abdominal pain syndrome and treatment. Obstetrician/gynecologist Andrea Lukes shares information about a new oral treatment for impacting menopausal symptoms
info@trianglephysiciancom
The Triangle Physician is published by: New Dally Design Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
that can cause painful intercourse. It’s a great issue to start the year. Now, imagine your practice news and specialized medical perspective in The Triangle Physician . Articles that are relevant to the Triangle medical community run at no cost to the contributor. And advertising dollars are well spent, with each issue reaching more than 9,000 readers – physicians, physician assistants, nurse practitioners, office administrators and other medical professionals throughout the region. Better than imagining, this year make it happen. Contact me at heidi@trianglephysician.com to learn about opportunities to showcase the qualities that distinguish you and your practice.
Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser.
Respectfully,
Heidi Ketler Editor
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Cover Story
Duke’s Multidisciplinary Syncope and Dysautonomia Clinic Improves Outcomes Duke University Medical Center has insti-
nity and permits appropriate risk stratifica-
forming physical exams, choosing ap-
tuted North Carolina’s first Syncope and
tion and evaluation using evidenced-based
propriate tests, interpreting test abnor-
Dysautonomia Clinic, designed to improve
algorithms,” says Camille G. Frazier-Mills,
malities and using the results to establish
diagnoses and lower health care costs using
M.D., M.H.S., of Duke Electrophysiology,
the cause of syncope. Findings point to
a structured, multidisciplinary approach.
who is among the program leaders.
improved diagnostic yield and reduction in hospitalization – utilizing brief observa-
“The clinic is designed to improve access for
Research supports using evidence-based
tion and involving a cardiac specialist –
syncope referrals from the ER and commu-
criteria for taking medical histories, per-
without affecting recurrent syncope and all-cause mortality among intermediaterisk patients presenting to the emergency room with syncope.1 Also known as fainting, syncope is the transient loss of consciousness and postural tone, which is characterized by rapidonset, short-duration and with spontaneous complete recovery. The condition lasts seconds to minutes, and the patients are functionally back to their baseline, so the etiology is often presumptive, impacting diagnostic accuracy and leading to inappropriate and unnecessary treatment. Syncope is a common problem. It estimated that 35-40 percent of the general population has a lifetime incidence of at least one syncopal episode. From one-to-two-million patients annually experience syncope, with a similar incidence in women and men. One percent of emergency medicine encounters is due to syncope and results in 30-40 percent subsequent admissions, costing $2.4 billion annually, according to the Medicare database. “Syncope can be benign or a marker of an impending life-threatening condition. So usually people take it pretty seriously, but not always,” says James P. Daubert, M.D., chief of Duke electrophysiology.
Camille G. Frazier-Mills, M.D., M.H.S., and Augustus O. Grant, Ph.D., M.B. Ch.B., are the attending physicians for the Duke Syncope and Dysautonomia Clinic.
6
The Triangle Physician
In addition to seeing syncope patients, Duke electrophysiologists are seeing an
increase in referrals for dysautonomia
Reflex syncope includes vasovagal synco-
of rapid growth or immediately following
patients, in particular postural orthostatic
pe, carotid sinus sensitivity and situational
a viral illness or trauma. Females are four
tachycardia syndrome. Dysautonomia is a
syncope. The most typical are vasovagal
to five times more likely than males to
disease or malfunction of the autonomic
and situational, accounting for more than
develop POTS, and there is a propensity
nervous system. In addition to cardiac is-
80 percent of all syncopal episodes in pa-
for POTS in some families. Although rare,
sues affecting heart rate and blood pres-
tients with no history of heart disease or
there are children born with life threaten-
sure, these patients can also suffer from
elevated risk of heart disease. It occurs
ing, non-familial forms.
migraines, chronic nausea, bowel disor-
more frequently in adolescents and young
ders, anxiety, chronic fatigue and sleep
adults, but can happen to almost anyone.
Drs. Frazier Mills and Daubert hope Duke’s
disorders.
It is usually preceded by prodromal symp-
syncope clinic will provide a source of
toms of autonomic activation, such as
patients with familial incidence who may
sweating, pallor and nausea.
participate in clinical trials investigating a
Dr. Frazier-Mills and Augustus O. Grant,
genetic link.
Ph.D., M.B. Ch.B., are the attending physicians for the Duke Syncope and Dysauto-
Syncope secondary to orthostatic hypoten-
nomia Clinic. They are assisted by a physi-
sion is defined as an abnormal decrease
All syncope patients seen in the emergen-
cian assistant and a nurse practitioner and
in systolic blood pressure when standing
cy department are referred for follow up
work in collaboration with providers in
up due to a circulatory abnormality. This
to the Duke Syncope and Dysautonomia
general cardiology, neurology, gastroenter-
can occur due to volume depletion, medi-
Clinic.
ology, psychiatry and sleep medicine.
cation changes and autonomic nervous Patient-Focused Care in the
system failure.
Syncope Clinic
“We are very excited about the clinic. It’s something we’ve wanted to do for a few
Orthostatic hypotension syndromes can oc-
“The needs of patients with autonomic
years now,” says Dr. Daubert. “We rec-
cur in anyone, but especially in older people,
dysfunction are multifactorial,” says Dr.
ognized that the care of these patients is
as an effect of certain prescription drugs and
Frazier-Mills. “Rather than moving from
typically challenging and time consuming.
a result of such medical disorders as Parkin-
many touch-points, the Duke clinic offers
They may get shuttled about, going from
son’s disease and diabetes, among others.
single access to a team of specialists and
doctor to doctor, without getting to the bot-
There also may be a genetic link.
expedited treatment.”
