s e p t e m b e r 2 014
Duke Center for Metabolic and Weight Loss Surgery Global Leaders in Minimally Invasive Bariatric Surgery
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
Language Barrier Update: Cervical Cancer Screening
now 87% Smaller
The Reveal LINQ Insertable Cardiac Monitor is a revolutionary system that transforms your ability to diagnose and treat even the most difficult-to-detect cardiac arrhythmias.
SMALL: 87% smaller than Reveal速 XT ICM, with 20% more data memory. SIMPLE: Simplified insertion procedure with <1 cm incision provides the most discreet cardiac monitoring option, with minimal scarring for greater patient acceptance.
CONNECTED: Only wireless insertable cardiac monitoring system that continuously
collects and trends data for up to 3 years, with automatic Medtronic CareAlert速 Notifications.
PRECISE: Clinically actionable, easy-to-read Medtronic CareLink速 reports reduce the
data management burden.
Shift into small at RevealLINQ.com
Innovating for life.
Duke Center for Metabolic and Weight Loss Surgery
Global Leaders in Minimally Invasive Bariatric Surgery
s e p t e m b e r 2 0 14
Update: Cervical Cancer Screening Lindsay Wojciechowski provides the latest recommendations on when to start and stop screening, as well as frequency.
Vol. 5, Issue 6
DEPARTMENTS 9 Gastroenterology
18 UNC Research News
Understanding of IBD-IBS from a Biopsychosocial Perspective
Largest Genetic Analysis Reveals New Way of Classifying Cancer
12 Practice Management
19 UNC Research News
More Older Patients in Emergency Department Are Malnourished
15 Duke Research News Cancer-Fighting Drugs Might Also Stop Malaria Early
20 WakeMed News
16 Duke Research News
Challenging Cases: Overcome Language Barriers
Revenue Cycle Management
- Age Does Not Increase Surgical Risks of Deep Brain Stimulation - Gut Flora Finding May Advance Development of HIV Vaccine
17 UNC Research News
-G arner Healthplex Exceeds Projections -F amily-Togetherness and Privacy Are Goals of Major BirthPlace Renovations
Welcome to the Area
New Approach Uncovers Cancer Genes
Dr. Margaret Boyse has found that accurate diagnosis is more likely with techniques for improved patient communication.
The Triangle Physician
COVER PHOTO: L-R: Back Row: Surgeons, Alfonso Torquati, M.D., MSci, Dana Portenier, M.D.; Front Row: Surgeons, Chan Park, M.D., Philip Omotosho, M.D., Jin Yoo, M.D.
If You Have Patients Who Could Benefit From A Rheumatologist, Dr.Anshul Rao of Johnston Health WelcomesYour Referrals! If you have patients who are suffering from arthritis, or related diseases, you have a rheumatology specialist nearby who welcomes your referrals. Anshul M. Rao, MD, a rheumatologist, is seeing adult patients ages 18 and older at offices in the Medical Arts Pavilion on the Smithfield campus of Johnston Health and at the Johnston Professional Plaza on the Clayton campus of Johnston Health. Dr. Rao finds it gratifying to offer a myriad of treatments that allow patients to maintain and continue their quality of life. He is treating patients suffering with the following conditions:
Gout Lupus Vasculitis Psoriatic Arthritis Myositis Pseudogout Scleroderma Osteoporosis Sarcoidosis Ankylosing Spondylitis Rheumatoid Arthritis Spondyloa Spondyloarthritis
Mon. - Wed. - Fri. 507 N. Bright Leaf Blvd. Suite 100
Call For Appointments: 919-934-3022 www.johnstonhealth.org
CLAYTON Tues. & Thur. 2076 Hwy 42W. Suite 330
From the Editor
Beyond Obesity 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
This month’s cover story highlights the expertise and experience of the Duke Center for Metabolic and Weight Loss Surgery, internationally known for its multidisciplinary approach to weight management and co-morbidity mitigation.
In consultation with their surgeon, patients select from a range of procedures that can result in weight loss and dramatic improvement in associated metabolic, hormonal and physiological conditions, such as diabetes, hypertension and sleep apnea. Duke’s weight-loss program encourages primary care physicians to take an active role in the ongoing surveillance and guidance of patients.
Also in this issue, gastroenterologist Douglas Drossman takes special care in understanding the correlation between disease and patient symptoms, particularly as it relates to irritable bowel syndrome. Nurse practitioner Lindsay Wojciechowski
Editor Heidi Ketler, APR firstname.lastname@example.org Contributing Editors Margaret B. Boyse, M.D. Douglas Drossman, M.D. Margie Satinsky, M.B.A. Lindsay Wojciechowski Creative Director Joseph Dally email@example.com
Advertising Sales info@trianglephysiciancom News and Columns Please send to firstname.lastname@example.org
helps make sense of recent recommendations for cervical cancer screening. Dermatologist Margaret Boyse shares her own best practices in overcoming language barriers to improve diagnoses. Practice management consultant Margie Satinsky offers a medical practice checklist for maintaining good financial health.
Fall is fast approaching. It’s a great time to set goals for next year and to remind
The Triangle Physician is published by: New Dally Design Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
you of the select audience of The Triangle Physician – the more than 9,000 professionals within the Raleigh-Durham medical community. For details on how you can make the most of your marketing dollars with coverage in this magazine – whether contributing news and medical insight at no cost or a cover feature or advertising at competitive rates – please contact me for details at heidi@ trianglephysician.com.
With great appreciation for all you do,
Heidi Ketler Editor
The Triangle Physician
Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. 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.
www.kendallmurphyphotography.com email@example.com Maternity
â€œGrow With Meâ€? packages
6/10/14 9:24 PM
Duke Center for Metabolic and Weight Loss Surgery Global Leaders in Minimally Invasive Bariatric Surgery By Jennifer Cash
is genetic or has other medical origins.
Recognition of obesity as a disease –
Greater understanding of obesity through-
chronic, progressive and disabling – repre-
out the medical profession is leading to im-
sents a significant advance. Last year, the
proved and safer outcomes for many who
The Duke Center for Metabolic and Weight
American Medical Association approved
struggle to fight the battle of the bulge. Di-
Loss Surgery is a center of excellence that
the disease status, which offered further
ets and exercise have not always been the
specializes in weight-loss surgery options
answer, especially for those whose obesity
to fit people in all stages of obesity. Patients eligible for the surgery are diagnosed with a body mass index (BMI) greater than 35. “We know obesity greatly impacts people’s lives. When we do surgery, we can help patients achieve their full potential,” says bariatric surgeon Alfonso Torquati, M.D., M.Sci., director of the Duke Center for Metabolic and Weight Loss Surgery. “Weight-loss surgery is for people that have been dealing with the medical problem of obesity,” says fellow bariatric surgeon Chan Park, M.D. The Road to Surgery Duke’s in-house bariatric team is comprised of six fellowship-trained surgeons, a physician assistant, a clinical psychologist, registered dieticians, an endocrinologist and nurses, along with other dedicated support staff. “Our multidisciplinary team has been around the longest in the Triangle area and has the most experience doing bariatric surgery,” says bariatric surgeon Dana Portenier, M.D. As a result, patients experi-
Ranjan Sudan, M.D., surgeon, reviews a case with Kimberly Ashley, R.N., clinical team leader.
The Triangle Physician
ence tremendous success.
