Inside Duke Medicine - April 2009 (vol. 18 No. 4)

VOLUME 18 NO. 4 n inside.dukemedicine.org n April 2009

A CLEAR VISION Duke Medicine strategic plans guide success in challenging times

Duke University Health System

Substantial progress toward long-term goals

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early five years ago, Duke University Health System articulated a strategic plan designed to serve as a roadmap to our long-term success. This plan made a health system-wide commitment to optimizing services, improving the way entities work together and attracting the best faculty and staff. In implementing and executing the operational actions associated with the strategic plan, DUHS has made significant progress. But there have also been challenges, particularly since the onset of the global economic downturn. At a time of such financial and economic

turbulence, it is important to understand that the organization has had a successful strategic plan which we continue to follow today, and that we are not simply reacting to the evolving pressures of a challenging environment. “The strategy has proven itself, and we are confident we are moving in the right direction,” said Molly O’Neill, the health system’s chief strategic planning officer. “But current conditions require us to be even more careful stewards of our resources and to stay focused on making the proper strategic investments.” Competitive pressures, O’Neill added, “did not

go away with the addition of economic pressures. The building blocks of the strategy — each of the goal areas — have proven appropriate for the changing environment.” The following is a review of our seven strategic priorities and how we have executed them thus far: Optimize services in Durham County DUHS recently solidified its commitment to the people of Durham County with the completion of a long-term lease extension for Durham Regional Hospital. Also, a Master Facility Plan has linked Duke University Hospital and Durham Regional in important ways through new specialty programs and transfer center enhancements to serve community continues on p.2

Duke University School of Nursing

Duke University School of Medicine

On a cautious, but steady, course

Nurturing excellence

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focus on strategic priorities and opportunities is keeping the Duke University School of Nursing on a steady but cautious course in stormy economic times. Associate Dean for Finance and Administration David Bowersox said the downturn contains a “silver lining” for DUSON. In times of economic weakness, people pursue professions such as nursing, for which there is robust market demand. Last year 50,000 qualified applicants were turned away nation-

ally from bachelor’s degree nursing programs. As part of a long-term strategy to address the demand, DUSON added a second cohort of more than 50 accelerated bachelor of science in nursing program students to its admission plan for fiscal year 2010. The school, which already admits 70-plus students each fall, plans to double enrollment within a few years. DUSON’s master’s degree program will see continued strong continues on p.3

he Duke University School of Medicine, like medical schools across the nation, faced financial pressures long before the current global economic recession. But progress in accomplishing goals set out in its 2005 strategic plan, and administrative initiatives in response to external funding declines, have put the School on a steady

course through these trying times. For example, those activities have put the School in a good position to capitalize on the funding opportunities of the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the “stimulus bill.” “All of our missions – education, research and clinical care – are severely continues on p.3

Match Day brings stellar residents to Duke … p.6

Inside Duke Medicine

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April 2009

Duke University Health System continued from p.1 needs and help manage patient flows across Duke Medicine. The creation of hospitalist and intensivist programs has led to greater integration and improved outcomes at Durham Regional, and significant capital investments in radiation oncology, intensive care, information systems, and other services have led to improved patient access and quality of care. DUHS has also made important commitments to community health through a myriad of projects in Durham, including the Lincoln, Walltown, Lyon Park and Holton clinics, and through Project Access, in which specialists donate time and expertise. Duke Medicine has made significant progress in meeting the projected workforce shortage in physicians, nurses, and physician assistants through recruitment

Duke University Hospital. file photo

Duke Raleigh Hospital has been upgraded and renovated. The new Duke Medicine Plaza specialty physician building is full, providing Wake County patients more convenient access to Duke faculty physicians. Also, clinical programs led by Duke faculty, such as the new and growing neurosurgery program, are driving the success We have a clear vision that guides our work of Duke toward future success, even in this challenging Raleigh Hospital. global economic environment. Investments and expansion of training programs. in cancer services, orthopaedics and As always, all capital investments cardiology, as well as state-of-the-art are subjected to a rigorous needs assessimaging technology, are improving the ment. Planning continues for a major access to the latest in Medicare care in addition to Duke University Hospital the community. and the creation of a new Ambulatory New facilities have opened in Cancer Center, should that project the Brier Creek area, Knightdale, receive Certificate of Need approval Morrisville and north Raleigh. from the state this spring. Considering Reorient multidisciplinary programs current capacity constraints and The new Duke Heart Center has projected teaching and health care needs facilitated greater collaboration and in a dynamic and growing region, it is essential that Duke invest in its long-term effectiveness among the many specialty care areas in the center, as well as future of providing efficient and effective among its faculty. The changes have education, research, and patient care for improved the patient experience and the citizens of North Carolina. aligned the whole organization around Strengthen our presence a single goal: patient-centered care. in Wake County Plans for similar realignments that The investments made in Wake break down organizational barriers County have begun to demonstrate and support patient-centered care the wisdom of this strategy. DUHS are underway in other clinical areas, facilities and clinical faculty have including cancer. made significant inroads and have Enhance pediatric services become an important part of addressing the health care needs of the The $7 million, 13-bed, pediatric county’s rapidly growing population. cardiology intensive care unit – the ■ ■ I N S I D E V olume 1 8 , I ssue 4

