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september

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

Carolina Partners in Mental HealthCare Integrated Health Care Improves Patient Likelihood of Getting Well

Also in This Issue AID Helps Group Open Independent Surgery Center

Many Forms of Psoriasis Affect Quality of Life

Top 10 Proposed MACRA Changes Ahead


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The Triangle Physician

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From the Publisher

Dermatology

Forging Onward Carolina Partners in Mental Health, the

provides a thorough overview of changes to

cover story this issue, offers an ideal

the MACRA Quality Payment Program.

package for patients - not just one provider

On the medical front, physician assistant

but an integrated team of specialized

Tracy Cloninger gives an interesting

providers who work together to address

overview of psoriasis and its various forms.

an individual’s often complex health care

While advertisements about treatment for

needs. The article presents the case as to

plaque psoriasis are ubiquitous, there are

why this arrangement leads to improved

other forms that can impact one’s health

outcomes.

and quality of life in significant ways.

It’s always exciting to hear from physician

Despite great unknowns, medical progress

advocate Marni Jameson Carey. This month

forges onward, and each of us benefits. We

she reports on the successful effort to open

would like to hear about your contributions

an independent surgical center in Vermont

in uncertain times, so we can share them

and the support her organization provided

with the 9,000-plus readers within the

during a two-year odyssey.

Raleigh-Durham medical community.

Practice consultant Margie Satinsky is

Please contact us at

dedicated to providing wise counsel

info@trianglephysican.com.

on critical, complex and ever-changing governmental and agency regulations. It’s a volatile landscape, and she translates it with great editorial finesse. This month she

Publisher

John Teague

The Triangle Physician T H E

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Publisher - John Teague John@TTP2LC.com

Creative Director - Joseph Dally jdally13@gmail.com

Contributing Editors Marni Jameson Carey Tracey S. Cloninger, P.A.-C. Margie Satinsky, M.B.A.

News and Columns Please send to info@trianglephysician.com

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“After five gall bladder attacks that mimicked a heart attack, my family doctor said ‘It’s time to have this thing out!’ My surgeon said,’Let’s do this robotically at Johnston Health.’ sa it went Now I’m thankful to say, perfectly! No pain, no recovery issues, not even a red mark!” Charlotte Davis Smithfield, NC

For Charlotte’s complete story, visit johnstonhealth.org.

Expert Care. Close To Home!

daVinci Robotic Surgery

SMITHFIELD

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CLAYTON


6

COVER STORY

Carolina Partners in Mental HealthCare Integrated Health Care Improves Patient Likelihood of Getting Well s e p t e m b e r 2 0 17

FEATURES

10

Physician Advocacy

AID Helps Group Open Independent Surgery Center After Two-Year Fight Marni Carey gives a play-by-play of the events leading up to a spectacular win for independent Vermont physicians.

11

Vol. 8, Issue 8

DEPARTMENTS 14 Research News Gold Nanostars and Immunotherapy Vaccinate Mice Against Cancer

15 News

Welcome to the Area

Dermatology

Understanding and Managing Psoriasis Flares Tracey Cloninger’s overview raises understanding of the many forms of psoriasis and its impact on quality of life. On the Cover: Meet the Carolina Partners Center for Interactive Care team. Back row: Jackie Camp, Ph.D.; Kelly Crenshaw, N.P.; Lisa Beresnyak, B.A.; Meagan Biggs; and Katie Godin, R.D., L.D.N. Front row: Sharon Wilkening, M.A., L.M.H.C.; John V. Yacono, M.D., F.A.C.P.; and Greg Carter, D.C.

september 2017

5

Category

Table of Contents


Category

Carolina Partners

Center for Integrative Care Integrated Health Care Improves Patient Likelihood of Getting Well Carolina Partners in Mental HealthCare’s Center for Integrative Care offers a holistic approach that expands patient care to an integrated health care team. It is led by a central mental health care provider who collaborates with the needed caregivers. “The goal is to make health care simpler and more effective by integrating traditional psychiatric health care into a broader spectrum of treatment modalities, including nutritional counseling, acupuncture, physical therapy, and primary care,” says the Center for Integrative Care (CIC) Care Coordinator Sharon Wilkening, L.P.C.

The Center for Integrative Care team.

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The Triangle Physician


Katie Godin, a licensed dietitian, discusses nutritional options with a client.

The idea of integrative health care is not a new one. “A cursory Google search will turn up a large body of scientific research on the subject. Yet it is something we rarely get to see in practice,” says Wilkening. “By and large, in western society, health care has been compartmentalized between various public and private facilities that have little to do with one another. “Think about it: You go to the physician for annual checkups, the hospital for acute maladies and injuries, your therapist for counseling, perhaps a separate psychiatrist for medication management. You or someone you know may suffer from substance abuse or maybe an eating disorder, in which case, you or they have likely been directed to yet another specialized clinic to get help.” The list goes on, says Wilkening. “Throughout this elaborate, convoluted process, these myriad institutions rarely collaborate or communicate beyond the bare minimum, and they might therefore vastly differ in how they choose to treat a patient.” The American Journal of Managed Care writes, “Despite the robust literature demonstrating the benefits of integrated care models, behavioral and physical health care delivery have tradi-

The goal is to make health care simpler and more effective by integrating traditional psychiatric health care into a broader spectrum of treatment modalities, including nutritional counseling, acupuncture, physical therapy, and primary care

tionally operated in separate spheres.”1

september 2017

7


Lisa Beresnyak, medical assistant and health coach, works with a Center for Integrative Care client.

