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o c t o b e r 2 0 11

Cary Internal Medicine & The Diabetes Center Excellence in Diabetes, Heart and Stroke Care

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 Lawrence Marks, M.D., Appointed Oncology Research Professorship Mammograpy: Making Sense of Mixed Messages MRI Is Important Adjunct in Breast Cancer Screening


Add a pinch of spice,

a hint of laughter,

and a correct diagnosis,

and you’ll get Robert.

Robert suffered from unexplained fainting spells. His physicians couldn’t figure out why. To find answers, they implanted a Reveal® Insertable Cardiac Monitor (ICM) to see if his spells were heart rhythm related.

(Actual size)

The Reveal ICM is a long-term heart monitor that may help you rule in or rule out an abnormal heart rhythm as the cause of unexplained fainting spells. In Robert’s case, they were, and now he has a pacemaker. Possible risks associated with the implant of a Reveal Insertable Cardiac Monitor include, but are not limited to, infection at the surgical site, device migration, erosion of the device through the skin and/or sensitivity to the device material. Results may not be typical for every patient.

Brief Statement Indications 9529 Reveal® XT and 9528 Reveal® DX Insertable Cardiac Monitors – The Reveal XT and Reveal DX Insertable Cardiac Monitors are implantable patient-activated and automatically activated monitoring systems that record subcutaneous ECG and are indicated in the following cases: • patients with clinical syndromes or situations at increased risk of cardiac arrhythmias; • patients who experience transient symptoms such as dizziness, palpitation, syncope, and chest pain, that may suggest a cardiac arrhythmia. 9539 Reveal® XT and 9538 Reveal® Patient Assistants – The Reveal XT and Reveal Patient Assistants are intended for unsupervised patient use away from a hospital or clinic. The Patient Assistant activates one or more of the data management features in the Reveal Insertable Cardiac Monitor: • To verify whether the implanted device has detected a suspected arrhythmia or device related event. (Model 9539 only); • To initiate recording of cardiac event data in the implanted device memory. Contraindications: There are no known contraindications for the implant of the Reveal XT or Reveal DX Insertable Cardiac Monitors. However, the patient’s particular medical condition may dictate whether or not a subcutaneous, chronically implanted device can be tolerated. Warnings/Precautions: 9529 Reveal XT and 9528 Reveal DX Insertable Cardiac Monitors – Patients with the Reveal XT or Reveal DX Insertable Cardiac Monitor should avoid sources of diathermy, high sources of radiation, electrosurgical cautery, external defibrillation, lithotripsy, therapeutic ultrasound and radiofrequency ablation to avoid electrical reset of the device, and/or inappropriate sensing. MRI scans should be performed only in a specified MR environment under specified conditions as described in the device manual. 9539 Reveal XT and 9538 Reveal Patient Assistants – Operation of the Model 9539 or 9538 Patient Assistant near sources of electromagnetic interference, such as cellular phones, computer monitors, etc., may adversely affect the performance of this device. Potential Complications: Potential complications include, but are not limited to, device rejection phenomena (including local tissue reaction), device migration, infection, and erosion through the skin. See the device manual for detailed information regarding the implant procedure, indications, contraindications, warnings, precautions, and potential complications/adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.

UC201003796 EN © Medtronic, Inc. 2009. Minneapolis, MN. All Rights Reserved. Printed in USA. 11/2009

For more information, visit www.fainting.com.


JOHNSTON HE ALTH


Contents

COVER STORY

6

Cary Internal Medicine & The Diabetes Center

Excellence in Diabetes, Heart and Stroke Care

o c t o b e r 2 011

Vol. 2, Issue 10

FEATURES

13

Radiology

Mammography: Making Sense of Mixed Messages

14

DEPARTMENTS 14 Radiology

Your Financial Rx

Putting Paul in the Hot Seat Paul Pittman chats about his role models,

Dr. Jennifer Van Vickle points to recent

thinking outside of the box and “post-

studies that prove annual mammography

modern” financial planning.

beginning at age 40 saves lives.

MRI Is Important Adjunct in Breast Cancer Screening

18 WakeMed News Physician Network Grows; New Executives Named

19 Rex Health Care News Cary Surgery Center Earns Accreditation

UNC Hospital News 20 Country’s First Inpatient Perinatal Psychiatry Unit Opens

20 Scientist to Study Post-Mastectomy Breast Reconstruction Decision Making

21 New Nanoparticle for Cancer Therapy; Cost-effective Infection-Control

22 24-Week Treatment for Hepatitis C Is Effective, Reduces Side Effect Exposure

23 Dr. Lawrence Marks Is Appointed to an Oncology Research Professorship

Duke Research News 24 Cost-effective Use of Breast Cancer MRI; Exercise and Arthritis

25 Study Reveals New Understanding of Cholesterol’s Role in Bone Loss

26 Nurse Transition Program to Evaluate Safety and Outcomes

27 Women’s Wellness Cover Image: From left, Dr. Prashant K. Patel, Dr. Amrita Parikh and Dr. Vijay K. Juneja form the internal medicine team at Cary Internal Medicine & The Diabetes Center. Jim Shaw Photography.

2

The Triangle Physician

Women’s Wellness Center Offers Opportunities for Clinical Research


Experience makes good medicine accurate

rapid results

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Raleigh Radiology is the oldest, and one of the most respected radiology practices in the Triangle area. We offer exceptional imaging services that include MRI (Magnetic Resonance Imaging) at 5 convenient outpatient imaging facilities throughout Wake & Johnston counties. Our team of 25 board certified radiologists cover all subspecialty areas including neuroradiology, vascular and interventional radiology, women’s imaging, musculoskeletal imaging, and abdominal imaging. We are committed to providing the best care for your patients and being there when you need us. When a practice has been around as long as we have, it’s evident that our motto rings true. At Raleigh Radiology, experience “truly does” make good medicine.

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From the Editor

What If…

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

Type 2 diabetes is deadly and pervasive, yet largely preventable through healthy diet and regular exercise. Once diagnosed, diabetes management is doable, but difficult at best. Among those on the forefront of diabetes prevention and management in the RaleighDurham region is the health care team of Cary Internal Medicine & The Diabetes Center, our cover story this month. Together, with diabetes educators and dieticians, the physicians guide patient-centered teams to effect proper self-care practices. Dr. Prashant Patel also has taken a lead in advancing diabetes awareness locally. When learning all that’s involved to manage diabetes – the necessary self care and major lifestyle changes – those with type 2 can only wish they had fixed their unhealthy habits sooner. It would have been so much easier. That’s the message they didn’t hear or didn’t want to hear. What if that message could inspire the appropriate response? Think of the lives, hardship and money that could be saved. Breast cancer is as yet unpreventable, but radiologists are refining imaging methods for early detection. In this issue, Dr. Carmelo Gullotto discusses the benefits of magnetic

Editor Heidi Ketler, APR

heidi@trianglephysician.com

Contributing Editors Carmelo Gullotto, M.D. Paul J. Pittman, C.F.P. Jennifer S. Van Vickle, M.D. Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G Photography Jim Shaw Photography jimshawphoto@earthlink.net Creative Director Joseph Dally

jdally@newdallydesign.com

Advertising Sales Carolyn Walters carolyn@trianglephysician.com Natalie Snapp natalie@trianglephysician.com News and Columns Please send to info@trianglephysician.com

resonance imaging in combination with mammography and ultrasound. Just as powerful is public awareness of the importance of early detection. So thanks to Dr. Jennifer Van Vickle for an article that can help us set the record straight about mammography. Money is always top of mind, so returning is our resident financial planner, Paul Pittman. This month, his column is presented in a question-and-answer format that offers a story on thinking outside the box and a heads up about the new “post-modern” investment strategy. The October issue of The Triangle Physicians is a great read, with important insight, news and information. You are encouraged to join our list of contributors and advertisers, who are reaching more than 9,000 physicians, physician assistants and health care administrators. With that kind of readership, you can only wonder, what if… ? As always, our gratitude for all you do!

Heidi Ketler Editor

4

The Triangle Physician

The Triangle Physician is published by New Dally Design 9611 Ravenscroft Ln NW, Concord, NC 28027 Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401 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. Opinion expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. However, 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.


On the Cover

Cary Internal Medicine & The Diabetes Center Excellence in Diabetes, Heart and Stroke Care C

ary Internal Medicine & The Diabetes

physicians in Wake County to be recognized

diabetes to reduce complications has always

Center is a full-service internal medicine

by the National Committee for Quality

been central to our practice,” says Dr. Patel.

practice, specializing in the treatment and

Assurance for meeting the highest standard

management of diabetes, heart disease,

in diabetes care in 2004. They also earned

Drs. Patel and Juneja acquired Cary Internal

stroke and women’s health.

NCQA recognition for excellence in heart/

Medicine & The Diabetes Center at 103

stroke care.

Blaines Court, after its founder, Fred C.

Leading the practice are Prashant K. Patel,

Oliver, M.D., retired in 2000. Having been “Diabetes is, as yet, incurable, but it is

established in 1979, the medical practice is

who have long recognized the connection

manageable with aggressive lifestyle changes

the oldest in Cary. Amrita Parikh, M.D., joined

between diabetes and complications that

and medication. Because diabetes and pre-

the practice in 2006. All three physicians are

can lead to heart disease and stroke. Through

diabetes are associated with the myriad

certified with the American Board of Internal

their proactive, patient-centered approach to

health problems that internists treat, helping

Medicine and members of the American

diabetes management, they became the first

patients effectively manage diabetes and pre-

College of Physicians.

PHOTO BY JIM SHAW PHOTOGRAPHY

M.D., F.A.C.P., and Vijay K. Juneja, M.D.,

Dr. Amrita Parikh (left) answers patient Joti Pallan’s women’s health questions.

6

The Triangle Physician


Cary Internal Medicine offers a full range of

third is undiagnosed and untreated.)

medical services, including routine physical

•T  ype 2 diabetes accounts for 95

and gynecologic examinations. Patients

percent of all diabetes cases.

have in-office access to the latest diagnostic

vascular) complications. Unlike patients with type 1 diabetes, the majority of patients with type 2 do not need insulin to survive.