Duke offers an individually tailored ap-
Duke’s comprehensive bariatric care in-
proach to bariatric surgery. After an initial
cludes monthly support groups. An evalu-
consultation with each patient, surgeons
ation process throughout the treatment –
help the individuals determine the right
from the pre-surgical education program
surgery for their unique medical condition.
to post-surgical support – ensures patients
Patients then meet with each member of
achieve their weight-loss goals.
the team. “Weight-loss surgery often has an incredIn addition to preparing patients mentally
ibly positive impact on individuals that is
for surgery, the psychologist educates
rarely seen with other surgical, medical
them on how surgery will impact their
or psychological treatments, which likely
lives afterward. “Helping patients prepare
gives patients a sense of hope for an alter-
for surgery, psychosocially, can help with
native future,” says Dr. Friedman.
potential challenges ahead and bolster a successful adjustment,” says clinical psy-
chologist Kelli Friedman, Ph.D.
Duke Center for Metabolic and Weight Loss Surgery specializes in advanced surgical
A dietician works with the patient to estab-
weight-loss techniques, including mini-
lish strategies for improved nutrition, be-
mally invasive endoscopic, single-incision
havior modification and exercise, and the
laparoscopic and robotic surgeries.
Endocrinologist Leonor Corsino, M.D., M.H.S., F.A.C.E.
endocrinologist addresses such existing conditions as diabetes. “Our close collabo-
“Our very experienced team leads in in-
ration with the surgical team as part of our
novation and is very well known nation-
typically lose 55 to 65 percent of excess
comprehensive bariatric surgical care in-
ally and internationally for its expertise.
weight, mostly in the first year.
cludes the management of their endocrine
At the same time, we are compassionate
conditions,” says endocrinologist Leonor
and, therefore, able to offer the latest treat-
Sleeve gastrectomy removes a large por-
ments in a holistic manner,” says bariatric
tion of the stomach to restrict food intake.
surgeon Ranjan Sudan, M.D.
Patients lose 40 to 55 percent of excess
Duke is the only multidisciplinary center
weight, most within one to two years.
in the Triangle. “In one single morning,
Roux-en-Y gastric bypass is the gold stan-
our patients can have an evaluation with
dard for weight-loss surgery and is chosen
Adjustable gastric banding places a
a weight-loss surgeon, endocrinologist,
by nearly two-thirds of patients. This pro-
band around the stomach to limit food in-
psychologist and nutritionist. This is very
cedure creates a small gastric pouch to
take. The band can be adjusted – loosened
unique and very valuable for our patients
limit food intake. Food passage is rerouted
or tightened – after surgery and in the clin-
wishing to take less time off from work,”
through the intestines to limit the number
ic. Patients lose 30 to 40 percent of excess
says Dr. Torquati.
of calories absorbed into the body. Patients
weight gradually, up to five years.
Adjustable Gastric Banding
Duodenal switch involves removing a
pertension, sleep apnea, hyperlipidemia,
surgeons. “We have trained a lot of the
portion of the stomach and “switching”
heart disease, asthma, osteoarthritis and
people that are out there. This is where
around the small intestine to alter the
they learned to do what they do,” says Dr. Park, a former fellow of the Duke program.
digestion process and limit food intake. Patients lose 60 to 80 percent of excess
“Bariatric surgery is an extraordinary phe-
weight, mostly in the first year. Dr. Sudan
nomenon; it is uncommon for a surgical
Not only do Duke’s bariatric surgeons im-
was the world’s first surgeon to perform
procedure to be responsible for the long-
pact patient lives through surgical care,
the duodenal switch procedure robotically.
term remission or mitigation of so many
they also work to influence legislators and
comorbid conditions,” says bariatric sur-
regulators across the state on health care
geon Philip Omotosho, M.D.
matters. Dr. Sudan, who is president of the
Revisional procedures are personalized
Bariatric Society of the Carolinas, has been
based on patients’ specific needs and conditions.
“After gastric bypass and sleeve gastrec-
working to improve access to bariatric care
tomy, the intestine starts producing larger
in North Carolina.
amounts of hormones that improve insulin action. In many patients with diabetes, abetes,” says Dr. Torquati, who is involved
Primary care and specialty physicians are invited!
with clinical research and studies the
What: “Selection and Medical
mechanisms involved in the resolution of
Management of Weight Loss Surgery
diabetes and cardiovascular diseases after
Patients” continuing education course,
presented by Duke
these changes result in remission of the di-
When: Saturday, Oct. 11 The cost of treating obesity-related medi-
Where: The Umstead Hotel in Cary
cal conditions far outweighs the cost of
Register: (919) 470-7034
weight-loss surgery, according to Dr. Omotosho. “Alongside durable weight loss, this is the unparalleled benefit of bariatric sur-
gery to our patients.”
Because pre-operative and follow-up care is essential for a successful surgical out-
Clinical psychologist Kelli Friedman, Ph.D.
Minimally Invasive General Surgery
come, the Duke Weight Loss Surgery team
The bariatric surgeons at Duke are highly
strives to build a working relationship with
trained in minimally invasive general sur-
gery. Advanced laparoscopic technologies result in less scarring, reduced pain and
Post-surgery patients are seen annually by
their bariatric surgeon. However, it is important for primary care providers to un-
Life-Changing Results Patients who undergo bariatric surgery at
“Our group offers the latest surgical ap-
derstand the support they should provide
Duke have tremendous success following
proaches to ‘general surgery’ problems,
to help keep their patients on the weight-
such as single-incision laparoscopic pro-
cedures for hernias and gallbladders; ab“You can see in a few months after surgery
dominal wall reconstruction for complex
Duke Minimally Invasive General and
a major change and how it will affect the
hernias; and endoluminal procedures for
Weight Loss Surgery has locations in Dur-
patient’s quality of life,” says Dr. Torquati.
reflux disease and Barrett’s esophagus, to
ham and Raleigh in close proximity to
name a few. Furthermore, we also see lipo-
Duke Regional Hospital, James E. Davis
Weight-loss surgery is not all about losing
mas, cysts and inguinal/umbilical hernias,”
Ambulatory Surgical Center and Duke Ra-
weight. “There are metabolic, hormonal
says bariatric surgeon Jin Yoo, M.D.
leigh Hospital. For more information on the weight-loss surgery program at Duke,
and physiological changes that occur after Since 1993, the Duke Minimally Invasive
and Bariatric Surgery Fellowship has of-
more information regarding referrals to the
Usually there is dramatic improvement in
fered world-class training to surgeons who
Durham or Raleigh clinic, call the physi-
such co-morbidities as Type 2 diabetes, hy-
are now among the nation’s best bariatric
cian liaison number: (919) 907-9077.
surgery,” says Dr. Park.
The Triangle Physician
Understanding of IBD-IBS from a Biopsychosocial Perspective By Douglas A. Drossman, M.D.
As providers we often struggle to understand
visceral sensitization may occur from prior
the patient’s illness experience in relationship
inflammation leading to abdominal pain and
to their disease, i.e. the observable data from
diarrhea in up to 20 percent of patients treated
X-ray, endoscopy or histopathology. With
with these potent agents.
structural disorders, such as inflammatory bowel disease or peptic ulcer disease, we
The chronic pain of illnesses like IBD-IBS is a
often assume that the patient’s symptoms
biopsychosocial, multidimensional process,
correlate highly with the evident disease
with sensory, emotional and cognitive
activity. However, a patient’s illness or their
contributions to the experience that relates to:
perception of ill health may vary considerably
1) Ascending visceral pain transmission
from their disease or the externally verifiable
2) Peripheral amplification of visceral signals
evidence of a pathological state.
