november/December
2 017
The Triangle Physician T H E
M A G A Z I N E
F O R
H E A L T H
C A R E
P R O F E S S I O N A L S
Wake Spine & Pain Specialists Effective Chronic Pain Management in a Changing Environment
Also in This Issue Firing advice, part II: Lawful protections and suggestions
Breast cancer: Genetic testing and breast density
Duke developing system to halt viral pandemics
T
4
COVER STORY
Wake Spine & Pain Specialists
Effective Chronic Pain Management in a Changing Environment n o v e m b e r / d e c e m b e r 2 0 17
FEATURES
8
Practice Management
Guidelines for Handling Involuntary Departures from Your Practice Practice management consultant Margie Satinsky share considerations on lawful disciplinary action.
10
V o l . 8 , I ss u e 1 0
DEPARTMENTS 12 Research News - Education on Use of Anticoagulants Makes Difference In Stroke Prevention - Millions Fund Creation of Quick National Pandemic Response System
13 News
Welcome to the Area
The Triangle Physician
Women’s Health
T H E
M A G A Z I N E
F O R
H E A L T H C A R E
P R O F E S S I O N A L S
Breast Cancer Awareness Scarlet Dial and Andrea Lukes discuss breast cancer, the most frequent cause of death in women worldwide. On the Cover: The medical staff at Wake Spine & Pain Specialists includes doctors (from left) Brian Hertzburg, Vijay Mandhare, Timothy Reis, and Mark Reznik.
november/december 2017
1
Category
Table of Contents
From the Publisher
Dermatology
First-line Tactics It’s been declared a “public health emer-
best practices for reducing the need for
gency,” and it’s in the news every day now.
disciplinary action. Women’s health specialists Scarlet Dial and Andrea Lukes coauthor a
Opioid addiction has killed more than
column on breast cancer risk analysis and the
64,000 Americans in 2016 alone, according
challenge of dense breast tissue.
to tentative data from the Centers for Disease Control and Prevention. More than
This will be our last issue of the year, so we
12,000 people died from opioid-related
wish you the very best this holiday season.
overdoses in North Carolina between 1999
We appreciate our regular advertisers, who
and 2016, according to the North Carolina
keep the presses running, and our regular
Department of Health and Human Services.
contributors. We thank readers for your continued interest.
The spotlight is on the medical community, and pain management specialists, including
We will return in 2018, which will be in
Wake Spine & Pain Specialists, is among
production in December. So as you prepare
those answering the call as a first line of
your marketing plans, please consider The
defense. In this issue’s cover story, the
Triangle Physician as a first-line tactic for
pain specialists discuss safe and effective
reaching the more than 9,000 in the Raleigh-
pain management practice that reduce the
Durham medical community.
chances of addiction. Best wishes and much appreciation, Also in this issue, practice management
Publisher
consultant Margie Satinsky concludes her
John Teague
two-part series by sharing human resources
The Triangle Physician T H E
M A G A Z I N E
F O R
H E A L T H C A R E
P R O F E S S I O N A L S
Publisher - John Teague John@TTP2LC.com
Creative Director - Joseph Dally jdally13@gmail.com
Contributing Editors Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Margie Satinsky, M.B.A.
News and Columns Please send to info@trianglephysician.com
Advertising Sales info@trianglephysician.com
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The Triangle Physician
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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. 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.
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Expert Care - Close To Home! SMITHFIELD
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CLAYTON
Cover Story
Wake Spine & Pain Specialists Wake
Spine
&Pain
Effective Chronic Pain Management in a Changing Environment
Interventional treatments include epidural steroid injections, radiofrequency ablations of the medial branch nerves to treat axial neck and back pain, SPG
Chronic pain is a complex condition that
plinary approach to treating pain. Our
blocks to treat chronic headaches, ky-
inflicts physical, emotional and financial
pain management physicians include
phoplasty for compression fractures, and
stress on patients and their families. So
both Anesthesiologists and Physiatrists
the newest advances in paresthesia-free,
often, chronic pain patients just accept a
who have completed training in Accredi-
high-frequency spinal cord stimulation
poor quality of life with decreased func-
tation Council for Graduate Medical Edu-
technology.
cation (ACGME) pain medicine fellow-
“The last thing patients want to do
The providers at Wake Spine & Pain
ships. This gives patients the tremendous
when in pain is to wait for an appoint-
Specialists are passionate about provid-
benefit of well-rounded, comprehensive
ment,” said Dr. Vijay Mandhare, Wake
ing life-changing, comprehensive and safe
treatment expertise.