•A  pproximately 20.6 million Americans

tests and treatments, such as: • Cardiovascular risk assessment, using treadmill stress testing,

age 20 and older, or 9.6 percent of the

According

population, have diabetes.

Education Program, heart disease and stroke

•A  mong those age 65 and older 10.9

electrocardiograms and lipid profiles; • Pulmonary function testing, using spirometry, and nebulizer treatments; skin tag, wart and mole removal, biopsies and laceration repairs;

the

National

Diabetes

accounted for about 65 percent of deaths in

million, or 26.9 percent are diagnosed

people with diabetes in 2002. Adults with

with diabetes.

diabetes had heart disease death rates two

•O  f those younger than 20,

• Minor surgical procedures, such as

to

to four times higher than adults without

approximately 215,000 have diabetes

diabetes. Their risk for stroke also was two to

(type 1 or type 2).

four times higher.

•A  bout 79 million Americans over age

• Bone density testing; and

20 (50 percent of adults age 65 and

Obesity and age are major risk factors for

• Vision testing.

older) have pre-diabetes.

diabetes. Abdominal obesity is an indicator of insulin resistance. The abdominal fat is

Medical care is expedited and convenience

Type 1 diabetes can occur at any age, most

thought to prohibit insulin from converting

is enhanced by onsite laboratory services.

commonly in juveniles but also in adults,

sugar, starches and other food into energy needed for daily life.

“Diabetes is, as yet, incurable, but it is manageable with aggressive lifestyle changes and medication. Because diabetes and prediabetes are associated with the myriad health problems that internists treat, helping patients effectively manage diabetes and pre-diabetes to reduce complications has always been central to our practice.” – Prashant Patel, M.D., F.A.C.P.

“The epidemic of obesity in America and our aging population, coupled with lack of awareness, assure the incidence of diabetes will increase,” says Dr. Patel. NDEP estimates the total number of people with diabetes in the United States will be 30.3 million in 2030, which will place the United States third in global prevalence, after India and China. “If recent trends in diabetes and pre-diabetes prevalence rates continue linearly over the next 50 years, future changes in the size and demographic characteristics of the U.S.

State of Diabetes in Nation a Concern

especially in their late 30s and early 40s.

population will lead to dramatic increases

Unlike people with type 2 diabetes, those

in the number of Americans with, or at risk

The statistics for diabetes are grim. Diabetes

with type 1 generally are not obese. The

for, diabetes,” says Dr. Juneja. “The current

– a group of diseases marked by high levels

distinguishing characteristic of a patient with

increase in the number of new cases in

of blood glucose resulting from defects in

type 1 diabetes is that ketosis and eventually

people age 40 to 59 raises the need for

insulin production, insulin action or both –

ketoacidosis develop if insulin is withdrawn.

interventions focused on this segment of the

ranks seventh as the leading cause of death

Therefore, these patients are dependent on

population.”

by disease in the United States. According

exogenous insulin.

to the Centers for Disease Control and

NDEP estimated the cost of diabetes in 2010

Prevention, the risk for death among people

Type 2 diabetes comprises an array of

at $174 billion. The total includes direct

with diabetes is about twice that of people of

dysfunctions resulting from the combination

medical costs ($116 billion) and indirect

similar age who do not have diabetes.

of

and

costs ($58 billion), those associated with

inadequate insulin secretion. Its disorders

loss of work, disability and premature

are

hyperglycemia

death. After adjusting for population age

• Diabetes affects 25.8 million people in

and associated with microvascular (i.e.,

and gender differences, the average medical

the United States, or 8.3 percent of the

retinal, renal, possibly neuropathic) and

expenditures among people with diagnosed

population. (Of that total, about one-

macrovascular (i.e., coronary, peripheral

diabetes were 2.3 times higher than what

Its 2011 fact sheet also reports:

resistance

to

characterized

insulin by

action

October 2011

7


over time), blood pressure and low-density lipoprotein cholesterol values – collectively known as the “ABCs” of diabetes. A1c values and self-monitoring of blood glucose (SMBG) guide therapy for achieving glycemic targets and minimizing the risk of complications. The self-care plan takes into consideration the patient’s age, school or work schedule, physical activity, eating patterns, social situation and cultural factors, and presence of complications of diabetes or other medical conditions. While

a

National

Diabetes

Education

Program (NDEP) study in 2007 found an acceptance of the importance of maintaining individual ABC goals among physicians, a significant number of them recognized their patients were not reaching their goals. Successful

management

goes

beyond

teaching the ABCs, says Dr. Patel. “The didactic approach is to teach the relevant information about the ABCs and provide recommendations to patient care. The approach that empowers patients with knowledge and understanding of the ABCs within the context of personalized goalsetting, skill-building and one’s daily roles is Dr. Prashant Patel (right) explains the features of an insulin pump with patient Ronald Herschkorn.

the most effective,” he says.

expenditures would be in the absence of

individualized care for patients with pre-

At The Diabetes Center, patients have an

diabetes.

diabetes and diabetes is based on proven

integrated health care team that includes

models and backed by years of experience,

a certified diabetes educator, a dietician,

“Treatment costs for people with diabetes are

says Dr. Patel. “Our practice is uniquely

the referring physician and other health

more than double those for people without

positioned to meet the growing need.”

care providers, as necessary. The team is

diabetes, mainly because of the high costs associated with complications,” says Dr. Juneja. Cardiovascular disease remains the most costly complication of type 2 diabetes.

coordinated by Drs. Patel and Juneja.

Diabetes Management Is Patient-Centered and Goal-Oriented The

foundation

for

effective

“The therapeutic alliance works closely with the patient to develop attainable goals diabetes

for metabolic control, improved lipid levels

The positive news is that diabetes can be

management is patient understanding and

and reduced blood pressure,” says Dr. Patel.

prevented or delayed. “Lifestyle changes

self-care practices that empower him or her

“It is a collaborative process in which the

and ongoing management of both type 1

to make day-to-day and often hour-to-hour

diabetes educator helps the patients gain the

and type 2 diabetes can also prevent many

decisions.

knowledge and problem-solving and coping

complications associated with the disease,”

skills needed to successfully self-manage the Patients must have a working knowledge of

says Dr. Juneja.

disease and its related conditions.”

the three key metabolic markers: hemoglobin The

8

Diabetes

Center’s

The Triangle Physician

comprehensive,

A1c (a measure of average blood sugar levels

“Our practice is unique in that we effectively


“Primary prevention remains an important area of focus for us. There needs to be more communication about pre-diabetes and the power of diabetes prevention with patients, as well as other health care professionals.” – Prashant Patel, M.D., F.A.C.P. manage diabetes in adults from A to Z,

month. Now my readings are consistently

beginning with diagnosis,” says Dr. Juneja.

between 100 to 130. I wish I had been referred sooner!”

Patient Frankie Lemons was referred by her serious hypoglycemic episodes resulting in

Medication Management and Monitoring

Oral diabetes medication is often prescribed

hospitalization. “When I was diagnosed with

The Diabetes Center physicians have the

for type 2 patients whose bodies still

type 2 diabetes, I believed oral medication

specialized understanding to prescribe

produce some insulin. When beta-cell failure

would be enough to manage my blood sugar

injectable insulin, oral pills and medication

develops, insulin injections are required

swings. Now, I have a better understanding

for

and prescribed either in combination with

of the impact of diet and lifestyle on my

weight control, as needed and to best

diabetes. I have focused on the proper

suit the patient. “There are many forms of

adjustments and haven’t been to the hospital

medication, and the type selected is based

Advanced care using a continuous glucose

since. I feel I have gotten my life back, and I

on a body’s response to it and the patient’s

monitoring system is prescribed for patients

am so grateful.”

ability to monitor and self-administer,” says

with diabetes that is difficult to control.

Dr. Patel.

“Studies have shown the benefits of using

internist to The Diabetes Center after several

blood

pressure,

cholesterol

and

diabetes pills or alone.

a CGM (continuous glucose meter), even

“I was referred by my family physician to The Diabetes Center because of wide variations

Insulin is the only medication that can be

in people with good blood sugar control,”

in my glucose levels, from the 40s to 500s,”

used to control the increases in blood sugar

says Dr. Patel. “The patients spent more time

says Ronald Hershkorn, a patient with type

that occur with type 1 diabetes. For those

every day within their target glucose range,

2 diabetes. “The staff and physicians helped

with type 2, insulin may be used alone or

had lower A1c levels and fewer low blood

me get started on the insulin pump, and

in combination with diabetes pills or other

sugar emergencies.”

I have had amazing results in less than a

medications. New CGM technology has enhanced comfort and convenience, minimizing user error in calculations and leading to greater patient compliance. Since continuous monitors are not as accurate as the standard meters, patients are advised to use a standard meter one or two times a day to confirm their CGM reading.

Lifestyle Changes and Weight Loss The Diabetes Prevention Program, a large study of people at high risk for diabetes funded by the National Institute of Diabetes and Digestive and Kidney Diseases, showed lifestyle intervention to lose weight and increase physical activity reduced diabetes

October 2011

9


“If recent trends in diabetes and pre-diabetes prevalence rates continue linearly over the next 50 years, future changes in the size and demographic characteristics of the U.S. population will lead to dramatic increases in the number of Americans with, or at risk for, diabetes.” – Vijay Juneja, M.D.

Before people develop type 2 diabetes, they almost always have pre-diabetes – blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. In studies, the rate of progression has ranged from an average of three years to 10 years. NDEP reported in 2008 that a survey found only 25 percent of those at high risk for diabetes believed they were at risk. In addition, only a small percentage (9 percent) of the population at risk for developing diabetes had been told by their physician.

incidence, especially among adults age 60

problems, says Dr. Patel. The combination

and older. It also found lifestyle intervention

of conditions in metabolic syndrome – high

It is estimated that about one-third of the U.S.

to be more cost effective than medications in

blood pressure, elevated insulin levels,

population has pre-diabetes, but is unaware

people with type 2 diabetes.

excess body fat around the waist and

of it. Symptoms can be subtle – such as

abnormal cholesterol levels – increase the

excessive urination, thirst, itching, difficulties

risk of heart disease, stroke and diabetes.

concentrating, weight loss – or absent.