Several conditions are forms of dysauto-
The general framework of treatment within
Understanding Syncope
nomia. They include: inappropriate sinus
the Duke Syncope and Dysautonomia Clin-
and Dysautonomia
tachycardia, vasovagal syncope, pure au-
ic is based on risk stratification and iden-
Syncope is a T-LOC due to transient global
tonomic failure, neutrally mediated hypo-
tification of specific mechanisms when
cerebral hypoperfusion characterized by
tension, autonomic instability, paroxysmal
possible. The goal is primarily treatment
rapid onsite, short duration and spontane-
sympathetic hyperactivity and a number of
of any underlying conditions, prevention
ous recovery. The classification of syncope
lesser-known disorders.
of recurrence and associated injuries and
tom of the condition and diagnosis.”
improvement in quality of life.
relates to cardiac output (CO) and total peripheral vascular resistance. A fall in either
Postural orthostatic tachycardia syndrome,
can cause syncope, though a combination
or POTS, is a related condition with a typi-
Initially, the medical team will assess for
of both is often present.
cal age of onset of 14–16 years of age in
structural heart disease, conduction abnor-
those who are otherwise healthy, primar-
malities, arrhythmias through use of echo-
Causes can be classified as cardiac syn-
ily females. While POTS may produce low
cardiography, electrocardiography and car-
cope (including arrhythmia and structural
blood pressure, the main problem is an
diac monitors. Autonomic testing also will
heart disease), syncope secondary to or-
extremely rapid heart rate on standing up.
be completed in appropriate patients.
thostatic hypotension and reflex syncope.
Those with POTS may also experience palpitations, dizziness and weakness. Roughly
A tilt table test is one tool used to assess
Cardiac syncope can occur when the
40 percent of them will experience synco-
for autonomic dysfunction. The patient is
heart’s electrical system malfunctions or
pe at least once.
placed at an angle on a table for about 3045 minutes, and blood pressure and pulse
there is an obstruction of blood flow out of the heart caused by a narrow heart valve
Like other forms of dysautonomia, the
rate are measured with the patient in differ-
or a thick heart muscle. Fortunately, most
cause of POTS is not fully understood. On-
ent positions. Patients with syncope may
syncope is not cardiac in nature.
set of symptoms often occurs after a period
experience abrupt, pronounced changes
february 2014
7
in heart rate and arterial pressure and char-
Dr. Frazier-Mills. “Some etiologies are defi-
acteristic sweating, pallor, near-syncope
nitely cured.”
poor long-term prognosis. Timely Evaluation Is Advised
and syncope. Returning the patient to the horizontal position halts the response and
For patients with dysautonomia, education
Physician referrals are encouraged. “We
typically giving fluids re-
and counseling on ways to manage their
think syncope patients should see us pret-
turns the patient to their
condition for improved quality of life are
ty early in the process, so diagnosis and
baseline.
key. Lifestyle modification, like proper ex-
treatment can begin immediately,” says Dr.
ercise and frequent small meals, a high-salt
Daubert.
Camille G. Frazier-Mills, M.D., M.H.S.
A Holter monitor/loop
diet and sufficient fluid intake, can help to
event recorder is worn
a large degree. Posture training and com-
Referring physicians may call the Duke
on an outpatient basis
pression stockings can help. Drugs such
Heart Center at (919) 681-5816. Patients are
for 24 hours, 48 hours
as fludrocortisone, midodrine, b-blockers
seen at the electrophysiology clinic, Duke
or for up to 30 days to
and SSRIs also can be used to improve he-
South 2F/2G.
identify abnormal heart
modynamics and symptoms. Resources
rhythms and rates as the
Augustus O. Grant, Ph.D., M.B. Ch.B.
James P. Daubert, M.D
8
potential cause of synco-
“Dysautonomia patients require frequent
1
pe. “Ideally, the patient
visits for medication adjustment and exten-
cope Evaluation in the Emergency Depart-
would have another syn-
sive counseling to help them cope with a
ment Study (SEEDS): A multidisciplinary
cope episode that the
debilitating condition that can strike sud-
approach to syncope management. Circu-
monitor would pick up,”
denly,” says Dr. Daubert. Some forms of dys-
lation. 2004 Nov 9.
says Dr. Daubert.
autonomia resolve over time and are not life
Shen WK, Decker WW, Smars P, et al. Syn-
threatening, though they may involve minor
2
“Treatment depends on
to major limitations in activities of daily liv-
2671. Soteriades ES, N Engl J Med.
the syncope etiology
ing. Patients with chronic, progressive, gen-
2002;347:878–885. Blanc JJ. Eur Heart J.
and then fixing the un-
eralized dysautonomia in conjunction with
2002;23:815–820.
derlying problem,” says
central nervous system degeneration have a
The Triangle Physician
Moya A, European Heart J. 2009;30:2631–
Gastroenterology
Functional Abdominal Pain Syndrome By Douglas A. Drossman, M.D.
People with functional gastrointestinal
up-regulation of incoming visceral afferent
disorders can have a variety of painful
signals, which can bring even regulatory
symptoms that range from irritable bowel
signals to a point of conscious awareness
syndrome (IBS), esophageal pain and func-
and distress.
tional dyspepsia (FD). These disorders are often triggered or worsened by gastrointes-
In a recent study, rectal thresholds and
tinal action, such as eating or defecation.
compliance were significantly reduced in IBS but not in FAPS, thus indicating that the
There is, however, another, less common
pain is not due to visceral hypersensitivity
condition of abdominal pain that is chronic
as much as to central (i.e., CNS) hypersen-
or frequently recurring and not associated
sitivity.
with changes in bowel patterns. This condition is called functional abdominal pain
A key issue in management of FAPS is es-
syndrome (FAPS).
tablishing an effective patient-physician relationship. Factors that contribute to an
The Rome Foundation has established
effective patient-physician relationship in-
symptom-based criteria (Rome III) to en-
clude empathy toward the patient, patient
able greater precision in making a diagno-
education, validation of the illness, reassur-
sis of FAPS. All of the following are needed:
ance, treatment negotiation and establish-
1) Continuous or nearly continuous
ment of reasonable limits in time and effort.
abdominal pain; 2) Absent or occasional relationship of
Medical Treatments for FAPS and chronic
pain with physiological events (e.g. eat-
pain are mostly targeted at improving the
ing, defecation, or menses);
CNS’s ability to modulate the pain and
3) Some loss of daily functioning;
down-regulate incoming visceral signals.