Spine & Pain Specialists founder. “We
tion and mobility.
pain treatments to help alleviate chronic
Our specialists explore various pain
make it a priority for our patients to have
pain burden on patients and their loved
management options, beginning with the
timely access to treatment by using a care
ones. It is our mission to relieve pain and
least invasive alternative and arriving at a
team approach.”
help patients regain a better quality of life.
patient-centric solution that provides the
Each care team is comprised of an
greatest amount of relief with the least
expert physician, highly trained advanced
Multidisciplinary Team Provides
amount of risk. This approach begins
practice providers (APP) and dedicated
Timely and Convenient Access
with physical therapy treatments, and
and attentive medical assistants. Our
Wake Spine & Pain uses a multidisci-
behavioral and psychological treatments.
APPs have years of experience in treating
4
The Triangle Physician
pain and work closely with their supervising physicians to enhance patient experience. “We are grateful to our care teams who are empathic, compassionate and genuinely care about our patients.” For a patient in pain, driving a long distance can be a major deterrent to seeking care. In recognition of this challenge, Wake Spine & Pain has five convenient clinic locations in the Raleigh (near Wake Med Hospital in North Raleigh, Rex hospital and Duke Raleigh hospital), Cary, and Garner areas. Every clinic is equipped with fluoroscopic procedure rooms and has direct access to physical therapy. This gives patients the benefit of receiving the full range of treatment at all our locations.
2) W hen opioids are used, the lowest
Dr. Reznik discusses treatment options.
possible effective dosage should be prescribed to reduce risks of opioid use
Opiate Crisis and the CDC During the past 18 months, numerous chang-
disorder or overdose; and 3) C linicians should always exercise
es to laws and guidelines have been intro-
caution when prescribing opioids and
duced to help mitigate the growing number
monitor all patients closely.
of overdoses by patients prescribed opioid medications in the state and across the
North Carolina STOP Act
country.
In July 2017, The North Carolina legislature
CDC Guideline for Prescribing Opioids
passed the Strengthen Opioid Misuse Preven-
for Chronic Pain, released March 2016, was
tion (STOP) Act to counter the high rate of
published to help physicians decrease risks
opiate overdoses. Some of its key provisions
associated with opioid use. The guidelines
are outlined below:
are based on the following three principles: 1) Non-opioid therapy is preferred for
The STOP act requires personal consultation between APPs and their supervising phy-
chronic pain outside of active cancer,
sicians in pain clinics upon initiating a patient
palliative, and end-of-life care;
on opiate therapy and every 90 days thereafter.
“The last thing patients want to do when in pain is to wait for an appointment. We make it a priority for our patients to have timely access to treatment by using a care team approach.”
Dr. Mandhare and Laurence Holman, N.P., collaborating on patient care.
november/december 2017
5
Dr. Hertzberg performs a fluoroscopic procedure.
Closely on the horizon, a mandatory
“In today’s environment, there is an urgent need for greater collaboration between the physicians from the different specialties and the primary care clinicians.”
special management approaches.
review of the patient’s 12-month prescription
Since inception, Wake Spine & Pain
history via the North Carolina Controlled
Specialists has always followed a compre-
Substance Reporting System (NCCSRS) will
hensive opiate treatment protocol to pro-
be required before a practitioner can pre-
tect patients from the significant risks that
scribe a Schedule II or Schedule III opioid
are associated with opioid therapy. Opiate
medication and every subsequent three
therapy is initiated only when patient satis-
month period thereafter if the treatment is
fies specific criteria and has not responded
continued.
to more conservative treatment options.