Early Intervention Can Turn Back the Clock

Statistics show that people with pre-diabetes

the support of a network of health care professionals, have the greatest effect

“Primary prevention remains an important

compared to people with normal blood

managing their diabetes,” says Dr. Patel.

area of focus for us,” says Dr. Patel, “There

glucose. “Those with pre-diabetes may

“Those who pursue aggressive lifestyle changes, such as losing weight, exercising and quitting smoking, in addition to

have a 1.5-fold risk of cardiovascular disease

needs to be more communication about

already be experiencing long-term damage

This treatment approach also can delay

pre-diabetes and the power of diabetes

to the body, especially the heart and

or prevent the development of metabolic

prevention with patients, as well as other

circulatory system,” says Dr. Patel.

syndrome

health care professionals.”

and

further

serious

health

Dr. Vijay Juneja and patient Frankie Lemons review the results of her continuous glucose monitoring.

10

The Triangle Physician


than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain,” says Dr. Parikh. Cary Internal Medicine physicians also monitor women for diabetes after they have experienced gestational diabetes. “Blood sugar usually returns to normal soon after delivery for most women with gestational diabetes, but the risk of developing type 2 diabetes in the future remains,” says Dr. Parikh. “It is estimated that half of women with gestational diabetes will develop diabetes within 10 to 15 years.”

Advocate for Patients and Physicians pre-diabetes,

“As with men, women’s most common heart

Dr. Patel has embraced a mission of patient

intervening early can actually turn back

attack symptom is chest pain or discomfort.

advocacy and medical stewardship.

the clock and return elevated blood

But women are somewhat more likely

“For

some

people

with

glucose levels to the normal range,” says Dr. Patel. Studies have shown that those

1

with pre-diabetes can prevent or delay the

2

development of type 2 diabetes by up to 58 percent through changes to their lifestyle that include modest weight loss and regular exercise.

5

Dr. Patel advises that testing for pre-diabetes

3

in patients with risk factors for diabetes begin at age 12 in children who are overweight and be repeated every three years.

Women’s Health, Heart and Diabetes The physicians with Cary Internal Medicine & The Diabetes Center are keenly aware of

4

the issues surrounding women’s health, particularly cardiovascular disease, the leading cause of death in women. Although heart disease is sometimes thought of as a “man’s disease,” it kills about the same number of women and men each year in the U. S. Unfortunately, 36 percent of women in a 2005 Centers for Disease Control and Prevention survey did not perceive themselves to be at risk for heart disease.

1. This 90°, soft cannula infusion set combines ease of use with maximum comfort. The Quick-serter® may be used to easily and comfortably insert the cannula under your skin. 2. The Quick-serter is the insertion device for the Quick-set. The Quick-serter insertion device makes insertions quick, easy, and virtually painless. 3. The Paradigm Revel Insulin Pump lets you customize your insulin delivery to fit your lifestyle and leave the hassle of insulin injections behind. The Revel Insulin Pump comes CGM ready, so when you want to add a transmitter and glucose sensor to your Revel Insulin Pump, you can have the added protection from lows and highs 4. CareLink® USB upload device wirelessly sends data from your MiniMed Paradigm® Insulin Pump to CareLink® Personal software. 5. A compatible glucose meter is included with all new insulin pump orders which automatically sends your test results wirelessly to your Paradigm® Revel™ Insulin Pump. This helps reduce the number of button pushes and data entry mistakes, making insulin pump therapy more convenient and accurate.

October 2011

11


From left, Angela Allen, Dawn Howdyshell and April Richardson are medical assistants at Cary Internal Medicine & The Diabetes Center.

He is frequently featured in the local media to help

North

raise awareness of diabetes prevention and early

Wainwright to the Quality, Access, Value Committee

detection. He has been involved in guiding health

and most recently the Acute Care Services Committee,

care policy in Washington, D.C., as a member of the

also referred to as the CON committee. In the fall of

Leadership Council for Improving Cardiovascular

2009, he was invited to serve on the Legislative Cabinet

Care, and in North Carolina, as a member of American

of the North Carolina Medical Society.

Carolina

House

Representative

William

Diabetes Association Leadership Council. He also served on the physician’s advisory board of a major

This year, Dr. Patel was honored to be selected for the

North Carolina health insurance company.

“Physician Profile” by the editorial board of The Wake

Dr. Prashant K. Patel

County Physician magazine. He also was selected as Dr. Patel is a founding member of the Triangle Indian-

a 2012 scholar of the North Carolina Medical Society

American Physicians Society (TIPS), which began

Leadership College.

in 2006, and of the North Carolina Indian-American Political Action Committee.

Physician Consultation and Referral Cary Internal Medicine & The Diabetes Center offers

In these capacities, he led a team of 10 physicians to

consultation services on diabetes for physicians who

the halls of Congress Oct. 8, 2009, when they met with

are in a position to detect diabetes early – namely

six North Carolina congressional leaders in the House

family physicians, pediatricians and primary care

and Senate about health care reform. In particular, they

physicians, such as internists and gynecologists.

Dr. Vijay K. Juneja

discussed a permanent fix to the flawed sustainable growth rate formula and effective tort reform.

Referrals also are welcome.

On Jan. 1, 2010, Dr. Patel was awarded a fellowship

Contact Cary Internal Medicine & The Diabetes Center

by the American College of Physicians. On March 1,

at (919) 467-6125 or visit www.caryinternalmedicine.

2010, he was appointed by Gov. Beverly Perdue to the

com. Dr. Patel also suggests the website

State Health Coordinating Council (SHCC). He was

betterdiabetescare.nigh.gov for more information.

then appointed by SHCC Chairman and the honorable

12

The Triangle Physician

Dr. Amrita Parikh


Radiology

Mammograpy

Making Sense of Mixed Messages By Jennifer S. Van Vickle, M.D.

The American Cancer Society recommends yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.

D

uring the past two years women have been barraged with mixed messages about mammography. The traditional recommendation of yearly mammography beginning at age 40 was thrown into question when the United States Preventive Services Task Force published recommendations in 2009. This left many women and health care providers confused about who should have mammograms, how often and when. Fortunately, the information isn’t as confusing as it seems. Numerous studies have shown

that mammography saves lives. The most recent information comes from the Swedish Two-County Trial. The study is the longest running prospective randomized controlled study of mammography ever conducted. The study included 133,065 women ages 45 to 74 and published initial results 10 years after the beginning of the study. The 10-year data showed a significant reduction in breast cancer mortality. The data published this summer include 29 years of follow-up and show that the benefit has doubled. This is consistent with other prospective studies. The combined data

of multiple prospective studies shows that mammography saves lives. The U.S. Preventive Services Task Force agrees that mammography saves lives. What the task force focuses on is tradeoffs related to a woman’s age, overall health and risk of having breast cancer. Since younger women are less likely to have breast cancer than older women, young women are more likely to have unnecessary call-back mammograms or biopsies that are benign. On the other

hand, older women may be more likely to have a positive callback or biopsy, but to be in poor health. As a result, diagnosing and treating the cancer may or may not prolong their lives. When informed and involved in the decision, most younger women prefer to take these issues in stride for the possibility that mammography may save their life. For women in poor health, discussion with their health care provider is important in deciding whether screening mammograms make sense for them.

Dr. Jennifer Van Vickle has been a women’s imaging and abdominal imaging radiologist with Raleigh Radiology since 2002. She also is medical director of ultrasound at Rex Hospital. Dr. Van Vickle earned her bachelor’s degree from the University of Chicago and master’s degree in theology, followed by her medical degree from Duke University. She completed an internship in internal medicine, a residency in diagnostic radiology and a fellowship in abdominal imaging and mammography at Duke University Medical Center. Areas of expertise include breast imaging, breast intervention, and abdominal and pelvic imaging, using computed tomography, ultrasound and magnetic resonance imaging.

These issues are taken into consideration by the American Cancer Society in its mammography guidelines. The American Cancer Society recommends yearly mammograms starting at age 40 and continuing for as long as a woman is in good health. One concern is that confusion about this information will dissuade women who may benefit from mammograms from getting them because they are anxious, have busy schedules or have trouble making financial ends meet. It is important to make decisions about screening mammograms based on a realistic perspective about mammography’s benefits, rather than these obstacles. Raleigh Radiology offers: • Extended morning, evening and weekend mammography hours. • Online and call-in scheduling • Rapid reporting to minimize the length of time women wait for their results. • Ultrasound-guided biopsies with rapid turn-around times. • Free screening mammograms to uninsured on National Mammography Day each October. • Self-pay discounts. • Educational materials to help women understand screening and self-breast exam. October 2011

13


Radiology

MRI Is Important Adjunct in

Breast Cancer Screening By Carmelo Gullotto, M.D.

M

agnetic resonance imaging (MRI)

scar and recurrent breast cancer in

Recent literature has demonstrated that

of the breasts is the most accurate

patients who have already been treated

in BRCA1 and BRCA2 carriers annual

for breast cancer.

surveillance with breast MRI is associated

imaging method to detect and stage breast cancer. Used in conjunction with

• Evaluating response to cancer treatment.

with a significant reduction in the incidence

mammography and ultrasound, breast MRI

• Identifying cancer not detected by

of advanced-stage breast cancers. In the

can solve diagnostic dilemmas and uncover

mammography in high-risk patients.

cohort of 1,275 women evaluated by Warner

occult disease.

et al, the group of patients in the breast MRI

Breast MRI can be helpful in these situations:

For certain women at high risk for breast

group had a significantly greater incidence

cancer,

Society

of being diagnosed with ductal carcinoma

dense

recommends annual breast MRI screenings

in situ and stage 1 breast cancer. While

breasts (as often found in younger

as an adjunct to screening mammography.

the group that did not undergo annual

women) when mammography and

Among them are women who have a greater

screening, breast MRI had a significantly

ultrasound fail to detect or characterize

than 20 percent calculated lifetime risk of

higher incidence of a diagnosis of stage 2 to

a palpable abnormality.

breast cancer (average lifetime risk in the

stage 4 breast cancer. These data confirm the

• Determining the extent of a known

United States is 12-13 percent) as defined by

ability of breast MRI to detect breast cancer

cancer and evaluating for possible

a risk calculator such as the Gail model. Also

at its earlier stages when it is potentially

occult disease in the contralateral

included in this group are those who have

more curable.

breast

detected

BRCA1 and BRCA2 gene mutations and those

mammographically. MRI is the most

with a first-degree relative who is a BRCA gene

Patients for whom the ACS states that

sensitive and specific imaging method

carrier. Typically patients in this high-risk group

there is currently insufficient evidence to

for local staging of breast cancer.

undergo alternating breast MRI and screening

recommend for or against screening breast

mammograms at six-month intervals.

