January 2012 by TTPLLC

f e b rua ry 2 012

Duke Electrophysiologists Leaders on the Mission to Get Hearts in Synch

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 Year of Discovery Follow Your Calling

Protecta XT TM

CRT-D and DR ICDs with SmartShock Technology TM

With Protecta, 98% of ICD patients are free of inappropriate shocks at 1 year and 92% at 5 years.*1

Brief Statement: Protecta™ CRT-D/DR ICDs Indications Protecta/Protecta XT implantable cardioverter defibrillators (ICDs) and CRT-D ICDs are indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias. Protecta/Protecta XT (CRT-D) ICDs are also indicated the reduction of the symptoms of moderate to severe heart failure (NYHA Functional Class III or IV) in those patients who remain symptomatic despite stable, optimal medical therapy and have a left ventricular ejection fraction ≤ 35% and a prolonged QRS duration. Atrial rhythm management features such as Atrial Rate Stabilization (ARS), Atrial Preference Pacing (APP), and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in ICD-indicated patients with atrial septal lead placement and an ICD indication. Additional Protecta/Protecta XT System Notes: The use of the device has not been demonstrated to decrease the morbidity related to atrial tachyarrhythmias. • The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 17%, and in terminating device classified atrial fibrillation (AF) was found to be 16.8%, in the VT/AT patient population studied. • The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 11.7%, and in terminating device classified atrial fibrillation (AF) was found to 18.2% in the AF-only patient population studied.

Additional Protecta XT DR System Notes: The ICD features of the device function the same as other approved Medtronic marketreleased ICDs. • Due to the addition of the OptiVol® diagnostic feature, the device indications are limited to the NYHA Functional Class II/III heart failure patients who are indicated for an ICD. • The clinical value of the OptiVol fluid monitoring diagnostic feature has not been assessed in those patients who do not have fluid retention related symptoms due to heart failure. Contraindications Protecta/Protecta XT CRT-ICDs are contraindicated for patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myocardial infarction, drug intoxication, drowning, electric shock, electrolyte imbalance, hypoxia, or sepsis. The devices are also contraindicated for patients who have a unipolar pacemaker implanted, patients with incessant VT or VF, or patients whose primary disorder is chronic atrial tachyarrhythmia with no concomitant VT or VF. Warnings and Precautions ICDs: Changes in a patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly over the device. Additionally, for CRT-ICDs, certain programming and device operations may not provide cardiac resynchronization.

www.medtronic.com * Primary prevention patient programmed for detection rate cut off at 188 bpm.

Potential Complications Potential complications include, but are not limited to, acceleration of ventricular tachycardia, air embolism, bleeding, body rejection phenomena which includes local tissue reaction, cardiac dissection, cardiac perforation, cardiac tamponade, chronic nerve damage, constrictive pericarditis, death, device migration, endocarditis, erosion, excessive fibrotic tissue growth, extrusion, fibrillation or other arrhythmias, fluid accumulation, formation of hematomas/seromas or cysts, heart block, heart wall or vein wall rupture, hemothorax, infection, keloid formation, lead abrasion and discontinuity, lead migration/dislodgement, mortality due to inability to deliver therapy, muscle and/or nerve stimulation, myocardial damage, myocardial irritability, myopotential sensing, pericardial effusion, pericardial rub, pneumothorax, poor connection of the lead to the device, which may lead to oversensing, undersensing, or a loss of therapy, threshold elevation, thrombosis, thrombotic embolism, tissue necrosis, valve damage (particularly in fragile hearts), venous occlusion, venous perforation, lead insulation failure or conductor or electrode fracture. 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 these devices to sale by or on the order of a physician.

Changes in a patient’s disease and/or medications may alter the efficacy of a device’s programmed parameters or related features.

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Contents

COVER STORY

Dr. Tristram Bahnson and Dr. Robert Lewis

Duke Electrophysiologists Leaders on the Mission to Get Hearts in Synch

february 2012

Vol. 3, Issue 2

FEATURES

Cardiology

New Anticoagulants Offer Greater Advantages

DEPARTMENTS 16 Your Financial Rx Is It a Career or a Calling?

18 Cardiology

Cardiology

A Lifesaving Gift: New Cardiac Lead is Doubly Beneficial

Will 2012 Be the Year of Atrial Fibrillation?

Dr. Donahue discusses the information

Dr. Paul Mounsey reviews advances in atrial

about new anticoagulants for atrial

fibrillation that now gives the majority of

fibrillation, including dabigatran,

patients a reasonable prognosis for success.

rivaroxaban and apixaban.

19 News

Prescription-Dispensing Program Results in Improved Outcomes and MOre

20 UNC Research News

Scientific Breakthrough of the Year; diverticulosis research disputes beliefs

21 UNC Research News

Study Could Lead to Treatment for Angelman Disease

23 News

However much you value wildlife conservation in North Carolina,

DEC NC

1234

24 Duke News

Primary stroke center certification and new ID scanner in Durham

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

The Triangle Physician

Robotic surgical system arrives in Durham; Cary hospital celebrates 20 years

25 News

Region’s Fellows Recognized for Advancing Science

right here in the Old North State. Conservation education efforts are preparing future generations to sustain your concern for the lands we protect today.

26 Duke News

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

27 News

www.ncwhf.org w

Joint Replacement Program Awarded Gold Seal of Approval Oncologist joins Rex Cancer Center; WakeMed opens pulmonology practice

28 News

Triangle Physician Network, cancer fund raiser and welcome

Stay in the game Don’t be sidelined by an injury Athletes all over the world—professional, Olympic, collegiate, and recreational— rely on the superior care of the specialists at Duke Sports Medicine. Our integrated program offers orthopaedic surgery and physical therapy for injuries, as well as research-based training for injury prevention and elite performance.

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An orthopaedics team ranked sixth in the nation by U.S.News & World Report The Duke Women’s Sports Medicine Program, one of the first established in the nation An accredited FIFA Medical Centre of Excellence— one of only two in the United States

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Appointments are available within 24 hours. Call 888-ASK-DUKE (275-3853). facebook.com/dukeortho twitter.com/dukeortho

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9193

From the Editor

Mysteries of the Heart 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

There is a lot of unknown surrounding atrial fibrillation – primarily its cause and its treatment. One thing is certain, developments in medical science – like cryoballoon ablation – are leading to improved outcomes. Duke

Editor Heidi Ketler, APR

heidi@trianglephysician.com

electrophysiologists introduced this new technology to the Triangle, and they are the focus of our Heart Health Month cover story. This issue of The Triangle Physician also features other cardiologists engaged in unraveling the mysteries of atrial fibrillation. Dr. Paul Mounsey discusses the promise of 2012 as a year of great discovery in the treatment of AF. Kevin Campbell explains the mechanics and benefits of a revolutionary quadripolar defibrillator. Dr. Tim Donahue reviews new anticoagulants for AF stroke

Contributing Editors Kevin R. Campbell, M.D. Timothy P. Donahue, M.D. Paul Mounsey, B.M. B.Ch., Ph.D., M.R.C.P., F.A.C.C. Paul Pittman, C.F.P. Photography Jim Shaw Photography jimshawphoto@earthlink.net Creative Director Joseph Dally

jdally@newdallydesign.com

prevention, including dabigatran, rivaroxaban and apixaban.

Advertising Sales Carolyn Walters carolyn@trianglephysician.com

Returning this month is our resident financial planning expert, Paul Pittman.

News and Columns Please send to info@trianglephysician.com

He tells us a story of a client whose attitude changed once he could focus on his calling as a physician. This is a great issue, and we sincerely appreciate all of our contributors. You, too, are invited to contribute news and insight. The editorial calendar on page 23 may help you plan the most appropriate issue in which to make your debut!

The Triangle Physician is published by: New Dally Design 9611 Ravenscroft Ln NW, Concord, NC 28027 Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401

Also, a heartfelt thanks to our advertisers, who have discovered the secret to reaching a very targeted and elite market. It’s no mystery that The Triangle Physician reaches some 9,000 medical professionals in 18 counties surrounding the Triangle.

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.

With great respect for all you do,

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.

Heidi Ketler

All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography.

Editor

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.