first in the state – opened at Duke University Hospital in January. The Division of Pediatric Blood and Marrow Transplantation continues to pioneer the use of umbilical cord blood stem cells and extend this lifesaving therapy across the country. The Duke University Hospital intensive care nursery is being reconfigured to increase capacity, and Duke University Hospital and Durham Regional Hospital are collaborating on neonatal care. Duke Children's Consultative Services has expanded in Wake County through new offices in Duke Medicine Plaza in Raleigh. Build a structure for ambulatory care Substantial progress has been made in developing a distinct operating infrastructure for ambulatory care that has resulted in substantial improvements in patient satisfaction, and tremendous success in the reporting of quality outcomes in outpatient services. The strength of our ambulatory care platform and services is now regarded as essential to the well being of the patient and the organization. Attract, retain and reward talented faculty and staff The health system’s clear vision starts with the patient, which we value most above all. We cannot provide the quality care they demand and deserve without quality employees. To recruit and retain the very best, Duke offers excellent benefits and widely-recognized programs for professional development. Last fall, Advance for Nurses

Inside Duke Medicine, the employee newspaper for the Duke University Health System, is published monthly by Duke Medicine News & Communications. Your comments, story ideas and photo contributions are always welcome and appreciated. Deadline for submissions is the 15th of each month.

magazine rated the health system as a workplace that excels in opportunities for continuing education, tuition reimbursement and rewards and recognition. Also, the Employee Tuition Assistance Program benefit increased in January to $5,250 per year to help employees get the education needed to advance their careers. Duke’s clinical faculty has grown significantly over the past few years and further expansion is planned over the next several years. Duke University Hospital and the Duke University School of Medicine continue to be recognized as among the top ten institutions in the country due to outstanding work done every day by our faculty and staff. Building upon the strength of the Duke name Advertising, community outreach and media relations campaigns over the past two years to build brand awareness for Duke Medicine, and its clinical faculty, have been effective. Those efforts have contributed to Duke’s national reputation for excellence and focused our organizational strength in support of our mission: “To transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidencebased medicine to improve community health, and leading efforts to eliminate health inequalities.” Summing up We have a clear vision that guides our work toward future success, even in this ever-changing and challenging global economic environment. The successes show we are headed in the right direction, but now more than ever the economic environment must be monitored for any signal that would require a course adjustment. We remain mindful that our success today is built upon the excellent work done by our current and past Duke Medicine employees; and it is that solid commitment to our ideals that will guide Duke Medicine successfully into the future. n

Contact us Campus mail: DUMC 104030 Deliveries: 2200 W. Main St., Suite 910-B, Durham, NC 27705 Phone: 919.660.1318 E-mail: [email protected] Credits Cartoon: Josh Taylor

Staff Editor: Anton Zuiker Managing Editor: Mark Schreiner Science Editor: Kelly Malcom Designer: Vanessa DeJongh Inside Online Editors: Bill Stagg and Erin Pratt Copyright © 2009 Duke University Health System

April 2009

Inside Duke Medicine

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School of Medicine

strategic around where our constrained resources are utilized,” said Andrews. continued from p.1 Indeed, much of the strategic plan stressed by external regulatory and and subsequent efforts of the school’s funding pressures,” said Dean Nancy administration, said Andrews, have Andrews, M.D., Ph.D. “But we have been student- and faculty-focused. a clear strategy that, together with our “We’re trying hard to be faculty outstanding faculty and staff, will guide friendly,” said Scott Gibson, executive us in making the decisions and the vice dean for administration. “It’s a balcritical investments we need to make to ance between investing in new programs ensure our continuing success.” in strategic areas of emphasis – which The School has the advantages of is important to our growth as a top tier a strong health system, a world-class school – and supporting the faculty and faculty and a very balanced research programs that got us here in the first portfolio, she said. place. We have to do both.” The School has been affected in Gibson points to numerous three ways: Reduced distributions from activities that grew out of the strategic endowments, lowered expectations plan, and continue even in these tight for philanthropic support, and, most economic times. These include Dean’s importantly, a flat NIH budget. Office bridge funding to promising investigators, “We've been very thoughtful and strategic improved assistance and mentoring for around where our constrained resources faculty who receive NIHK-Awards, are utilized.“ — Dean Nancy Andrews, M.D., Ph.D. improvements to But, in reviewing the School’s research administration, and a forthstrategic plan initiatives, said Dean coming faculty work-life initiative led Andrews, it is clear that, despite the by Chancellor Victor J. Dzau, M.D. economy, the School has continued to Still, the School has had to make focus resources on its core objectives. tough choices. Examples of this progress include “We have had to make adjustthe strengthening of the Medical ments to our internal economy Scientist Training Program that in response to the new economic supports M.D./Ph.D. students, and the situation, which actually started School’s role in creating the University- several 4-5 years ago when the budget wide Global Health Institute, Duke for the National Institutes of Health Translational Medicine Institute, flattened after a period of tremendous Duke Institute for Brain Sciences and growth. These changes were essential investment in core facilities. to our ability to stabilize our financial “We’ve been very thoughtful and picture,” said Gibson.