MRI includes:

• Imaging

mammographically

that

was

not

• Differentiating between post surgical

the

American

Local staging breast MRI: Mammographically detected invasive ductal carcinoma was identified in the left breast (yellow arrow). Right breast lesion was seen on MRI but was mammographically occult (red arrow). Subsequent MRI-guided biopsy of the right breast lesion yielded invasive ductal carcinoma.

14

The Triangle Physician

Cancer

High-risk screening breast MRI: Chronic seroma from a prior procedure was identified (yellow arrow). An area of suspicious enhancement was mammographically occult (red arrow). Subsequent MRI-guided biopsy yielded high-grade ductal carcinoma in situ.


NEWSOURCE-JUN10:Heidi

8/5/10

Dr. Carmelo Gullotto is a body imaging radiologist and breast magnetic resonance imaging specialist, board certified in diagnostic radiology by the American Board of Radiology. He has been with Wake Radiology since 2004. Special clinical interests are abdominal imaging and MRI. A native of Syracuse, N.Y., Dr. Gullotto is a graduate of Duke University School of Medicine in Durham, where he was a resident in diagnostic radiology and a fellow in abdominal imaging. He is a member of the Radiological Society of North America, North Carolina Medical Society and the Wake County Medical Society.

12:57 PM

Page 1

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• Patients with a 15-20 percent lifetime risk of breast cancer • Patients with a personal history of

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lobular carcinoma in situ, atypical lobular or atypical ductal hyperplasia • Patients with a personal history of breast cancer

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population, breast MRI is a useful adjunct to screening mammography in the detection of breast cancer, a problem solver for diagnostic dilemmas not fully evaluated by mammography and ultrasound, and useful in evaluating extent of disease in patients with newly diagnosed breast cancer. Citations “American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography,” published in the March/April 2007 CA: A Cancer Journal for Clinicians (Vol. 57, No 2: 75-89). First author: Debbie Saslow, Ph.D., American Cancer Society. “MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer,” published in the March 29, 2007 New England Journal of Medicine (Vol. 356, No 13: 1295-1303). First author: Constance D. Lehman, M.D., Ph.D., University of Washington Medical Center, Seattle. “Prospective Study of Breast Cancer Incidence in Women With a BRCA 1 or BRCA 2 Mutation Under Surveillance With and Without Magnetic Resonance Imaging,” published in the May 2011 Journal of Clinical Oncology (Vol. 29, No 13: 1652-1654). First author: E Warner, Sunnybrook Odette Cancer Centre, Women’s College Research Institute, Ontario.

Managing your patients’ health is your life’s work. Managing physicians’ wealth is mine. Financial Rx for Physicians: • • • • •

Aiding Wealth Creation, Preservation and Protection Business Management Tax-strategies Liability Protection Asset Preservation

Trust your wealthcare to a specialist. The Preferred ClienT GrouP Paul J. Pittman CFP® President and Managing Director 919-459-4171 paul.pittman@pcgnc.com www.pcgnc.com Securities offered through LPL Financial Member NASD/SIPC Wealth preservation and protection • estate planning • charitable giving • buy-sell agreements and transfers

October 2011

15


Your Financial RX

Putting Paul in the Hot Seat By The Triangle Physician

Because markets are inefficient, you have to combine non-correlating assets, as well as defensive positioning and active management. It’s not a buy-and-hold kind of world out there anymore.

would give me a great sense of satisfaction. I now feel as if I am making something good out of what my parents went through. TTP: What has been your biggest surprise in working with physicians? Paul: Physicians are caregivers and healers, but they are also business owners. I used to be surprised by their resourcefulness, but not any more. One outstanding example

This month, The Triangle Physician is going

gave me the desire and conviction to work

is a urologist in Cary, Dr. Marc Benevides.

to turn the tables a bit and interview Paul

with families to help them achieve financial

Not only is he a spectacular physician on

Pittman, a certified financial planner and

peace of mind. I don’t want other people to

the cutting edge of his specialty and a great

regular contributor to this column.

go through the struggle my family did, and

person, but he is also an extremely astute

I don’t want other people to lose what they

businessman.

TTP: Paul, you have been writing

already have.

your Financial Rx column for many

He once old me that as the check signer

years now. Aside from all of the great

TTP: It sounds like very hard lessons to

for his practice he would be astonished by

information you have passed on, what

learn, and your parents must have been

the amount paid for medical supplies. After

makes you different from all of the

good teachers.

further investigation, he was “horrified.” He

financial advisors out there?

could not believe what his practice was Paul: Terrific teachers and great role models

paying for catheters, gauze, urine strips and

Paul: I know there are many out there who

for me on how to live life. As I watched my

such.

physicians could work with, but I truly believe

parents during those tough years, it became

in what we’re doing here (The Preferred

apparent to me that they were very clear

Client Group), and that what we stand for is

on two things. First, taking care of family

unique. Let me share something with you.

was their No. 1 priority. They made sure we

When I was 17, my father was laid off from a

had basic material needs taken care of and

long career and found himself unemployed

then they surrounded us with love. Second,

at age 56. Not many companies were looking

they knew what they valued and what they

to hire a 56 year old. My mother had a full-

cherished, and they lived those values.

time job, but they struggled to work and raise three kids. Money was always tight. We lived

Because of my parents’ experience, I

from paycheck to paycheck. But through

realized that my passion was to help people

their love and hard work, we made it.

financially. If I could, through thoughtful financial planning, help people multiply

The story has a happy ending, but that

their current savings and earnings, as well

experience left an indelible mark on me. It

as protect what they already have, then that

16

The Triangle Physician


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

some bonds and some treasuries; I am

theory, because we see the markets as

referring to philosophical diversification.

inefficient. This means you have to combine

If the economy and markets have told

non-correlating assets, as well as defensive

us anything over the last 10 or so years,

positioning and active management. It’s

it is to incorporate different investment

not a buy-and-hold kind of world out there

philosophies in your investments.

anymore.

Modern portfolio theory sees the markets

TTP: Paul, thank you for your time and

as efficient. This may have been the case in

insight. We will continue this interview

the past, but not anymore. We now utilize

in next month’s issue.

what we refer to as post-modern portfolio

So he decided to do something about it. He found that many of the established United States manufacturers were willing to deal with him directly, that products his practice already used could be obtained at a significantly reduced price. Interestingly enough, it didn’t stop there. The desire to save on overhead in his office morphed into Physicians’ Own Pharmacy, a physicianowned medical supply company. Any physician interested in saving overhead at no expense to quality can become a member shareholder. Details are available at popmedical.com. Physicians have relinquished so much control of so many aspects of their practices to insurance companies, vendors, etc., this is one way to regain an element of that control and expense. And it’s one example of how physicians are thinking outside of the box when it comes to running the business side of their practice. TTP: Interesting story. We sometimes forget that physicians are businesspeople, too. Any investment advice you’d like to give our readers in this economy? Paul: Absolutely! One of the most overused terms in the investment business is diversification, but it is very important. I am not just talking about owning some stocks, Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

October 2011

17


WakeMed News

Physician Network Grows The WakeMed Physician Practices network

Madan, M.D., who brings 25 years of family

access, supporting a team of directors,

continues to expand access in Wake County,

medicine experience.

managers and staff.

Accent Urgent Care centers in Raleigh and

Several new physicians will join WakeMed’s

Mr. Harrington will oversee all aspects of

Cary and new primary care practices in

existing primary care practices this fall. The

the revenue cycle, including continued

north Raleigh and Apex. New physicians

following physicians joined this summer:

process improvements undertaken during

most recently with the acquisition of two

also are being added in the existing Brier

the past two years. Additionally, he will be

Creek and downtown Raleigh primary care

Amy Erickson, D.O., joined Brier Creek

tasked with managing health care reform

practices.

Medical Group in August as a board-certified

implementation related to revenue cycle,

family medicine physician with experience

and adjusting processes and procedures to

The urgent care centers joined the WakeMed

in private practice and in the United States

accommodate system growth.

Physician Practices network Oct. 1. The

Air Force. Dr. Erickson earned her medical

Cary location is adjacent to WakeMed

degree in osteopathic medicine from the

“Mr. Harrington was selected from a wide

Cary Hospital and the Raleigh location is

University of New England College of

range of well-qualified candidates for

near the corner of Blue Ridge and Harden

Osteopathic Medicine, Biddeford, Maine,

his depth and breadth of experience in

roads. Accent Urgent Care serves adults

and completed her residency in family

outstanding health care organizations. His

and children of all ages seven days a week,

practice at Albany Medical College.

broad financial and revenue cycle expertise

with more than a dozen providers, including physicians and physician assistants.

will help us negotiate highly competitive Brian Klausner, M.D., is board certified in

managed care contracts and prepare for

internal medicine, and joined City Center

anticipated changes related to health care

WakeMed also acquired North Wake Internal

Medical Group in downtown Raleigh in

reform. We are looking forward to welcoming

Medicine, a well-established primary care

September. Dr. Klausner received his

him into the WakeMed family,” said William

practice in north Raleigh, which will add to

medical degree from Georgetown University

K. Atkinson II, Ph.D., president and chief

its physician network Susheel Atree, M.D.;

School of Medicine and completed his

executive officer.

Behnaz Atree, M.D.; and Rosa Messer,

residency in internal medicine at University

M.D., effective Nov. 1. The practice at

of Chicago Hospitals.

WakeMed North Healthplex will be relocated

Mr. Harrington has more than 25 years of experience in health care finance. Most

to the adjacent Physicians Office Pavilion

VP of Revenue Cycle Named

recently, he served as vice president of

at North Healthplex to accommodate the

Effective Oct. 17, Dudley Harrington will

managed care and revenue cycle for MCG

expansion of North Healthplex into a full-

assume the role of WakeMed Health &

Health Inc., in Augusta, Ga. MCG Health

service women’s hospital.