It makes sense to integrate health care, says Wilkening. “The argument is almost self-evident: You are more likely to get well, if your treatment plan is centralized and therefore tailored to your precise needs as an individual, particularly if you suffer from comorbid disorders that must be treated in tandem.” CIC Health Coach Lisa Beresnyak asks the reader to imagine he or she is suffering from insomnia and anxiety. “A foray into the insulated health care landscape as it stands now might very well yield a long, frustrating road to nowhere.” The patient may be seen by a psychiatrist who prescribes antianxiety medication and sleeping pills. Then, when the new medication regimen affects the patient’s energy levels and appetite, she starts to binge eat. The patient’s physical health then starts deteriorating, so she sees a dietician who recommends exercise. But her medical barriers make exercise difficult, and this affects her self esteem. The patient spirals into depression, so she goes back to the psychiatrist, who prescribes antidepressants as well as cognitive behavioral therapy with another therapist. “Before you know it, the patient is bouncing between three or four different specialists who each have a piece of the puzzle of her health, but none of whom have the whole picture. Worse, they are sabotaging one another’s treatment plans without even realizing it,” says Beresnyak. On top of it all, Beresnyak says, the various doctor visits are getting too expensive and emotionally draining. She points to a study that has shown a significant percentage of patients with substance abuse problems are unwilling to undertake the work required to go to numerous appointments and therefore stop going.2 CIC is solving this dilemma, says Beresnyak. She describes the scenario that occurs when a patient arrives at CIC with similar diagnoses of insomnia and anxiety.

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The Triangle Physician


“Your therapist, dietician, exercise counselor, and medication manager all exist on one personalized care team, and they can work together to give you the best treatment possible. The mounting expenses and complications disappear.”

“We believe in the power of treatment options that can

Wilkening says Carolina Partners has always been committed to innovation in health care. “Our practice philosophy has long disavowed a one-size-fits-all solution to health care. We believe in the power of treatment options that can be catered to the specific needs of each patient who walks through our doors. “The Center for Integrative Care is an important step in this direction, not just for the

be catered to the specific needs of each patient who walks through our doors.”

company, but for the American health care system in general. It’s time to move away from the chaos of segregated health care and in the direction of the integrative approach.” Carolina Partners has offices throughout the Raleigh-Durham region and across North Carolina. More information is available online at www.carolinapartners.com. References 1

Minkoff, Neil D. “Treating Behavioral Health Disorders in an Accountable

Care Organization.” AJMC. 16 Dec. 2016. Web. 16 July 2017. http://www.ajmc.com/journals/ajac/2016/2016-vol4-n4/treating-behavioralhealth-disorders-in- an-accountable-care-organization 2

“Common Reasons Why Those

Who Need Treatment Don’t Get It.” 16 Dec. 2016. Web. 16 July 2017. https://www.elementsbehavioralhealth. com/addiction-recovery/commonreasons-why-those- who-need-treatmentdont-get-it/ Greg Carter , DC

Katie Godin, RD, LDN

Kelly Crenshaw, NP

Lisa Beresnyak, BA

Steven Lambeth

Mary Tyrey, BSN, RN

Jakie Camp, PHD

Sharon Wilkening, MA

september 2017

9


Physician Advocacy

Dermatology

AID Helps Group Open Independent

Surgery Center After Two-Year Fight By Marni Jameson Carey

Helping independent doctors nationwide, the

FTC’s attention but also filed a letter during the

Florida-based Association of Independent Doc-

open comment period that got picked up by the

tors celebrated yet another victory for patients

media. That got the state’s legal authorities to

by helping doctors in Vermont open a freestand-

really take this seriously and let our regulators

ing surgical center they had had been fighting to

know that people nationally were watching this

build for two years.

case to see whether they would vote in favor of

The doctors, part of Health First, had been

Marni Jameson Carey is the executive director of the Association of Independent Doctors. You may reach her at (407) 571-9316 or marni@aid-us.org. Visit www.aid-us.org for more information.

competition.”

pleading with state regulators to get the certifi-

The decision allows independent doctors

cate of need to build the facility. Area hospitals,

to create the first independent multispecialty

worried about competition, opposed the center.

outpatient surgery center in the state, and break

Health First had even filed a lawsuit, but

into a general surgery market that has been

the controversy dragged on. Frustrated, Health

exclusively controlled by hospitals. Vermont’s

First Executive Director Amy Cooper, who had

only other freestanding surgical center is an eye

learned of AID’s success in working with the

clinic.