The Triangle Physician

sponsored by the National Institutes of

Dr. Daubert and Duke cardiologists

ongoing observation. • Are eligible for catheter ablation and

the heart’s electrical activation.

Health, and Duke is the No. 1 enrolling

Augustus Grant, M.D.; Geoffrey Pitt, M.D.,

In most cases, pacemakers, ICDs and CRT

center. In addition, the data storage

Ph.D.; and Kent Nilsson, M.D., offer a weekly

devices can be implanted non-surgically

and analysis center resides at the Duke

Inherited Arrhythmia Clinic for patients

by inserting leads in the heart through a

Clinical Research Institute. (Visit www.

who are highly prone to arrhythmias and

vein under the collarbone. Cardiothoracic

dcri.org.)

an elevated risk of sudden cardiac death.

february 2012

They include individuals with a family history of sudden cardiac death, patients who have already experienced a near-fatal arrhythmia with no clear cause, and those

Sana M. Al-Khatib, MD, MHS Cardiac Electrophysiology

Donald D. Hegland, MD Cardiac Electrophysiology

diagnosed with or suspected to have long QT syndrome (LQTS), Brugada syndrome or catecholaminergic polymorphic ventricular tachycardia (CPVT).

Brett D. Atwater, MD

The Inherited Arrhythmia Clinic also sees

Cardiac Electrophysiology

patients with heart-muscle disorders – in-

Patrick M. Hranitzky, MD Cardiac Electrophysiology

cluding arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), hypertrophic cardiomyopathy and other inherited cardiomyopathies. The Inherited Arrhythmia Clinic is a component of Duke’s Adult Cardiovascular Genetics Clinic (ACGC).

Tristram D. Bahnson, MD Cardiac Electrophysiology

Kevin P. Jackson, MD Cardiac Electrophysiology

Genetic testing and interpretation of the results are also available. A key part of this clinic is a full-time genetics counselor, who can help interpret these tests and advise patients and their families on the pros and cons of testing in their particular situation. For more information, call (919) 681-6197.

James P. Daubert, MD Cardiac Electrophysiology

Jason I. Koontz, MD, PhD Cardiac Electrophysiology

Duke Heart Center specialists offer treatment regimens that are individualized using the full scope of new and investigational therapies to prevent and treat AF and other abnormal heart rhythm problems. Ongoing patient evaluation ensures the chosen therapy remains effective and without detrimental side effects.

Camille G. Frazier-Mills MD, MHS

Kent R. Nilsson, MD, MA

Cardiac Electrophysiology

Augustus O. Grant, PhD, MB, ChB

Jonathan P. Piccini, Sr., MD, MHSc

Cardiac Electrophysiology

Ruth Ann Greenfield, MD

Kevin L. Thomas, MD

For more information, visit www. dukehealth.org/heart_center/programs/ heart_rhythm_services/programs. Appointments with a Duke heart specialist may be made by calling (800) 633-3853 or (800) MED-DUKE. “We offer vast experience, garnered from years of treating atrial fibrillation, as well as other heart conditions, and assure that each patient receives a comprehensive and customized therapy plan,” says Dr. Daubert. “Duke Heart physicians also are actively engaged in cutting-edge research to develop new devices, and patients can often benefit by participating in clinical trials.”

The Triangle Physician

Cardiac Electrophysiology

Cardiology

New Anticoagulants Offer Greater Advantages By Timothy P. Donahue, M.D.

Knowledge of the subtle differences between the two new medications can help physicians select the right drug and set patient expectations. After decades of warfarin use for stroke

dietary modification. Drug interactions are

prophylaxis in patients with atrial fibrillation,

few and mostly involve strong inhibitors or

the landscape has changed dramatically in

inducers of glycoprotein P (dabigatran and

the last 18 months with the approval of the

rivaroxiban) or drugs that affect cytochrome

new anticoagulants dabigatran (Pradaxa)

3A4 (rivaroxiban).

and rivaroxiban (Xarelto). Because no head-to-head trial has ever Both drugs have fared well in clinical trials,

been done comparing the two drugs, it can

but knowledge of the subtle differences

be difficult to decide which medication to

between the two can help physicians select

choose for a given patient. Here are some

the right drug and set patient expectations.

things to consider:

To follow is a brief review of the findings of the RE-LY and ROCKET AF trials, which

Dabigatran may be better:

evaluated each drug respectively.

• For patients with a history of stroke in spite of adequate anticoagulation, since

Dr. Tim Donahue has been practicing with Triangle Heart Associates/ Duke since 2009. Prior to that, he served as chief of electrophysiology at Ochsner Clinic serving southern Louisiana. Dr. Donahue earned his medical degree from Louisiana State University. He completed an internship in internal medicine at Emory University Hospital and fellowships in cardiology and cardiac electrophysiology at the University of Florida. Professional interests include diagnosis and treatment of heart rhythm disorders. Dr. Donahue sees patients at Triangle Heart Associates in Durham and can be reached at 919-220-5510.

• For patients with coronary artery disease,

Both drugs proved to be superior to

it showed a significant decrease in the

since the incidence of myocardial

warfarin when taken as directed. The

incidence of ischemic stroke.

infarction trended lower in rivaroxibantreated patients and higher in dabigatran-

majority of the benefit was driven by

• For patients taking strong inhibitors or

the reduction in the risk of hemorrhagic

inducers of CYP3A4 and P-gp, such as

stroke, which was lower in both dabigatran

ketoconazole, itraconazole, ritonavir,

(relative risk 0.26, confidence interval 0.14-

rifampin and conivaptan, which are

While these drugs offer great new advantages

contraindicated with rivaroxiban.

over warfarin therapy, they do have their

0.49) and rivaroxiban (RR 0.59, CI 0.37-0.93) compared to warfarin-treated patients.

• For patients in whom cardioversion is

treated patients compared to warfarin.

shortcomings. Both drugs increase the

Dabigatran also significantly lowered the

planned. In RE-LY, 672 patients treated

risk of GI bleed compared to warfarin and

risk of ischemic stroke (RR 0.76, CI 0.60-

with dabigatran 150mg underwent

both remain expensive for patients who

0.98). The rate of all bleeding was similar in

cardioversion. Rates of embolism and

have no prescription drug coverage. Both

patients treated with warfarin vs. either of

thrombus-positive TEE were similar

companies, however, do offer assistance

the new anticoagulants, but both dabigatran

compared to warfarin-treated patients. In

programs for indigent patients.

and rivaroxiban increased the frequency of

ROCKET-AF, planned cardioversion was

gastrointestinal bleeding significantly.

an exclusion criterion.

It should be a short wait for the introduction of the next competitor in this rapidly

In addition to improved safety, ease of use

Rivaroxiban may be better:

growing space. Approval of the factor Xa

is another compelling attribute of these new

• For patients who may have trouble

inhibitor apixaban (Eliquis) is expected

drugs. Rivaroxiban showed no increase in

complying with a twice daily regimen,

in the next several months. This twice-a-

side effects compared to warfarin and is taken

since it is taken once daily (with the

day drug impressed researchers by hitting

once daily. Dabigatran caused dyspepsia in

evening meal).

solid clinical endpoints, such as reduction

6 percent of patients and is taken twice daily.

in hemorrhagic stroke, bleeding and death

• Because it has no apparent non-

Neither drug requires routine monitoring

bleeding side effects. (Dabigatran causes

of coagulation parameters or significant

dyspepsia in 6 percent of patients.)

compared to warfarin.

february 2012

Cardiology

Will 2012 Be the Year of Atrial Fibrillation? By Paul Mounsey, B.M. B.Ch., Ph.D., M.R.C.P., F.A.C.C.