Hospitals vice president of revenue cycle,

is a not-for-profit corporation supporting

responsible for managing its $1 billion in net

the research and education mission of the

revenues.

Medical College of Georgia by operating a

WakeMed Physician Practices established Wake Specialty Physicians-Apex Medical

478-bed medical center, 154-bed children’s

Group, a new family medicine practice

In this role, Mr. Harrington will lead patient

medical center, sports medicine center,

June 1. The practice is located in WakeMed

financial services, reimbursement/managed

ambulatory care center and radiation

Apex Healthplex and features Ragini

care and the administrative arm of patient

therapy center.

18

The Triangle Physician


WakeMed News Prior to MCG Health, he was director of

she managed the financial and operational

“Pandora was offered the permanent position

managed care services for McLeod Health

audit functions for the system and was

because of her perpetual professionalism,

Inc., in Florence, S.C., and previously was

the key contact on the Health Insurance

integrity, trustworthiness and exceptional

in the same position with Carolinas Hospital

Portability and Accountability Act and

performance during her long tenure at

System in Florence.

confidentiality-related matters.

WakeMed,” said William K. Atkinson II, Ph.D., president and chief executive officer.

Mr. Harrington earned a bachelor’s degree in

Last year, Ms. Holloway was named interim

“Pandora has significant audit experience

science, with a concentration in accounting,

executive director of corporate compliance

and will work closely with WakeMed’s full

and master’s in business administration from

and chief compliance officer, responsible for

leadership team to adhere to and strengthen

Francis Marion University. He is also a fellow

all compliance-related activities, including

our corporate compliance policies.”

of the Healthcare Financial Management

compliance with the requirements in

Association.

contractual agreements with the Centers for

Ms. Holloway holds a master’s degree in

Medicare and Medicaid Services and the

business administration, which she earned

Department of Health and Human Services,

from Pfeiffer University, and is certified in

Office of the Inspector General.

health care compliance and as an internal

Compliance Officer Accepts Permanent Post Pandora

Holloway

WakeMed

Health

has &

been Hospitals

named chief

compliance officer.

auditor. She also is a guest lecturer with the Ms. Holloway is responsible for helping

University of North Carolina School of Public

the organization stay abreast of laws and

Health, recipient of the WakeMed Circle of

regulations, communicating changes and

Quality Service award and a member of the

Ms. Holloway has been a WakeMed

providing education related to compliance

Garner Chamber of Commerce Board of

employee since 1982, serving the system

matters. She also will identify challenges and

Directors.

for the majority of this time as director of

work to strengthen corporate compliance

compliance and audit services. In this role,

across the system.

Rex Health Care News

Cary Surgery Center Earns Accreditation

The Triangle Physician 2011/12 Editorial Calendar November

Urology – Alzheimer’s

Rex Surgery Center of Cary L.L.C. has earned a one-

“I am proud of our team for their flexibility and

year term of accreditation from the Accreditation

hard work that it took to receive this accreditation,”

Association for Ambulatory Health Care Inc.

said Cindy Vincent, R.N., M.S.N., director of Rex

December

Pain Management – Sleep Disorder

January

Diabetes – Banking

February

Heart Disease in Women Accounting for Medical Practices

Surgery Center of Cary.

March

Rex Hospital’s surgical services have long been the leading choice for Wake County residents, with

During the last fiscal year, Rex Surgery Center

more than 34,000 procedures performed last year.

physicians performed more than 3,000 outpatient surgeries in gynecology; plastic surgery; ear

Men’s Health – Vision New Medical Devices

April

Women’s Health Marketing Your Services

May

Accreditation was achieved through participation

nose and throat; orthopedics; urology; podiatry;

Orthopedics – Medical Insurance

in the Early Option Survey Program, a voluntary

and other general clinical areas at the centrally

Neurology – Sleep Apnea

process that enables an organization to measure

located, state-of-the-art facility. Rex Surgery Center

the

of Cary partnered with 25 surgeons in February to

quality

of

services

and

performance

against nationally recognized standards. The

transition to a freestanding surgery center.

June July

New Imaging Technologies Electronic Medical Records

August

Digestive Disease Computer Technologies

accreditation process involves self-assessment

September

by the organization, as well as a thorough review

The

by the Accreditation Association for Ambulatory

symbol that an organization is committed to

Health Care Inc. (AAAHC) surveyors, who have

providing high-quality health care and that it has

extensive experience in the ambulatory health

demonstrated that commitment by measuring up

care environment.

to the nationally recognized high standards.

AAAHC

accreditation

certificate

is

a

Sports Medicine – Physical Therapy

October

Breast Cancer Reconstructive Surgery

November

Urology – Robotic Surgery

December

Pain Management

October 2011

19


UNC Hospital News

Country’s First Inpatient Perinatal Psychiatry Unit Opens The University of North Carolina Department

programming for women during pregnancy

of Psychiatry and the UNC Women’s Mood

and postpartum. Services include:

Disorders Program have opened a five-bed unit for women with moderate to severe post-partum depression (PPD), the first of its kind in the country.

positive mother-baby interaction

• Individualized assessment and treatment

patient rooms refrigeration and freezer storage •L  actation, nutrition and ob-gyn

•B  iofeedback therapy

5 percent of which will need specialized

•M  other-infant attachment therapy;

inpatient care.

•F  amily and partner-assisted

consultants For general information about our Women’s

interpersonal psychotherapy

Neurosciences Hospital will offer specialized

•H  ospital-grade breast pumps,

psycho-educational, art and

Ten to 15 percent of women will have PPD,

units, the new unit within the North Carolina

•G  liders for pumping and nursing in

plans with a multidisciplinary team •G  roup therapies, including behavioral, mindfulness

Modeled after European mom-and-baby

•E  xtended visiting hours to maximize

Mood Disorders Program, call (919) 966-9640.

•T  herapeutic yoga geared for pregnancy and postpartum women

To make referrals to the inpatient program, call the UNC Psychiatry Admissions Office at

•P  rotected sleep times

(919) 966-8721.

Scientist to Study Post-Mastectomy Breast Reconstruction Decision Making A UNC School of Medicine physician/

patients’ decisions. “Deciding about breast

years to understand consumers’ preferences

scientist has received a five-year grant

reconstruction requires a patient to predict

about purchasing decisions. We will use it

award to examine patients’ decision-making

how she would feel after the procedure,

to better understand women’s preferences

process about breast reconstruction and the

a process called ‘affective forecasting.’

about breast reconstruction. We also plan to

effects of reconstruction on quality of life and

Extensive

has

evaluate the ability of breast cancer patients

body image.

shown that people have difficulty making

to predict how they will feel after surgery,

accurate predictions about how they will

which is so critical to decision making, yet

The $862,700 career development award

feel, tending to overestimate the effects of

largely unexplored.”

to Clara Lee, M.D., M.P.P., a plastic and

disease and treatments on their wellbeing

reconstructive surgeon, is from the National

and to underestimate their ability to adapt

The goal of the research is increased

Institutes of Health.

to change and the effects of other aspects of

awareness that “will eventually lead to more

their lives.”

patients receiving the treatments they prefer

psychological

research

Dr. Lee, an associate professor of surgery,

and ultimately to better quality of life for

explained, “The decision about whether

Dr. Lee is a member of UNC Lineberger

or not to have breast reconstruction

Comprehensive Cancer Center medical

should depend almost completely on a

staff. She is a recipient of a 2010 Lineberger

Dr. Lee will be mentored during the grant

patient’s personal preferences. And yet

Population Sciences Award, which enabled

period by Michael Pignone, M.D., M.P.H., a

we find that rates of breast reconstruction

her and her team to conduct some of the

professor of medicine, chief of the division of

in the United States vary greatly by race,

preliminary research that supports the NIH

general medicine and clinical epidemiology,

socioeconomic status and geography. In this

project.

and

study, we will evaluate the decision-making

women with breast cancer.”

a

member

of

UNC

Lineberger

Comprehensive Cancer Center; and Peter

process and the quality of decisions about

The study is unique in several ways. One

Ubel, M.D., John O. Blackburn Professor of

reconstruction.”

is the use of a technique from marketing

Marketing, Fuqua School of Business, and

research

analysis,”

professor, Sanford School of Public Policy at

The research team also intends to study

according to Dr. Lee. “Market researchers

Duke University. Both are national experts in

some novel psychological aspects of

have been using conjoint analysis for many

medical decision making.

20

The Triangle Physician

called

“conjoint


UNC Hospital News

Investigation Reveals Potential of New Nanoparticle Design for Cancer Therapy A new type of nanoparticle developed

significant growth inhibition of pancreatic

are more easily targeted to tumors than most

in the laboratories at the University of

tumors, which are extremely difficult to treat.

existing particles. We need to thoroughly

North Carolina has shown potential for

The nanoparticle has two to three times the

determine the pharmacokinetics and other

more effective delivery of chemotherapy

therapeutic efficacy over oxaliplatin.

important properties of the PSQ particle in

to treat cancer. Wenbin Lin, Ph.D., Kenan

order to translate this particle platform to the

Distinguished Professor of Chemistry and

The nanoparticle is different from other

Pharmacy, and colleagues report their

nanoparticles in its high drug loading and

finding in the Sept. 14 issue of Angewandte

its ability to release chemotherapeutics in a

Other UNC scientists involved in the research

Chemie,

controlled fashion. The release of therapeutic

are graduate students Joseph Della Roca,

cargoes depends on the naturally occurring

B.S.; Rachel C. Huxford, M.S.; and Erica

molecules that are more abundant in many

Comstock-Duggan, B.S.

the

German-based

flagship

chemistry journal. In laboratory studies, Dr. Lin and colleagues

clinic.”

tumors.

developed and tested a new type of

This work is supported by 2010 funding

nanoparticle that can deliver larger amounts

Dr. Lin explained: “The polysilsesquioxane

from

of a drug and will not leak the drug as the

(PSQ) particle we have developed carries

Cancer

particle circulates through the blood stream

extremely high loadings of oxaliplatin-

Partnerships and the Carolina Center of

on its way to the target.

based chemotherapeutics. The particles

Cancer Nanotechnology Excellence. The

the

National

Cancer

Nanotechnology

Institute’s Platform

are stable under normal physiological

12 partnerships and nine centers were

In the proof-of-concept experiments, they

conditions, but can be readily reduced to

designed to promote and support individual,

tested the nanoparticle’s ability to deliver

release the platin cargoes in highly reducing

circumscribed multi-disciplinary research

therapeutic doses of the chemotherapy drug

tumor microenvironments that have high

projects that will address major barriers

oxaliplatin to colon and pancreatic tumors.

concentrations of reducing agents. As a result,

and fundamental questions in cancer using

The oxaliplatin-based particles showed

they have very little background release and

innovative nanotechnology solutions.