3) Reduced inhibition by the central nervous system (CNS) of ascending pain signals at
An important example of this possible incongruity can be noted in inflammatory bowel disease (IBD), ulcerative colitis or
the level of the dorsal horn 4) Central amplification via psychological distress
Crohn’s disease. Some patients with active and ulcerating IBD may have few symptoms
Thus, chronic pain involves dysregulation of
and may not even present for treatment until
neurophysiological processes at spinal and
a complication, such as bleeding, obstruction
supraspinal levels. Furthermore, with chronic
or abscess, arises. That is because mucosal
pain, increased afferent visceral stimuli do not
inflammation alone is not sufficient in many
contribute as much as CNS upregulation of
cases to cause pain or other gastrointestinal
incoming visceral afferent signals, which can
symptoms. The pain of IBD relates to
bring even regulatory (normally subliminal)
penetrating ulcers that reach neural plexi,
signals to a point of conscious awareness and
fistulas, obstruction or severe inflammation.
In contrast, it is not uncommon for us to see
Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment. Dr. Drossman is president of the Rome Foundation (www.theromefoundation. org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www.drossmancenter.com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patientprovider relationship. Drossman Gastroenterology P.L.L.C. (www.drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.
patients with IBD who report marked pain and
Our understanding of IBD-IBS pain in terms of
diarrhea, but with endoscopic or radiological
both peripheral (gut) and central (brain and
mild or microscopic disease, a similar
spinal cord) acting factors leads to important
phenotype to that of post-infectious irritable
therapeutic implications for the treating
bowel syndrome (PI-IBS). We now call this
physician. The management of centrally
driven chronic pain may evoke more centrally
syndrome, in which opioids paradoxically
targeted treatments in addition to or instead
Both IBD-IBS and PI-IBS share similar
of anti-inflammatory agents, for example.
pathophysiological origins with evidence for
Antidepressants, including selective serotonin
mucosal inflammation (more so in IBD), often
reuptake inhibitors to tricyclic antidepressants,
Grover, M.; Herfarth, H.; Drossman, D.A. The
in response to infection, which then leads to
and psychological treatments, including
functional-organic dichotomy: Post-infectious
loss of mucosal membrane integrity, cytokine
cognitive behavioral therapy and hypnosis,
irritable bowel syndrome and inflammatory
activation and upregulation of myenteric
are examples of centrally targeted therapies
bowel disease-irritable bowel syndrome. Clinical
nerves, causing pain. The dissociation
for chronic pain as might occur in IBD-IBS.
Gastroenterology and Hepatology 2009;7:48-53
between illness and disease in IBD is most
Narcotic use should be avoided as continued
evident since the use of potent biological
use can escalate gastrointestinal symptoms,
Grover, M.; Drossman, D.A. Pain management
anti-TNF (tumor necrosis factor) agents that
leading to opioid induced constipation or
in inflammatory bowel disease; IBD Monitor
can literally wipe out observable disease, yet
the infrequently recognized narcotic bowel
Cervical Cancer Screening By Lindsay Wojciechowski
Cervical screening has saved women’s
As a result, guidelines for cervical cancer
lives. It can detect potentially pre-
screening have changed in the last few
cancerous changes caused by sexually
years, often creating confusion for primary
transmitted human papillomavirus. If left
care providers. The recommendations
untreated, abnormal cells may progress to
overall suggest less frequent testing.
invasive cervical disease. In the United States, cervical cancer screenWhile the Papanicolaou test (or Pap
ing guidelines are issued by several organiza-
smear) is considered reliable, it’s not
tions. The remainder of this article summa-
perfect. As a result, many colposcopies
rizes the recent updates from: 1) The United
and other follow-up procedures occur that
States Preventative Services Task Force (USP-
likely are unnecessary.
STF) in 2012; 2) the American Cancer Society, the American Society for Colposcopy
According to Mahdavi & Monk (2005), it
and Cervical Pathology and the American
is estimated that 50-60 million Pap smears
Society for Clinical Pathology (ACS/ASCCP/
are done every year in the United States
ASCP) in 2012; and 3) the American College
and that approximately 3.5 million of these
for Obstetricians and Gynecologists (ACOG)
are read as abnormal. Approximately
Lindsay A. Wojciechowski is a nurse practitioner and consultant to the Women’s Wellness Clinic and the Carolina Women’s Research and Wellness Center (CWRWC). She has worked as a clinical nurse practitioner for Triangle Family Practice at Duke University Medical Center since 2006. She also has taught courses at the Duke University School of Nursing. Ms. Wojciechowski’s focus is on women’s health and family medicine, and she also is the lead medical writer for the Women’s Wellness Clinic.
How frequently to screen: All guidelines
2.5 million women therefore undergo colposcopy despite the fact that most
When to start cervical cancer screen-
recommend testing women aged 21-29
human papillomavirus (HPV) infections
ing: All organizations recommend onset of
every three years with cytology only. HPV
clear without treatment.
screening at age 21, regardless of the age of
testing in women under the age of 30
first sexual activity. All women older than
has been shown to detect transient HPV
The good news for adolescent girls is that
21 who have never been screened should
infections, often leading to unnecessary
even with HPV infection, the changes in
colposcopies. Testing for HPV is not recommended in women under the age of
cervical cytology usually resolve or go
away on their own. In fact, up to 90-95
When to stop screening: All recommend
percent of low-grade lesions (and some
screening to stop at age 65, assuming that
high-grade lesions) in adolescents will
the woman has had adequate screening
For women older than 30, frequency of
spontaneously resolve (Moscicki et al.,
in the past (three consecutive negative
screening depends on the type of testing
cytology results or at least two consecutive
negative cytology/HPV co-tests in the last
• ACOG and ACS/ASCCP/ASCP recom-
10 years). The clinician may determine
mend testing every five years with both
follow-up evaluation should not be done
that there are women older than 65 with
cytology and HPV testing. Co-testing
unnecessarily. There are disadvantages
concerning symptoms, high risk of new
with both cytology and HPV testing can
to frequent and potentially unnecessary
exposure or poor screening history that
lead to earlier diagnosis of high-grade le-
colposcopies, as well as treatments with
warrants continued screening.
sions. • USPSTF recommends testing either every
(LEEPs) or ablative treatments. They
Women who have had a hysterectomy
five years with both cytology and HPV or
(that was unrelated to cervical cancer) are
every three years with cytology only.
consequences, discomfort and potential
not advised to undergo cervical cancer
adverse health outcomes.
The Triangle Physician
• Older women who have not been screened adequately over the years
should receive testing (cytology every
BOTOX® COSMETIC • COOLSCULPTING® • FACIAL FILLERS • MICRODERMABRASION • AND MORE
three years or co-testing every five
Your Skin needs
years) until 70-75 years of age.
No guidelines recommend HPV testing only, unless in clinical settings with limited cytology resources.
Your skin needs the protection and strength of a defensive line. We offer that defense in great medical grade skin care products and skin rejuvenation procedures from Southern Dermatology including:
Management of abnormal Pap smears is beyond the scope of this article. Certainly
• BOTOX COSMETIC® • LASER HAIR REMOVAL • COOLSCULPTING® • MICRODERMABRASION • LATISSE
providers are encouraged to consult with experts and to consider each woman individually.
We’re part of the team to provide you with the most advanced therapies for prevention and early detection of skin cancer!