4) The pain is not due to malingering;
These include psychotropic agents, be-
5) Insufficient symptoms to meet criteria
havioral approaches and complementary
for another functional gastrointestinal
treatment strategies. Psychotropic agents
disorder that would explain the pain.
include the tricyclic antidepressants and se-
Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment. Dr. Drossman is president of the Rome Foundation (www.theromefoundation. org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www.drossmancenter.com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patientprovider relationship. Drossman Gastroenterology P.L.L.C. (www.drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.
rotonin norepinephrine reuptake inhibitors. Criteria must be fulfilled for the previous
Behavioral approaches may include stress
three months with symptom onset at least
management, hypnosis and cognitive-
Selected Reading
six months prior to diagnosis.
behavioral therapy (CBT), while comple-
Sperber, A.D. & Drossman, D.A. Review
mentary treatments include massage and
article: The functional abdominal pain
acupuncture.
syndrome. Alimentary Pharmacology and
Unlike acute pain, chronic pain, like that of FAPS, has a multidimensional construct
Therapeutics 2011; 33: 514–524.
with sensory, emotional and cognitive con-
It is becoming increasingly common to use
tributions to the pain experience, which are
combinations of treatments to improve pain
related to abnormalities in neurophysiologi-
benefit while keeping side effects at a mini-
cal functioning at peripheral, spinal and su-
mum. For example, a provider may use an
praspinal levels. In chronic pain, peripheral
antidepressant in combination with a low-
contribution in the form of increased affer-
dose augmenting agent of another class
ent visceral stimuli does not play as great
or a behavioral treatment like CBT with an
a role as central nervous system (CNS)
antidepressant.
Grover, M & Drossman, D.A. Functional Abdominal Pain. Curr Gastroenterol Rep August 2010. Drossman, D.A. Functional Abdominal Pain Syndrome. Clinical Gastroenterology and Hepatology 2004;2:353–365. february 2014
9
Orthopedic Surgery
Update on
Dupuytren’s Contracture Treatment By John M. Erickson, M.D.
Dr. John Erickson is a hand and upper extremity surgeon at the Raleigh Hand Center. He is board-certified in orthopedic surgery and completed additional fellowship training in hand and upper extremity surgery at Vanderbilt University. Dr. Erickson earned his medical degree from the University of Texas Southwestern Medical Center in Dallas and completed his orthopedic surgery training at the University of Michigan Hospitals in Ann Arbor. He has a special interest in sports injuries, wrist fractures and hand tumors. Dr. Erickson can be reached at (919) 872-3171. For more information about the Raleigh Hand Center visit www.raleighhand.com.
Dupuytren’s disease is a benign, fibropro-
out Europe about the condition that now
tren’s disease is individualized, and is de-
liferative disorder affecting the hands of
bears his name. Since that time, there has
pendent on patient age, degree of flexion
many adults. The condition is character-
been extensive research and improved
contracture, extent of disease and patient
ized by abnormal deposition of collagen
understanding of the disease process.
desires. For patients with minimal flexion contractures, education about Dupuy-
within the palmar fascia of the hand leading to development of nodules and cords
Myofibroblast cells and alterations in col-
tren’s disease is provided and observation
in the palm. As the pathologic fibrous
lagen remodeling have been implicated in
is recommended. Patients are instructed
tissue contracts, progressive flexion de-
the pathogenesis of Dupuytren’s contrac-
to report when they can no longer place
formities of the digits develop that prevent
ture. The clinical course of Dupuytren’s
their hand flat on a table (the “table top
the patient from fully straightening the
disease is variable, but most patients de-
test”). Most surgeons recommend inter-
digits. The condition is most commonly
velop slowly progressive, painless flexion
vention when a patient develops a func-
seen in men age 40 and above, and the
contractures in the small and ring fingers.
tionally limiting contracture in a digit.
incidence increases in older There is no known cure for Du-
populations.
puytren’s
disease.
However,
is
current treatment is aimed at
thought to be a disorder of
reducing flexion contractures,
autosomal dominant inheri-
improving joint range of motion
tance of variable penetrance.
and restoring hand function. Oral
Due to the high prevalence of
medications, splinting and hand
disease in patients of Scandi-
therapy have not been clinically
navian, Celtic and Northern
proven to be effective in patients
European ethnicity, it has
with Dupuytren’s contractures.
Dupuytren’s
disease
Intralesional corticosteroid injec-
been speculated that the Vikings distributed this genetic predilection
As the joint contractures worsen, patients
tions may soften Dupuytren’s nodules
during their travels.
report functional difficulty with shaking
and cords, but this medication does not
hands, wearing gloves and reaching into
relieve joint contractures. Radiotherapy
The condition was first described in 1614
a pocket. Patients with more aggressive
has gained interest in Europe but is not
by Felix Plater of Switzerland and received
disease may also develop plantar fibro-
commonly performed for this condition in
its eponym from Baron Guillaume Dupuy-
matosis (Ledderhose disease) and penile
the United States.
tren in the 1800s. Dupuytren was a French
involvement (Peyronie’s disease). The traditional treatment option and cur-
anatomist and military surgeon for Napoleon who lectured extensively through-
10
The Triangle Physician
The treatment of patients with Dupuy-
rent gold standard is surgical fasciectomy.
In this procedure, the diseased fibrous tissue is meticulously dissected and excised, allowing the joint contractures to be released. Post-operative splinting and hand therapy are recommended for several weeks afterwards. Most patients achieve significant improvement in function and digit range of motion after surgical treatment. Recently, less-invasive percutaneous treatments for Dupuytren’s have been promoted. These options include collagenase injections (Xiaflex) and needle aponeurotomy (NA), both of which can be performed in the office. Percutaneous techniques are gaining favor among surgeons and patients, due to quicker recovery and low complication rates. Some patients who are not good surgical candidates due to medical co-morbidities may be better candidates for lessinvasive techniques. Collagenase injections were approved by the United States Food and Drug Administration in 2010 after demonstrating promising results and high patient satisfaction in the hand surgery literature. This medication dissolves Dupuytren’s tissue, allowing the surgeon to disrupt the pathologic cords as an office-based procedure. The recent clinical results with collagenase use in our office have been encouraging.
Expert, cost effective and timely care is what Carolina Endocrine has to offer your patients. • Neck Ultrasounds (ECNU certified) • Fine needle aspiration biopsies • Nuclear medicine studies
All in one convenient location at 3840 Ed Drive, behind Rex Hospital.
919-571-3661
www.CarolinaEndocrine.com Dr. Michael Thomas, Ph.D. Dr. Khushbu Chandarana Courtney Kovalick, PA-C Eileen Andres, PA-C
february 2014
11
Women’s Wellness
A Pill for Pain with Intercourse? By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
After menopause, about 60 percent of
fene (Osphena) for treatment of dyspa-
1
women experience vulvovaginal atrophy.
reunia. The oral medication works as a
The condition causes vaginal dryness,
selective estrogen receptor modulator. It
itching, burning and dyspareunia, or pain-
also is approved for the treatment of hot
ful intercourse. Intercourse can result in
flashes associated with menopause
bleeding, urinary frequency or urgency and recurrent urinary tract infections.