School of Nursing continued from p.1 enrollment, and the new Doctor of Nursing Practice Program has two qualified applicants for every available seat. “We’re meeting societal needs and doing our part to strengthen Duke Medicine,” Bowersox said of DUSON, where tuition creates over 80 percent of revenue. The School continues to execute its long-term strategic plan, he said, and has a clear vision for future success. “We have excellent coordination among forward-thinking administrative and faculty leaders, as well as a committed staff, who are driving our continued success,” Bowersox said. Within those long-term goals, DUSON plans to pursue eight to 10 strategic faculty hires in the coming year to help support planned growth.

Two new positions reflect the strategic plan’s call for incorporating technology innovations into academic programs. A director of educational excellence and an educational technologist will help faculty with the latest Web-based teaching technologies. “Using technology to strengthen our distance-based and online programs is at the core of what we do and differentiates us from our peer schools,” Bowersox says. “We are seen nationally as a technology leader.” Another goal calls for translating nursing research into improved nursing care delivery, through creation of the Duke Nursing Translation Institute. The institute, in Duke South, plans to add professionals dedicated to improving models of care based upon the latest nursing research. A concern moving forward is student financial support. While scholarships from DUSON’s endow-

Earlier this year, the School implemented a number of expense management actions, followed by changes to its overhead allocation methodology, implementation of a gift assessment and a one-time balance assessment — structured as a loan — for discretionary funds greater than $500,000. These measures were necessary for the School to shore up its budget over the next years. The strategic plan has been enhanced by work to streamline research administration. The Research Administration Continuous Improvement (RACI), an initiative begun in 2007, involves University and School of Medicine senior leadership and faculty and staff advisors in ongoing efforts to make administrative functions as efficient as possible and investigatorfriendly. An example of this work is the streamlined process for account code creation, the reduction in budget requirements for modular grants and the

soon-to-be-released research portal. “This initiative was designed to help all researchers, and it has put us in very good condition to prepare for the ARRA economic stimulus,” said Gibson. Meanwhile, students continue to be a primary focus of the School, which has embarked on a modernization of learning facilities. Last fall, a high-tech Gross Anatomy Lab and Fresh Tissues Lab were opened in the lower level of Davison Building. And, the School is proceeding with plans to build a learning center, supported by a $35-million donation by The Duke Endowment last year. However, because of the economic situation, the School has had to defer plans to build a state-of-the-art research building. “With our top-notch faculty and a committed staff working together on our shared strategic vision, we will make progress despite the tough environment,” said Dean Andrews. n

ment are cushioned from the economy in the very short term — with payouts pegged to a three-year average return — 60 percent of ABSN students rely on private loans. DUSON’s proposed fiscal year 2010 budget is balanced and conserva-

tive, reflecting almost no investment earnings income for operations. Meanwhile, non-essential spending is on hold and the 2010 budget keeps most non-salary expenses at 2009 levels, aiming to avoid impacting students, research or clinical practice. Bowersox sees DUSON as well-positioned. Leadership is closely monitoring its financial status, and the national and global economies, to keep expenses in line and to fully meet the needs of those who would like a DUSON education. “The dean and five associate deans of our school agreed as a team soon after the economic downturn began what we valued most. We reaffirmed our strong commitment to focus on two goals — balancing the budget and prioritizing resources to the areas of most significant strategic importance, with students at the top of the list,” he said. n

Inside Duke Medicine

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April 2009

AT A G L A N C E

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I value the other people I work with.

— Rick Gray, clinical research assistant. Read more of what he had to say on page 7.

■■INSIDE JOKE

■ ■ i t f i g u r es

■ ■ on t h e move

DUMC Instrument Shop moves Engineering and Operations has announced that the Medical Center Instrument Shop has relocated from the Bell Building to the Old Best Products building, at 3438 Hillsborough Road in Durham. To find it, look for the blue canopy. Hours of operation are 7:30 a.m.-4 p.m., Monday-Friday. Phone: 684-3464.