In conclusion, it is necessary to emphasize that although the factors addressed above (age of first screen, type of test, frequency of screening) are very important, they have
We keep you safe. Make an appointment today!
less impact on the effectiveness of cervical
DERMATOLOGY & SKIN CANCER CENTER 919-782-2152
cancer screening than does thorough follow up after abnormal screening results.
SKIN RENEWAL CENTER 919-863-0073
According to Saslow et al. (2007), half of
women who are diagnosed with invasive cervical carcinoma have never had a pap smear. In addition, another 10 percent had not had a pap smear in the last five years.
ACNE • MOHS SURGERY • SKIN CANCER • PSORIASIS • ECZEMA • DERMATITIS • ALOPECIA DER131_AD_Triangle Physican 1_3-Defense.indd 1
55 Vilcom Center Drive Boyd Hall, Suite 110 Chapel Hill, NC 27514
Drossman Gastroenterology PLLC a patient-centered gastroenterology practice focusing on patients with difficult to diagnose and manage functional GI and motility disorders. The office is located within the multidisciplinary health care center, Chapel Hill Doctors. Dr. Douglas Drossman is joined by physician’s assistant, Kellie Bunn, PA-C. Appointments are scheduled on Tuesday and Wednesday and most laboratory studies are available.
Unfortunately, early cervical cancer is usually asymptomatic, emphasizing the importance of screening and follow up. Close and careful follow up with all patients with abnormal results is crucial to the wellbeing of the patient.
References Mahdavi, A. & Monk, B.J. (2005). Vaccines against
cervical cancer: promises and challenges. Oncologist, 10:528.
8/19/14 11:00 AM
Moscicki, A.B., Shiboski, S., Hills, N.K. (2004). Regression of low-grade squamous intra-epithelial lesions in young women. Lancet, 364:1678. Saslow, D., Castle, P.E., Cox, J.T. (2007). American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin, 57:7.
Revenue Cycle Management By Margie Satinsky
Financial stability is an important goal for all medical practices. Assuming that you’ve created and use both operating and capital budgets, what can you do to keep your practice in good financial health? We recommend focusing on the big picture of revenue cycle management, as well as on the individual components that comprise it. Here’s the big picture and specific suggestions.
Fees charged to payers and patients
Reimbursement by managed care plans and government payers Participation in value added incentive programs Appointment scheduling Financial Information provided to all patients
Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She’s the author of numerous books and articles, including Medical Practice Management in the 21st Century. For more information, visit www.satinskyconsulting.com.
Communications with patients prior to visit or procedure
Issue identification of issues and problem resolution:
Billing and collections
Benchmarking financial performance
Corrective action Documenting revised processes Staff training
Accounts Receivable (AR) by specific payer Erroneous payer reimbursement that does not correspond to contract
• Analyze your payer mix for both
not, the problems lie not with the
management is clear, look at the list
managed care and government payers.
programs but with your own negative
of recommendations. Resolve to make
• Stay current on payer specific methods
attitude and with your staff’s inability
changes to enhance your practice’s
of reimbursement and negotiate often.
to use information that already resides
Plans rarely come to you with offers of
in your practice management and/or
Now that the scope of revenue cycle
higher reimbursement. Both public and
electronic health record systems.
• Regularly review the list of services
private payers are shifting to pay for
• Enhance your chances of receiving
that you provide and make sure the
value payment methods. An example
payment for all care that you provide
mix is appropriate. For example, if you
is Blue Cross Blue Shield of North
by obtaining accurate demographic
offer services that are reimbursable
Carolina, which has both a Blue Quality
information and verifying insurance
by insurers as well as other services
Physicians Program (BQPP) and a
coverage before every visit or proce-
for which patients pay out of pocket, does the mix produce your targeted net
• Look closely at the many ways in which
• Provide patients with written financial
you can receive financial incentives
policies for your practice before the
• Review the fees that you charge at least
for providing and documenting quality
visit/procedure. Request payment at
annually. Use the Medicare Resource-
and cost-efficient care. Don’t be so
the time of the visit. After the second
Based Relative Value Scale for your
quick to dismiss these programs as
no-show, charge for the visit. Encourage
state as a benchmark.
“not worth my time.” More often than
prompt payment but be willing to
The Triangle Physician
develop payment plans to help patients
about rates of payment and actual
system. Ask your vendor for guidance
meet their financial obligations.
vs. expected reimbursement by CPT
if you need it.
• Code each visit appropriately and
code. If problems arise, notify the payer
• Get the right help from the right
make sure you are up-to-date on coding
immediately and resolve the issues
professionals. CPAs report on the
before they escalate.
activity that has occurred and make
changes. External coding auditors can
• Know where to get all the information you
sure you have proper controls in
• Make sure that your billing staff or out-
need to review financial performance.
your practice. Practice management
side billing and collections company
CPAs provide general information but
consultants who understand workflow
scrubs claims before sending them to
don’t give you the patient- and payer-
help you assess workflow and identify
different payers. Sloppy claims submis-
specific details that you can find in your
sion leads to an unnecessary buildup of
practice management system.
provide good guidance.
• Take advantage of the reporting capa-
rejected claims. • Submit
and resolve problems. • Take the financial pulse of your practice
bilities of your practice management
after you complete all of the suggestions above. You can expect good results!
receive electronic deposits into your bank account. • Manage claims denials carefully. You’re leaving money on the table if you don’t review denials, take corrective action, and train your staff not to make the same error over and over again. • Work your accounts receivable (AR) methodically, focusing on the largest and most recent claims. • Separate unpaid claims that are 90 days or older and send them to an external collections agency. • Implement a clear policy for write-offs. Take claims that you are unlikely to collect off your books. • Develop and implement clear policies and procedures for revenue cycle management. Put them in writing. • Clarify responsibilities for your revenue cycle management program. Most practices let the practice manager take charge and work with both an internal team and external professionals. • Train staff on the entire revenue cycle
just the component for which an individual is responsible. Successful revenue management depends on the interrelationship of the parts. • Abandon the habit of judging financial performance
month’s net profit (loss) with that of the previous month. Instead, use standard ratios and by comparing the actual to the expected performance. • Review
information Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
Overcoming Language Barriers By Margaret B. Boyse, M.D.
According to the United States Census Bu-
for his skin condition.
reau, approximately 60.6 million people, nearly one in five people age five or older,
He had a horrible case of dermatitis, with
speak a language other than English; a
inflamed skin on his neck, arms and legs.
number that has grown by 158 percent
All I had to go by was the appearance of
over three decades. Additionally, those
it, so we had to try different treatments to
speaking a language other than English
get him better. I initially treated the patient
at home (7 percent), said they spoke Eng-
for eczema and psoriasis, but later came
lish “not at all,” while another 15.4 percent
to the conclusion that Mr. X was afflicted
said they spoke English “not well.”
with dermatitis from an infestation.
Clearly, good communication between
A guiding principle in our work is that
caregivers and patients is essential to
treatment of skin conditions must be
safe, high-quality health care services. Re-
based on a correct diagnosis. If I’m hav-
Approximately 60.6 million people, nearly one in five people age five or older, speak a language other than English search shows that communication failures
ing problems with a case and ask, “Why
between patients and physicians contrib-
isn’t my treatment working?” I’m asking
ute to adverse events and medical errors.
the wrong question. The more important question is: “Is my diagnosis correct?”