Not all women want to take hormones.
Many women stop having sexual inter-
In fact, in a large-scale survey (REVIVE)
course as a result.
by Sheryl A. Kingsberg, Ph.D., (2013)3, of 3,046 postmenopausal women with vul-
Vaginal dryness – a hallmark of vaginal at-
vovaginal atrophy, most women were not
rophy (atrophic vaginitis) – is the thinning
taking hormones. Overall, only 40 percent
and inflammation of the vaginal walls due
of those women were currently using
to a decline in estrogen (www.mayoclinic.
treatment with 29 percent being over-the-
org). This also impacts the vulva.
counter and 11 percent being hormonal.
In a 2007 survey by the North American
Reasons cited for using the over-the-
Menopause Society, one third of respon-
counter treatments were: no side effects
dents found that vulvovaginal atrophy
(65 percent), safe for long-term use (57
(VVA) negatively impacted their sexual in-
percent), no breast cancer concerns (51
terest, mood and self-esteem. Many wom-
percent) and no hormone exposure con-
en found it “embarrassing” to talk about
cern (51 percent). Further, many partici-
such a personal subject.
pants noted that vaginal hormones can be messy, cause vaginal discharge and do
Healthcare providers should recognize
not relieve symptoms sufficiently. More
the importance of dyspareunia associated
than half of women (55 percent) indicated
with VVA in postmenopausal women. Ef-
they would prefer an oral product.
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 cofounded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position (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 Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals for management of heavy menstrual bleeding. Call (919) 251-9223 or visit www.cwrwc.com.
a nonhormonal vaginal lubricant. Ad-
fective options are available. An Oral Treatment for
ditional endpoints that also showed im-
What Can Be Done for
Vulvovaginal Atrophy?
provement included analysis of parabasal
Vulvovaginal Atrophy?
The pivotal studies leading to approval
cells, superficial cells and vaginal pH.
Current treatments for VVA include sys-
of Osphena included three placebo-con-
temic hormone therapy, vaginal estrogen
trolled clinical trials (two 12-week efficacy
The safety of Osphena was shown in
products and over-the-counter nonhor-
trials and one 52-week, long-term safety
these studies as well. Although there can
monal lubricants. Although hormones
trial).4 A total of 787 women received pla-
be side effects, no serious side effects oc-
can work, there are risks with systemic
cebo and 1,102 women received 60 milli-
curred among study participant that were
hormones and local hormones. Lubri-
gram Osphena daily.
thought to be related to Osphena. The most common adverse events include hot
cants or moisturizers have limited benOverall, self-reported dyspareunia dem-
flush, vaginal discharge, muscle spasms,
onstrated a statistically significant im-
genital discharge and hyperhidrosis (ex-
In June 2013, the United States Food and
provement. Interestingly, all participants
cessive sweating).
Drug Administration approved ospemi-
(placebo and Osphena groups) received
efit.
12
The Triangle Physician
NEWSOURCE-JUN10:Heidi
8/5/10
12:57 PM
Page 1
Optional Treatment – Selective Estrogen Receptor Modulators Selective estrogen receptor modulators (SERMs) are compounds that
Do They Like What They See?
interact with intracellular estrogen receptors in target organs as estrogen receptor agonists or antagonists.5 Treat-
Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.
ments with SERMs have been used to prevent and treat breast cancer, postmenopausal osteoporosis and now postmenopausal vulvovaginal atrophy.
Our services range from consultation, to design, to creation and implementation of strategic plans.
The tissues impacted by SERMs potentially include genitourinary, uterine, breast and bone tissue. Each SERM has the unique profile of impacting these tissues depending on the expression of estrogen receptor subtypes.
newsource & Associates
Conclusion The impact of dyspareunia associated with vulvovaginal atrophy can be significant for postmenopausal women.
Call (540) 650-3686 or send inquiries to hketler@verizon.net.
Our network of smart, creative, award-winning specialists serves the health care industry throughout the Mid-Atlantic.
Maybe it’s happiness in a child’s eyes. Whatever the desired outcomes, count on us to ensure your key messages have the 20/20 clarity to deliver.
The new option of an oral SERM that significantly improves this problem is an important development for wom-
55 Vilcom Center Drive Boyd Hall, Suite 110 Chapel Hill, NC 27514
Drossman Gastroenterology PLLC a patient-centered gastroenterology practice focusing on patients with difficult to diagnose and manage functional GI and motility disorders. The office is located within the multidisciplinary health care center, Chapel Hill Doctors. Dr. Douglas Drossman is joined by physician’s assistant, Kellie Bunn, PA-C. Appointments are scheduled on Tuesday and Wednesday and most laboratory studies are available.
919.929.7990
www.drossmangastroenterology.com
en’s health. References Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med 2009;6:2133-2142.
1
Simon JA, Komi J. Vulvovaginal atrophy (VVA) negatively impacts sexual function, psychosocial well-being, and partner relationships. Poster presented at North American Menopause Association Annual Meeting; October 3-6,2007; Dallas, Texas.
2
Kingsberg SA, Wysocki S, Magnus L, Krychman ML, Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (Real Women’s Views of Treatment Options for Menopausal Vaginal Changes) survey, J Sex Med 2013 July 10(7):1790-9.
3
Drossman Gastroenterology
Full Prescribing Information for Osphena (package insert).
4
Maximov PY, Lee TM, Jordan VC. The discovery and development of selective estrogen receptor modulators (SERMs) for clinical practice. Curr Clin Pharmacol 2013 May;(2):135-55.