Federal Trade Commission to promote competi-

“By joining AID as a chapter, we sent a

tion and block monopolies, reached out to the

strong signal that we’re serious about maintain-

national nonprofit.

ing competition and put everyone on notice that we are not going away,” said Cooper. The addition of a Vermont AID chapter was crucial given the dynamics in the state, added Cooper. “By forming a state chapter, we reinforced Health First’s resolve to do what’s best for patients and help independent doctors maintain their small practices.” Members are also now part of AID’s online

In April, 15 Health First doctors joined

directory of independent doctors, a growing

AID, creating a Vermont Chapter. That gave AID

database designed to help patients and referral

enough horsepower to represent their interests

sources find independent doctors.

to both the FTC, the Green Mountain Care Board

Established in 2013, AID now has 1,000

responsible for issuing the approval and local

members in 33 states across the country and

media.

chapters in California, Florida, South Carolina,

In May, AID wrote a letter to the board argu-

Vermont, and soon Texas and Pennsylvania.

ing for approval of the new center. The letter got

The nonprofit trade association speaks out on

the attention of state and national media. In July,

behalf of independent doctors who don’t have

the doctors got the green light to build their sur-

the time, resources or clout to fight the forces

gical center. In 90 days, AID helped win a battle

facing them, and educates consumers, lawmak-

the doctors had been fighting for two years.

ers, businesses and the media about why saving

“AID played a key role in our victory,” said Cooper. “AID not only brought the matter to the

10

The Triangle Physician

America’s independent doctors matters.


Dermatology

Understanding and Managing

Psoriasis Flares By Tracey S. Cloninger, P.A.-C.

Psoriasis is a condition characterized by red

Inverse psoriasis forms in-between skin folds

scales and patches on the skin that can appear

in recessed areas of the body, such as the under-

anywhere on the body.

arms and groin, where skin makes continuous

The exact cause of psoriasis has not been

direct contact with other skin. Unlike other types

determined, but it is an autoimmune disease

of psoriasis, inverse psoriasis is characterized by

believed to be linked to genetic roots. Psoriasis

smooth rashes rather than raised bumps, and it

“flares” when skin cells in affected areas grow

is less scaly to the touch.

rapidly, creating a buildup of scaly tissue. Stress,

Guttate psoriasis appears as patches of

injury, bacterial infections and certain medica-

small red spots (papules) on the skin, usually

tions can trigger flares.

shaped like drops of water, smaller than 10 mil-

Psoriasis comes in a variety of types, each

limeters in size with a pink hue. Bacterial infec-

of which manifests slight differences in symp-

tions, such as strep throat, can trigger flares of

toms as well as triggers and affected regions of

guttate psoriasis. This is sometimes unexpected,

the body. No type of psoriasis is contagious or

as some types of bacterial infections do not

infectious, but it is often painful.

show obvious or easily recognizable symptoms.

Psoriasis vulgaris (plaque psoriasis)

Pustular psoriasis can be identified by

is the most common

the presence of pus-

type of psoriasis is

tules, or white pus-

plaque psoriasis, also

filled bumps most of-

known as psoriasis

ten on the hands and

vulgaris. Plaque psori-

feet. Pustules also

asis appears as raised

can appear between

patches (bumps) of

skin folds as well as

scaly,

silvery-white

on the tongue. Al-

skin, usually appear-

though pustular pso-

ing

riasis is sometimes

on

the

scalp,

knees, lower back and

accompanied

elbows. Most often,

such symptoms as

the bumps join into clusters.

by

fever, chills or headache, it is not infectious.

Erythrodermic psoriasis is the least com-

Nail psoriasis can appear underneath

mon but most serious form of psoriasis. Suffer-

surfaces of fingernails and toenails. This usually

ers often find bright red inflamed skin over the

causes pitting on the surface of the nail. It can

entire body, sometimes from head to toe. Eryth-

cause discoloration of the nail and/or separation

rodermic psoriasis adversely affects the overall

from the nail bed. It is common for an affected

function of the body’s systems by compromising

nail to darken and eventually fall off.

the skin’s ability to protect against temperature

Dermatology providers are specially trained

extremes and infections. As such, this type of

to identify the specific type of psoriasis and rec-

psoriasis can be life threatening. It most often ap-

ommend a treatment plan. Usually the type of

pears in patients who have already developed a

psoriasis is determined by a physical examina-

different type of psoriasis, but not always.

tion and/or a tissue biopsy of the affected area.

Physician assistant Tracey Cloninger of Southern Dermatology earned her bachelor’s degree in physical education from the University of North Carolina, her physician assistant degree from East Carolina University
and her master of education degree in exercise physiology from the University of Georgia. As a physician assistant Cloninger collaborates with physicians on complex cases. She is a member of the American Academy of Physician Assistants, North Carolina Academy of Physician Assistants and Society of Dermatology Physician Assistants. “My passion is to help young patients make good lifestyle choices, so their healthy skin lasts a lifetime.” Cloninger can be reached at (919) 782-2152.

Blood tests are not an effective method.

september 2017

11


Physician Advocacy

Highlights of Proposed 2018 Changes to MACRA Quality Payment Program By Margie Satinsky, M.B.A.

The

Medicare

Access

and

CHIP

Reauthorization Act of 2015 brought many

For more information, visit www.satinskyconsulting.com.