38% In voluntary health assessments, 38 percent of Duke's employees reported consuming the recommended 5-9 servings of fruits and vegetables per day. Find out more about the Duke Farmer's Market, a great source for fruit, vegetables and other good-for-you things, on Page 7. Source: LIVE FOR LIFE

■ ■ r esou r c es

New parks guide supports fun, healthy habits The Partnership for a Healthy Durham, in partnership with Duke Medicine, has created a new brochure that highlights many of Durham County’s parks, trails and amenities so that more people become aware of and access these free and low-cost resources. Download the brochure for free — in English or Spanish — at: http://www. healthydurham.org

lea d e r s h i p

Pickett appointed Durham Regional CMO

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isa Clark Pickett, M.D., co-director of the critical care unit at Durham Regional Hospital, has been appointed chief medical officer for that hospital. Her appointment, effective April 1, will help Durham Regional continue to build the highest quality medical care for patients there. “Dr. Pickett is highly respected by the medical staff and completely knowledgeable about LISA CLARK PICKETT, our high priority M.D. areas of focus in the hospital, specifically our surgical services and patient care services,” said Kerry Watson, chief executive officer of Durham Regional Hospital (DRH). In her new role, Pickett will oversee the implementation of several of DRH’s strategic initiatives, including clinical patient care, improved physician relations and a continuing improvement in surgical services. “There are a number of potential areas for new collaboration between Durham Regional Hospital and the rest of the Health System that utilize the best of both institutions, and I am eager to help facilitate these ventures,” said Pickett. William Fulkerson, Jr., M.D.,

Durham Regional Hospital. file photo

senior vice president for clinical affairs for DUHS, has known Pickett since she first came to Duke. “She brings a tremendous amount of dedication and patient centeredness to her practice, and she’s respected by all who have worked with her,” said Fulkerson. “As CMO, she will be a very effective liaison with the administration to the medical staff at Durham Regional because of her values and her focus. She’s been a champion for quality and will continue to advance measures of safety and quality at

DRH among the medical staff and the administration.” Pickett has been an intensivist at Durham Regional since 2001, and is currently the chief of the Division of General Surgery, the surgical director for the Critical Care Unit for Durham Regional Hospital and the graduate education medical director for surgery. She was instrumental in the recent renovation of the ICU/CCU at Durham Regional, which resulted in a state-ofthe-art 22-bed unit. The CMO role will be reduced

from a near full-time position to a parttime position, said Watson, allowing Pickett to continue her clinical duties as a general surgeon. “It is my view that a CMO can be more effective if they have the ability to continue to be an active and practicing member of the medical staff,” said Watson. “So, some of the lower priority administrative duties will be reassessed, allowing Dr. Pickett to focus on the high-priority areas of supporting physician practice and medical practice management.” Pickett identifies physician relations as one of her top concerns as she begins this new role. “I’m looking forward to getting to know the community physicians better, and to help enhance and reinforce the relationship of our hospital to those physicians. The greatest challenge of the CMO role is to help our entire, diverse medical staff feel like one team, with a single mission of excellent patient care,” she said. Pickett is an assistant professor of Medicine at Duke University Medical Center and is certified in critical care medicine and surgery. She attended Harvard Medical School, and completed a Critical Care fellowship at Duke University Medical Center Surgical Intensive Care Unit in 1998. n

Inside Duke Medicine

April 2009

■ ■ H U M A N R E S O U RC E S

Submit 2008 health care receipts by April 15 Faculty and staff enrolled in 2008 health or dependent care reimbursement accounts must submit receipts for services provided from Jan. 1 through Dec. 31, 2008, to WageWorks by April 15, 2009, for reimbursement.

Lotto winners pass luck to needy children

Duke Medicine will team up with the American Heart Association to get employees moving on April 8, the National Start! Walking Day. This event is part of a new national movement that encourages employees to live longer, stronger lives by adopting a comprehensive walking and nutrition program. Chancellor Victor J. Dzau invites all Duke Medicine employees to wear sneakers or walking shoes to work on April 8, and to join together in one of three lunchtime walks or one of three evening Live for Life walking events. For those who join us at the lunch hour walks on April 8, Duke Medicine will provide refreshments and Live For Life will give away Live For Life dollars to randomly chosen participants for use in their store.

Lunch hour walks: Durham Regional Hospital – 12 p.m. Join us at the employee entrance for a one-mile walk around the perimeter of the hospital grounds. Duke Clinic – 12 p.m. Gather on the Baker House lawn for a 1.2-mile walk through Duke Gardens. Duke Raleigh Hospital – 11:30 a.m. Meet on the front lawn for a one-mile walk around the medical campus.

Evening walks, provided by LIVE FOR LIFE: Durham Regional – 5 p.m. Meet at the employee entrance for a one-mile walk. East Campus wall – 5:30 p.m. Meet for a 1.7-mile walk. Wallace Wade Stadium/West campus – 5:30 p.m. Meet for a 2.9 mile walk.

Hungry? Check out ‘What’s Cooking’

If you’ve been reading Inside Online, you know those delicious things have been recently offered for lunch in Duke University Health System’s hospital eateries. To keep you up to date on this important topic, Inside Online – the employee news Web site for Duke Medicine, provides links to weekly menus every Monday morning. The links provide full menus for Duke North’s Atrium Café, the Food Court in Duke Clinic and the cafeterias at Durham Regional Hospital and Duke Raleigh Hospital.

Claim forms are available online at http:// hr.duke.edu/forms, or at the Human Resources office, 705 Broad St. in Durham.

Wear your sneakers to work

■■MENUS

Asiago crusted chicken. Green beans with sesame seeds. Potato leek soup.