5
february 2014
13
Duke Research News
Long-Term Spinal Cord Stimulation Stalls Parkinson’s Symptoms in Rats Researchers at Duke Medicine have shown
balance. L-dopa, the standard drug treat-
movements were replaced with the active
that continuing spinal cord stimulation
ment for Parkinson’s disease, works by
behaviors of healthy mice and rats.
appears to produce improvements in
replacing dopamine. While L-dopa helps
symptoms of Parkinson’s disease and may
many people, it can cause side effects and
Because research on spinal cord stimula-
protect critical neurons from injury or de-
lose its effectiveness over time.
tion in animals has been limited to the stimulation’s acute effects, in the current study
terioration. Deep-brain stimulation, which emits elec-
Dr. Nicolelis and his colleagues investigat-
The study performed in rats was published
trical signals from an implant in the brain,
ed the long-term effects of the treatment in
online Jan. 23 in the journal Scientific Re-
has emerged as another valuable therapy,
rats with the Parkinson’s-like disease.
ports. It builds on earlier findings from the
but less than 5 percent of those with Par-
Duke team that stimulating the spinal cord
kinson’s disease qualify for this treatment.
For six weeks, the researchers applied elec-
with electrical signals temporarily eased
“Even though deep-brain stimulation can
trical stimulation to a particular location in
symptoms of the neurological disorder in
be very successful, the number of patients
the dorsal column of the rats’ spinal cords
rodents.
who can take advantage of this therapy is
twice a week for 30-minute sessions. They observed a significant improvement in the rats’ symptoms, including improved motor skills and a reversal of severe weight loss. In addition to the recovery in clinical symptoms, the stimulation was associated with better survival of neurons and a higher density of dopaminergic innervation in two brain regions controlling movement – the loss of which cause Parkinson’s disease in humans. The findings suggest that the treatment protects against the loss or damage of neurons. Clinicians are currently using a similar application of dorsal column stimulation to manage certain chronic pain syndromes in
“Finding novel treatments that address
small, in part because of the invasiveness
humans. Electrodes implanted over the spi-
both the symptoms and progressive nature
of the procedure,” Dr. Nicolelis said.
nal cord are connected to a portable generator, which produces electrical signals
of Parkinson’s disease is a major priority,” said the study’s senior author Miguel Ni-
In 2009, Dr. Nicolelis and his colleagues
that create a tingling sensation to relieve
colelis, M.D., Ph.D., professor of neurobiol-
reported in the journal Science that they
pain. Studies in a small number of humans
ogy at Duke University School of Medicine.
developed a device for rodents that sends
worldwide have shown that dorsal column
“We need options that are safe, affordable,
electrical stimulation to the dorsal column,
stimulation may also be effective in restor-
effective and can last a long time. Spinal
a main sensory pathway in the spinal cord
ing motor function in people with Parkin-
cord stimulation has the potential to do this
carrying information from the body to the
son’s disease.
for people with Parkinson’s disease.”
brain. The device was attached to the surface of the spinal cord in rodents with de-
“This is still a limited number of cases, so
Parkinson’s disease is caused by the pro-
pleted levels of dopamine, mimicking the
studies like ours are important in examin-
gressive loss of neurons that produce do-
biologic characteristics of someone with
ing the basic science behind the treatment
pamine, an essential molecule in the brain,
Parkinson’s disease. When the stimula-
and the potential mechanisms of why it is
and affects movement, muscle control and
tion was turned on, the animals’ slow, stiff
effective,” Dr. Nicolelis said.
14
The Triangle Physician
Duke News The researchers are continuing to investi-
Hao Zhang, Thais Vinholo and Chi-Han
This research was supported by a National
gate how spinal cord stimulation works and
Wang of Duke University School of Medi-
Institutes of Health Transformative Award
are beginning to explore using the technol-
cine; and Romulo Fuentes and Marco Au-
(R01-NS073125-03),
ogy in other neurological motor disorders.
relio M. Freire of the Edmond and Lily Safra
Pioneer Award (DP1-OD006798) and the
In addition to Dr. Nicolelis, study authors
Institute of Neuroscience of Natal in Brazil.
grant ‘‘Plano de Acao Brasil Suica CNPq
an
NIH
Director’s
590006/2010-0’’ awarded to Dr. Nicolelis.
include Amol P. Yadav of Duke University;
$25,000 Grant Helps Pediatric Oncology prevent and cure these devastating diseases.
ogy CRO (clinical research organization), we understand the importance of research and
“Duke Children’s is proud to accept this
the price tag associated with that effort,” said
incredible gift from Ockham,” said Dan
Jim Baker, chief executive officer of Ockham.
Wechsler, M.D., Ph.D., chief of the division
“Our employees embraced this approach
of pediatric hematology-oncology. “This gift
last year by helping raise money for two fami-
Ockham Development Group, a Cary, N.C.,-
will truly make an impact for our patients and
lies living with the challenging experience of
based oncology clinical research organiza-
our research and we are extremely grateful
pediatric cancer.
tion, will donate $25,000 to the Division of
to Ockham for joining us in our fight against
Pediatric Hematology-Oncology at Duke
pediatric cancer.”
“This gift to the Duke Children’s Hospital & Health Center marks another step forward
Children’s Hospital & Health Center. The Ockham donation reflects the com-
for Ockham as we continue to seek the most
The Division of Pediatric Hematology-Oncol-
pany’s commitment to supporting pediatric
effective channels to support those suffering
ogy at Duke Children’s provides the full spec-
cancer patients around the globe, according
from the diseases we battle every day.”
trum of clinical services to infants, children,
to a Duke press advisory. During the past
adolescents and young adults. The division’s
year, Ockham employees in Scotland and
Ockham employs about 300 employees
physicians, nurse practitioners, clinical nurse
the United States raised nearly $20,000 to pro-
around the world, including 100 in Research
specialists, research nurses and basic scien-
vide assistance to the families of two children
Triangle Park. The company was named one
tists provide the expertise required to success-
suffering from cancer as part of a company
of the fastest growing companies in the re-
fully diagnose and treat children afflicted with
health and fitness effort.
gion by the Triangle Business Journal. It is expanding to new headquarters at CentreGreen
cancer and a variety of blood disorders and to perform research that may potentially help
“As a life sciences company and as an oncol-
Two in Cary this coming November.
Rex News
New Mobile Mammography Unit Increases Access to Preventive Care for Women Rex Healthcare’s newest mobile mam-
The mobile screenings complement high-
of Revlon, Kay Yow Cancer Fund, Komen
mography unit hit the road Jan. 22. Its first
er-level screening and care available at all
for the Cure-Triangle to the Coast and Ho-
stop: Wake County Health and Human
Rex Mammography locations. If a patient’s
logic.