Starting Jan. 1, 2018, practitioners can-
Each care team conducts a daily review of
not prescribe more than a five-day supply
the day’s schedule where our physicians
of any Schedule II or Schedule III opioid
collaborate with their APPs and discuss
or narcotic upon initial consultation of
challenging cases and treatment plans,
treatment for acute pain. For patients with
leveraging their multidisciplinary back-
acute pain following a surgical procedure
grounds.
the prescription cannot exceed seven days.
“We find that communication and
This requirement does not apply to cancer
close collaboration among the care team
care, palliative care, hospice care, or medi-
members treating the patient leads to better
cation-assisted treatment for substance use
patient satisfaction and greater overall out-
disorders.
comes,” said Dr. Timothy Reis.
In January 2020, all practitioners will
“We are passionate about combating
be required to electronically prescribe all
the opioid crisis in our state and ensuring
targeted controlled substances. This is in an
our patients and community are safe. By ad-
effort to reduce fraud stemming from stolen
hering to our opiate standard of care and de-
prescription pads or forged prescriptions
veloping treatment plans that integrate opiate therapy with other treatment modalities,
Wake Spine & Pain Opiate
we are proud to see that our patients con-
Standard of Care
sistently experience significant reduction
Undoubtedly, opiate therapy has an impor-
in pain, improvement in general activities,
tant role in pain management but should not
quality of life and sleep,” Dr. Mandhare said.
be used as a first-line therapy and requires
6
The Triangle Physician
Recommendations and Collaboration
Dr. Reis reviews patient care.
For nearly a decade, Wake Spine & Pain Specialists has served the Triangle community in the responsive delivery of interventional pain treatment. Its medical professionals continue to stand ready to consult with primary care clinicians and surgeons in assessing and caring for patients. “In today’s environment, there is an urgent need for greater collaboration between the physicians from the different specialties and the primary care clinicians,” said Dr. Brian Hertzberg. “It is essential to have expert physicians navigate the way, using multimodal treatments and
relationship is key is to providing respon-
board certified in physical medicine and
a tailored plan for the patient to get opti-
sible pain management.”
rehabilitation and pain medicine.
mal pain relief.” The CDC recommends avoiding the
Wake Spine & Pain Promise
Dr. Mark Reznik graduat-
concurrent use of opioids and benzodiaz-
“Patients will receive unparalleled, timely,
ed from medical school at
epines due to risks including the poten-
personalized care from trusted profession-
the University of Medicine
tial for synergistic effects on respiratory
als who always place the patient at the
and Dentistry of New Jer-
depression that can lead to overdose and
center of all that we do,” Mandhare said.
sey, School of Osteopathic
even death. Physician collaboration is im-
“Together, our team will help you achieve
Medicine. He completed his residency in
portant to the success of a safe treatment
so much more in meeting the pain man-
physical medicine and rehabilitation from
plan that prevents patients from having to
agement needs of your patients.”
Thomas Jefferson University in Philadel-
choose between pain relief and treatment for depression, said Hertzberg.
phia, Pa. He completed an ACGME fellowPhysician Team
ship in pain medicine at Drexel University
Furthermore, CDC affirms that opi-
In 2009, Dr. Vijay Mandhare
in Philadelphia. He is board certified in
oids are not first-line therapy. Primary
founded Wake Spine and
physical medicine and rehabilitation and
care physicians who elect to start opioid
Pain Specialists. A native
pain medicine.
therapy are advised to establish an opioid
of Louisiana, he earned
protocol that includes setting functional
his medical degree from Louisiana State
Dr. Brian Hertzberg earned
goals and outlining expectations for treat-
University. He completed his anesthesia
his medical degree from
ment, obtaining informed consent and
residency at the University of Washington.
the University of North
signing a treatment agreement, conduct-
He completed his ACGME pain medicine
Carolina-Chapel Hill. He
ing a risk assessment including a mental
fellowship at Ford Health System in De-
completed his residency
health status and risk of substance abuse,
troit, Mich. He is board certified in both
in anesthesia and an ACGME fellowship
performing urine drug screening to test
anesthesiology and pain medicine.
in pain medicine at Pennsylvania State
for compliance and reviewing prescription history in NCCSRS.