Claim forms and supporting documentation must be postmarked or faxed to WageWorks by April 15. Claims for 2008 submitted after this date will not be reimbursed.

■ ■ T O Y O U R H E A L TH

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Paul and Sue Rosenau endowed the Legacy of Angels Fund to support Duke research into pediatric disease. PHOTO by Jon Gardiner By Jim Rogalski

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aul and Sue Rosenau have a special photograph of their granddaughter Makayla. She is two months old, dressed in a yellow outfit with a yellow ribbon tied about her silky brown hair. A wide smile graces her face, which is further accented by sparkling blue eyes. It is the only photo they have of their granddaughter smiling. Within a month of that photo being taken, Makayla was diagnosed with Krabbe disease, a rare neurodegenerative disorder affecting the central and peripheral nervous system. Most babies with Krabbe disease die within two years. Makayla was no exception. “You feel so helpless that there is nothing you can do to make things better,” Sue says. “My heart died the day she was diagnosed, and again when she died.” Where they once felt helpless as they watched Makayla’s physical abilities slowly deteriorate, the working-class couple now feel empowered that they can do something significant to combat this devastating disease that affects an estimated one in 100,000 newborns. Last May, the Rosenaus, of Waseca, Minn., won the $180 million Powerball lottery five years to the day of Makayla’s death. The Rosenaus have donated an initial $250,000 to Duke Medicine to establish the Legacy of Angels Fund in Makayla’s honor. It supports the ground-breaking research of Duke’s Joanne Kurtzberg, M.D., director of the Duke Pediatric Blood and Marrow Transplant Program and professor of pediatrics

and pathology. “We feel Dr. Kurtzberg is a champion for children. Duke is the place doing the largest amount of research and we are excited that we can help.” In 1993, Kurtzberg was the first-ever to perform an unrelated cord blood transplant on a leukemia patient. She discovered that umbilical cord blood transplantation can be an effective treatment for Krabbe disease when caught presymptomatically. “The Rosenau’s generosity enables us to explore Krabbe research in new directions and hopefully come up with alternatives in detecting the disease early and improving the child’s quality of life as soon as possible,” Kurtzberg says. The Rosenaus also are establishing their own nonprofit, The Legacy of Angels Foundation. Its mission is to find both a better treatment and a cure for Krabbe disease; to promote and expand the Newborn Screening Program throughout the nation; and to further research in finding a cure for cystic fibrosis. “We got blind-sided by this disease,” Paul says. “We knew nothing about it at first but got involved with other families going through it. We were all trying to find answers. We came to Duke because it’s the best in the world for this disease.” “It’s our hope and dream to help save other families and children from going through this,” Sue says. “If we help to save one child it is worth it.” n For information about contributing to Kurtzberg’s research through the Legacy of Angels Fund at Duke Medicine, contact Tom Kosempa at 919-667-2602.

Go to http://inside.dukemedicine.org and look for the blue salad bowl logo.

■ ■ R E S E A RCH

Symposium on DukeSingapore collaboration R. Sanders Williams, M.D., senior vice chancellor for academic affairs, will convene East Meets West: Singapore-Duke Research Collaborations from 8 a.m.-4 p.m. on Thursday, May 7 in the Levine Science Research Center Auditorium. The symposium will feature the research synergies between Duke and Singapore-based colleagues, with presentations on research and potential areas of collaboration involving infectious diseases, health services, cancer, neurosciences, cardiometabolics, education and other clinical research. Register by sending a message before April 24 to Patricia O’Brien, [email protected]

■■SUSTAINABILIT Y

Duke observes Earth Month With an eye toward Earth Day on April 22, Duke is hosting a month-long series of events to continue raising awareness about green living. Earth Month@Duke

Environmental Markets Symposium Series: Carbon Offsets 1:30-5:30 p.m., Friday, April 10 9 a.m. to 12:30 p.m., Saturday, April 11 French Family Science Center Information: http://tinyurl.com/ch7t63

Free Compost Surplus 3-6 p.m., Tuesday, April 7 9 a.m.-noon, Saturday, April 11 Gate 12, Duke Forest

Garbology: See how much trash could have been recycled 10:30 a.m. to 1:30 p.m. Friday, April 10 Main quad, West Campus

Inside Duke Medicine

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April 2009

e d u cat i o n

Match Day brings stellar residents to Duke “It's an extreme blessing to be matched to Duke. What Duke is doing in orthopaedics is amazing, and my prayers were answered.“

LEFT: Peering into the future? A Match Day envelope just before the OK to open. Photo by Jared Lazarus

BELOW: Duke University Medical Center residency training programs will be full with a new cohort of 163 top-notch medical school graduates.