Services.
screening mammogram recommends immediate follow up, she is contacted direct-
The hospital’s mobile screening efforts
Serving a 15-county radius, including ru-
ly to prevent any delays in proper follow-
have provided nearly 40,000 mammo-
ral areas with limited access to medical
up diagnosis and treatment.
grams since the program began in 2001. Earlier treatment in the course of a breast
care, the mobile unit delivers easy-access, high-quality screenings to women in un-
The new unit is one of two operated by
cancer diagnosis can greatly increase a
derserved areas, regardless of their health
Rex. It was made possible by the Rex
patient’s chance of survival.
insurance or financial status.
Healthcare Foundation and the support
february 2014
15
ECU News
Cancer Specialists Join ECU Physicians Three cancer specialists have joined the Brody School of Medicine at East Carolina University and its group medical practice, ECU Physicians.
Andrew Ju, M.D.
Daniel Oh, M.D.
Mahvish Muzaffar, M.D.
Andrew Ju, M.D., joined the department of radiation oncology as an assistant professor. He has a medical degree from the University of Wisconsin School of Medicine and Public Health. He completed an internship year at Wisconsin and residency training in radiation medicine at Georgetown University Hospital in Washington, D.C. His clinical and research interests are head and neck cancer, prostate cancer, skin cancer and the use of the CyberKnife radiotherapy system for the treatment of prostate cancer and re-irradiation of head and neck cancers. Daniel Oh, M.D., also joined the department of radiation oncology as an assistant professor. He has medical and doctoral degrees from the University of North Carolina at Chapel Hill. He completed an internship year at UNC
and residency training in radiation oncology at Duke. His clinical and research interests are prostate, breast and lung cancers and translational and clinical research in those cancers, especially gene expression profiling in breast cancer. Mahvish Muzaffar, M.D., has joined the department of oncology as a clinical assistant professor. She has a medical degree from the Kazakh National Medical University in Almaty, Kazakhstan, and completed an internship and residency training in oncology in India. She also completed residency training in internal medicine and a fellowship in medical oncology at the University of Toledo Medical Center in Ohio. Her clinical and research interests are breast and gastrointestinal cancers. All three physicians see patients at Leo W. Jenkins Cancer Center at 600 Moye Blvd. in Greenville. Appointments are available by calling (252) 744-2900.
Wake Med News
Cardiology Patient Navigator Program Focused on Reducing Readmission WakeMed Health & Hospitals was selected as one of 11 health care systems nationwide to participate in the American College of Cardiology Patient Navigator Program. The new program will serve as a test for patient-centered solutions to issues that impact patient health and readmissions. “WakeMed Health & Hospitals is a pioneer in heart disease treatment and care by putting an emphasis on a team approach to meeting patients’ ongoing care and needs and helping them make a seamless transition from the hospital to the home,” said ACC President John G. Harold, M.D., M.A.C.C. According to the American College of Cardiology (ACC), nearly one in five patients hospitalized with heart attack and one in four patients hospitalized with heart failure are readmitted within 30 days of discharge, often for conditions seemingly unrelated to the original diagnosis. Readmissions can be related to issues like stresses within the hospital, fragility on discharge, lack of understanding of discharge instructions and inability to carry out discharge instructions.
16
The Triangle Physician
“Our responsibility to patients begins prior to admission and extends beyond discharge,” said Betsy Gaskins-McClaine, vice president, WakeMed Heart & Vascular Services. “Educating patients about their condition, coordinating ongoing follow-up after discharge, collaborating with expert heart and primary care providers and supporting healthy lifestyle resources in our community are all key to helping our patients and their families manage cardiovascular conditions, achieve optimum health and minimize risk for hospitalization.” The ACC Patient Navigator Program combines the power of the National Cardiovascular Data Registry infrastructure with improvement strategies, toolkits and other best practices learned from the Hospital to Home Initiative. WakeMed participates in both the registry and H2H program. ACC plans to enroll at least 35 hospitals in the patient navigator program by the end of 2015. Funding support is provided by AstraZeneca.
UNC Research News
$900,000 Grant Awarded
Unprecedented Collaboration Aims to Improve Autism Services Researchers at the University of North Carolina at Chapel Hill have been awarded a State Implementation Grant of $900,000 from the Maternal and Child Health Bureau of the United States Department of Health and Human Services to improve services for young children with autism spectrum disorder and their families.
ings School of Global Public Health, the School of Social Work and the Cecil G. Sheps Center for Health Services Research.
North Carolina was one of only four states to be awarded funding by the bureau during this cycle, and this initiative is one of the first to involve nearly all of the major autism spectrum disorder (ASD) programs on UNC’s campus. The grant is under the directorship of Stephen Hooper, Ph.D., associate dean and chair of UNC School of Medicine’s Department of Allied Health Sciences (DAHS) in collaborative leadership with Rebecca Edmondson Pretzel, Ph.D., associate director of the Carolina Institute for Developmental Disabilities (CIDD). The three-year project has the primary purpose of linking both university and state partners to lower the ages by which young children receive appropriate developmental screening, ASDspecific screening, diagnostic assessments and early intervention. A key component of this program will be assessing the needs of families from across the state, particularly with respect to their experiences with early screening, diagnostic assessments and early intervention. Increasing public awareness of the early signs and symptoms of ASD also will be an annual objective, with significant efforts being devoted to rural and underserved regions of the state and examining the pathways by which families have access to the necessary services to address their child’s medical and developmental needs. In addition to its primary goals, this grant will allow researchers to examine strategies to increase access to family-centered medical homes that coordinate care with pediatric subspecialities, increase public and provider awareness of the signs and symptoms of ASD and complete a statewide needs assessment addressing family needs and barriers to coordinated care. To accomplish the grant’s objectives, DAHS and CIDD collaborators have enlisted the expertise of key UNC programs with a major focus on ASD, including North Carolina Area Health Education Centers’ Treatment and Education of Autistic and related Communication-handicapped Children (AHEC TEACCH) program, Frank Porter Graham Child Development Institute, the Gill-
Stephen Hooper, Ph.D., and Rebecca Edmondson Pretzel, Ph.D., are the grant directors.