All eligible clinicians in groups that choose

changes to reimbursement for Medicare patients.

the virtual group option must participate, and

It went into effect on Jan. 1, 2017, and this first year

the participation decision to choose this option

is considered to be a transition year.

must be made prior to the 2018 performance

One part of the program, the Quality Payment

Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She has helped many physicians start new practices, assess the wisdom of affiliating with a larger health care system and improve their current practices. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century.

not qualify as MIPS eligible.  

period.

Program (QPP), generated many questions

2. Easier low-threshold exemption. An increase

and concerns from small, independent and

in the 2017 low-volume threshold to $90,000 or

rural practices. In response to these concerns,

200 patients would enable more small practices

Centers for Medicare & Medicaid (CMS) issued

and eligible clinicians in rural and Health Pro-

a proposed rule on June 20 that would make

fessional Shortage Areas (HPSAs) to be exempt

changes to the QPP in 2018, Medicare Access and

from MIPS participation.

CHIP Reauthorization’s (MACRA’s) second year. Comments were due back to CMS by Aug. 18.

3. Facility-based measurement. The transitional 2017 transitional year has no provisions

The 2018 proposed rule for the QPP both

for facility-based measurement. The proposed

amends some of the existing requirements and

change would implement an optional, volun-

contains new policies for physicians, and other

tary, facility-based scoring mechanism based

clinicians who are participating in QPP in either

on the Hospital Value Based Purchasing Pro-

the Advanced Alternative Payment Models

gram. The option would be available only for

(APM) or Merit-based Incentive Payment System

facility-based clinicians who have at least 75

(MIPS) tracks.

percent of their covered professional services

This article identifies and explains 10 of the most important proposed changes, focusing on

supplied in the inpatient hospital or emergency room setting.

the MIPS track that most eligible clinicians are

4.  New hardship category under Advancing

expected to select. For a complete explanation

Care Information: CMS has proposed adding

of the proposed changes to both the MIPS and

a new hardship category for clinicians in small

APM tracks, check the resources listed at the end

practices under the Advancing Care Information

of the newsletter.

(ACI), the new name for the meaningful-use performance category.

12

The Triangle Physician

1. New participation option. A new “virtual

5. More options for submission by MIPS-eligi-

groups” participation option would give solo

ble clinicians: Moving away from the 2017 re-

groups (i.e., solo practitioners and groups

quirement for one submission mechanism per

of 10 or fewer eligible clinicians) the option

performance category, the proposed rule would

of coming together “virtually” in order to

allow MIPS-eligible clinicians and groups to sub-

participate in MIPS for a year.

mit measures and activities through multiple

 Solo practitioners that wish to join a vir-

submission mechanisms within a performance

tual group must meet the definition of MIPS

category as available and applicable to meet the

eligible. A group that wishes to join a virtual

requirements of the quality improvement activi-

group may include eligible clinicians that do

ties or ACI performance categories.


25 percent respective weights.

(PTNs), which support clinician

egory: Eligible clinicians would have

c.  CMS’ future plans for changing

the option of continuing the use of 2014

weights remains at raising cost to 30

strategies: TCPI.ISC@TruvenHealth.

Edition Certified Electronic Health Re-

percent for the 2021 MIPS payment

com. Regionalized Quality Innova-

cord Technology (CEHRT) or using the

year (using 2019 data for reporting)

tion Network-Quality Improvement

and beyond.

Organizations provide assistance:

2015 edition. There’s an exception for

practices in quality improvement

http://quiprogram.org/contact-

eligible clinicians for whom the elec-

10.  Improvement Scoring for Quality

tronic health record was decertified

and Cost: The proposed rule adds a

retroactively effective to performance

mechanism for rewarding improvement

periods in 2017.

in performance for these two catego-

Support for small, underserved and

ries. Higher improvement would trans-

rural areas provides direct and custom-

late to more points.

ized assistance to small practices. In North

7. Timeframe for reporting in ACI category: In response to input from the phy-

zones?map=qin.

Carolina, Alliant GMCG is the designated

sician community, CMS has proposed retaining the 90-day reporting period. 8. More ways to earn bonus points: a. Eligible clinicians could add bonus

antquality.org.

the resources below.

•N  orth Carolina Medical Society

• CMS website: http://qpp.cms.gov.

points in the scoring methodology

•C  MS Quality Payment Program Center.

for: (1) caring for complex patients;

Call (866) 288-8292 or send an email

(2) using the 2015 edition CEHRT

support organization: QPPsupport@Alli-

For more information, contact one of

website: www.ncmedsoc.org. • Major software vendors, who offer

to QPP@cms.hhs.gov.

guides, webinars and technical

exclusively; (3) incorporating MIPS

• CMS-approved local organizations

performance improvement in scor-

that support clinician practices in

ing quality performance; and (4)

quality improvement strategies.