Christopher Jones, medical student from UC-San Francisco

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hen Match Day envelopes were opened across the country last month, Duke University Medical Center’s residency training directors were elated to learn that all of Duke’s slots were filled up. That good news capped off a system-wide effort to recruit some of the most competitive candidates from among the nation’s graduating medical students. Duke was the institution of choice for 163 high-caliber students, who will begin their graduate medical education at Duke this summer. Match Day is the annual day in March when graduating medical students across the country learn where they will spend the next three to seven years of their training. “The applicants come from excellent schools all over the country,” said John Weinerth, M.D., associate dean of graduate medical education (GME). He said Duke invigorated its efforts to attract the best and the brightest candidates by promoting Duke’s richly varied GME opportunities. That was echoed by Harvey Jay Cohen, M.D., chair of the Department of Medicine. Cohen said he was pleased with the very strong applicant pool and even more pleased with the ultimate cohort that matched to the department. “We went to considerable lengths in the recruitment process to explain what our program is about, and to have candidates meet with the residents currently in the program,” said Cohen. The department received 3,354 applications, and interviewed 407 candidates for its 51 slots. House staff, faculty members and School leaders, including Dean Nancy Andrews, M.D., Ph.D. and Chancellor Victor J. Dzau, M.D., also met with the candidates to share what attracted them to Duke. “One of the key things that people always look at is the character of both the house staff and faculty here, and how they interact,” said Cohen. “I think the applicants got a good feel for this being a place where people enjoy working together.” After last year’s match, Weinerth commissioned a survey to determine

what factors could be accentuated to ensure Duke’s competitive appeal to top students. “We learned that more personal contact, better communication about the advantages for spouses and families, and sharing the special aspects of Durham would improve our recruitment,” said Weinerth. Even Hollywood played a part, with the NBC television drama E.R. in January featuring a storyline in which a Duke Medicine clinical faculty member — wearing an official Duke name badge, no less — praised Duke and Durham as a great place to train, live and raise a family. The extra attention to recruitment efforts paid off. “It’s an extreme blessing to be matched to Duke,” said Christopher Jones, a medical student from the University of California at San Francisco. “What Duke is doing in orthopaedics is amazing, and my prayers were answered.” Jones matched to Duke’s orthopaedic residency training program, and will spend the next five years here. He credited his decision to a warm and inviting welcome from William T. Hardaker, Jr., M.D., director of the program, and Jim Nunley, M.D., chief of orthopaedic surgery, as well as the smart facilities, didactic curriculum and Duke’s storied sports and undergraduate academic traditions. Duke’s well-deserved reputation is key to continued success at Match Day, said Michael Cuffe, M.D., vice dean for medical affairs. “Our success is directly attributable to the strengths of our departments, and the commitment and excellence of our current faculty, house staff, and educators,” said Cuffe. The widely recognized excellence of Duke’s clinical faculty and the School of Medicine, a commitment to GME through endowed funds, and recent initiatives such as the Global Residency Program and a new MD/ MBA management track have only made Duke a more desirable institution at which to train, he said.

infographic by vanessa dejongh

Match day: Assignments for new Duke residents

Internal Medicine 45

Anesthesiology 14 Emergency Medicine 8

Family Medicine 3

Medicine-Preliminary 6 Med-Prelim/Neurology 3 Neurological Surgery 3 Neurology 4

8 Orthopaedic Surgery 8 Otolaryngology 2 Pathology 4 Dermatology 3

Psychiatry 7 Radiology-Diagnostic 12 General Surgery 7

Surg-Prelim/Urology 2 Medicine-Pediatrics 6 Medicine-Psychiatry 2 Pediatrics 16

Up to five of the new residents may qualify for that new management track, said Dev Sangvai, M.D., MBA, associate program director of the Duke Medicine Management and Leadership Pathway for Residents. This track will combine rigorous clinical training with formal project-based rotational opportunities across the system — clinical care, research, and education. “While many Duke students choose to continue their medical education in another location, a significant number of our graduates chose to stay with us,” said Weinerth. Twenty-six Duke graduates will remain here for their residencies, while others will complete their training at

Harvard University, the University of Michigan, UCLA, Stanford, Johns Hopkins and other schools. “Our students did quite well, with most matched to highly competitive fields or programs,” said Ed Buckley, M.D., vice dean for education. All of Duke’s 102 graduating medical students matched to top-level residency programs, in specialties from internal medicine to pediatrics to neurosurgery. The National Matching Resident Program reports that this year was the biggest Match Day on record, with more than 15,000 graduating medical students applying. n

Inside Duke Medicine

April 2009

b enef i t s

L I V E F OR L I F E

More than a paycheck

Understanding your net worth at Duke

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our annual salary is just one part of your total compensation at Duke. For most faculty and staff, Duke also pays a portion of health insurance, helps with retirement nest eggs and offers other valuable benefits such as life insurance and tuition assistance. Your personalized benefits statement will arrive by mail at your home by early May, providing an overview of the value of your total compensation package, which includes salary and benefits. “In today’s economy, it is essential for each Duke faculty and staff member to become more familiar with the benefits connected to their job,” said Kyle Cavanaugh, vice president of Human Resources at Duke. “I believe that Duke’s combination of direct pay, benefits — and a supportive work environment — makes Duke an unbeatable place to work.” On average, for every dollar an employee earns, Duke contributes about 25 cents in additional benefits. This includes financial provisions such as insurance or retirement plans, as well as investments in discounts, wellness programs and other opportunities. Each employee’s total compensation package is unique, based on individual choices. To highlight elements that comprise total compensation, at right is a chart showing what a total compensation package might look like for a typical monthly-paid employee earning a $56,182 salary. n

By taking a proactive approach to your life and taking advantage of Duke’s wellness programs, you can prevent disease and become healthier.