Inexpensive Infection Control Measures Could Save Lives and Billions of Dollars University of North Carolina at Chapel

associated pneumonias and central line-

The first intervention was strict enforcement

Hill researchers have found that adopting

associated bloodstream infections involved

of standard hand hygiene practices on the

an inexpensive set of infection control

simple steps that lead to dramatic reductions

unit. All health care workers are expected

measures could potentially save many

in not only the targeted infections, but also

to wash their hands with soap and running

thousands of lives and billions of dollars.

mortality and costs,” said Bradford D. Harris,

water or an alcohol-based rub on entering

The study appears in the September 2011

M.D. Dr. Harris led the study while serving as

and leaving a patient’s room, before putting

issue of Health Affairs.

an associate professor of anesthesiology and

on and after removing gloves, and before and

pediatrics in the UNC School of Medicine.

after any task that involves touching potentially

At any given time, one of every 20 hospital

He is now a medical officer at the U.S. Food

contaminated surfaces or body fluids.

patients has a hospital-acquired infection,

and Drug Administration in Washington, D.C.

according to the US Department of Health

The second intervention was implementing

and Human Services. This leads to an

The study was conducted in the Pediatric

a bundle of measures aimed at preventing

estimated 99,000 deaths in the United States

Intensive Care Unit at North Carolina Children’s

ventilator-associated pneumonia. Examples

each year and up to $33 billion in preventable

Hospital, which is one of the five University of

included elevating the head of the patient’s

health care costs.

North Carolina Hospitals. The study tested

bed while the patient is receiving breathing

three interventions aimed at preventing and

assistance from a ventilator, giving the

reducing hospital-acquired infections.

patient daily breaks from sedation and then –

“…Two

initiatives

targeting

ventilator-

October 2011

21


UNC Hospital News while the patient was unsedated – assessing

with central-line catheters still need them.

But adoption of the three interventions collectively could save this single hospital

whether or not the patient is ready to come off the ventilator, and providing daily oral

Results of the study showed that patients

unit an estimated $12 million a year, the

care (teeth brushing, mouth washes, etc.)

admitted after these interventions were

study found. If replicated nationwide, these

with a long-lasting antiseptic.

fully implemented were released from the

measures potentially could save thousands

hospital an average of two days earlier, their

of lives and billions of dollars each year.

ensuring

hospital stay cost about $12,000 less and the

compliance with guidelines for the use

number of patient deaths were reduced by

UNC co-authors of the study are Cherissa

and maintenance of central-line catheters.

2 percent.

Hanson, M.D.; Claudia Christy, Tina Adams,

The

final

Examples

intervention

included

was

using

Andrew Banks and Tina Schade Willis, M.D.

sponges

impregnated with an antiseptic, using

The costs for implementing these measures

Matthew Maciejewski, Ph.D, an associate

catheters

antibiotics

were modest. Examples include roughly $21

professor at Duke University School of

whenever possible and performing two

a day for oral care kits and about 60 cents a

Medicine who, holds adjunct professor

assessments per day of whether patients

day for antiseptic patches and hand sanitizers.

appointments at UNC, is also a co-author.

impregnated

with

24-Week Treatment for Hepatitis C Is Effective, Reduces Side Effect Exposure A new multinational study finds that a

treated with a combination of peginterferon alfa

therapy is just as effective as 48 weeks,” he

24-week treatment course for hepatitis C

and ribavirin, which is the current standard of

said. About two-thirds of the patients who

that adds telaprevir to peginterferon alfa

care. Nineteen of the patients in the study were

started with triple therapy were eligible for

and ribavirin is just as effective as a 48-week

enrolled at UNC Hospitals in Chapel Hill or at

shorter duration of treatment by clearing virus

regimen for many patients.

Medical Specialty Services in Greensboro, where

early in their treatment course.

UNC runs a hepatitis C practice in collaboration This is good news for up to four million

with the Moses Cone Health System.

people in the United States who suffer from

In addition, the study found uniformly high rates of sustained virologic response

this chronic liver disease, many of whom

All of the patients started the study by taking

regardless of the race or ethnicity of the

will undergo treatment for hepatitis C, said

all three drugs for 12 weeks. They stopped

patients, and no matter whether they had

Michael W. Fried, M.D. Dr. Fried is professor

taking telaprevir after week 12. Then patients

advanced fibrosis or cirrhosis of the liver.

of medicine at the University of North

who tested negative for the hepatitis C virus

Carolina at Chapel Hill, director of the UNC

were randomized to receive either 12 weeks

Side effects associated with telaprevir reported

Liver Center and a co-author of the Illuminate

or 36 weeks of additional treatment with

in the study include rash and anemia, but

study, published in the Sept. 15 issue of The

the other two drugs, peginterferon alfa and

in most cases these side effects were mild

New England Journal of Medicine.

ribavirin. One group received a total of 24

or moderate and could be managed by the

weeks of treatment while the other group was

patient’s physician, Dr. Fried said.

“The medications that we use to treat hepatitis

treated for 48 weeks.

C do have some side effects, and shortening

The

study

was

funded

by

Vertex

the duration of treatment shortens a patient’s

In the 24-week group, 92 percent of the

Pharmaceuticals and Tibotec. Vertex markets

exposure to these side effects,” Dr. Fried said.

patients ultimately achieved a sustained

telaprevir in the United States under the brand

virological response, meaning that the

name Incivek. Tibotec plans to market the

Lead author of the study, which was

hepatitis C virus remained undetectable in

drug in Europe.

conducted at 74 sites in Belgium, the

their blood after treatment was discontinued.

Netherlands and the U.S., was Kenneth E.

In the 48-week group, 88 percent achieved a

The U.S. Food and Drug Administration

Sherman, M.D., Ph.D., of the University of

sustained virological response. According to

approved Incivek on May 23 for the treatment

Cincinnati College of Medicine.

Dr. Fried, sustained virological response is

of chronic hepatitis C in combination with

analogous to cure of hepatitis C.

peginterferon alfa and ribavirin. Peginterferon

The study included 540 patients with chronic

alfa is marketed under the brand name

genotype 1 hepatitis C who had not previously

“These are very nearly identical results,

Pegasys, while ribavirin is sold as Copegus

been treated or who could not be successfully

showing that 24 weeks of treatment with triple

and Rebetol.

22

The Triangle Physician


UNC Hospital News

Lawrence Marks, M.D. Is Appointed to an Oncology Research Professorship Lawrence B. Marks, M.D., chairman of the

aimed at improving the therapeutic ratio of

and lectured about this sensitive issue and

University of North Carolina Department of

radiation therapy, largely through reducing

serves on several national panels addressing

Radiation Oncology, has been appointed the

the normal tissue effects of radiation. He

this issue.

Dr. Sidney K. Simon Distinguished Professor

has conducted many prospective clinical

of Oncology Research at UNC-Chapel

trials to better understand radiation-induced

He is a member of the American Society of

Hill. The professorship, established by a

lung and heart injury for patients receiving

Radiation Oncology, the American Society

$500,000 gift from Wally (class of ’66) and Lil

radiation to the chest. He is currently

of Clinical Oncology and the recipient of

Loewenbaum of Austin, Texas, is named in

funded by grants received from the National

numerous awards and honors.

honor of Mr. Loewenbaum’s grandfather, Dr.

Institutes of Health to conduct studies to

Sidney K. Simon.

better understand the physiologic and

Prior to joining UNC as chair in 2008, Dr.

dose-related causes of radiation-induced

Marks was the Banks Anderson, Sr., M.D.,

cardiopulmonary injury.

Professor of Radiation Oncology at Duke

“Dr. Marks is a national and international leader in the area of radiation oncology

University, where he also directed the

with research spanning the basic-to-clinical

Dr. Marks is a national leader in studying

residency training program. He earned his

continuum. He is developing analyses and

the frequency and causes of “human-errors”

medical degree at the University of Rochester

trials which seek to maximize radiation

in the radiation oncology clinic. This work

and completed his residency in radiation

therapy’s effectiveness while minimizing

has led to the implementation of guidelines

medicine at Massachusetts General Hospital.

damage to healthy tissues. His work on

successfully reducing such errors, thereby

human factors in the radiation oncology

enhancing patient safety. He has published

clinic is receiving broad attention and is having a positive influence on patient safety across the United States,” said Shelley Earp, M.D., director of UNC Lineberger Comprehensive Cancer Center. “Dr. Marks is a thoughtful and energetic leader who has built UNC’s Department of Radiation Oncology into a thriving clinical and research enterprise that not only provides outstanding patient care but also trains therapists, dosimetrists and young physicians in this rapidly-evolving field,” said William L. Roper, M.D., M.P.H., dean of the UNC School of Medicine and chief executive officer of the UNC Health Care System. “The Loewenbaums’ support recognizes the need to enhance (Dr. Marks’) work improving the safety and effectiveness of radiation therapy, not only at UNC, but nationwide,” he added. Dr. Marks is a recognized expert in the treatment of patients with breast and lung cancer. The thrust of his work has been

October 2011

23


Duke Research News

Breast Cancer MRI Could Benefit High-Risk Women Without Insurance Although a magnetic resonance imaging

For the Duke screening trial, a team of

Ford said that finding is important given the

screening can be expensive, it has been

“patient navigators” visited low-income

tendency of MRI screenings in the general

shown to be beneficial and cost effective

communities around Durham, where they

population to flag normal breast tissue as

for women at high risk of breast cancer who

identified women with no health insurance

suspect, leading to unnecessary worries and

have little or no insurance, researchers at

or limited policies and provided them with

costly biopsies.