Yet many physicians are likely to confront the reality of patients who cannot understand them at some point in their medical careers. At Southern Dermatology & Skin Cancer & Skin Renewal Center, we are not strangers to cross-cultural medical encounters. We have people from all over the world in Raleigh. Sometimes in dermatology you don’t need a medical history, but when you do need the history and you’re unable get it, it can be very challenging. I can recall “Mr. X” a patient from a small island off the coast of Vietnam who did not speak any English; it proved to be extremely challenging to communicate with this patient, who desperately needed help
The Triangle Physician
Despite our communication problems, I
Dr. Margaret Boyse practices at Southern Dermatology & Skin Cancer & Skin Renewal Center. After earning her medical degree from the University of Texas, she completed her internship at Walter Reed Army Medical Center and residency at the University of Michigan. Special interests include: general adult and pediatric dermatology, dermatologic surgery, cosmetic dermatology and skin cancer. She is a member of the American Academy of Dermatology and North Carolina Medical Society. Visit www.southernderm.com for more information. feel sure Mr. X understood that we were desperately trying to help him, and that he had to make a leap of faith to take the medicines we prescribed, knowing that without treatment, his condition almost certainly would get worse. So I offer the following advice on overcoming language barriers that is based on years of experience: • Use simple words; avoid jargon and acronyms. • Limit/avoid technical language. • Speak slowly (don’t shout). • Articulate words completely. • Repeat important information. • Provide educational material in the languages your patients read. • Use pictures, demonstrations, video or audiotapes to increase understanding. • Give information in small chunks and verify comprehension before going on. • Always confirm patient’s understanding of the information – patient’s logic may be different from yours.
Duke Research News
Cancer-Fighting Drugs Might Also Stop Malaria Early Scientists searching for new drugs to fight
One of the advantages of her team’s ap-
stage of malaria that lurks in the liver also
malaria have identified a number of com-
proach is that focusing on the liver stage
worked against the stage that lives in the
pounds – some of which are currently in
of the malaria lifecycle – before it has a
clinical trials to treat cancer – that could
chance to multiply – means there are fewer
add to the anti-malarial arsenal.
parasites to kill.
Malaria-free mice that received a single dose before being bitten by infected
Duke University assistant pro-
mosquitos were able to avoid
fessor Emily Derbyshire and
developing the disease alto-
than 30 enzyme-blocking molecules called protein kinase
Medicines for malaria have
inhibitors that curb malaria
been around for hundreds of
before symptoms start.
years, yet the disease still afflicts more than 200 million
By focusing on treatments that
people and claims hundreds
act early, before a person is
of thousands of lives each
infected and feels sick, the
year, particularly in Asia and
researchers hope to give malaria – especially drug-resistant strains – less time to spread.
Bites from mosquitoes like this one are responsible for transmitting malaria, a disease that claims hundreds of thousands of lives each year. Photo credit: Wikimedia Commons.
Africa. Part of the reason is malaria’s ability to evade attack. One of the most deadly forms
Using a strain of malaria that primarily
of the parasite, Plasmodium falciparum,
The findings appear online and are sched-
infects rodents, Ms. Derbyshire and Jon
has already started to outsmart the world’s
uled to appear in a forthcoming issue of
Clardy of Harvard Medical School tested
most effective antimalarial drug, artemis-
the journal ChemBioChem.
1,358 compounds for their ability to keep
inin, in much of southeast Asia. Infections
parasites in the liver in check, both in test
that used to clear up in a single day of treat-
tubes and in mice.
ment now take several days.
person to person through mosquito bites.
“It used to be that researchers were lucky
Diversifying the antimalarial arsenal could
When an infected mosquito bites, para-
if they could identify one or two promising
also extend the lifespan of existing drugs,
sites in the mosquito’s saliva first make
compounds at a time; now with advances
since relying less heavily on our most com-
their way to the victim’s liver, where they
in high-throughput screening technology
monly used weapons gives the parasite
silently grow and multiply into thousands
we can explore thousands at once and
fewer opportunities to develop resistance,
of new parasites before invading red blood
identify many more,” said Ms. Derbyshire,
Ms. Derbyshire said.
cells – the stage of the disease that triggers
an assistant professor in the Departments
malaria’s characteristic fevers, headaches,
of Chemistry and Molecular Genetics and
Another advantage is that the compounds
chills and sweats.
Microbiology at Duke.
they tested suppress multiple malaria pro-
Most efforts to find safe, effective, low-cost
Focusing on a particular group of enzyme-
drugs for malaria have focused on the later
blocking compounds called protein kinase
stage of the infection when symptoms are
inhibitors, they identified 31 compounds
“That makes them like a magic bullet,” she
the worst. But Ms. Derbyshire and her team
that inhibit malaria growth without harm-
are testing chemical compounds in the lab
ing the host. Several of the compounds are
to see if they can identify ones that inhibit
currently in clinical trials to treat cancers
The research was supported by Duke Uni-
malaria during the short window when the
like leukemia and myeloma.
versity, Harvard Medical School and the
Malaria is caused by a single-celled parasite called Plasmodium that spreads from
teins at once, which makes it harder for the
National Institutes of Health (Grant Num-
parasite is still restricted to the liver, before symptoms start.
parasites to develop ways around them.
The same compounds that stopped the
ber: GM099796) September 2014
Duke Research News
Age Does Not Increase Surgical Risks of Deep Brain Stimulation Implanting deep brain stimulation devices
medications. But as the disease progresses –
poses no greater risk of complications to older
and as people age – tremors and side effects
“Our study should help patients and families
patients than it does to younger patients with
of medication, including involuntary muscle
considering DBS as a potential treatment
movements, are less controllable. So it’s this
option for managing the symptoms of
researchers at Duke
older population for whom DBS could be
Parkinson’s disease,” Dr. Lad said. “It also
provides guidance to surgeons about the risks of common complications among older patients.”
The findings, pub-
In the study, Dr. Lad and colleagues
lished Aug. 25, in
analyzed data from more than 1,750 patients
the journal JAMA
who underwent DBS from 2000-2009. Of
Dr. Lad said the findings could work to
those, 132 patients, or about 7.5 percent,
remove age as a potential criterion to
concerns that pa-
experienced at least one complication within
exclude patients from getting DBS, which
tients older than
90 days of having the DBS device implanted.
is currently under-utilized overall and
age 75 are poorer candidates for deep brain
Complications included wound infections,
even more so among older people with
stimulation (DBS), because they may be
pneumonia, hemorrhage or pulmonary
prone to bleeding, infections or other com-
Nandan Lad, M.D., Ph.D.
In addition to Dr. Lad, study authors include
plications that can arise after surgeries. In the Duke-led analysis, the researchers
Michael R. DeLong; Kevin T. Huang; John
“Parkinson’s disease is one of the most
determined that increasing age did not
Gallis; Yuliya Lokhnygina; Beth Parente;
common movement disorders, and it
significantly affect the overall complication
Patrick Hickey; and Dennis A. Turner.
primarily afflicts older people,” said senior
rates, although the 90-day risk of older
author Nandan Lad, M.D., Ph.D., director of
patients acquiring pneumonia was elevated.
The National Institutes of Health funded the
the Duke Neuro-Outcomes Lab. “For many,
Dr. Lad said this complication is typical
study (CA 156687).
movement disorders can be managed with
among older people undergoing surgeries.
Gut Flora Finding May Advance Development of HIV Vaccine nally arise to fight the virus are ineffective.
also cross-react to the HIV envelope.”
testines appear to
These initial, ineffective antibodies target
Dr. Haynes said the body fights most new
play a pivotal role
regions of the virus’s outer envelope called
infections by deploying what are known as
in how the HIV vi-
gp41 that quickly mutates, and the virus
naïve B cells, which then imprint a memory
rus foils a success-
escapes being neutralized. It turns out that
of the pathogen so the next time it encoun-
ful attack from the
the virus has an accomplice in this feat –
ters the bug, it knows how to fight it.
the natural microbiome in the gut.
ganisms in the in-
Barton F. Haynes, M.D.