University in Hershey, Pa. He is board Dr. Timothy Reis gradu-
certified in both anesthesiology and pain
“We strive to work with patients
ated from medical school
medicine.
who are referred to our practice to not
at the Virginia College of
only minimize their opioid use, but at
Osteopathic Medicine in
Contact Information
the same time integrate alternative mo-
Blacksburg, Va. He com-
Three convenient ways to schedule
dalities and interventional treatments that
pleted his residency in physical medicine
appointments:
relieve their pain and improve their func-
and rehabilitation and an ACGME pain
By fax: 919-787-7247
tion,” said Dr. Mark Reznik. “Pharmaco-
medicine fellowship at Virginia Common-
By phone: 919-787-7246
vigilance and a trusted physician/patient
wealth University Health System. He is
Online at www.wakespine.com
november/december 2017
7
Practice Management
Guidelines for Handling
Involuntary Departures from Your Practice This is the second in a two-part series regarding
By Margie Satinsky, M.B.A.
2) Document all disciplinary action that may
disciplinary action and involuntary departures
have preceded the decision to terminate.
from your practice. Last month we covered dis-
3) Create and share policies and procedures
ciplinary action. In some situations, disciplinary action is effective in addressing and resolving per-
with all employees before problems arise. 4) Apply personnel actions consistently.
formance issues. In other situations, performance
Margie Satinsky, MBA, is President of Satinsky Consulting, LLC, a Durham NC consulting company that specializes in medical practice management. Thanks to attorney Patti Bartis with Parker Poe for assistance on this article. For additional information, go to www.satinskyconsulting.com or www.parkerpoe.com.
doesn’t improve, and as a practice owner you wish
Size Matters
to terminate an employee. This article provides im-
Employers with 15-plus employees are subject
portant insights into the termination process.
to federal laws that prohibit making employment decisions based on race, color, gender, national
Employment at Will in North Carolina
origin, religion, age or disability. If you are think-
North Carolina is what is known as an “employ-
ing about terminating an individual in a protected
ment at will” state. Absent a contract for employ-
category, verify that the basis for termination is
ment for a definite period of time, employment
not discriminatory.
is terminable at the will of either the employer
Employers with 50-plus employees are sub-
or employee. There’s an important caveat here
ject to the requirements of the Family Medical
that many employers forget – that employment
Leave Act and smaller employers can face dis-
can be terminated at almost any time (although
crimination claims based on state law. Conduct
some times are better than other times) for any
an independent review to make sure that the ac-
lawful reason.
tion is supported by documentation, is compli-
Let’s explore the application of the rule, starting with important proactive steps prior to
ant with business policies and procedures and is consistent with past personnel actions.
employee termination. We’ll then identify special situations related to size, health considerations,
Health Considerations
and employee activities and end with employee
If an employee has recently returned from medical
communication and security precautions.
leave or has requested future medical leave, think twice before proceeding with termination. Some-
Proactive Steps Prior to Employee
one who has just returned from medical leave may
Termination
interpret the termination as retaliation for having
Here are four proactive steps that employers can
missed work. Similarly, someone who is planning
take to avoid legal problems:
to take leave may misinterpret the termination as
1) Determine whether or not there is an agree-
8
The Triangle Physician
punishment or interference with leave rights.
ment in place to employ an individual for a
Furthermore, if the individual is covered
definite period of time. Such an agreement
by the employer’s health insurance, losing a job
may take the form of a written contract, an
prior to or during a health crisis is extremely
email exchange or oral communications. If
stressful,
an agreement exists, read the fine print re-
continuation rights. In some cases it may make
garding required advance notice and sever-
sense to postpone the termination. If you do
ance payments.
proceed, make sure the termination is defensible.
notwithstanding
health
insurance
Whistle Blowers Employees who report violations of laws and regulations are protected from adverse employment actions under numerous statutes and in some circumstances, under the common law of North Carolina. Before deciding to terminate, consider whether or not the employee has complained about or reported a perceived or actual legal violation. Employees Who Have Engaged in a Protected Concerted Activity Non-management employees have the
legitimate reason for dismissal. He/she
is unlawful. Make sure to communicate
right to communicate with one another
may believe that unlawful motivation (e.g.