Duke Run/Walk Club It’s not too late to join the Run/Walk Club. The club welcomes runners of all speeds, abilities and interest levels. Although many of the members in the club run or walk just for fun, some set personal goals that they pursue throughout the year. Whether you are preparing for a race, just love to be outdoors, or need a kick in the pants just to get you out the door, the Duke Run/Walk club is a great step to get and keep you motivated.

A complete pay package 76% 9% 7% 6% 1% 1%

Salary Health Insurance/Employee Health Services Faculty/Staff Retirement Plan Contribution Social Security/Government Programs Disability Insurance/Group Life Insurance Educational Assistance

Watch a video with employees about the value of working at Duke at http://www.hr.duke.edu/value

“I enjoy working with people. I really like that interaction when new patients come in or if families need to know where to go. It’s fun.”

Peggy Holmes, service associate, Patient Information Services, 4 months at Duke “The opportunities that Duke offers are amazing. You could start off in housekeeping and end up a director if you have the goal for it. Duke gives you the tools to get there.” Juanita Johnson, staff assistant, Multicultural Center, 5 years at Duke

“I value the other people I work with. We’re the kind of people that share interests in the same things. The benefits are also great. The health care plan pays for itself.” Rick Gray, clinical research assistant, Thoracic Oncology, 1 year at Duke

rick gray

Monthly Update

Here are just a few of the wellness benefits available to you as a Duke University Health System employee:

What do you value about working at Duke?

peggy holmes

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“I value the retirement plan because it’s extra money, and the more, the better. If you don’t have enough of your own money, then you have that to fall back on because of Duke. It’s something we’ll need when we do retire. We don't want to retire, then have to come back to work.” LaShosta Parham, lead food service worker, Duke Dining Services, 12 years at Duke

The Run/Walk Club meets on Mondays and Wednesdays, 5:30 p.m.-6:30 p.m. at East Campus (across from Whole Foods) and at West Campus (in front of Wallace Wade Stadium). The Run/Walk Club also meets at Durham Regional Hospital from 5–6 p.m. at the employee entrance. Can’t make it to a weekly group session? Sign up for the Independent Run/Walk Club, and log your sessions online. Register now at http://www.hr.duke.edu/runwalk/

Become a Locavore Locavores eat local food whenever possible. It’s better for the environment, the local economy, and your health. At the Duke Farmers Market, buy locally grown fruits and vegetables, watch cooking demos by our Duke Chefs and get healthy recipe ideas. The Duke Farmers Market opens April 24th from 11:00 a.m.-2 p.m. and is held every Friday through the end of July, except for July 3. The Market is located in front of the Medical Center Bookstore next to the walkway connecting Duke University Hospital and Duke Clinic. Find out more: http://www.hr.duke.edu/ eohs/livelife/market.html

Go mobile marketing Can’t make it to the Friday Farmers Market at Duke? Sign up for the Duke Mobile Market and let local farmers share their weekly harvest with you. Pre-purchase a share and each Tuesday the farmer will have your produce ready for pick up at the Duke Gardens. For more info, visit http:// www.hr.duke.edu/mobilemarket

The Science & Research Supplement to Inside Duke Medicine VOLUME 18 NO. 4

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April 2009

F E A T UR E

Enzyme protects against heart attacks Mice born without a certain enzyme can resist the normal effects of a heart attack and retain nearly normal function in the heart's ventricles and still-oxygenated heart tissue, according to a study by researchers at Duke University Medical Center. The findings raise the possibility of a therapy that could stimulate the growth of blood vessels and limit damage from a heart attack as well as prevent an attack from occurring at all, the scientists said. “There were blood vessels everywhere in these mice born without the enzyme," said Jonathan Stamler, M.D., professor of medicine and biochemistry and author of the study published in the online Proceedings of the National Academy of Sciences on March 27. "The hope is that this discovery someday could result in a therapy for new blood vessel growth that could be a sort of natural bypass in humans.”

Less invasive treatment for Parkinson’s A novel stimulation method, the first potential therapy to target the spinal cord instead of the brain, may offer an effective and less invasive approach for Parkinson’s disease treatment, according to pre-clinical data published in the journal Science by researchers at Duke University Medical Center. Researchers developed a prosthetic device that applies electrical stimulation to the dorsal column in the spinal cord. The device was attached to the surface of the spinal cord in mice and rats with depleted levels of the chemical dopamine – mimicking the biologic characteristics of someone with Parkinson’s disease along with the impaired motor skills seen in advanced stages of the disease. When the device was turned on, the dopamine-depleted animals’ slow, stiff movements were replaced with the active behaviors of healthy mice and rats. “We see an almost immediate and dramatic change in the animal’s ability to function when the device stimulates the spinal cord,” says senior study investigator Miguel Nicolelis, M.D., Ph.D., the Anne W. Deane Professor of Neuroscience at Duke.