But when the HIV virus invades and be-
system, according “Gut flora keeps us all healthy by helping
gins replicating in the gastrointestinal
the immune system develop and by stimu-
tract, no such naïve B cells are dispatched.
The study, published Aug. 13 in the journal
lating a group of immune cells that keep
Instead, a large, pre-existing pool of mem-
Cell Host & Microbe, builds on previous
bacteria in check,” said senior author Bar-
ory B cells respond – the same memory
work from researchers at the Duke Human
ton F. Haynes, M.D., director of the Duke
B cells in the gut that fight bacterial infec-
Vaccine Institute that outlined a perplexing
Human Vaccine Institute. “But this research
tions such as E. coli.
quality about HIV: The antibodies that origi-
shows that antibodies that react to bacteria
to new research from Duke Medicine.
The Triangle Physician
Duke Research News This occurs because the region of the HIV
pool triggered by gut bacteria that cross-
Lockwood, Robert Parks, Krissey E. Lloyd,
virus that the immune system targets, the
reacts with the HIV envelope,” said lead
Christina Stolarchuk, Richard Scearce, An-
gp41 region on the virus’s outer envelope,
author Ashley M. Trama. “This supports
drew Foulger, Dawn J. Marshall, John F.
appears to be a molecular mimic of bac-
the notion that the dominant HIV antibody
Whitesides, Thomas L. Jeffries Jr., Kevin
terial antigens that B cells are primed to
response is influenced by previously acti-
Wiehe, Lynn Morris, Bronwen Lambson,
vated memory B cells that are present be-
Kelly Soderberg, Kwan-Ki Hwang, Georgia
fore HIV infection and are cross-reactive
D. Tomaras, Nathan Vandergrift, Katherine
with intestinal bacteria.”
J. L. Jackson, Krishna M. Roskin, Scott D.
“The B cells see the virus and take off –
Boyd, Thomas B. Kepler and Hua-Xin Liao.
they make all these antibodies, but they aren’t protective, because they are target-
Dr. Haynes said the finding provides com-
ed to non-protective regions of the virus
pelling new information for HIV vaccine
This study was supported by funds from
development, which is the next phase of
the National Institute of Allergy and In-
fectious Diseases, part of the National Institutes of Health, through the Center
Dr. Haynes and colleagues said the findings were confirmed in tests of people
“Not only can gut flora influence the devel-
of HIV/AIDS Vaccine Immunology (U19-
who were not infected with HIV. Among
opment and function of the immune sys-
AI067854) and the Center for HIV/AIDS
non-infected people, the researchers iso-
tem, but perhaps also pre-deter mine our
Vaccine Immunology-Immunogen Discov-
lated mutated gp41-gut flora antibodies
reaction to certain infections such as HIV,”
ery (UM1-AI100645-01); as well as from the
that cross-react with intestinal bacteria.
Dr. Haynes said.
National Cancer Institute, also part of NIH, through a Viral Oncology Training Grant
“The hypothesis now is that the gp41 anti-
In addition to Dr. Haynes and Ms. Trama,
body response in HIV infection can be de-
study authors include M. Anthony Moody,
rived from a pre-infection memory B cell
S. Munir Alam, Frederick H. Jaeger, Bradley
UNC Research News
New Approach Uncovers Cancer Genes UNC Lineberger Comprehensive Cancer
growth rates. A high growth rate of
In fact, one of the genes identified –
Center researchers have developed a
cells, also known as cell proliferation, is
CPT1A – is already a target for drug
new integrated approach to pinpoint the
recognized to be associated with poor
development in lymphoma and could
genetic “drivers” of cancer, uncovering
prognosis for breast cancer patients.
potentially be tested for breast cancer patients as well. Drugs targeting CPT1A
eight genes that could be viable for Analyzing multiple types of genomic
have been shown to inhibit human
data, UNC Lineberger researchers were
cancer cell line growth in vitro and in
The study, published online August 24 in
able to identify eight genes that were
mouse models of lymphoma.
Nature Genetics, was authored by Michael
amplified on the genomic DNA level,
Gatza, Ph.D., lead author and post-doctoral
and necessary for cell proliferation in
This analytical approach used to better
research associate; Grace Silva, graduate
luminal breast cancer, which is the most
student; Joel Parker, Ph.D., director of
common sub-type of breast cancer.
includes a comprehensive and integrated
targeted breast cancer therapy.
analysis of multiple data types including
bioinformatics, UNC Lineberger; Cheng and senior
“Using this new computational approach,
gene expression data, somatic mutations,
author Chuck Perou, Ph.D., professor of
we were able to take advantage of the
DNA copy number and a functional
genetics and pathology.
rich data resources that exist and identify
genomics data set.
Fan, research associate;
a number of new potential drug targets These researchers studied a variety of
for a specific subset of breast cancer
“While we were able to pinpoint drivers
cancer-causing pathways, the step-by-step
patients. This is an important step down
for breast cancer, this approach can and
genetic alterations in which normal cells
the road towards more personalized
will be applied to other tumor types in
transition into cancerous cells, including
medicine,” said Dr. Perou.
the future,” said lead author Mike Gatza.
the pathway that governs cancer cell
UNC Research News
Largest Cancer Genetic Analysis Reveals New Way of Classifying Cancer Researchers with The Cancer Genome Atlas Research Network have completed the largest, most diverse tumor genetic analysis ever conducted, revealing a new approach to classifying cancers. The work, led by researchers at the UNC Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill and other The Cancer Genome Atlas (TCGA) sites, not only revamps traditional ideas of how cancers are diagnosed and treated, but could also have a profound impact on the future landscape of drug development.
Charles M. Perou, Ph.D.
“We found that one in 10 cancers analyzed in this study would be classified differently using this new approach,” said Charles M. “Chuck” Perou, Ph.D., professor of genetics and pathology at UNC Lineberger and senior author of the paper, which appeared online Aug. 7 in Cell. “That means that 10 percent of the patients might be better off getting a different therapy – that’s huge.” Since 2006, much of the research has identified cancer as not a single disease, but many types and subtypes and has defined these disease types based on the tissue – breast, lung, colon, etc. – in which it originated. In this scenario, treatments were tailored to the affected tissue, but questions have always existed, because some treatments work and fail for others, even when a single tissue type is tested.