I wonder if, when all of the dust has settled,

Atrial

fibrillation

almost

always

we will come to think of 2012 as the year

symptomatic in patients who are not rate

To be sure, dabigatran has been shown

when atrial fibrillation finally came of age?

controlled. But among patients who have

to be associated with some increase in

received adequate rate-control therapy,

gastrointestinal bleeding, especially in

atrial fibrillation frequently remains highly

the elderly, but this is not a feature of

prevent stroke has been around for many

symptomatic. Patients are often very

rivaroxaban therapy. It is probable that

years, protection has come with significant

breathless and tired from their arrhythmia,

these two drugs will be joined by a third

effort both for the patient and the health

although symptoms can often only be

agent, Apixaban, within the next six to

care provider. This began to change in

recognized in retrospect when atrial

nine months, and with these three drugs in

2011, and 2012 will see a flowering of

fibrillation has been corrected.

our therapeutic armamentarium, it will be

Although

warfarin

anticoagulation

possible to offer the majority of patients a

these changes. Before yearâ&#x20AC;&#x2122;s end, we will probably have two or three alternatives to

With the increasing availability of effective

viable alternative to warfarin.

warfarin therapy, and this will likely be to

catheter-based and minimally invasive

Where Is Invasive Therapy in 2012?

our patientâ&#x20AC;&#x2122;s benefit.

surgical therapy for atrial fibrillation, it has

We have moved from an era of being able

become more worthwhile to try to restore

to offer a few patients with paroxysmal atrial fibrillation and minimal structural

Recurrences of atrial fibrillation are common, however, and patients frequently require more than one procedure to achieve success.

heart disease catheter-based pulmonary vein isolation to an era in which the vast majority of patients with symptomatic atrial fibrillation can be offered a tailored catheter-based, or minimally invasive

Catheter ablation first became available in

sinus rhythm and reap the symptomatic

surgical procedure with a reasonable

the mid-1990s, and it is hard to believe that

benefits that come with this.

prospect of success.

invasive procedure has so quickly come to

What of the New Anticoagulants?

The basis of catheter therapy for atrial

dominate the working lives of many elec-

The mainstay of anticoagulation, vitamin

fibrillation was the recognition that ablation

trophysiologists. With major advances in

K antagonism, is of proven benefit, but

of pulmonary vein tachycardias could

technology since the 1990s, it is now pos-

for many patients this is less than a

abolish paroxysmal atrial fibrillation. This

sible to offer a catheter-based or minimally

satisfactory therapy. For patients doing

approach was ineffective in the majority of

invasive procedure to the vast majority

poorly on warfarin, there has been little to

patients with persistent atrial fibrillation or

of patients with atrial fibrillation and give

offer except for the patient to soldier on or

paroxysmal atrial fibrillation in the context

them a reasonable prospect of a success-

to deny the patient the proven benefit of

of structural heart disease.

ful outcome. These are truly revolutionary

antithrombotic therapy.

the ability to treat atrial fibrillation with an

times in the atrial fibrillation world. With the introduction of the direct thrombin Why Is Arial Fibrillation Important?

inhibitor, dabigatran (Pradaxa) and the

The prevalence of atrial fibrillation in

factor Xa inhibitor rivaroxaban (Xarelto),

2011 is about five million, and we must

patients now have a real alternative. These

anticipate an exponential growth over the

orally active agents offer the same or better

next 15 to 20 years as the population ages.

prophylaxis against thrombotic stroke, with

With atrial fibrillation comes stroke, but the

an important reduction in the incidence

crippling quality-of-life issues that face so

of cerebral bleeding. No blood tests are

many patients are less well recognized.

required, and dosing is standard except in patients with impaired renal function.

The Triangle Physician

The catheter Maze operation.

After undergraduate medical education internship and residency at the University of Oxford in the United Kingdom Dr Mounsey did his Cardiac Electrophysiology Fellowship at the University of Virginia. He was on the faculty of the University of Virginia for many years before joining the University of North Carolina to head up the Cardiac Electrophysiology program. He is interested in the treatment of all kinds of heart rhythm disturbances. He is especially interested in catheter ablation of atrial fibrillation and ventricular tachycardia.

can be done using a minimally invasive

the vast majority of patients with atrial

thorascopic

fibrillation.

transdiaphragmatic

abdominal approach. A large amount of the surgery can be accomplished,

These then are exciting times indeed in the

and then under the same anesthetic an

atrial fibrillation world. Gone are the days

electrophysiologist can perform limited

when standard treatment for a patient with

catheter ablation to areas of the heart

atrial fibrillation was digoxin and warfarin.

inaccessible to the surgeon (Figure 2).

In the symptomatic patient, we can almost always offer amelioration of the symptoms

The addition of a combined epicardial and

with conversion to sinus rhythm, and with

endocardial approach to atrial fibrillation,

all patients we can offer meaningful stroke

the so-called hybrid approach to standard

prophylaxis, either with warfarin or with

catheter-based

one of the new direct thrombin or factor

techniques,

means

meaningful intervention is possible for

Xa inhibitors.

We have known for a long time that it was possible to interrupt atrial fibrillation in the majority of patients using an open surgical procedure â&#x20AC;&#x201C; the MAZE procedure. With the advent of three-dimensional mapping techniques, it has become possible to recreate a version of the maze procedure using catheters that is effective in the majority of patients with structural heart disease, including severe cardiac failure (Figure 1). Recurrences of atrial fibrillation are common, however, and patients frequently require more than one procedure to achieve success. In addition, a proportion of patients will remain long term on an antiarrhythmic drug. Surgical approaches have emerged where a proportion of the MAZE operation

Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

february 2012

Your Financial Rx

Is It a Career or a Calling? By Paul Pittman, C.F.P.

“…for the first time in many years he was enjoying practicing medicine again.”

and was in tremendous angst and turmoil over the business side of his practice. He thought he was burned out. He actually dreaded going to work in the morning. Fast forward six months. We’re playing golf together, and he tells me that for the first time in many years he is enjoying

When it comes to choosing a career, I was

pact on me, and I will remember it forever.

practicing medicine again. This one

taught a long time ago that if you found

I had been working with this particular

statement not only made me feel very

something you truly loved and could also

client, a physician, for only about six

good, but also validated my own personal

make a living doing it, then you would be

months. We had painstakingly dissected,

calling.

very successful.

restructured and simplified his entire financial

situation,

streamlined

his

This physician told me he had been

Many people pick their employment path

payroll, billing and retirement plan, and

skeptical when his friend urged him to

out of responsibility, income potential or

dramatically lowered his investment risk

contact me months prior. He had been

just random luck. Few know from a very

working with a broker at a large firm for

early age exactly what they want to do with

many years, and he wondered what could

their lives.

be so different between his broker and this other guy (me). Reluctantly, yet willing to

Most health care professionals I have

take a new approach, he gave me a call.

met say they knew they wanted to be in that field for as long as they could

I remember the first time we met. He

remember. This is the difference

was cold and distant. For about an hour

between a career and a calling. A

and a half, I listened to him talk about

calling is an overwhelming attraction

money, insurance, employees, hospitals

to a specific purpose that you would

and overhead. After all of this, I asked

perform, if you could, for free.

him one simple question. “What made you decide to become a doctor?” The mood

When you are in medical school, you may

of the conversation shifted and his entire

discover the love of being a healer, but

personality changed. He literally lit up when

in the real world you find that so much

he talked about medicine. I had not asked

of your day is taken up with other tasks.

and expenses. We had spent many hours

These other tasks are important, and even

together in person, on the phone and

an integral part of running a successful

by email during the previous months.

Six months later, we’re on the golf course

practice, but it probably is not your calling.

All aspects of his financial life (personal,

together, and this physician confides that

business and family) were now crystal

now he feels more knowledgeable and

clear to him, his partners and his spouse.

in control. He doesn’t worry about the

I have been advising clients for more than 25 years now, and I recently was paid the

him one question about his finances.

financial side of his practice anymore. He

ultimate compliment from one of them.

This was a person who had come to me

especially likes that I never tried to sell him

This compliment made a tremendous im-

through the advice of a mutual friend

anything.

The Triangle Physician

Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 459-4171 and paul.pittman@pcgnc.com. Email us If you would like to receive Paul’s Weekly Market Commentary.

I am no miracle worker. I leave that up to medical professionals, but I did one thing with him that I do better than anyone in the financial field; I listened, really listened. I didn’t have an agenda that a financial firm had expected from me, nor did I have any idea if

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I was going to be able to help him. I took the initial meeting out of respect for our mutual friend. That meeting actually uncovered not

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only a working relationship, but also what I hope will be a lifelong friendship. This made me think about the physician

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with his yellow pad and just listens, really listens. He is not managing a business, filing payroll taxes, battling with insurance companies, making sure his retirement plan deposits are being made, worrying about the stock market, new government regulations, or how many patients he has to see to make a living. He is living his

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february 2012

Cardiology

A Lifesaving Gift

New Cardiac Lead Is Doubly Beneficial By Kevin R. Campbell, M.D.