Duke University Medical Center report.

information about breast cancer prevention and treatment. The patients were then

“MRI really should not be considered a

The researchers, who presented their

separated into two groups based on known

standard of care for routine breast cancer

findings at a health disparities conference

breast cancer risk factors, including close

screening because it is expensive and too

hosted by the American Association for

family members who had been diagnosed

sensitive,” Dr. Ford said. “But this study

Cancer Research in Washington, D.C., in

with the disease.

proves that if it is used in the right population,

September, said the findings could help

this test can be cost effective and lifesaving.”

ease breast cancer disparities among

Nearly 300 women – 33 percent African-

underserved women.

American – who met the criteria for high risk

Patient navigation was instrumental in

were given MRI screenings. The technology

ensuring that patients got the right screening

“Early detection and treatment of breast

is expensive, but can be more sensitive,

and follow-up. “We actually go out to

cancer in these high-risk women are

particularly among younger women who

different health fairs and community events,

important goals, particularly if we can find

have denser breast tissue that can pose a

identify women at Point 1 and then guide

a cost-effective way of achieving them,” said

challenge to mammography.

them through the process from that day

Anne C. Ford, M.D., assistant professor of

onward,” said Lamisha Banks, one of the

obstetrics and gynecology at Duke University

Another 299 women were considered

study navigators and co-authors. “We stick

Medical Center and lead author of the study.

normal risk, and got traditional, less costly

with them through treatment and beyond.”

“By catching these tumors early, treatment

mammograms. Of the normal risk group, 40

may be less expensive than for advanced

percent were African-American.

disease.”

In addition to Dr. Ford and Ms. Banks, study authors include: Xiomara Boyce, Stephanie

Among the normal-risk trial participants,

Robertson, Endya Frye, Nora Tolbert, Laurie

A problem that persists in the fight against

mammography detected one breast cancer

Lee, Gloria Broadwater and Victoria L.

breast cancer is the disparity in death

case. MRI screenings turned up seven

Seewaldt.

rates between blacks and whites. While

cancers in the high-risk group, demonstrating

African-American women are diagnosed

that a targeted use of MRI screenings could

Funding for the trial was provided by Susan G.

with the disease less often, they have a

offer an effective approach for high-risk

Komen for the Cure, Triangle Affiliate; Avon;

disproportionately higher death rate. Better

women.

the National Breast Cancer Foundation; the

screening programs could help by catching

Breast Cancer Relief Foundation; and the

breast cancer tumors earlier, before they

The MRI screenings also had a lower rate

become lethal and spread.

of false positives than mammography. Dr.

Kate B. Reynolds Charitable Trust.

Exercise Eases Arthritis in Obese Mice Without Weight Loss Adding

exercise,

The insight suggests that excess weight

Published Sept. 27 online in the journal w,

scientists at Duke University Medical Center

alone isn’t what causes the aches and pains

the findings are now being tested in people.

have found that physical activity improves

of osteoarthritis, despite the long-held notion

arthritis symptoms even among obese mice

that carrying extra pounds strains the joints

“What’s surprising is that exercise, without

that continue to chow down on a high-fat diet.

and leads to the inflammatory condition.

substantial weight loss, can be beneficial

24

another

incentive

The Triangle Physician

to


Duke Research News to the joints,” said Farshid Guilak, Ph.D.,

glucose poorly and had much higher blood

inflammatory molecules associated with

professor of orthopedic surgery at Duke and

levels of molecules that trigger the chronic

arthritis, but they lost their punch because

senior author of the study. “Ideally, it would

inflammation associated with osteoarthritis.

they could not organize into a force. “I

be best to be fit and lose a little weight, but

don’t want to say exercise is turning off that

this shows that exercise alone can improve

But when these animals got regular running

the health of your joints,” Dr. Guilak said.

wheel workouts, many of the harmful effects

inflammatory signal, it just impairs it.”

diminished – even though the mice ate the

The findings add to a growing body of

Even modest improvements could have a

same high-fat food and shed no weight.

research exploring fitness vs. fatness.

major impact if the findings are borne out

Glucose tolerance improved, while the

Ongoing studies at Duke and elsewhere

in people. The Arthritis Foundation reports

inflammatory response was disrupted among

are examining the role of diet, exercise and

that one in five adults in the United States

key signaling molecules called cytokines,

inflammatory diseases.

have been diagnosed with arthritis, and the

easing the development of arthritis.

annual cost of treating it and other rheumatic conditions has been tabbed at $128 billion.

“This shows that if you are obese, it’s better If the extra weight on the joints had been

to exercise,” Dr. Guilak said. “Sometimes

the cause of the arthritis, the researchers

pain can be a barrier to starting exercise,

Many cases of arthritis are associated

noted, exercise would have exacerbated the

but if you overcome it, in the long term, it’s

with obesity and inactivity, so the Duke

problem. Instead, it helped.

better.”

high-fat diet induces knee osteoarthritis, and

“We’re trying to understand the interaction of

In addition to Drs. Guilak and Griffin,

then whether exercise provides a protective

physical activity and obesity,” said Timothy

study authors included Janet L. Huebner,

effect.

M. Griffin, Ph.D., lead author of the study. Dr.

Virginia B. Kraus and Zhen Yan. The study

Griffin was formerly at Duke and is now at the

was supported by grants from the National

Using two sets of male mice – half fed a high-

Oklahoma Medical Research Foundation.

Institutes of Health and from the Arthritis

fat diet and the other fed regular food – the

“Even though there was the same amount of

Foundation.

researchers noted significant differences

body fat, the fat was different.”

researchers set out to determine whether a

among the two groups. The mice on the highfat food gained weight rapidly, processed

Dr. Griffin said the fat cells still produced

Study Reveals New Understanding of Cholesterol’s Role in Bone Loss Researchers at Duke University Medical

occurred independently of their ability to

“In the current study in mice, we showed

Center have found that high cholesterol

lower circulating cholesterol,” said Donald

that a high-cholesterol diet alone significantly

contributes to a loss of bone density by

McDonnell, Ph.D., chairman of the Duke

decreased bone quality,” said Erik Nelson,

blocking formation of new bone cells and

Department of Pharmacology and Cancer

Ph.D., a postdoctoral research associate in the

encouraging the activity of mechanisms

Biology. “The question was: Had scientists

McDonnell laboratory. However, they noted

responsible for breaking down bone.

explored

cholesterol

that only when cholesterol was converted to

actually impacted bone biology? They hadn’t.

whether

lowering

27-hydroxycholesterol did it negatively impact

The findings from studies on mice open new

When you hear hooves, think horses, not

bone.

possibilities for the treatment and prevention

zebras – look for a more obvious explanation.”

of osteoporosis and highlight a possible new

“We found that by binding to the estrogen

way that cholesterol-lowering statin drugs

Instead of focusing on cholesterol itself,

receptors, 27-hydroxycholesterol interferes

may improve bone health, according to a

the

a

with the positive actions of estrogens in

medical center press release.

breakdown product of cholesterol called

bone,” Dr. Nelson said. “We also found that

27-hydroxycholesterol and demonstrated that

a second class of proteins, liver X receptors,

“For years, people thought that the positive

this molecule actually inhibited the positive

were targets of 27-hydroxycholesterol in bone.

effects of statin drugs on bone mineral density

actions of estrogens on bone.

The combined actions of this byproduct of

Duke

researchers

focused

on

October 2011

25


Duke Research News cholesterol on the estrogen receptors and

were unclear,” Dr. McDonnell said. “These

Pharmacology and Cancer Biology; Xiaojuan

liver X receptors resulted in a doubly harmful

data not only provide an explanation for this

Wang and Diane Gesty-Palmer of the Duke

impact on bone.”

positive activity of estrogen but also highlight

Division of Endocrinology, Metabolism and

new approaches that can be used to treat this

Nutrition; Glenda Evans and Sundeep Khosla

disease.”

of the Endocrine Research Unit of Mayo Clinic

They found that supplemental estrogen could improve bone density in mice with elevated

College of Medicine in Rochester, Minn.; and

27-hydroxycholesterol, noting that estrogens

Dr. Nelson said there are drugs that can

Michihisa Umetani of the Departments of

induced the expression of a protein called

artificially increase the amount of SHP, which

Pediatrics and Pharmacology, University of

“SHP” in developing bone cells that inhibited

stops this bone-loss process, so it may be

Texas Southwestern Medical Center in Dallas.

the negative activity of the liver X receptor.

possible to develop therapeutics that have a similar effect in humans.

Without in

estrogen,

which

postmenopausal

Support for the work came from the National

occurs

women,

Institutes of Health, the National Institute of

the

“In the meantime, the data we have generated

Diabetes and Digestive and Kidney Diseases,

27-hydroxycholesterol continued signaling

thus far suggest an unanticipated positive

the Arthritis Foundation and a Department of

through liver X receptor, which decreased the

activity of statins and add to the list of

Defense postdoctoral award.

amount of bone.

health benefits associated with lowering cholesterol,” Dr. McDonnell said.

“Although estrogens have been used for years for the treatment and prevention of post-

Other authors include Carolyn D. DuSell (now

menopausal osteoporosis, the mechanisms

with Genentech), Matthew K. Howe, Ryan

by which it accomplished its positive actions

D. Michalek and Jeffrey Rathmell of Duke

Nurse Transition Program to Evaluate Safety and Outcomes Durham Regional Hospital is one of 112

and confidence, prior research has not

Muir, R.N., M.S.N., nursing program manager

hospitals chosen by the National Council

examined actual patient outcomes. The

at Durham Regional Hospital. “This online

of State Boards of Nursing to participate in

data collected will measure actual patient

model of training suits our new nurses well.

an innovative, multi-state study to evaluate

outcomes, such as infection rates, patient

The topics are relevant to what they need,

safety and quality outcomes in nurse

falls, patient satisfaction, as well as new

and the support from their preceptors and

transition from school to practice.

nurse competencies, job satisfaction and job

managers gives them the confidence to

stress.

perform their best.”