The Triangle Physician
In their work, TCGA researchers analyzed more than 3,500 tumors across 12 different tissue types to see how they compared to one another – the largest data set of tumor genomics ever assembled, according to Katherine Hoadley, Ph.D., research assistant professor in genetics and lead author. They found that cancers are more likely to be genetically similar based on the type of cell in which the cancer originated, compared to the type of tissue in which it originated. “In some cases, the cells in the tissue from which the tumor originates are the same,” said Dr. Hoadley. “But in other cases, the tissue in which the cancer originates is made up of multiple types of cells that can each give rise to tumors. Understanding the cell in which the cancer originates appears to be very important in determining the subtype of a tumor and, in turn, how that tumor behaves and how it should be treated.” Drs. Perou and Hoadley explain that the new approach may also shift how cancer drugs are developed, focusing more on the development of drugs targeting larger groups of cancers with genomic similarities, as opposed to a single tumor type as they are currently developed. One striking example of the genetic differences within a single tissue type is breast cancer. The breast, a highly complex organ with multiple types of cells, gives rise to multiple types of breast cancer – luminal A, luminal B, HER2-enriched and basal-like – all of which were previously known. In this analysis, the basal-like
breast cancers looked more like ovarian cancer and cancers of a squamous-cell type origin, a type of cell that composes the lower-layer of a tissue, rather than other cancers that arise in the breast. “This latest research further solidifies that basal-like breast cancer is an entirely unique disease and is completely distinct from other types of breast cancer,” said Dr. Perou. In addition, bladder cancers were also quite diverse and might represent at least three different disease types that also showed differences in patient survival. As part of the Alliance for Clinical Trials in Oncology, a national network of researchers conducting clinical trials, UNC researchers are already testing the effectiveness of carboplatin – a common treatment for ovarian cancer – on top of standard of care chemotherapy for triple-negative breast cancer (TNBC) patients, of which 80 percent are the basal-like subtype. The results of this study (called CALGB40603), which were published in the Aug. 6 issue of Journal of Clinical Oncology, showed a benefit of carboplatin in TNBC patients, according to a UNC press advisory. This new clinical trial result suggests that there may be great value in comparing clinical results across tumor types for which this study highlights as having common genomic similarities. As participants in TCGA, UNC Lineberger scientists have been involved in multiple individual tissue-type studies, including most recently an analysis of a comprehensive genomic profile of lung adenocarcinoma. Dr. Perou’s seminal work in 2000 led to the first discovery of breast cancer as not one, but in fact, four distinct subtypes of disease. These most recent findings should continue to lay the groundwork for what could be the next generation of cancer diagnostics.
UNC Research News
More Older Patients in Emergency Department Are Malnourished More than half of emergency department patients age 65 and older who were seen at UNC Hospitals during an eight-week period were either malnourished or at risk for malnutrition. In addition, more than half of the malnourished patients had not previously been diagnosed, according to a new study by researchers at the University of Timothy F. Platts-Mills, M.D., M.Sc. North Carolina at Chapel Hill. The study was published online August 13 by the journal Annals of Emergency Medicine. “Malnutrition is known to be a common problem among older adults. What is surprising in our study is that most of the malnourished patients had never been told that they were malnourished,” said Timothy F. Platts-Mills, M.D., M.Sc., assistant professor of emergency medicine in the UNC School of Medicine and senior author of the study.
“Our findings suggest that identifying malnutrition among older emergency department patients and connecting these patients with a food program or other services may be an inexpensive way to help these patients,” Dr. Platts-Mills said. “Older adults make more than 20 million visits to United States emergency departments each year. Our results add to a growing body of evidence that more needs to be done to develop the capacity of emergency departments to address the underlying conditions that impact health for older adults, particularly for those with limited resources.” The study included 138 adults age 65 and older who sought treatment in the emergency department at UNC Hospitals during an eight-week period. All were patients with no cognitive impairments, were not critically ill and did not live in a nursing home or skilled nursing facility. The nutritional status of each was assessed using the Mini Nutritional Assessment Short-Form (MNA-SF), a six-item tool that combines body mass index and the patient’s answers to questions about weight loss, decline in food intake, recent stress or disease, mobility and neuropsychological disorders. The results produce a score from 0 to 14. Malnutrition is de-
fined as a score of 7 or lower, while at risk for malnutrition is defined as a score from 8 to 11. Sixteen percent were found to be malnourished and most of these (77 percent) said they had not previously been diagnosed as malnourished. Sixty percent were found to be either malnourished or at risk for malnutrition. There were no significant differences in the prevalence of malnutrition between men and women, across levels of education or between those living in urban versus rural areas. However, the prevalence of malnutrition was higher among patients who reported having depressive symptoms, difficulty eating (due to dental pain, ill-fitting dentures, etc.) or difficulty buying groceries (due to lack of transportation, lack of money, etc.). First author of the study is Greg F. Pereira, B.S.P.H., a recent graduate of the UNC Department of Nutrition. Co-authors are Wesley C. Holland; Mark A. Weaver, Ph.D., research assistant professor in the UNC Gillings School of Global Public Health; and Cynthia M. Bulik, Ph.D., distinguished professor of psychiatry in UNC School of Medicine and nutrition in the UNC Gillings School of Global Public Health.
Garner Healthplex Exceeds Projections The numbers show that WakeMed Garner Healthplex was needed in the community when it opened its doors Aug. 19, 2013. Since then, more than 22,600 patients have been seen in the facility’s emergency department – far surpassing the projected first-year numbers of 14,642. On opening day, the Garner Healthplex emergency department (ED) treated 29 patients, according to a WakeMed press ad-
visory. Within the first month, the medical and nursing staffs were treating 52 patients per day. Now, care is provided to an average of 64 patients daily. The highest patient volume to date is 102 patients in one day, which occurred this past June 9. In addition to the 10-bed, 24-7 ED, WakeMed Garner Healthplex offers lab and imaging services, including diagnostic X-rays, ultrasounds, computed tomography scans and
magnetic resonance imaging, as well as primary and specialty care physician practices for adults and children.
WakeMed Garner Healthplex: Year in Review (8/19/13 – 8/10/14) ED patients: 22,653 Adult patients: 18,172 Pediatric patients: 4,481 Highest-volume day: 102 (June 9, 2014)
Family-Togetherness and Privacy Are Goals of Major BirthPlace Renovations WakeMed Health & Hospitals is investing $10.6 million in a 2,400-square-foot expansion and renovation of the Women’s Pavilion & Birthplace in Raleigh. It is slated to debut next summer. According to a press advisory, the expansion supports WakeMed’s patient/ family-centered approach that encourages rooming-in, allowing families to stay together throughout the celebration of new life and making it easier for mothers to have privacy.
The family-centered expansion will heighten maternal and infant care by including: • Fifteen spacious labor-and-delivery suites that ensure privacy and comfort. • Three state-of-the-art surgical suites for C-section and special needs deliveries. • A new antepartum high-risk unit for the complex needs of high-risk pregnancies, with eight private rooms with advanced technology. • A comprehensive program of services
and staff to protect both mother and child during pregnancy and immediately after birth “This expansion is significant for women with high-risk pregnancies. The new antepartum unit will provide expectant mothers experiencing a high-risk pregnancy or delivery with the safest environment and the most specialized care available,” said Thad McDonald, M.D., medical director of WakeMed Physician Practices-Obstetrics/ Gynecology. The improvements are reportedly designed to complement WakeMed’s LevelIV Neonatal Intensive Care Unit (NICU), the only one in Wake County. The new birthplace will be in close proximity. Each year, more than 7,500 babies are born at WakeMed’s hospitals in Raleigh and Cary – more than any other hospital system in Wake County. The WakeMed Foundation is working to raise $2.5 million through its Labor of Love campaign. To learn more or to donate, visit www.wakemed.org and select charitable giving.
$10.6 million renovation is planned for the Women’s Pavilion & Birthplace at the Raleigh Campus.