As November ended last year, the United

provide benefit to the patient.

States Food and Drug Administration approved the Quartet Left Ventricular

But two poles limited placement. The ideal

Quadripolar Pacing Lead.

location for the lead is very lateral in the left ventricle. That puts the lead near a nerve

Hardly a week later, I gave the first person

that controls the diaphragm, for instance.

in the Triangle region of North Carolina a

An impulse meant to stimulate the left

new lease on quality of life by implanting

heart might also activate the phrenic or

the revolutionary defibrillator ventricular

diaphragmatic nerve and cause a patient’s

lead in his chest at Johnston Medical

diaphragm to jump, hiccup-like.

Center. In fact, the patient was among the first 20 or so in the nation to receive the

Or suppose one of the poles was placed

“quad” lead.

near heart tissue destroyed by a prior heart attack. Dead heart muscle will not respond

Invented by St. Paul, Minn.-based St. Jude

to the electrical pulse.

Medical Inc., the quad lead gives cardiac electrophysiologists a range of new options

The new lead has not two, but four metal,

for re-synchronizing hearts that suffer from

contacts or poles – quadipolar. Because of

pump failure.

the nature of a defibrillator, the doubling of potential electrical poles in the ventricular

Biventricular defibrillators save millions of

lead results in a quadrupling of possible

patients facing sudden cardiac failure and

contact pairings – and, thus, possibilities

congestive heart failure. The tiny, implant-

for successfully placing a lead in a

able devices deliver an electrical shock

favorable position.

during a cardiac arrest that returns the heart beat to normal rhythm. Without the

The benefits are wide ranging. Some

defibrillation shock, patient mortality ap-

patients need more energy to effectively

proaches 90-plus percent. In contrast, the

pace the lead in the left ventricular

device can reduce heart failure symptoms

position. That can drain a defibrillator’s

by pacing the left and right ventricles in a

battery more quickly and, thus, require

synchronous manner.

more frequent surgeries to replace the device. More pacing possibilities means

The electrical circuit in the left ventricular

lower voltage required to successfully

lead involves two separate electrical poles

resynchronize the heart and, thus, longer

that serve as an anode (positive) and a

battery life.

cathode (negative). These poles are often in a particularly tricky spot in the chest.

Similarly, a lead placed too close to the

Until November, the second ventricular

nerve to the diaphragm could require a

lead, called the left ventricular or coronary

second surgery to reposition the lead, or

sinus lead, had just two metal poles –

the left ventricular lead may need to be

bipolar – that had to be placed in a lateral

disabled. For a person facing heart failure,

position within the left heart in order to

both are daunting options.

The Triangle Physician

Dr. Kevin R. Campbell, a board-certified cardiologist, is a specialist in electrophysiology and speaks nationally on prevention of sudden cardiac death in women. He received his medical degree at Bowman Gray School of Medicine at Wake Forest University and completed his residency at the University of Virginia and a fellowship in cardiovascular disease and electrophysiology at Duke University Medical Center. WHV-Wake Heart & Vascular, the state’s largest independent cardiology practice, is recognized nationally in a number of areas, including advanced electrophysiology procedures and radial cardiac catheterization/interventional procedures. Three WHV physicians recently were cited as 2011-2012 Best Doctors in America.

Johnston Medical stood at the vanguard of this revolutionary technology because of its dedication to bringing cutting-edge technology to patients. It is one of the few community hospitals in the state to offer radio-frequency ablation, for instance. It helped that my practice, WHV-Wake Heart & Vascular, is involved in numerous research studies. We know about potential procedures even before they are approved, which means this quiet corner of a largely rural county had access to cutting-edge medicine long before patients in North Carolina’s most medical-savvy cities. It meant a wonderful Christmas gift for one patient last December at Johnston Medical.

News

Prescription-Dispensing Program Results in Improved Outcomes and Much More Physicians’ Own Pharmacy (POP Medical)

Save patients time and money. Patients

Americans would have their prescription

offers a point-of-care pharmaceutical dis-

who are sick, in pain, post-op or simply too

filled in their doctor’s office instead of a

pensing program that is a convenient and

busy will appreciate the convenience and

pharmacy if given the choice.

cost-effective method for supplying patients

security that comes with receiving their

with the medications they need at the time of

medications directly from their health care

POP Medical provides a point-of-care

their office visit.

provider. This program also offers patients

dispensing

a time-saving alternative to long waits at the

medications, both name brand and generics.

pharmacy.

Applying innovative technology and a

Many practices today are writing more

solution

for

prepackaged

pharmacist-verified system, a practice’s

prescriptions than they are ordering labs and X-rays, etc. Yet these scripts generate no

Increase physician income. Medication

staff members are able to give patients

revenue to one’s practice.

dispensing is a significant way to generate

medications quickly and safely.

additional income for a physician’s practice. POP Medical’s physician-dispensing model

With net revenue ranging from $5-$10 per

is designed to preserve the entire treatment

prescription dispensed using the POP

flexibility to meet a practice’s dispensing

process within the practice, improve

Medical model, an active in-office dispensing

needs. Using bar code technology, a

compliance and enhance the “trust factor”

program can strengthen the practice’s

pharmacist verifies the medication for each

that inherently comes with a full-service

bottom line.

bottle dispensed. Once verified by POP

formulary

assures

Medical’s pharmacist, a patient-specific label

practice. Improve treatment compliance to imKey benefits include:

practice-specific

and education sheet is created.

prove patient outcomes. AARP studies

• Continuity and quality of care

suggest as many as 30 percent of all prescrip-

The POP Medical system is fully secure,

• Improved patient outcomes

tions go unfilled each year. In-office medica-

approved by the North Carolina Board of

• Enhanced revenue stream

tion dispensing ensures patients have their

Pharmacy, and HIPAA-compliant, while

• Seamless and efficient turn-key operation

medications in hand before leaving the phy-

allowing physician practices to:

• No startup cost or inventory to purchase

sician’s office.

•T rack patient use and dispensing history •C omplete real-time inventory management •R eceive monthly, custom reporting

National averages indicate that physicians

Growing Trend

write two prescriptions per patient visit and

Declining reimbursement rates and the

see 20 patients a day. Patients then take

emergence

those prescriptions to a local pharmacy

care is leading doctors to explore ancillary

for fulfillment. POP Medical enables a

services designed to heighten the patient

physician’s practice to fill most prescriptions

experience and capture revenue that has

POP Medical offers a seamless turn-key

in the office, thereby generating significant

been traditionally referred outside of the

program that includes real-time insurance

new revenues for the practice and providing

practice.

adjudication, pharmacist-verified and claims

consumer-driven

health

•B enefit from automated inventory control based on preset min-max inventory controls

processing. Electronic adjudications make

an added service to its patients. A growing number of practices are offering a

it possible to electronically submit and

The POP Medical solution covers name

dispensing option, which is reportedly easy

receive payment from virtually any insurance

brand and generic drugs. Using the turn-key

to implement, cost effective and differentiates

company, including Medicare and Medicaid,

Dispensing Solution program, the practice is

the practice from others. Manhattan Research

in much the same way a pharmacy does.

furnished with the prepackaged medication

projects an estimated increase of 10-20

and sells it to the patient for the patient’s co-

percent in dispensing among all physicians

Physicians’ Own Pharmacy, LLC offices are

pay. Using the averages stated above, this

nationwide in the next three to five years.

located at 160 MacGregor Pines Drive, Suite 111, Cary, NC 27511. For more information call

program could generate between a reported $150-$200 per physician per day in profit.