the decision with other team members in
RADAR: BAY15001 race, age or repeated absences for mediAd: Version 1 cal reasons) was at play. and conditions of their employment. ProDate: 6/15 for the purpose of improving the terms
a timely and consistent way. Compliance with HIPAA Security
tected activity of this sort can range from
It’s prudent to provide a short and
holding a meeting to discuss unionization
accurate statement of the reason for
Rule Requirements
to “liking” a negative comment about the
termination, even if the conversation is
Last but not least, comply with your own
workplace that a co-worker has posted on
uncomfortable and awkward. Tell the
HIPAA Security Rule requirements for all
Facebook.
truth rather than unintentionally leading
employee departures, regardless of who
an employee to believe that the motivation
made the decision to part ways.
Don’t assume that making a negative comment about an employer is grounds for termination, even if it is a violation of your social media policy. Although employers can limit certain types of communications by its employees (e.g. disclosure of protected health information, harassing communications or false statements), many social media policies have overly broad restrictions. If a communication constitutes a protected activity, the termination based on the offensive communication could give rise to an unfair labor practice claim. Communication with the Employee and the Entire Team Because North Carolina does not have a law requiring employers to provide a reason for termination, some employers assume that termination without any reason at all is acceptable. Regardless of the legalities, dismissal
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november/december 2017
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WI
Women’s Health
Dermatology
Breast Cancer Awareness By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. and Scarlet B. Dial, F.N.P.-C.
October of each year is a month for women
We encourage readers to log into our
(and men) to consider breast cancer awareness.
website, www.cwrwc.com and take the quiz on
Breast cancer is the most frequent type of non-
our home page. This is important because many
skin cancer in the United States. Further, breast
women qualify for this hereditary testing.
cancer is the most frequent cause of death in women worldwide.
Andrea S. Lukes, MD, MHSc, FACOG, founded the Women’s Wellness Clinic (private practice) and the Carolina Women’s Research and Wellness Clinic (research center) which are both located in Durham, NC. Dr. Lukes received a combined medical degree and master’s degree in statistics from Duke University and completed her residency at the University of North Carolina School of Medicine. Her areas of expertise is in women’s health, including heavy menstrual bleeding, uterine fibroids, endometriosis, contraception, menopause and migraines. Most recently, Dr. Lukes was hired as the Chief Medical Officer of Health Decisions CRO which is specialized within women’s health. The Women’s Wellness Clinic is accepting new patients, 919-251-9223, www.cwrwc.com
10
The Triangle Physician
Breast cancer as noted above is the most commonly diagnosed cancer worldwide. The
Health care providers in the United States
highest incidence rates are in North America,
recommend routine screening for breast cancer
Australia/New Zealand, western and northern
with mammography. One of the first steps the
Europe. The lowest rates are in Asia and sub-
providers at the Women’s Wellness Clinic do
Saharan Africa (UpToDate, Feb 02, 2017). The
is assess a woman’s individual risk of breast
differences between nations include societal
cancer. The predominant risk factors include
changes due to differences in fat intake, body
a personal history of breast cancer (or ovarian
weight, age at menarche, the practice of
cancer), a family history of breast or ovarian
lactation, and reproductive patterns such as
cancer, a genetic predisposition (BRCA status),
fewer pregnancies and later age at first birth.
and radiotherapy to the chest at a young age.