(919) 383-5998 or

incorporating the option to use fa-

Practice Transformation Networks

Margie@satinskyconsulting.com.

support. • Satinsky Consulting L.L.C.:

cility-based scoring for facility-based clinicians. b. MIPS-eligible clinicians, groups, vir-

AC N E

MOHS SURGERY

SKIN CANCER

PSORIASIS

ECZEMA

tual groups and advanced Alternative Payment Models (APMs) with 15 or fewer clinicians could receive five additional bonus points in their final score by submitting data on at least one performance category in the 2018 MIPS performance period. c. Small practices but not larger ones could continue to receive three extra points for measures in the quality performance category that don’t meet data completeness requirements. 9. Weighting MIPS components: a.  Contrary to expectations, for 2018 the quality component would be weighted at 60 percent and the cost

SHE WANTED HER DAUGHTER TO HAVE THE BEST CARE AVAILABLE I R E F E R R E D H E R T O S O U T H E R N D E R M AT O L O G Y

component at 0 percent, allowing FOR THE MOST ADVANCED SKIN CANCER TREATMENTS, REFER YOUR PATIENTS TODAY!

practices to continue developing their processes for procuring and interpreting cost data. b. Improvement activities and ACI would remain at their current 15 percent and

919-782-2152

southernderm.com ROSACEA • HIVES

VITILIGO

DER131_AD_Triangle Physican BEST CARE 1/3.indd 1

K E R AT O S I S • WA R T R E M O VA L 1/30/17 3:28 PM

september 2017

13

Physician Advocacy

6. Options for reporting in the ACI cat-


Research News

Gold Nanostars and Immunotherapy Vaccinate Mice Against Cancer By combining a Food and Drug Adminis-

deeper within a tissue, according to the

nothing to affect the tumor in the untreated

tration-approved cancer immunotherapy

advisory.

leg. While a few mice responded well to

with an emerging tumor-roasting nano-

“The nanostar spikes work like light-

the immunotherapy alone, with the drug

technology, Duke University researchers

ning rods, concentrating the electromag-

stalling both tumors, none survived more

improved the efficacy of both therapies in

netic energy at their tips,” said Vo-Dinh.

than 49 days.

a proof-of-concept study using mice.

“We’ve experimented with these gold na-

The group treated with both the im-

The potent combination also attacked

nostars to treat tumors before, but we want-

munotherapy and the gold nanostar photo-

satellite tumors and distant cancerous

ed to know if we could also treat tumors we

therapy fared much better, with two of the

cells, completely curing two mice and

didn’t even know were there or tumors that

five mice surviving more than 55 days.

effectively vaccinating one against the

have spread throughout the body.”

disease. The results appeared online in Scientific Reports on Aug. 17.

“When a tumor dies, it releases par-

To attack distant cancerous cells out-

ticles that trigger the immune system to

side of the treatment site, Vo-Dinh teamed

attack the remnants,” said Vo-Dinh. “By

“The ideal cancer treatment is non-

up with colleagues Brant Inman, M.D.,

destroying the primary tumor, we activated

invasive, safe and uses multiple approach-

M.S., and Gregory M. Palmer, Ph.D., in the

the immune system against the remaining

es,” said Tuan Vo-Dinh, the R. Eugene and

Departments of Surgery and Radiation On-

cancerous cells, and the immunotherapy

Susie E. Goodson Professor of Biomedical

cology at Duke University Medical Center,

prevented them from hiding.”

Engineering and director of the Fitzpatrick

and Paolo F. Maccarini, Ph.D., of Duke Bio-

The combined treatment worked so

Institute for Photonics at Duke University.

medical Engineering. They combined this

well that, in a bit of a surprise, one mouse

“We also aim at activating the patient’s own

gold nanostar therapy with a cancer immu-

is still alive nearly a year out with zero re-

immune system to eradicate residual meta-

notherapy recently cleared by the FDA and

currence of the cancer. Even a month later,

static tumors. If we can create a long-term

in clinical use.

when the researchers injected more can-

Normally, the body’s immune system

cerous cells, the mouse’s immune system

protects against the growth of cancerous

attacked and destroyed them without a

The new approach relies on a “pho-

cells. Many tumors, however, overproduce

problem indicating a vaccine effect in the

tothermal immunotherapy” technology

a molecule called PD-L1, which effectively

cured mouse.

developed by an interdisciplinary group of

disables T cells, the immune system’s main

Duke researchers that uses lasers and gold

soldiers, the Duke advisory said.

anticancer immunity, then we’d truly have a cure.”

“This is our goal – our dream,” said Vo-Dinh.

nanostars to heat up and destroy tumors in

Several pharmaceuticals are being

While researchers conducted this

combination with an immunotherapeutic

developed to attempt to block the action

proof-of-concept experiment with a small

drug, according to a Duke Health press

of PD-L1, allowing the immune system to

number of mice, the results are encour-

advisory.

destroy the cancerous cells. Inman has

aging. The Duke researchers now plan to

This photothermal therapy hinges on

been active in the early development and

follow up with larger cohorts and to work

the widely demonstrated fact that nanopar-

current clinical use of these drugs – which

with other clinical researchers to test the

ticles accumulate preferentially within a

were used in this study – to treat bladder

treatment on mouse models of brain,

tumor due to its leaky vasculature.

cancer.

breast and lung cancer.