According to a POP Medical news advisory,

(919) 616-0373 or toll free (855) 4POPMED or

a recent national found that, three out of four

visit www.popmedical.com.

february 2012

UNC Research News

HIV Prevention Research Named Scientific Breakthrough of the Year The HIV Prevention Trials Network 052

pharmacologists and physicians has been

global fight against AIDS. They are wonder-

study, led by Myron S. Cohen, M.D. of the

working on the idea that antiretrovirals

ful examples of how Carolina’s faculty con-

University of North Carolina at Chapel Hill,

might make people less contagious,” said

duct research that saves lives.”

has been named the 2011 Breakthrough of

Dr. Cohen, who is distinguished professor

the Year by the journal Science.

of medicine, microbiology and epidemiol-

Since their release, the study results have

ogy at UNC. “By 2000, the UNC study team

been reverberating throughout the policy

HPTN 052 evaluated whether antiretroviral

thought the idea was strong enough to try to

community. U.S. and international organi-

drugs can prevent sexual transmission of

prove it. This idea eventually became HPTN

zations, such as the World Health Organi-

HIV among couples in which one partner

052,” he said.

zation, the President’s Emergency Plan for AIDS Relief and the Joint United Nations

has HIV and the other does not. The research found that early treatment with anti-

It would be another five years before re-

Programme on HIV/AIDS, have incorpo-

retroviral therapy reduced HIV transmission

searchers from the HIV Prevention Tri-

rated or soon will incorporate “treatment as

in couples by at least 96 percent.

als Network started enrolling people in

prevention”– the strategy proved by HPTN

the study, eventually nearly 2000 couples

052 – into their policy guidelines for battling

The study was funded by the National In-

at 13 sites in nine countries. In May 2011,

the AIDS epidemic.

stitute of Allergy and Infectious Diseases

four years before the study’s scheduled

(NIAID), part of the National Institutes of

completion, an outside monitoring board

“While I am obviously thrilled to have this

Health.

requested that the results be released

research recognized as the Science break-

immediately, because they were so over-

through of the year,” Dr. Cohen said, “wit-

whelmingly positive.

nessing the translation of this scientific

The editors at Science, the flagship publi-

discovery on a global scale truly is the best

cation of the American Academy for the Advancement of Science, said in its an-

“Prevention of HIV-1 Infection with Early An-

nouncement that “In combination with oth-

tiretroviral Therapy” was published Aug. 11

er promising clinical trials, the results have

in the New England Journal of Medicine.

reward.” The research was conducted by the HIV Prevention Trials Network, which is funded

galvanized efforts to end the world’s AIDS epidemic in a way that would have been in-

Jon Cohen, a writer for Science, said in an

by NIAID, with additional funding from the

conceivable even a year ago. ‘The goal of

article about the breakthrough, “HPTN 052

National Institute on Drug Abuse and the

an AIDS-free generation is ambitious, but it

has made imaginations race about the what-

National Institute of Mental Health, both

is possible,’” United States Secretary of State

ifs like never before, spotlighting the scien-

part of the National Institutes of Health. Ad-

Hillary Clinton told scientists last month.

tifically probable rather than the possible.”

ditional support was provided by the NIAIDfunded Adult AIDS Clinical Trials Group.

The HPTN 052 study is proof of a concept

UNC-Chapel Hill Chancellor Holden Thorp

more than 20 years in the making. “From the

said, “We’re proud that Science magazine

The complete list of top 10 scientific break-

time the first AIDS drugs were developed in

has recognized Mike Cohen and his col-

throughs of the year was published online.

the mid-1990s, our UNC team of virologists,

leagues for such inspiring leadership in the

Diets High in Fiber Won’t Protect Against Diverticulosis For more than 40 years, scientists and

colon wall. A new study of more than 2,000

Chapel Hill School of Medicine, found

physicians have thought eating a high-

people reveals the opposite may be true.

that consuming a diet high in fiber raised,

fiber diet lowered a person’s risk of

rather than lowered, the risk of developing

diverticulosis, a disease of the large

The study, conducted by researchers

diverticulosis. The findings also counter

intestine in which pouches develop in the

at the University of North Carolina at

the commonly held belief that constipation

The Triangle Physician

UNC Research News increases a person’s risk of the disease.

bowel movements and reduce the risk

fewer than seven bowel movements per

of diverticulosis. This recommendation

week, individuals with more than 15 bowel

“Despite the significant morbidity and

is based on the idea that a low-fiber

movements per week were 70 percent

mortality of symptomatic diverticulosis,

diet will cause constipation and, in

more likely to develop diverticulosis.

it looks like we may have been wrong for

turn, generate diverticula as a result of

decades about why diverticula actually

increased pressure in the colon. However,

The study found no association between

form,” said Anne Peery, M.D., a fellow in the

few studies have been conducted to

diverticulosis and physical inactivity or

gastroenterology and hepatology division

back up that assumption. “Our findings

intake of fat or red meat. The disease’s

at UNC and the study’s lead researcher.

dispute commonly held beliefs because

causes

The study appears in the February 2012

asymptomatic diverticulosis has never

researchers believe gut flora may play a

issue of the journal Gastroenterology.

been rigorously studied,” said Dr. Peery.

role.

“While it is too early to tell patients what to

The UNC study is based on data from

Dr.

do differently, these results are exciting for

2,104 patients aged 30-80 years who

needed before doctors change dietary

researchers,” said Dr. Peery. “Figuring out

underwent outpatient colonoscopy at

recommendations, but the study offers

that we don’t know something gives us the

UNC Hospitals from 1998-2010. Participants

valuable insights on diverticulosis risk

opportunity to look at disease processes in

were interviewed about their diet, bowel

factors. “At this time, we cannot predict

new ways.”

movements and level of physical activity.

who will develop a complication, but if we

Diverticulosis affects about one-third of

“We were surprised to find that a low-

diverticula form we can potentially reduce

adults over age 60 in the United States.

fiber diet was not associated with a higher

the population at risk for symptomatic

Although most cases are asymptomatic,

prevalence of asymptomatic diverticulosis,”

disease,” said Dr. Peery.

when

remain

Peery

said

unknown,

but

research

the

can better understand why asymptomatic

they

said Dr. Peery. In fact, the study found

can be severe, resulting in infections,

complications

develop

those with the lowest fiber intake were 30

UNC co-authors include Patrick Barrett,

bleeding, intestinal perforations and even

percent less likely to develop diverticula

Doyun Park (currently at Albert Einstein

death. Health care associated with such

than those with the highest fiber intake.

College of Medicine), Albert Rogers,

complications costs an estimated $2.5 billion per year.

Joseph

Galanko,

Christopher

Martin

The study also found constipation was not

and Robert Sandler, gastroenterology &

a risk factor and that having more frequent

hepatology division chair. The research

Since the late 1960s, doctors have

bowel movements actually increased a

was supported by grants from the National

recommended a high-fiber diet to regulate

person’s risk. Compared to those with

Institutes of Health.

Study Could Lead to Treatment for Angelman Syndrome Results of a new study from the University

sleep disturbance, and motor and balance

electrical or chemical signals to other

of North Carolina at Chapel Hill may

disorders. Individuals with the syndrome

neurons via the synapse.

help pave the way to a treatment for a

typically have a happy, excitable demeanor

neurogenetic disorder often misdiagnosed

with frequent smiling, laughter and hand

Angelman syndrome is linked to mutations

as cerebral palsy or autism.

flapping.

or deletions in the Ube3a gene inherited

Known as Angelman syndrome, or AS, its

No effective therapies exist for AS, which

allele. In most tissues of the body, both

most characteristic feature is the absence

arises from mutations or deletions of the

the maternal and paternal alleles are

or near absence of speech throughout the

gene Ube3a on chromosome 15. The

expressed. But in rodents and humans, the

person’s life. Occurring in one in 15,000

Ube3a protein produced by the gene is a

paternal Ube3a allele is intact but silent, or

live births, other AS characteristics include

key component of a molecular pathway

dormant.

intellectual and developmental delay,

that is very important to all cells, especially

severe intellectual disability, seizures,

brain neurons by helping them pass

from the mother; thus, the maternal

What

apparently

accounts

for

the

february 2012

UNC Research News dormancy of that allele is a strand of

handling

ribonucleic acid known as antisense RNA,

download/robotLab2011.php).

(see

http://pdspdb.unc.edu/

chromosome 15 are associated with clas-

which in terms of gene expression keeps paternal Ube3a silenced, or off.

Once

DNA copies, or duplications, in maternal sic forms of autism. “If you have too little

Using a library of United States Food and

Ube3a you have Angelman syndrome. If

referred to as the genome’s “dark matter,”

Drug

the maternal allele is duplicated, it might

antisense RNA makes no functioning gene

obtained from the National Institutes of

product, but works to repress expression

Health (the National Institutes of Health

of another gene by binding to its RNA.