Within the U.S., breast cancer accounts for
We screen women for the Myriad myRisk
more than 250,000 cases each year and more
Hereditary Cancer test, which is a 28-gene
than 40,000 deaths (PubMed, Cancer Statistics
panel that identifies an elevated risk for eight
2017). Health care providers must be diligent in
hereditary cancers:
recommending screening mammography.
tivity of mammography, decrease callbacks
awareness of the importance of breast can-
for additional imaging, lower the number
cer screening, we are providing access to
of unnecessary biopsies of benign lesions,
mobile mammography for our patients.
and overall reduce the stress imposed on
This will make the first step in screening for
women through these additional tests and
breast cancer easy. We encourage women
procedures.
to call our clinic at (919) 251-9223 to learn
Patients
more details.
whose
last
Women’s Health
For convenience, as well as increased
mammogram
showed heterogeneously dense (C) or
Breast cancers in an early stage can
extremely dense (D) breasts may call
be in situ carcinomas of the breast that are
our clinic at (919) 251-9223 to learn more
either ductal or lobular. The invasive breast
about this clinical study opportunity and to
cancers can vary by histologic subtypes
schedule an appointment to discuss your
(SEER database of the National Cancer
hereditary cancer risk, cancer screening
Institute from 1992-2001): infiltrating ductal 76
and prevention plan.
percent, invasive lobular 8 percent, ductal/
At the Women’s Wellness Clinic, we
lobular 7 percent, mucinous (colloid) 2.4
strive to offer our patients the most up-to-
percent, tubular 1.5 percent, medullary 1.2
date care with a personalized touch. It is
percent and papillary 1 percent.
our role as health care providers to ensure
The goals of using hereditary cancer
our patients, their family and friends, as
tests like Myriad myRisk along with
well as our community are aware of the
screening mammography are to predict a
importance of breast cancer prevention
woman’s risk of developing breast cancer
and early diagnosis through screening
and detect and diagnose breast cancer at
mammography. We welcome new patients
an early stage. The results of these tests
and accept most major insurance carriers.
Scarlet Dial is a board-certified family nurse practitioner offering more than 10 years of primary care experience along with advanced gynecological care. Dial has a bachelor’s degree in economics from Vanderbilt University along with a bachelor’s degree and master’s degree in nursing from Duke University. She provides expert care in treating anxiety, depression, diabetes, hypertension, and obesity along with IUD placement, care of abnormal pap smears and pelvic ultrasound. She does laser hair removal and cosmetic injections. Dial is also a sub-investigator on Women’s Wellness clinical research studies and director of business development for the clinic
allow clinicians to implement prevention and treatment management according to medical society guidelines.
MOHS MICROGRAPHIC SURGERY • EXCISIONAL SURGERY • CRYOSURGERY
Breast density is a limiting factor in interpreting mammography results and associated with an increased risk for breast cancer. Dense breast tissue seen on mammography may obscure an underlying cancer lesion. Breast density is a radiologic finding and only determined through mammography. The most common reporting of breast density is through the Breast Imaging Reporting and Data System, fifth edition (BIRADS), which defines breast tissue as: (A) almost entirely fatty, (B) scattered areas of fibroglandular density, (C) heterogeneously dense, or (D) extremely dense. For women age 35-75 years with heterogeneously dense (C) or extremely dense (D)
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PHOTODYNAMIC THERAPY • LASER SURGERY • TOPICAL MEDICATION
DER17862_AD_Triangle Physician Ad ALL.indd 4
3/15/17 9:08 AM
november/december 2017
11
Research News
Education on Use of Anticoagulants Makes Difference In Stroke Prevention Only about half of patients with atrial
a lifesaver.”
Lopes, M.D., Ph.D., professor of medicine
fibrillation worldwide take anticoagulant
Granger and colleagues conducted a
at Duke and the principal investigator for
drugs, despite the medications being high-
study in five countries – Argentina, Brazil,
Brazil. “While this was a secondary out-
ly effective in preventing strokes.
China, India and Romania – to test their in-
come, it highlights the potential benefit of
tervention.
improved anticoagulation care.”
Increasing the use of anticoagulation therapies could prevent hundreds
More than 2,200 patients were en-
A limitation of the cluster-randomiza-
of thousands of strokes each year. A new
rolled at 48 hospitals and monitored for a
tion design, in which recruited expert cen-
study shows that education, measurement,
year. The centers were randomly divided
ters were assigned to one or the other arms
and feedback are effective approaches to
to either provide standard care or a com-
of the study, was a potential overestimation
increasing the use of anticoagulants and
prehensive educational effort – customized
of the baseline use of anticoagulants in the
demonstrate on a large scale how this im-
to each country – that explained the ben-
non-intervention sites.
provement can be achieved.
efits of anticoagulant therapies, as well as
In a large, international study led
their risks.