The Triangle Physician
News Welcome to the Area
Melissa Maria Erickson, MD
Sachin Shrikar Kunde, MD
Orthopedic Surgery of the Spine
Pediatric Gastroenterology; Pediatrics
Duke University Hospitals Durham
WakeMed Health & Hospitals Raleigh
Kate Scott Ettefagh, MD
Thomas Joseph Lawton II, MD
Mary Kenney Cirigliano, DO Pittsboro Family Medicine Pittsboro Danya Julina Josserand, DO Orthopedic Surgery
Triangle Orthopaedic Associates, PA Durham Sameer Mohammad Maroof, DO Adolescent & Young Adult Medicine; Diabetes; Family Medicine; Family Practice; General Practice; General Preventive Medicine
UNC Hospitals Chapel Hill Ammon Milton Fager, MD Hematology and Oncology, Internal Medicine
Duke University Hospitals Durham Andrew Clarke Flandry, MD Family Medicine
Hakim Azfar Ali, MD
UNC Hospitals Chapel Hill
Pulmonary Disease and Critical Care, Internal Medicine
Lauren Franz, MD
Duke Pulmonary Transplant Clinic Durham Melody Anita Russell Baldwin, MD Abdominal Surgery; Gynecology; Obstetrics
Child Psychiatry; Psychiatry
Center for Developmental Epidemiology Durham
Harris and Smith OB/GYN Durham
Marc Gregory Granata, MD
Maya Said Bitar, MD
6228 Seven Lakes West West End
University of North Carolina Chapell Hill Christian Blake Cameron, MD Internal Medicine; Nephrology
Duke University Hospitals Durham David Christopher Caretto, MD Occupational & Environmental Medicine
Duke University Hospitals Durham Neil Caye Chungfat, MD Ophthalmology
UNC Dept of Ophthalmology Chapel Hill Michael Stuart Coleman, MD Internal Medicine
North Hills Internal Medicine Raleigh Jeffrey Ward Cooney, MD Neurology
Kevin Otey Herman, MD Diagnostic Roentgenology Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Radiology; Pediatric Radiology; Neuradiology; Vascular and Interventional Radiology
UNC Hospitals Chapel Hill David Kemp Hower, MD Internal Medicine
Eagle Hospital Physicians c/o Alamance Regional Medical Center Burlington Lisa Brooks Hutchison, MD
Department of Family Medicine Aycock Building Chapel Hill George S. Edwards III, M.D. Operative and Nonoperative Care of Hand, Wrist, Elbow and Shoulder
Raleigh Hand Center Raleigh James Merritt Edwards, MD Gynecologic Oncology; Gynecology; Maternal and Fetal Medicine; Obstetrics; Gynecologic Surgery; Critical Care Medicine; Obstetrics and Gynecology; Urogynecology
Duke University Hospitals Durham
Abdominal Surgery; Colon and Rectal Surgery; Critical Care Surgery; General Surgery; Head and Neck Surgery; Medical Oncology; Neoplastic Disease; Oncology, Internal Medicine; Radiation Therapy; Surgery; Surgery - Surgical Critical Care; Surgical Oncology
Duke University Medical Center Durham Lauren Simel Lewis, MD Obstetrics and Gynecology
Duke Womenâ€™s Health Associates Durham James Robert Lovrich, MD Critical Care Pediatrics
UNC Hospitals Chapel Hill Tracy Ann Manuck, MD Maternal and Fetal Medicine; Obstetrics; Obstetrics and Gynecology
University of North Carolina Chapel Hill Chapel Hill Niharika Bansal Mettu, MD Hematology and Oncology, Internal Medicine
Duke University Hospitals Durham Mimi Chandler Miles, MD Family Medicine
UNC Hospitals Chapel Hill
UNC Hospitals Chapel Hill Thorsten Markus Seyler, MD Orthopaedic Sports Medicine; Orthopedic Surgery; Orthopedic Surgery, Adult Reconstructive; Orthopedic Surgery, Trauma
Duke University Durham Roozbeh Sharif, MD Critical Care-Internal Medicine; Hospitalist; Internal Medicine; Internal Medicine Critical Care Medicine; Internal Medicine - Sleep Medicine; Pulmonary Disease and Critical Care, Internal Medicine; Pulmonary Disease, Internal Medicine
Duke University Hospitals Durham Afreen Idris Shariff, MD Internal Medicine
Rex UNC Healthcare Raleigh Mayank Singhal, MD Internal Medicine
Novant Health Franklin Medical Center Louisburg Mark Quentin Smith, MD Diagnostic Radiology
Durham Neil Kenton Stafford, MD Hospitalist; Internal Medicine
Hospital Medicine Durham Jennifer Danielle Stromberg, MD Family Medicine; Family Medicine - Sports Medicine; Student Health
Richard Joseph Oâ€™Brien, MD Clinical Neurophysiology; Neurology
Duke University Student Health Services Durham
Koyal Jain, MD
Duke University Neurology Durham
Khoon Ghee Queenie Tan, MD
Frunze Petrosyan, MD
Duke University Hospitals Durham
Internal Medicine - Nephrology
UNC Hospitals Chapel Hill Infectious Diseases, Internal Medicine
Christina Marie Drostin, MD
Kenneth Leung, MD
Diagnostic Radiology; Musculoskeletal Radiology; Neuroradiology; Pediatric Radiology; Radiology; Vascular and Interventional Radiology
Duke Medical Center Durham
Child Psychiatry; Pediatrics; Psychiatry
Matthew Girard Johnson, MD
UNC Hospitals Chapel Hill
UNC Department of Pathology and Laboratory Medicine Chapel Hill
Cody James Alexander Schwartz, MD
Duke University Hospitals Durham
Cardiac Electro physiology, Internal Medicine; Cardiovascular Disease, Internal Medicine; Critical Care-Internal Medicine; Diabetes; Gastroenterology, Internal Medicine; Hematology and Oncology, Internal Medicine; Hospitalist; Internal Medicine; Internal
Nephrology, Internal Medicine
Johnston Health Smithfield
UNC Hospitals Chapel Hill
Ann Marie Reed, MD
Chad Samuel Kessler, MD
2712 Alderman Durham
Suzanne Leigh Katsanos, MD
Administrative Medicine; Emergency Medicine; Internal Medicine
Pediatric Rheumatology; Pediatrics
Durham VAMC Durham
Alexie Danielle Riofrio, MD
Sonita Khan, MD
Duke University Hospitals Durham
Wayne Memorial Hospital - EMA Group Goldsboro Bharati Kochar, MD
Diagnostic Radiology; Musculoskeletal Radiology; Radiology
Catherine Koontz Rogers, MD Psychiatry
UNC Hospitals Chapel Hill
Gastroenterology, Internal Medicine
UNC Hospitals Chapel Hill
Szymon Lukasz Wiernek, MD Cardiology; Cardiovascular Disease, Internal Medicine
UNC Hospitals Chapel Hill
Editorial Calendar October Cancer in women Wound management November Urology ADHD December Otorhinolaryngology Pain management September 2014
SCREENING MAMMOGRAPHY. NOW IN SMITHFIELD.
THE BEST PROTECTION IS EARLY DETECTION. For 25 years, we served Smithfield from Johnston Memorial Hospital. Now we’re back. In a new location. And we bring with us more than 60 years as the region’s premier provider of outpatient imaging. We also bring screening mammography to your community. And, because early detection is what it’s all about, access and scheduling couldn’t be easier. What’s more, the appointment itself is just 30 minutes from check-in to exam completion. So there’s never been a better time (or place) for a checkup.
At your request, Wake Radiology can easily obtain your most recent mammogram from other practices.
TO LEARN MORE, CALL 919-232-4700 OR VISIT WAKERAD.COM.
Wake Radiology | 218 Venture Dr. Smithfield, NC Behind the Carolina Premium Outlets Hours: Monday-Friday 8:00am-4:30pm Appointments: 919-232-4700 | wakerad.com
The Triangle Physician September 2014