“While this is certainly not the first project where various programs have collaborated on issues of ASD, it is the first project where programs have collaborated around improving the coordination of state services to children suspected of having ASD and their families,” Dr. Hooper said. “We are fortunate to receive these additional resources from the Maternal and Child Health Bureau, and excited about this opportunity to enlist the expertise of our UNC partners and key state agencies, such as the Autism Society of North Carolina, the state of North Carolina Early Intervention Program and the North Carolina Department of Public Instruction pre-kindergarten programs, in addressing these ASD-related needs across the state.” “The state of North Carolina is fortunate to have a number of service systems in place to address the needs of young children with developmental disabilities and their families,” said Dr. Edmondson Pretzel. “We are confident that this new funding will enhance current efforts and facilitate additional improvements for young children with ASD and their families.” For more information on the newly awarded ASD State Implementation Grant, contact Dr. Hooper at stephen_hooper@med.unc.edu or Dr. Edmonson Pretzel at becky.edmondson@cidd.unc.edu.
february 2014
17
UNC Research News
Level I Pediatric Trauma Center Verification Is Triangle’s First North Carolina Children’s Hospital has
pediatric trauma program and assistant
pital stays than those cared for in adult trau-
been verified by the American College of
professor of surgery and pediatrics. “… The
ma centers,” said Wesley Burks, M.D., chief
Surgeons (ACS) as a Level I pediatric trau-
pediatric trauma team can assess, stabi-
physician of North Carolina Children’s Hos-
ma center.
lize and treat life-threatening issues in the
pital. “We’ve offered child-specific trauma
shortest time possible to give that child the
care for a number of years. Becoming a
best chance of survival and recovery.”
Level I pediatric trauma center is taking our
The University of North Carolina Medical
commitment to providing the best care one
Center hospital is the first in the Triangle and one of only two in the state to receive
The two-day ACS verification visit last Octo-
step further, and we are proud to be one of
ACS’s recognition for having the highest
ber included a detailed review of pediatric
only five programs in the entire Southeast
level of expertise in treating critically in-
trauma cases and thorough examination of
to earn this distinction.”
jured children. It joins the ranks of 40 other
the overall program, from pre-care through
ACS-verified Level I pediatric trauma cen-
rehabilitation. Of note, the ACS report in-
ters across the country.
cluded an assessment categorizing the
Components of UNC’s pediatric trauma program include: • Five fellowship-trained pediatric surgeons; • Pediatric surgical specialists in anesthesia, neurosurgery, otolaryngology/ENT, orthopedics, urology, plastic surgery, and oral and maxillofacial surgery; • 20-bed pediatric intensive care unit staffed by board-certified pediatric intensivists; • Pediatric rehabilitation and supportive care services, including physical therapy, speech therapy, occupational therapy, rehabilitation and psychology, as well as a
According to the Centers for Disease Con-
program’s care of patients with severe trau-
children’s supportive care team,
trol, trauma from unintentional injury is the
matic brain injury as “exceptional.”
recreational therapy and a hospital school;
leading cause of death among children under 18, accounting for more than 9,000
“The criteria for obtaining Level I trauma
deaths each year. That’s about 25 child
verification are amazingly stringent,” said
deaths a day, or one child death every
trauma program manager Jennifer Haynes,
hour. Almost 9 million children are treated
who led the preparation effort. “They are
for injuries in hospital emergency depart-
designed to ensure a center has both the
• Trauma outreach education at local
ments each year, and more than 225,000
capability and dedication to provide the
and state levels for hospitals and
children are hospitalized annually as a re-
absolute highest level of care from the
sult of such injuries.
minute a patient hits the door to the day of discharge.”
• Leadership of Orange County Safe Kids program; • Representation on regional and state trauma advisory councils;
EMS providers; and • Research programs and performance improvement efforts to ensure that each patient
“When a child experiences a traumatic injury, minutes can be the difference be-
“Abundant research has shown that injured
experience leads to the best
tween life and death,” said Kimberly Er-
children treated in pediatric trauma centers
possible outcome.
ickson, M.D., medical director of UNC’s
have lower mortality rates and shorter hos-
18
The Triangle Physician
Community Support
Krzyzewski Leads Giving Program
that Encourages Community-Driven Events Duke Children’s Hospital & Health Center has launched the
gram, which raised more than $1.5 million in its 32 years to sup-
Duke Children’s Community Partners, a year-round fund-raising
port research, education and care.
campaign to directly support education, patient care and research. Mike Krzyzewski, head coach of Duke University men’s
“Duke Children’s Card Program legacy of children helping
basketball, is the honorary chairman.
children will expand through Community Partners to engage a greater population of advocates and compassionate donors in
Through the year-round community giving program, individuals
support of Duke Children’s,” said Coach Krzyzewski.
and organizations are empowered to develop events and initiatives that reflect their distinct interests and fund-raising goals.
Duke Children’s Holiday and All-Occasion cards are available
The 20th annual MIX 101.5 Radiothon for Duke Children’s from
year-round at www.dukechildrenscards.org.