Granger said additional studies are needed to better understand why such a
by the Duke Clinical Research Institute
Patients were given brochures and
large proportion of patients remains un-
and five coordinating centers around the
shown videos, and then monitored at doc-
treated. In the meantime, he said, applying
world, a multifaceted informational cam-
tor visits to get their feedback and learn of
the interventions tested in this study has
paign aimed at patients, families, and phy-
any problems that kept them from being
been shown to improve care.
sicians led to a 9 percent absolute increase
on the medication. Physicians received
In addition to Granger and Lopes,
in the use of anticoagulation therapies. The
education on treatment of atrial fibrillation
study authors include Dragos Vinereanu,
increased use of the drugs was accompa-
through articles and webinars. They also
M. Cecilia Bahit, Denis Xavier, Jie Jiang,
nied by a small, but notable reduction in
received audits for the specific treatment
Hussein R. Al-Khalidi, Wensheng He, Ying
the risk of stroke.
of each of their patients via regular phone
Xian, Andrea O. Ciobanu, Deepak Y. Ka-
calls.
math, Kathleen A. Fox, Meena P. Rao, Sean
“If this intervention could be broadly applied, which we believe is possible, the
The researchers reported that among
D. Pokorney, Otavio Berwanger, Carlos
public health implications would be sub-
patients at centers that received the educa-
Tajer, Pedro Barros, Mayme L. Roettig, and
stantial,” said Christopher Granger, M.D.,
tional intervention, the use of anticoagula-
Yong Huo.
professor of medicine at Duke and senior
tion therapies rose by 11.7 percent, com-
The investigator-initiated study re-
author of a study presented at the Europe-
pared to a 2.6 percent rise in their usage in
ceived support through education and
an Society of Cardiology meeting.
the non-intervention group. In the interven-
research grants from pharmaceutical com-
tion group of patients not treated at base-
panies that market anticoagulation drugs,
line, 48 percent were on an anticoagulant
including Boehringer Ingelheim Pharma-
at one year.
ceuticals Inc., Daiichi Sankyo, Bayer Phar-
The findings were simultaneously published Aug. 28 in Lancet. “More than 33 million people worldwide have atrial fibrillation, which is a
“Our study also found a reduction
leading cause of stoke. Improving adher-
in strokes in the intervention group com-
ence to anticoagulation therapy would be
pared to the control group,” said Renato
maceuticals, Bristol-Myers Squibb, and Pfizer Inc.
Millions Fund Creation of Quick National Pandemic Response System The Duke Human Vaccine Institute received a $12.8 million, 30-month grant
cy to develop a system capable of halting
PA) Pandemic Prevention Platform (P3),
viral pandemics within 60 days.
or DARPA P3, seeks to combine exper-
from the U.S. Department of Defense, De-
The program, called Defense Ad-
tise in virology, immunology, and clinical
fense Advanced Research Projects Agen-
vanced Research Projects Agency (DAR-
manufacturing to rapidly identify and re-
12
The Triangle Physician
Ph.D., who will lead the institute’s effort as director of the Duke
and Zika before they spread widely.
Regional Biocontainment Laboratory at the Duke Human Vaccine
“Naturally occurring infection with highly pathogenic, in-
Institute.
fluenza strain remains a significant global challenge to both ci-
The DARPA P3 program also partners with investigators at
vilians and the United States military,” said Barton Haynes, M.D.,
the University of Pennsylvania (Drew Weismann), University of
director of the Duke Human Vaccine Institute. “As a result, there
Texas Austin (George Georgiou), and Synthetic Genomics Vac-
is a critical need for fast-acting antiviral countermeasures, such
cines Inc. (Kurt Kamrud).