Clinical Collection), the UNC team dis-

Drs. Zylka and Philpot caution against

Administration-approved

drugs

be a contributing factor to autism.”

covered that irinotecan, a topoisomerase

using topoisomerase inhibitors now to

“We wanted to determine if there could

inhibitor known to be active in the central

treat Angelman syndrome, given the limits

be a way to ‘awaken’ the dormant allele

nervous system – robustly “awakened”

of current knowledge.

and restore Ube3a expression in neurons,”

Ube3a. Subsequently, the team identified

said neuroscientist Benjamin D. Philpot,

the FDA-approved medication topotecan

“We’d like to stress that these compounds

Ph.D., associate professor of cell and

and several other topoisomerase inhibitors

are not ready to be used clinically for

molecular physiology, one of three senior

as drugs which can “awaken” Ube3a.

Angelman syndrome,” Dr. Zylka said. “We

investigators in the study and a member of the UNC Neuroscience Center.

don’t know what the off-target effects might “When we gave topotecan to these neurons

be on a gene or genes with similar DNA

they would now glow, indicating that the

sequences. We need to figure out optimal

In a report of the research published

paternal allele was now on,” Dr. Philpot

concentrations and dosing before we move

online Dec. 21 in the journal Nature, the

said. Topotecan apparently awakened the

to clinical trials. And we need to determine

interdisciplinary team of UNC scientists

dormant Ube3a allele by down-regulating,

which drug is best.”

says it has found a way to “awaken” the

or reducing, antisense RNA in the

paternal allele of Ube3a, which could lead

paternal copy of Ube3a, the researchers

For people to use these drugs now for

to a potential treatment strategy for AS.

determined.

Angelman syndrome, without further

“We have taken advantage of a tool that

When topotecan was given to the

Dr. Philpot said, “one that could jeopardize

allows us to distinguish between active

genetically engineered mice, “it unsilenced

successfully bringing these compounds to

and inactive alleles,” Dr. Philpot said. “That

the paternal Ube3a allele in several regions

clinical trials.”

tool is a modified mouse that’s engineered

of the nervous system, including neurons

so that the Ube3a gene has a fluorescent

in several areas of the brain and in the

Along with Drs. Philpot, Zylka and Roth,

‘reporter’ gene attached to it, which tells

spinal cord,” the authors stated. These

co-authors from UNC were Hsien-Sung

you when the gene is on or when it’s

findings also held true for irinotecan.

Huang, John A. Allen, Angela M. Mabb,

preclinical studies, might be a health risk,

off. When the gene is on, neurons will

Ian F. King, Jayalakshmi Miriyala, Bonnie

fluoresce in yellow, but won’t when the

Importantly,

the

Taylor-Blake, Noah Sciaky, J. Walter Dutton

gene is off.”

unsilenced paternal Ube3a was functional

Jr., Hyeong-Min Lee, Xin Chen, Jian Jin and

and was expressed by the gene in amounts

Arlene S. Bridges.

the

protein

from

Other “tools” available on the UNC campus

comparable to that of normal maternal

come from study senior author Bryan

Ube3a in control animals.

The research was supported in part by

L. Roth, M.D., Ph.D., Michael Hooker

funds from the Angelman Syndrome

distinguished professor of pharmacology

The

co-author,

Foundation, the Simons Foundation, the

and translational proteomics and director

neuroscientist Mark J., Zylka, Ph.D.,

National Institute of Mental Health, the

of the National Institute of Mental Health

assistant professor of cell and molecular

National Eye Institute, the National Institute

Psychoactive Drug Screening Program.

physiology and a UNC Neuroscience

of Neurological Disorders and Stroke,

These include highly automated robotics

Center member, said the study is “the first

the National Institute of Mental Health

of the sort normally found in major

example of a drug that regulates antisense

Psychoactive Drug Screening Program and

pharmaceutical companies: fluid-handling

RNA and, as a result, regulates (protein)

the North Carolina TraCS Institute, funded

robotics

levels of a coding gene.”

by the NIH Clinical and Translational

and

automated

high-content

study’s

third

senior

imaging that combine the molecular tools

Science Awards (CTSA).

of modern cell biology with automated

According to Dr. Philpot, the increased sci-

high-resolution microscopy and robotic

entific interest in Ube3a is because certain

The Triangle Physician

Duke News

Da Vinci Si Surgical System Arrives at Durham Regional Hospital Durham Regional Hospital has introduced

complex surgical procedures using the da

the da Vinci Si Surgical System to its

Vinci Si.”

•N ew ergonomic settings for greater surgeon comfort.

operating room. The hospital is currently using robotic

“Durham Regional has always been

The da Vinci Si is a state-of-the-art surgical

surgery for many procedures, including

committed to providing patients with

robot that provides patients with all the

but not limited to – fibroid removal,

the safest, minimally invasive options for

benefits of a minimally invasive procedure.

hysterectomy, weight loss surgery and

treatment,” said Craig Sobolewski, M.D.,

For many patients, this means an easier

kidney surgery.

chief of the division of minimally invasive

recovery, less postoperative pain, a shorter hospital stay and smaller scars.

gynecologic surgery. “The da Vinci Si Features of the da Vinci Si include:

Surgical System provides our surgeons

•E nhanced three-dimensional, high-

with the most sophisticated tools currently

“Robotic surgery is one of the most

definition vision of operative field with

available. This technology further enables

effective, least invasive surgical treatments

up to 10x magnification.

us to continue to give our patients the

available,” said Lisa Pickett, M.D., chief medical officer, Durham Regional Hospital. “Thanks to the generous support of our Durham Hospital Corporation Board, we now offer our surgeons unparalleled precision, dexterity and control for many

• S uperior visual clarity of tissue and anatomy.

surgeries.”

• S urgical dexterity and precision far greater than the human hand.

For more information about Durham

•U pdated and simplified user interface to enhance operating room efficiency.

WakeMed News

WakeMed Cary Hospital is celebrating

1,200 employees and a medical staff of more

its 20th anniversary and recognizing its

than 700 physicians. Within the last year,

advances since that first day of service Dec.

WakeMed Cary Hospital’s: • Emergency department saw more than 41,600 patients.

Center, which is today WakeMed Cary Hospital, featured 80 inpatient beds, eight

more than 2,470 babies. • Surgical services performed more than 9,700 procedures.

intensive care beds and six operating

• Cardiovascular care continues to grow

rooms. Ancillary services included a lab

in volume and types of procedures

and radiology. In the first year, the hospital had 300 physicians on its medical staff, 200 employees and 250 volunteers.

performed. • Nursing

units

March

Men’s Health – Vision New Medical Devices

April

Women’s Health Marketing Your Services

May

June

Neurology – Sleep Apnea

July

• Women’s Pavilion & Birthplace delivered Upon opening, Western Wake Medical

durhamregional.org.

Orthopedics – Medical Insurance

16, 1991, when 10 patients were treated in the admitted into the hospital.

Regional’s da Vinci Si System, visit www.

The Triangle Physician 2012 Editorial Calendar

Cary Hospital Celebrates 20 Years of Care emergency department and one patient was

best possible chance for less invasive

continue

provide

outstanding care with more than 10,500 patient discharges in fiscal year 2010.

Today, WakeMed Cary Hospital serves Cary and the surrounding western Wake County

Learn more about WakeMed Cary Hospital

communities with 156 inpatient beds, nearly

by visiting www.wakemed.org.

New Imaging Technologies Electronic Medical Records

August

Digestive Disease Computer Technologies

September

Sports Medicine – Physical Therapy

October

Breast Cancer Reconstructive Surgery

November

Urology – Robotic Surgery

December

Pain Management february 2012

Duke News

Joint Commission Awards Primary Stroke Center Certification After undergoing an onsite evaluation and

United States, with about 4.7 million stroke

– in 2003. A list of programs certified by

demonstrating compliance with nationally

survivors alive today.

The Joint Commission is available at www.

developed standards for stroke care, Durham Regional Hospital has earned The Joint Commission’s Gold Seal of Approval

qualitycheck.org. In stroke care, time until treatment is critical. “By achieving certification as a Primary

Founded in 1951, The Joint Commission

Stroke Center, Durham Regional Hospital

seeks to continuously improve health

has proven it has the ability to provide

care for the public, in collaboration with

“We’re proud to achieve this distinction

effective, timely care to stroke patients

other stakeholders, by evaluating health

from The Joint Commission,” said Kerry

and significantly improve outcomes for

care organizations and inspiring them to

Watson,

for certification as a primary stroke center.