While several researchers around the

In the experiment, the Duke research-

world are pursuing such techniques using

ers injected bladder cancer cells into both

Reference

nanoparticles, Vo-Dinh has pioneered the

hind legs of a group of mice. After waiting

“Synergistic Immuno Photothermal Nano-

development of a unique type of nanopar-

for the tumors to grow, the researchers

therapy (SYMPHONY) for the Treatment

ticles called gold nanostars, which have

began trying different types of treatments

of Unresectable and Metastatic Cancers.”

the advantage of geometry. Because gold

– but only on one of the legs.

Yang Liu, Paolo Maccarini, Gregory M.

nanostars have multiple sharp spikes, they

Those that received no treatments

Palmer, Wiguins Etienne, Yulin Zhao,

are able to capture the laser’s energy more

all quickly succumbed to the cancer, as

Chen-Ting Lee, Xiumei Ma, Brant A. Inman

efficiently. This allows them to work with

did those receiving only the gold nanostar

& Tuan Vo-Dinh. Scientific Reports, Aug. 17,

less exposure, making them more effective

phototherapy, because the treatment did

2017. DOI: 10.1038/s41598-017-09116-1.

14

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Falon Victoria Brown, DO Dermatology; Hospitalist; Internal Medicine

SRMC-Graduate Medical Ed Dept Clinton

Andrew Charles Caldwell, DO Family Medicine

Family Health Associates of Sanford Sanford

Katie Lyn Clouthier, DO Pediatrics

UNC Chapel Hill Chapel Hill

Rodger Brent Cook, DO General Practice

Elm City

Cristiana Abrantes Costa, DO

Ronald Jason Pope, DO

Elizabeth Runge Blyth, MD

Leslie Horn Clark, MD

Abdominal Surgery; General Surgery

Pediatrics

Abdominal Surgery; Gynecology; Gynecology/Oncology

Boice-Willis Clinic P.A. Rocky Mount

Karen Denise Szymanski, DO General Surgery; Plastic & Reconstructive Surgery; Plastic Surgery

Boice Willis Clinic, PA Rocky Mount

Muhammad Mostafa Abd-El-Barr, MD Neurological Surgery; Spinal Reconstructive Surgery

Duke University Medical Center Durham

Kyle Jordan Abshire, MD Emergency Medicine

Duke University Hospitals Durham

Hematology and Oncology, Internal Medicine

Serdal Aktolga, MD

Duke University Medical Center Durham

Duke University Hospitals Durham

J. Richard Lee Evanson, DO Orthopedic Sports Medicine; Orthopedic Surgery – Adult Reconstructive, Pediatric, Trauma, Ankle Foot, Hand

Duke Univ Dept of Orthopaedic Surgery Durham

James Edward Everhart, DO Internal Medicine

Duke University Medical Center Durham

Jeremy Meyer Force, DO Internal Medicine; Oncology

Duke University Medical Center Durham

Courtney Hudson Hinton, DO Family Medicine; Family Practice

Avance Care Raleigh

Michael Hwang, DO Diagnostic Radiology; General Practice; Vascular and Interventional Radiology

UNC-CH, Dept of Radiology Chapel Hill

Steven James Jones, DO Family Medicine

Sampson Regional Clinton

Mark Andrew Kleman, DO Nephrology, Internal Medicine

UNC Division of Nephrology Chapel Hill

Aaron Isaac Loochtan, DO Neurology

Duke University Hospitals Durham

Christina Renee MacRosty, DO Pulmonary Disease and Critical Care, Internal Medicine

UNC Hospitals Chapel Hill

Geriatrics; Internal Medicine

Robert William Andrews, MD Durham

William Thomas Atchley, MD Internal Medicine; Pulmonary Disease and Critical Care, Internal Medicine

UNC Div of Pulmonary Diseases & Critical Care Medicine Chapel Hill

Sanford Pediatrics Sanford

Romin Bonakdar, MD Internal Medicine

UNC Hospitals Chapel Hill

Brian Conrad Brimmage, MD Gynecology; Obstetrics; Obstetrics & Gynecology - Endocrinology/ Infertility,Reproductive, Surgery

Raleigh OB/Gyn Centre Raleigh

David Andrew Brown, MD

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University of North Carolina Hospitals Chapel Hill

Kathleen Marie Claus, MD Anesthesiology - Critical Care Medicine

Duke University Medical Center Durham

Catherine Louw Coe, MD Family Medicine; Family Practice; Hospitalist; Urgent Care

UNC Family Medicine Chapel Hill

Plastic & Reconstructive Surgery; Plastic Surgery/Hand Surgery

Alexander Harrison Consky, MD

Duke Plastic, Maxillofacial & Oral Surgery Durham

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Anthony Bruno, MD Administrative Medicine; Orthopedic Surgery

Wayne Memorial Goldsboro

Timothy David Buff, MD Emergency Medicine

UNC Hospitals Chapel Hill

Andrew Blake Buletko, MD Neurology; Vascular Neurology

Maxillofacial Surgery; Surgery

Suma Das, MD Neurology

Duke University Hospitals Durham

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Duke Raleigh Hospital Raleigh