as therapeutic antibodies, that can be rapidly isolated, evolved, manufactured, and safely delivered.” According to a Duke press advisory, the P3 program builds
Welcome to the Area
on expertise at the Duke Human Vaccine Institute, which provides
Physicians
training for safely working with and handling highly infectious
Hospitalist; Internal Medicine
pathogens. The national training program is based out of the Duke
Richard Warren Dickson, DO FirstHealth Moore Regional Hospital Pinehurst
Rita Ibrahim Mikhail, DO Family Medicine
Sampson Regional Medical Center Clinton
Nimit Mahendra Patidar, DO Hospitalist; Internal Medicine
FirstHealth Moore Regional Hospital Pinehurst
Siddharth Hemant Sheth, DO Hematology and Oncology, Internal Medicine
UNC Hospitals Chapel Hill
Adil Hassan Mohammed Ahmed, MD A biopharmaceutical production facility at the Duke Human Vaccine Institute operates under strict FDA manufacturing standards and will be integral to a rapid pandemic response. Photo by Shawn Rocco, Duke Health
Geriatric Medicine; Family Medicine Hospice and Palliative Medicine; Family Practice; Hospitalist
Duke University Hospitals Durham
Renee Lin Betancourt, MD
Regional Biocontainment Laboratory, which is one of 14 containment laboratories funded by the federal government as safe and secure facilities for infectious diseases research. The Duke Human Vaccine Institute operates a biopharmaceutical production and development unit that complies with current U.S. Food and Drug Administration’s Good Manufacturing Practice. The unit was created to develop and manufacture HIV vaccines and will be integral to developing and delivering therapies that could be used to protect people from new emerging diseases. The Duke Human Vaccine Institute will collaborate to provide the necessary platform to achieve DARPA’s goal of swiftly rolling out effective medical countermeasures against pandemic viral infections, the advisory said. “The Duke Regional Biocontainment Laboratory, and the Duke Infectious Disease Response Training Program are at the core of the Duke Human Vaccine Institute’s Pandemic Preparedness Program to safely and securely develop drugs, diagnostics and vaccines to improve global health,” said Gregory Sempowski,
Cytopathology; Forensic Pathology; Hematology Pathology
UNC Hospitals Chapel Hill
Tonya Lashon Blache, MD Preventive Medicine/Occupational; Public Health & General
1117 Chilmark Avenue Wake Forest
Sarah Katherine Blanchard, MD Pediatrics
Asvin Minoo Ganapathi, MD Cardiovascular Surgery; Surgery (general); Thoracic Surgery
Duke University Hospitals Durham
James Patrick Given, MD Psychiatry
V.A. Raleigh Raleigh
John T. Henley Jr., MD Otolaryngology
20002 Bragg Chapel Hill
Adam Anthony Ingraffea, MD Dermatology; MOHS-Micrographic Surgery
Cary Skin Center Cary
Ryan Christopher Jessee, MD Internal Medicine; Rheumatology
Duke University Hospitals Durham
John Wesley Latting, MD Diagnostic Radiology; Radiology; Therapeutic Radiology
Duke University Hospitals Durham
Jessica Lorena Lombardo, MD Internal Medicine
Durham VA Medical Center Durham
Vasavi Paidpally, MD Diagnostic Radiology; Radiology
Duke University Medical Center Durham
Nita Navin Parekh, MD Diagnostic Radiology; Neuroradiology
Durham
Christopher Robert Polage, MD
Durham
Clinical Pathology; Medical Microbiology
Kelsey Robert Budd, MD Diagnostic Roentgenology Radiology; Vascular and Interventional Radiology
Duke University Medical Center Department of Pathology Durham
UNC Hospitals Chapel Hill
Robert James Searles, MD
Tiffany Lynn Covas, MD
Duke University Hospitals Durham
Addictionology or Addiction Medicine; Adolescent & Young Adult Medicine; Alcohol and Drug Abuse; Dermatology; Emergency Medicine/Sports Medicine; Family Medicine
Duke University Hospitals Durham
Anesthesiology
Brian Andrew Sullivan, MD Gastroenterology, Internal Medicine
Duke University Hospitals Durham
november/december 2017
13
News
spond to disease outbreaks such as SARS, pandemic influenza
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