Hospital

stroke patients,” said Jean E. Range, M.S.,

excel in providing safe and effective care

president. “We are pleased to have

Durham

Regional

R.N., C.P.H.Q., executive director, Disease-

of the highest quality and value. The Joint

The Joint Commission recognize our

Specific Care Certification, The Joint

Commission evaluates and accredits more

commitment to providing the best possible

Commission.

than 18,000 health care organizations

care to our patients and our community.”

and programs in the United States. An The Joint Commission’s Primary Stroke

Each year about 795,000 people experience

Center Certification is based on the

a new or recurrent stroke, which is the

recommendations

nation’s third leading cause of death. On

centers published by the Brain Attack

average, someone suffers a stroke every

Coalition

40 seconds and someone dies of a stroke

Association’s statements and guidelines

every 3.1 minutes. Stroke is a leading

for stroke care. The Joint Commission

cause of serious, long-term disability in the

launched the program – the nation’s first

and

for

the

primary American

stroke Stroke

independent, not-for-profit organization, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care. Learn more about The Joint Commission at www. jointcommission.org.

Palm Vein Scanning Improves Patient Identification Durham Regional Hospital is now using

of identification, it offers yet another

Palm vein scanning is more accurate than

innovative palm vein scanning technology

safeguard to ensure we provide the right

fingerprint matching or facial recognition,

to register and identify patients.

care to the right patient.”

and because palm vein patterns are unique and never change, the technology protects against identity theft.

Intended to be faster, safer and more

Using harmless, near-infrared light, a

convenient than traditional registration,

scanner illuminates the unique vein

the PatientSecure Palm Vein Biometric

pattern in a patient’s hand. From that vein

Enrollment in the PatientSecure system

Identification System is designed to ensure

pattern, the PatientSecure system creates

takes only a couple of minutes. To enroll,

the right care is provided to the right

an encrypted digital code, which is linked

a patient places his right hand flat against

patient every time.

to a patient’s electronic health record.

a scanner and presents two forms of

Scans for registration and identification are

photo ID, such as a driver’s license and

complete in seconds, and once enrolled, a

employment ID. Children as young as five

patient’s medical record can be retrieved at

years of age can be scanned. Traditional

any Duke medical facility.

registration will still be available for

“This technology will transform our patients’ registration experience,” said Jonathan Hoy, chief financial officer for Durham

Regional.

“Providing

patients who choose not to take advantage

quality,

safe health care starts with accurate

In addition to being more convenient than

identification. Palm vein scanning is not

traditional registration, the PatientSecure

only simpler and faster than other means

system is safer, according to Mr. Hoy.

The Triangle Physician

of this technology.

News

Region’s Fellows Recognized for Advancing Science Scientists in the Triangle region were among 539 granted fellows of the

“All of these individuals are world-class scientists, who have made

American Association for the Advancement of Science.

discoveries that drive their fields forward,” said Nancy Andrews, M.D., dean of the Duke University School of Medicine, in a Duke University

The American Association for the Advancement of Science (AAAS) is

news advisory. “With this honor, they join a very distinguished group of

awarded for scientifically or socially distinguished efforts to advance

scientific leaders. We are very fortunate to have so many people of this

science or its applications. The 2011 fellows were elected by the AAAS

caliber on our faculty.”

Council in November and will be awarded in a ceremony at the Fellows Forum, during the AAAS Annual Meeting in Vancouver, British Columbia,

“These are all outstanding scientists whom we are proud to have as

in February.

colleagues,” said Sally Kornbluth, Ph.D., vice dean for basic science at Duke University School of Medicine. “They are also terrific citizens

The new AAAS fellows from Duke University Medical Center are:

and leaders who make important contributions to the life of the Duke

Richard Brennan, Ph.D., chair of the Duke Department of Biochemistry,

community.”

in the area of structural biology and his work deciphering mechanisms of gene expression and multi-drug resistance.

2011 AAAS fellows from the University of North Carolina at Chapel Hill were awarded for contributions in biological sciences. They are: Henrik

Bryan Cullen, Ph.D., professor of molecular genetics and

G. Dohlman, William E. Goldman, Fernando Pardo-Manuel de

microbiology, in the field of virology, particularly for studies on human

Villena, Nancy Raab-Traub, Jeff Sekelsky and Yue Xiong.

immunodeficiency virus and his role of microRNAs in viral pathogenesis. New AAAS fellows from the North Carolina State University were awarded Mariano Garcia-Blanco, M.D., Ph.D., professor of medicine and

for contributions in physics. They are Harald Ade and Jerzy Bernholc.

professor of molecular genetics and microbiology, $in RNA biology, and particularly for unraveling the importance of RNA-protein interactions that

AAAS is the world’s largest general scientific society and publisher of the

regulate messenger RNA splicing and control pathogenic RNA viruses.

journal Science, among others.

Sue Jinks-Robertson, Ph.D., professor of molecular genetics and microbiology, in the fields of genetics and molecular biology, particularly for advancing the understanding of basic mechanisms of mutagenesis and homologous recombination of chromosomes. Donald McDonnell, Ph.D., Glaxo-Wellcome Professor of Molecular and Cellular Biology and chair of the Duke Department of Pharmacology and Cancer Biology, for research that has provided fundamental insights into the molecular mechanisms underlying the pharmacological activities of nuclear receptor ligands in physiology and disease. From Duke University, the new AAAS fellows are: Ingrid Daubechies, Ph.D., James B. Duke Professor of Mathematics, for her seminal work in wavelets, as well as significant contributions in the area of signal processing, quantum mechanics, discrete geometry and applied mathematics. Xinnian Dong, Ph.D., professor of biology, for her research on the interactions of plants and microbes, and for her service to the American Society of Plant Biologists and the journal Plant Cell. Dan Kiehart, Ph.D., chair of the department of biology, for his contributions to developmental biology through detailed study of the embryonic development of fruitflies.

february 2012

Duke News

Joint Replacement Program Awarded Gold Seal of Approval Durham Regional Hospital has earned The

has demonstrated its commitment to

organization to the next level and helps

Joint Commission’s Gold Seal of Approval

the highest level of care for the patients

create a culture of excellence. This is a

for its joint replacement program by

in their joint replacement program,”

major step toward maintaining excellence

demonstrating compliance with The Joint

says Jean Range, M.S., R.N., C.P.H.Q.,

and continually improving the care we

Commission’s national standards for health

executive director, Disease-Specific Care

provide.”

care quality and safety in disease-specific

Certification,

care.

“Certification is a voluntary process and I

The Joint Commission’s Disease-Specific

The

Joint

Commission.

commend Durham Regional Hospital for

Care Certification Program, launched

Durham Regional underwent a rigorous

successfully undertaking this challenge

in 2002, is designed to evaluate clinical

on-site survey Dec. 12. An orthopedic

to elevate its standard of care and instill

programs across the continuum of care.

Joint Commission surveyor evaluated the

confidence in the community it serves.”

Certification requirements address three

hospital for compliance with standards

core areas: compliance with consensus-

of care specific to the needs of joint

“With Joint Commission certification,

based national standards, effective use of

replacement

families,

we are making a significant investment

evidence-based clinical practice guidelines

including infection prevention and control,

in quality on a day-to-day basis,” says

to manage and optimize care, and an

leadership and medication management.

Kerry Watson, Durham Regional Hospital

organized

president. “Achieving Joint Commission

measurement and improvement activities.

