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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.

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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

Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401

Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. 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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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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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.

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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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