(TTPS) follows newly licensed registered

Each new nurse is provided with online

The program lasts six months, though the

nurses hired to work at Durham Regional

training in addition to their duties on the

nurse has ongoing support for another six

and other hospital settings in Illinois, Ohio

unit. They report to a manager who provides

months. New nurses can choose whether

and North Carolina during their first year of

input and a preceptor who keeps a record

or not to enroll in the program. Currently, 49

employment.

of their training and offers assistance

Durham Regional nurses are participating.

The NCSBN Transition to Practice Study

along the way. The five online transition TTPS will compare patient outcomes in

modules

and

According to the NCSBN, health institutions

organizations that use the National Council

teamwork, patient-centered care, evidence-

with TTPS programs have seen a marked

of State Boards of Nursing (NCSBN)

based practice, quality improvement and

drop in attrition, along with improved patient

transition model with those organizations

informatics. Clinical reasoning and safety are

outcomes. This program’s goal is to create a

that use their own methods of transition.

integrated throughout each module.

consistent best practice method of training

While

previous

studies

of

include

communication

transition

new nurses that can be replicated across

programs have looked at retention rates, new

“The TTPS program is a wonderful addition

the country to ensure consistent quality of

nurse satisfaction, preceptor satisfaction

to the hands-on training and orientation our

care and to decrease turnover rates of new

and nurse’s perceptions of competence

new nurses already receive,” said Margaret

nurses.

26

The Triangle Physician


Women’s Wellness

Women’s Wellness Clinic

Opportunities for Clinical Research By Andrea S. Lukes, M.D., M.H.Sc., F.A.C.O.G.

We continue to offer clinical research studies

(1,000-3,000)

effectiveness,

The physicians at the Women’s Wellness

for our patients. Such opportunities include

monitor side effects, and to compare it to

Clinic offer personalized, evidence-based

FDA clinical trials. There are different types

commonly used treatments, and to collect

medical care for women. Providing clinical

of FDA clinical trials that we offer at the

information to allow the drug or treatment to

trials to our patients allows us to educate

Women’s Wellness Clinic include:

be used safely

patients and ourselves about the newest

Phase 4 trials: These are post marketing

technologies and medications for women’s

Phase 1 trials: Usually involves experi-

studies (done after approval of a drug) to

health.

mental drug or treatment in a small group of

help delineate additional information on a

people (20-80) for the first time to evaluate

drug’s risks, benefits, and optimal use.

to

confirm

its safety, determine safe doses, and identify

One of our newest clinical trials is a Phase 1 study entitled: Clinical Research Study on

side effects

The types of studies done through the

Phase 2 trials: Experimental drug or

Women’s Wellness Clinic focus on women’s

treatment is given to larger group of people

health, including causes of heavy periods

Please call us at 919.251.9223 for

(100-300) to see if it is effective and to further

and treatments for heavy periods, PMS,

more information.

evaluate safety, doses, and side effects

migraines, ovarian function, birth control,

Phase 3 trails: Experimental drug or

menopause, vaginal atropy, and more.

Ovulation and Ovarian Activity.

treatment is given to large groups of people

SANDHILLS SLEEP DISORDERS CENTER

Dr. H. Tellez, MD Board Certified Neuromuscular Medicine Board Certified Neurology

Dr. G. Chin, (Chintapudi) MD, DABSM Board Certified Sleep Medicine Board Certified Neurology

Our Priority Is Your Sleep! The Specialities • Sleep Apnea • Sleep Studies • Memory Disorder • Brain/Spine MRI • Gait Problem • EEG • Neuropathy, ie: CTS • NCV- EMG Laboratory

888-614-7420 • www.SNSleepSolutions.com 295 Olmstead Blvd., Suite 12 Pinehurst, NC 28374 (910) 235-0595

102 Dennis Drive Sanford, NC 27331 (919) 708-5008

609 Attain Street, Unit 101 Fuquay-Varina, NC 27526 (919) 552-8917

october 2011

27


News Welcome to the Area

Physicians Michael Ryan Abern, MD Duke Urology Durham

Lea Lynne Bardy, MD Pathology University of North Carolina Hospitals Chapel Hill

Jose Fernando Bestard, MD

Jason Michael Kidd, MD

Sheena Harris, PA

Internal Medicine University of North Carolina Hospitals Chapel Hill

Alamance Regional Medical Center Burlington

Todd Kiefer, MD Internal Medicine, Cardiology Duke University Hospitals Durham

Brian Thomas Klausner, MD

Ashley Rosann Haskin, PA Durham

Rachel Holston, PA Durham Regional Hospital Durham

Raleigh

Wake Med City Center Clinic Raleigh

Nicole L Lane, PA

Holly Marie Biggs, MD

Anne Monica Lachiewicz, MD

Katherine Marie Mackin, PA

Internal Medicine University of North Carolina Hospitals Chapel Hill

Triangle Orthopaedic Associates Durham

Internal Medicine Duke University Hospitals Durham

Donald Lyle Budenz, MD University of North Carolina Chapel Hill

Emily A Evans-Hoeker, MD UNC Reproductive Endocrinology & Infertility Chapel Hill

Narges Farahi, MD UNC Dept of Family Medicine Chapel Hill

Iman Ghaderi, MD UNC Dept of GI Surgery Chapel Hill

Natasha Faye Harrison, MD University of North Carolina Hospitals Chapel Hill

Fletcher Lee Hartsell, MD Neurology University of North Carolina Hospitals Chapel Hill

Jun He, MD Psychiatry University of North Carolina Hospitals Chapel Hill

Ashley Rebekah Presar Hinson, MD Pediatrics Duke University Hospitals Durham

Jeffrey John Horvath, MD Radiology Duke University Hospitals Durham

Neva Margaret Howard, MD University of North Carolina Hospitals Chapel Hill

Ifeoma Jacqueline Igboeli, MD WakeMed Raleigh

Shalaka Dayarum Indulkar, MD Pediatric Neurology of North Carolina Cary

Daryhl Lindsay Johnson, MD Univ of North Carolina Dept. of Surgery Chapel Hill

Edmund Hilton Jooste, MD Department of Pediatric Anesthesiology Durham

Melissa Rahhyung Kang, MD Carrboro

Sujay Mansukhlal Kansagra, MD Pediatrics, Neurology University of North Carolina Hospitals Chapel Hill

28

The Triangle Physician

John Armand Mastrangelo, MD

Durham

Melissa Murfin, PA Elon University, Elon

Durham

Rebecca Yvonne Mumpower, MD

Sola Egberanmwen Ogunniyi, PA Raleigh

Fletcher

Matthew Gordon Rein, MD

Brenda Lee Quincy, PA Elon University, Elon

Internal Medicine Duke University Hospitals Durham

Kelli Renee Roe, PA

Yashica Yvonne Ruffin, MD

Brian Savage, PA

Durham

Wake Forest

Deanna Mary Sasaki-Adams, MD

Danielle Shelley, PA

Neurological Surgery UNC Dept of Neurosurgery Chapel Hill

WakeMed Faculty Physicians Gen. Surgery & Trauma, Raleigh

Saif Lutfi Shafiq, MD Duke University Hospitals Durham

Michael James Shealy, MD Pathology Duke University Medical Center Durham

Usha Soundarapandian, MD Doctors Making Housecalls Durham

Bijoy Damodaran Thattaliyath, MD Duke University Hospitals Durham

Megan Aileen Webster, MD Psychiatry Psychiatric Associates of North Carolina Raleigh

Sara Elizabeth Wobker, MD Pathology University of North Carolina Hospitals Chapel Hill

Eric Hamilton Wright, MD Emergency Medicine University of North Carolina Hospitals Chapel Hill

Vijay Yerubandi, MD Duke University Hospitals Durham

Physician Assistants Shannon Michelle Billings, PA Carolina Skin Care Pinehurst

Kellie Ann Bunn, PA Raleigh

Detra Monteiz Yvonne Chambers, PA Durham

Duke University Medical Center, Durham

Jason Sonnenschein, PA Carrboro

Clinical Trials Do you have patients with any of these problems?

Ovulation and Ovarian Activity Women’s Wellness Clinic Dr. Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.

If you are a healthy female age 18-40 years with regular periods, then you may qualify for a research study on the effects of an investigational medication on ovulation and ovarian function. The research study procedures include: • physical exam • PAP smear • ultrasounds • blood draws • EKG Reimbursement up to $225 per week (for up to 20 weeks if you qualify). This study is being conducted by Dr. Andrea Lukes at the Women’s Wellness Clinic. Women’s Wellness Clinic is located by the Streets of SouthPoint. For more information call (919) 251-9223 or visit www.cwrwc.com.


“More than a doctor. Like a friend.”

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

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

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

WHV Locations in Johnston County 910 Berkshire Road Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147

2076 NC Hwy 42 West, Suite 100 Clayton, NC 27520 Phone: 919-359-0322 Fax: 919-359-0326

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

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


©2011 Wake Radiology. All rights reserved. Radiology saves lives.

All For One — Fighting To Make A Difference.

Robin, survivor since 2006

One in every eight women will develop breast cancer in her lifetime, and we’re among the ones who are fighting back. We also have careers at Wake Radiology, where we put the power of imaging on your patient’s side: fellowship-trained radiologists, caring technologists that are ARRT certified, and state-of-the-art technology. We’re committed to helping patients make the most of these odds, starting with their annual screening mammogram, so we offer 8 convenient Triangle screening

Scan now to request a Screening mammogram with your smartphone.*

locations many with Saturday and evening appointments. At Wake Radiology, it’s all for one — in a fight we take very personally. Wake Radiology is the only multi-site outpatient imaging service provider in the Triangle to receive the American College of Radiology’s designation of Breast Imaging Centers of Excellence.

Wake Radiology salutes the grit, the grace, and the undaunted courage of every cancer survivor. Wake Radiology. Fighting for every One.

PROUDLY SUPPORTING THESE IMPORTANT ADVOCATES FOR WOMEN

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CALL 1 NUMBER TO SCHEDULE AT THE LOCATION OF YOUR CHOICE | 919-232-4700 | wakerad.com

The Triangle Physician October 2011  

The Triangle Physician October 2011 Serving about 9, 000 MDs, PAs, and NPs in the Triangle Area of North Carolina. If you have the need to g...

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