UNC Vascular and Interventional Radiology Chapel Hill

UNC Hospitals Chapel Hill

Mirnela Byku, MD

Austin Xavier Dixon, MD

Adam Shane Barnett, MD

UNC Division of Cardiology Chapel Hill

Kiri Wiggins Bagley, MD Pediatric Nephrology; Pediatrics

Internal Medicine

Duke University Hospitals Durham

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UNC Dept of Pathology & Laboratory Medicine Chapel Hill

Hannah Elizabeth Foote Bensimhon, MD General Practice; Internal Medicine

UNC Hospitals Chapel Hill

Jay Berdia, MD Ophthalmology

Duke Eye Center Durham

Sayanti Bhattacharya, MD Psychiatry

Duke University Durham

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UNC Pediatric Hematology Oncology Chapel Hill

Cardiology; Cardiovascular Disease, Internal Medicine

Nihan Kaya Cannon, MD Hospitalist; Internal Medicine

Rex Healthcare Raleigh

Donald Michael Caraccio, MD Internal Medicine

UNC Hospitals Chapel Hill

Diagnostic Radiology; Radiology; Vascular and Interventional Radiology

Duke University Hospitals Durham

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UNC Hospitals Chapel Hill

Damien Eugene Earl, MD Neurology

Duke University Hospitals Durham

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Adva Tal Eisenberg, MD

Pediatrics

Endocrinology, Internal Medicine

Durham

Duke University Hospital Durham

Yeh-Chung Chang, MD Pediatric Infectious Diseases

DUMC Dept of Pediatrics Durham

Sugong Chen, MD Abdominal Surgery; Bariatric Medicine; Colon and Rectal Surgery; Critical Care Surgery; General Surgery

Duke Center for Metabolic & Weight Loss Surgery Durham

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Duke University Hospitals Durham

Mai Kamal El Mallah, MD Pediatric Pulmonology; Pediatrics

Duke Pediatric Pulmonary Division Durham

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University of North Carolina Hospitals Chapel Hill

Chineme Ijeoma Enyioha, MD Family Medicine

UNC Family Medicine Chapel Hill september 2017

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Stephen John Greene, MD

Sara Cristina Koenig, MD

Anesthesiology - Critical Care Medicine, Pain Medicine

Cardiology; Cardiovascular Disease, Internal Medicine

Duke University Hospitals Durham

Duke University Hospitals Durham

Addictionology or Addiction Medicine; Administrative Medicine; Blood Banking/Transfusion Medicine; Clinical Pathology

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Andrew Steven Griffin II, MD

Internal Medicine; Psychiatry

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Family Medicine

Emergency Medicine

Scharles Alicia Konadu, MD

UNC Family Medicine Center Chapel Hill

Duke University Hospitals Durham

Gastroenterology, Internal Medicine

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Lynn Marie Fraser, MD

Zachary James Hager, MD

Duke University Hospitals Durham

Anesthesiology - Pain Medicine, Pain Management

Hospitalist; Internal Medicine

Prabhat Kumar, MD

Duke University Medical Center Durham

Cardiac Electrophysiology - Internal Medicine; Cardiology; Cardiovascular Disease - Internal Medicine

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Morrisville

Pinehurst Surgical Pinehurst

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NASH OB-GYN Associates, P.A. Rocky Mount

Desmina Ayodele Friday, MD Child Psychiatry; Psychiatry

University of North Carolina Hospitals Chapel Hill

Marat Fudim, MD Cardiovascular Disease, Internal Medicine

Duke University Hospitals Durham

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Duke Eye Center Durham

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Duke University Hospitals Durham

Diagnostic Radiology

Elena Jean Koepke, MD

Ugwuji Nkiruka Maduekwe, MD

Duke University Hospitals Durham

Anesthesiology

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University of North Carolina Hospitals Chapel Hill

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Univ of North Carolina Medical Ctr Chapel Hill

Eric Michael Holland, MD Cardiology; Cardiovascular Disease, Internal Medicine

UNC Center for Heart & Vascular Chapel Hill

Mark Joseph Gage, MD

James Stanley Howard, MD Hospitalist; Internal Medicine

614 W Main Street Durham

Duke University Hospital Durham

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Timothy Scott Howard, MD

Pediatrics

Anesthesiology; Pain Medicine

Duke Children’s Hospital & Health Center Durham

Wilson Orthopedics Wilson

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Anesthesiology

Anatomic and Clinical Pathology; Blood Banking/Transfusion Medicine

UNC Memorial Hospital Chapel Hill

Christine Dao Gladman, MD Internal Medicine

UNC Internal Medicine Clinic Chapel Hill

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Univ of North Carolina Hospitals Chapel Hill

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Pediatrics; Pediatrics - Child Abuse Pediatrics

Carrboro

Nash Anesthesia Associates Rocky Mount Orthopedic Surgery, Trauma

Stephanie Christine MacPherson, MD

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Kim Graham Johnson, MD Neurology; Psychiatry, Geriatric