Feb. 11-12 is a lead example. “Duke Children’s is engaging individuals and organizations in unprecedented ways to take ownership of fund-raising efforts that build on their unique strengths,” Coach Krzyzewski said. “Community Partners offers endless possibilities and opportunities for communities to unite together in support of a loved one, neighbor, colleague or friend, both today and for future generations.” Top-level Community Partners will be invited to Coach Krzyzewski’s annual Coach K Closed Practice Session for Duke Children’s. Community fund-raising events should complement Duke Children’s mission to make life better for children. To learn more about Duke Children’s Community Partners Program, visit www. dukechildrens.org. Coach Krzyzewski most recently served as the honorary chairman of the Duke Children’s Holiday and All-Occasion Card Pro
february 2014
19
News Welcome to the Area
Physicians Joshua Arthur, MD Pediatrics
Durham Hassan Karim Dakik, MD Gastroenterology, Internal Medicine; Internal Medicine
Durham
Laura Leigh Hans, MD Pediatrics - Neurodevelopmental Disabilities; Child Psychiatry; Pediatrics; Pediatrics Developmental - Behavioral
Durham
Amit Kalra, MD
James Patrick Hummel, MD
Lawrence Thomas Kim, MD
Cardiac Electro physiology, Internal Medicine; Cardiovascular Disease, Internal Medicine
Abdominal Surgery; Colon and Rectal Surgery; Critical Care Surgery; General Surgery; Head and Neck Surgery; Surgery; Surgery - Surgical Critical Care; Surgical Oncology
UNC Division of Cardiology Chapel Hill
Lawrence Thomas Kim, MD Abdominal Surgery; Colon and Rectal Surgery; Critical Care Surgery; General Surgery; Head and Neck Surgery; Surgery; Surgical Oncology
University of North Carolina Hospitals Chapel Hill
Kathryn Wulbern Koval, MD Emergency Medicine
University of North Carolina Hospitals Chapel Hill
The Triangle Physician 2014 Editorial Calendar March Orthopedics Hematology
Tammi Michele Waters, DO General Preventive Medicine; Pediatrics; Family Medicine; Family Medicine Adolescent Medicine; Family Medicine - Geriatric Medicine; Family Practice; Family Practice/Geriatric Medicine; General Practice; Adolescent & Young Adult Medicine; Adolescent Med
April Pediatrics Infectious disease May Women’s health Neurology
Durham
University of North Carolina Hospitals Chapel Hill
Fuquay-Varina Primary Care Fuquay-Varina
Robert William Lampman, MD
Marc Lawrence Levi, MD
Medical Oncology; Hematology and Oncology, Internal Medicine
June Cancer in men Pulmonary
Karl Richard Bernat Jr., MD
July Sports medicine Rheumatology
Infectious Diseases, Internal Medicine; Internal Medicine
Hospitalist; Internal Medicine Hospital Medicine
Durham
Amanda Carolyn Layne, MD Pathology
Duke University Hospitals Durham Eddy Jose Morales, MD Musculoskeletal Radiology; Diagnostic Radiology
Duke University Medical CenterDept of Radiology Durham Hassan Karim Dakik, MD Gastroenterology, Internal Medicine; Internal Medicine
Durham
Amit Kalra, MD Infectious Diseases, Internal Medicine; Internal Medicine
Durham
Song-Yih Tu, MD Emergency Medicine
Sandhills Emergency Physicians, PA Pinehurst Jennifer Yishen Chen, MD Surgery - Surgical Critical Care; Critical Care Surgery; General Surgery; Abdominal Surgery; Surgery
Anesthesiology
John Homer Barton Jr., MD
The University Of North Carolina at Chapel Hill Chapel Hill
1112 Glen Eden Dr Raleigh
William Franklin Pendergraft III, MD
Internal Medicine
Immunology; Internal Medicine; Internal Medicine - Nephrology; Nephrology, Internal Medicine
UNC Kidney Center, Div of Nephrology Chapel Hill Sean David Rotolo, MD Neurology
University of North Carolina Hospitals Chapel Hill
Duke Primary Care Harps Mill Raleigh Ryan Philip Lamb, MD
August Gastroenterology Nephrology
Emergency Medicine
Raleigh
Subash Cheriyan Mathew, MD Pediatrics; General Practice; Pediatrics; General Practice
Raleigh
William James Sydney Jr., MD
October Cancer in women Wound management
Pain Medicine
Shaun Richard Rybak, MD Diagnostic Radiology; Pediatric Radiology; Radiology; Radiology, Neuradiology; Vascular and Interventional Radiology
University of North Carolina Hospitals Chapel Hill
September Bariatrics Neonatology
NCMB Raleigh
James Lewis Abbruzzese, MD Oncology, Internal Medicine; Medical Oncology
Duke University Medical Center Durham
Hyeon Yu, MD
November Urology ADHD December Otorhinolaryngology Pain management
Radiology; Vascular and Interventional Radiology; Interventional and Vascular Radiology
UNC School of Medicine Chapel Hill
University of North Carolina Hospitals Chapel Hill
John Nathan Copeland, MD Child and Adolescent Psychiatry; Psychiatry; Geriatric Psychiatry
University of North Carolina Hospitals Chapel Hill
Daniel Lemoin Duncan, MD Pathology; Pathology - Clinical; Pathology - Anatomic
University of North Carolina Hospitals Chapel Hill
Katherine Lea Fredlund, MD Emergency Medicine
University of North Carolina Hospitals Chapel Hill Anisha Maini Gulati, MD Psychiatry; Psychiatry, Geriatric; Psychosomatic Medicine; Psychoanalysis
University of North Carolina Hospitals Chapel Hill
20
The Triangle Physician
However much you value wildlife conservation in North Carolina,
DEC NC
11
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quadruple it.
That’s right! Your conservation effort is increased by a 3-to-1 matching gift. So, when you are one of the first to display the new North Carolina Wildlife Habitat Foundation NCDMV license tag, your $10 tag contribution to the organization becomes $40 in lands preserved. The all-volunteer North Carolina Wildlife fe Habitat Foundation assists in acquisition, on, management, and protection of land in North Carolina for the conservation of habitats needed to preserve wildlife
right here in the Old North State. Conservation education efforts are preparing future generations to sustain your concern for the lands we protect today. At www.ncwhf.org, download the license tag application and see the good works in process. pp Your new tag shows your support and your n contribution is put to work…times four. co
www.ncwhf.org w
Do Heavy Periods
Uterine Fibroids
associated with
Affect You?
Consider Volunteering for a Clinical Research Study Uterine fibroid symptoms can affect any woman, anytime, anywhere. If you’re premenopausal, up to 49 years old, and have heavy periods associated with uterine fibroids, you may qualify for this oral investigational medication study. As a participant, you will receive all study-related care and investigational medication at no cost. If uterine fibroids affect you, consider volunteering.
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330841_ABV-M12-813-UF-Flyer-ENG_r2.pdf 1
7/1/13 10:29 AM
3D MAMMOGRAPHY WE’RE TALKING WAY BETTER IMAGING, EARLIER DETECTION, FEWER FALSE POSITIVES AND LESS CHANCE OF A CALL BACK. END OF DISCUSSION.
3D MAMMOGRAPHY • GREATER ACCURACY • REDUCED ANXIETY • NOW AT WAKE RADIOLOGY Let’s have a frank discussion. You can’t treat what you can’t detect. And 3D mammography, along with your regular 2D exam, is revolutionizing breast cancer detection. How? By significantly improving clarity for earlier detection and fewer false positives. Which, of course, reduces recall rates and the anxiety that comes with additional tests. To learn more about 3D mammography or to schedule an appointment, visit wakerad.com. Like we said, you can’t treat what you can’t see. And now we’re seeing better than ever. Wake Radiology | North Hills Breast Center | 919-232-4700 | wakerad.com Daily, evening and Saturday appointments | 20 minutes from check-in to exam completion