“In

patients

achieving

Joint

and

Commission

certification for our total joint program

certification, Durham Regional Hospital

provides us a framework to take our

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News

Oncologist Joins Rex Cancer Center of Wakefield Hematologist and medical oncologist

and went on to complete his residency in

opportunity to observe not only his clinical

Nirav Dhruva, M.D., has joined Rex

internal medicine at the University of North

expertise but his compassion and care for

Hematology Oncology and will be located

Carolina at Chapel Hill (UNC-CH). Dr. Dhruva

his patients. Dr. Dhruva’s experience in a

at Rex Cancer Center of Wakefield.

also completed a fellowship in hematology

community satellite setting will benefit our

and medical oncology at UNC-CH.

patients and our Wakefield center as we

Dr. Dhruva is board certified in internal medicine,

hematology

and

continue to see more patients diagnosed

medical

“Dr. Dhruva performed a rotation at

oncology. His clinical research includes

Rex’s main campus during his clinical

studies related to lung, breast and skin

fellowship at UNC,” said Vickie Byler,

Rex Cancer Center of Wakefield reportedly

cancers. He earned a medical degree from

director of the Rex Cancer Center. “This

saw a 20 percent increase in new patients.

the Medical College of Georgia in Augusta

gave the physicians and co-workers the

with cancer.”

WakeMed Establishes New Pulmonology Practice WakeMed Health & Hospitals has added

and more. Both physicians have critical

The two physicians are accepting new

pulmonology to its range of specialty phy-

care experience and also treat inpatients

patients and most major insurance plans.

sician practices.

at Cary Hospital through the intensivist

More information is available online at

program.

www.wakemedphysicians.com or by call-

The Wake Specialty Physicians-Pulmonol-

ing (919) 350-2700.

ogy office is adjacent to WakeMed Cary Hospital and features two physicians: Sangeeta Joshi, M.D., and Sanjay Patel, M.D., MPH.

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The practice is committed to helping patients work through the diagnosis and treatment of medical problems related to the lungs and respiratory system. “Nationwide, there is a shortage of pulmonologists. For patients with respiratory diseases, access to a pulmonologist is critical for managing chronic diseases and potentially avoiding hospitalization,” said Bill Atkinson, Ph.D., M.P.H., M.P.A., WakeMed president and chief executive officer. Drs. Joshi and Patel are board certified and specialize in managing chronic and acute respiratory conditions, such as lung disease, emphysema and chronic obstructive pulmonary disease, respiratory failure, allergies and asthma, lung injuries

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february 2012

News

Rolesville Family Practice Joins Physician Network

Welcome to the Area

Physicians Lloyd Maurice Alderson,MD Brain Tumor Center at Duke Durham

Joseph Brian Borawski,MD Emergency Medicine Duke University Hospitals Durham

Krista Everett Evans,MD

Rolesville Family Practice is the newest primary care practice to join Triangle Physician Network

General Surgery University of North Carolina Hospitals, Chapel Hill

Eldesia LaBren Granger,MD

(TPN).

Internal Medicine, Pediatrics University of North Carolina Hospitals Chapel Hill

It is led by board-certified family

Oksana Kantor,MD

physician Robert P. Taylor, M.D., who established the practice with a mission to deliver quality care in a respectful environment. Dr. Taylor provides comprehensive family care for patients starting at

age

five,

immunizations,

Anesthesiology AA of NC, Raleigh

Daisuke Francis Nonaka,MD Anesthesiology UNC Healthcare, Dept of Anesthesiology, Chapel Hill

Lana Sue O’Neal,MD Durham

Morrisville

Physician Assistants

Stephen Andrew Telloni,MD

Charles Wesley Bell,PA

Internal Medicine University of North Carolina Hospitals Chapel Hill

Family Medicine FastMed Urgent Care

Christopher Michael Terry,MD

Family Medicine

Steven Seth Shay,MD

Abigail Claudia Bivans,PA

Anesthesiology University of North Carolina Hospitals Chapel Hill

Marisa Galavotti,PA

Hadley Ann Trotter,MD

Trudy Jo Kerlin,PA

Emergency Medicine University of North Carolina Hospitals Chapel Hill

Geriatric Medicine Doctor’s Making Housecalls

Daniel Wayne Vande Lune,MD

Family Medicine

Jessica R Ling,PA

University Orthopaedics and Sports Medicine Smithfield

Gina Elizabeth Mauldin,PA

Seth Robert Yarboro,MD

Daniel McKearney,PA

Orthopedic Surgery University of North Carolina Hospitals, Chapel Hill

Family Medicine Health Zone Medical Center

Sarah Wistran Young,MD

Family Medicine

Neurology Duke Neurology of Raleigh

Dana Ann Shumate,PA

Internal Medicine West End

preventive care, minor surgical care and home visits.

Upcoming Event

TPN is a physician-led, notfor-profit, joint effort between University

North

Carolina

Health Care System and Rex Healthcare. The network consists of more than 23 practices and 75 physicians who deliver a full-range of primary care and specialty services to Raleigh, Durham,

Chapel

Hill

and

surrounding areas. TPN primary care

practices

coordinate

with the health care system’s electronic medical records and operational support, as well as specialty and sub-specialty care providers. For more information, visit www.tpnmd.org. Rolesville Family Practice’s office is located at 102 Southtown Circle in Rolesville. To schedule an appointment, call (919) 554-9412 or learn more about the practice at www. rolesvillefamilypractice.com.

The Triangle Physician

Chapel Hill’s Big Running Event in April to Benefit UNC Lineberger For a second year, the Wells Fargo Tar Heel 10 miler and Fleet Feet 4+ mile run will benefit UNC Lineberger Comprehensive Cancer Center April 21. Runners can register online at http://tarheel10miler.com and enter the code “beatcancer5” to donate $5 per entry to cancer research and treatment in our community. A $30 donation to the cancer center will be made for each volunteer who affiliates with UNC Lineberger. “Thank you to Endurance Magazine for once again choosing UNC Lineberger as a charity partner,” said Shelley Earp, M.D., UNC Lineberger’s director.

“Our missions are aligned; we are all working to make Chapel Hill and North Carolina healthier.” The races attracted more than 3,500 runners to Chapel Hill this past April. Among the crowds were UNC researchers, doctors, nurses and other staff – all running a hilly course to benefit cancer research and treatment at UNC Lineberger Comprehensive Cancer Center. Overall, more than $10,000 was raised for the cancer center’s programs. Runners wishing to raise more for UNC Lineberger should watch the cancer center’s Facebook page for information on how to set up their own individual or team fund-raising website.

“More than a doctor. Like a friend.”

We know it by heart.

Trust. WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it. We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.

Cardiovascular Professionals in Johnston, Wayne and Wilson Counties Mateen Akhtar, MD, FACC Benjamin G. Atkeson, MD, FACC Kevin R. Campbell, MD, FACC Randy A.S. Cooper, MD, FACC Christian Gring, MD, FACC

Matthew A. Hook, MD, FACC Eric M. Janis, MD, FACC Diane E. Morris, ACNP Ravish Sachar, MD, FACC Nyla Thompson, PA-C

Waheed Akhtar, MD, FACC Malay Agrawal, MD, FACC Sunil Chand, MD, FACC Paul Perez-Navarro, MD, FACC Joel Schneider, MD, FACC

Cardiovascular Services Echocardiography Nuclear Cardiology Interventional Cardiology Carotid Artery Interventions Cardiac Catheterization Cardiac CT Angiography and Calcium Scoring Electrophysiology and Cardiac Arrhythmias Peripheral Vascular Interventions Pacemakers / Defibrillators Stress Tests Holter Monitoring Lipid and Anti-Coagulation Clinics Vascular Ultrasounds / AAA Screening

WHV Locations in Johnston, Wayne and Wilson Counties 910 Berkshire Road Smithfield, NC 27577

2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520

2605 Forest Hills Road South West Wilson, NC 27893

2400 Wayne Memorial Drive, Suite A Goldsboro, NC 27534

Phone: 919-989-7909 Fax: 919-989-3147

Phone: 919-359-0322 Fax: 919-359-0326

Phone: 252-243-7049

Phone: (919) 736-8655 Fax: (919) 734-6999

When it comes to your cardiovascular care – We know it by heart. To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).

55 Board-certified subspecialized radiologists | 18 Triangle Locations Evening and weekend hours for many services | MRI 7 days a week Physician decision support

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Wake Radiology. Excellent decision. WAKE RADIOLOGY EXTENDED HOURS Screening Mammogram: Evenings & Saturdays CT, Ultrasound & Routine Radiology: Saturdays MRI: 7 days a week

WAKE RADIOLOGY EXPRESS SCHEDULING Centralized Scheduling: 919-232-4700 Chapel Hill Scheduling: 919-942-3196

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