Duke University Hospitals Durham

Morgan Simonds Jones, MD Endocrinology, Internal Medicine

UNC Endocrinology Chapel Hill

Karen Elizabeth Kimel-Scott, MD Internal Medicine

UNC Ambulatory Care Center Chapel Hill

James Robert Lachman, MD Orthopedic Surgery; Orthopedic, Ankle Foot

Duke Orthopaedic Surgery Durham

Brittany Marie Larson, MD Family Medicine

Duke Primary Care Meadowmont Chapel Hill

Daniel Joseph Lattin, MD

Duke University Medical Center Durham

Joan Alberto Maradey, MD Internal Medicine

UNC Hospitals Chapel Hill

Sami William Mardam-Bey, MD Orthopedic Surgery; Orthopedic Surgery, Pediatric Wake Orthopaedics Raleigh

Christine Standahl McClain, MD Psychiatry UNC Hospitals Chapel Hill

Ophthalmology; Pediatric Ophthalmology

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Duke Eye Center Durham

Duke University Medical Center Durham

Alexander Clayton Lemons, MD Orthopedic Surgery; Orthopedic Surgery of the Spine Pinehurst Surgical Pinehurst

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Duke University Medical Center Durham

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Duke University Health Durham

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Duke University Hospitals Durham

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Duke University Hospitals Cary

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Duke University Hospitals Durham

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UNC Hospitals Chapel Hill

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Jeffers, Mann & Artman Pediatrics Raleigh

Joseph Timothy McLamb, MD Orthopaedic Surgery

102 E April Lane Goldsboro

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UNC Dermatology Chapel Hill

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Duke University Medical Center Durham

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UNC Hospitals Chapel Hill

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Andrea Nicole Trembath, MD

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Cardiology; Cardiovascular Disease, Internal Medicine

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Duke Medicine Durham

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Nicholas Andrew Turner, MD

Surgery; Urological Surgery; Urology

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Osamuede Osemwota, MD

Duke University Hospital Durham

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Lana Michelle Rivers, MD

Duke University Medical Center Durham

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Shannon Marie Page, MD Anesthesiology

Regional Anesthesia, PLLC Durham

Sophia Catherine Nyberg Paraschos, MD Internal Medicine; Pediatrics

University of North Carolina Hospitals Chapel Hill

Arielle Jaclyn Perez, MD Abdominal Surgery; General Surgery

UNC Dept of Surgery Chapel Hill

Rebecca Ann Previs, MD

University of North Carolina Hospitals Chapel Hill

Iris Lillian Vance, MD

The University of North Carolina at Chapel Hill Chapel Hill

Gastroenterology, Internal Medicine

Benjamin Dee Smith, MD

Audey Lewis Veach, MD

Diagnostic Roentgenology Radiology; Musculoskeletal Radiology; Nuclear Medicine; Nuclear Radiology; Pediatric Radiology; Roentgenology

Pediatrics

Scott William Schimpke, MD

UNC School of Medicine Chapel Hill

Elizabeth Michelle Volz, MD

Abdominal Surgery; Bariatric Medicine; General Surgery

Jacquelyn Anne Smith, MD

Chapel Hill

Internal Medicine

Duke Hospital Durham

Teresa Danielle Samulski, MD Cytopathology; Pathology

UNC Chapel Hill Chapel Hill

Duke University Hospitals Durham

Rebecca Lynne Scholl, MD

Duke University Hospitals Durham

Duke University Hospitals Durham

Allison Marshall Puechl, MD

Briana Lynn Scott, MD

Obstetrics & Gynecologic Surgery, Critical Care Medicine, Endocrinology/ Infertility, Gynecologic Oncology

Duke University Hospitals Durham

R: BAY15001 rsion 1 Richard Quan, MD 6/15 Pediatric Gastroenterology 3410 Forest Grove Ct Durham

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Duke University Hospital Durham

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Rabina Kochar Walsh, MD

Duke University Hospitals Durham

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Duke University Durham

Jason Lucious Williams, MD Pediatric Cardiology; Pediatrics

Duke Children’s Hospital Durham

Internal Medicine; Cardiology; Cardiovascular Disease, Internal Medicine - Clinical Cardiac Electrophysiology

Kully Lynn Woodruff, MD Internal Medicine; Pediatrics

Durham

Duke Universty Medical Center Durham

Chad Joseph Zack, MD

Paul Brian Tessmann, MD

Duke University Hospital Durham

Cardiovascular Disease; Internal Medicine - Interventional Cardiology

Jozef Zelenak, MD

305 Aldersbrook Court Cary

Child Psychiatry; Psychiatry

Zelenak Psychiatry, PLLC Raleigh

Leslie Anne Thomas, MD Internal Medicine; Pediatrics

Jiang Zhu, MD

University of North Carolina Hospitals Chapel Hill

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Wake Emergency Physicians, PA Cary

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Duke University Hospitals Durham

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UNC Rheumatology Chapel Hill

Emergency Medicine

Jonathan Edward Scott, MD

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Duke University Hospitals Durham

Duke University Hospitals Durham

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Jessica Laurel Thompson, MD

Duke University Hospitals Durham

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Carolyn Melinda Ziemer, MD

University of North Carolina Hospitals Chapel Hill

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UNC Dermatology Chapel Hill

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UNC Hospitals Chapel Hill

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