Despite its reputation, carefully measured doses of radiation provide a wide range of helpful medical uses. file photos

The bright side of radiation By Kelly Malcom

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adiation, despite its dangerous reputation, has a wide range of medical uses. It comes down to a matter of dose. Small doses of radioactive tracers introduced into the body can help radiologists identify metabolic abnormalities. At higher doses, radiation can be used to kill cancer cells and treat other disease. “Duke has been at the forefront of developing and utilizing radiation for clinical purposes,” said Edward Coleman, M.D., vice chair of the Department of Radiology and chief of Nuclear Medicine. Pinpointing a disease’s location within the body is crucial to optimizing treatment, he said. Radionuclide imaging, like positron emission tomography (PET), can help physicians measure important bodily functions, such as glucose metabolism and blood flow. A positron is a particle that gives off gamma rays that can be used to produce an image. Combining different methods of imaging allows for an accurate picture of a disease’s advancement. “The type of imaging that has risen to the forefront is PET imaging, which is used every day primarily as a tool in diagnosing and managing

99m, which is used for imaging of the kidneys, bones, brain, heart and other structures. Duke is a leader in the developing field of targeted radiotherapy, which uses radiation delivered directly to a diseased organ. Zalutsky and his colleagues have developed pioneering treatments using radio-labeled antibodies to target brain tumors. Paul Suhocki, associate Small doses of radioactive tracers professor of Radiology, is workintroduced into the body can help ing with radioactive spheres injected directly through blood identify metabolic abnormalities. vessels to the liver to target tumor cells while sparing vulnerable “One of the most common normal cells. radiopharmaceuticals used in PET is Despite their many medical uses, fluorine-18-FDG, otherwise known radionuclides can be notoriously as F-18,” said Neil Petry, assistant difficult to come by. They must be professor of Radiology. created and are most commonly made F-18 has a short half-life of only in what is known as a cyclotron. A two hours, which means it takes only cyclotron is a particle accelerator that four hours to decay. It’s useful in idenspins atoms in a circular magnetic field. tifying cancers because cancerous cells metabolize sugar faster than normal Duke has a small cyclotron located in ones. Thus, the radioactive F-18 will Duke South that is used to create concentrate in cancer more and show radionuclides in support of clinical PET studies, most commonly, F-18. up as a “hot spot” on an image. However, the short half-life “Surgeons can then use that of F-18 limits its use for certain information to determine a course functions. of treatment,” said Petry. Other commonly used radionuclides include “Most of the work being done I-131 sodium iodide, which is used to in the U.S. is using a very limited see RADIATION, p.9 image the thyroid, and technetiumcancers,” said Michael Zalutsky, Ph.D., professor of Radiology and Radiation Oncology. Prior to a PET scan, a patient is either injected with, swallows, or inhales a radiopharmaceutical that will then accumulate in the body, illuminating areas of particularly high cell metabolism.

Inquiry

April 2009

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“PET imaging is used every day as a tool in diagnosing and managing cancers.“ ­­– Michael Zalutsky, Ph.D. RADIATION, continued selection of radionuclides, ones that can be made conveniently and easily. What is needed is to have access to the array of radionuclides with different lifetimes, energy spectra and chemistries,” said Zalutsky. For example, he said, a radionuclide-tagged antibody clears slowly from the body compared to a radioactive sugar. “If you wanted to do PET with an antibody, it would clear so slowly the images from F-18 would not be useful. However, there is a wide range of radionuclides that are currently unavailable but have been demonstrated in lab studies to have potential treatment uses.” Several national agencies, including the National Cancer Institute and the National Academy of Sciences, have identified the need for increased production of radionuclides for research and clinical use in the U.S. Based on these recommendations,

Dr. Zalutsky and Victoria Christian, chief operating officer of Duke Translational Research Institute, are working with several institutional partners at the North Carolina Research Campus(NCRC) in Kannapolis to develop a pilot biomedical accelerator complex (BAC) intended to produce these key research radionuclides to support clinical research at Duke and across the nation. “The BAC is a way to leverage the resources and scale of the NCRC to create a resource for radiochemistry and targeted radiotherapy that would more than meet the growth needs of Duke, and include North Carolinabased institutions like UNC-CH, N.C. State and others, as well as institutions throughout the U.S.,” she said. Meanwhile, Duke’s Center for Molecular and Biomolecular Imaging is bringing together researchers from radiology, biomedical engineering, oncology and other basic and clinical disciplines to discover new ways to noninvasively diagnose and treat disease. n

New radiopharmacy moves to Davison Duke’s radiopharmacy has long been located in the famed Bell Building through a heavy door laden with radioactive warning labels. While the name may seem foreboding, every precaution is taken by employees to minimize exposure and to maintain the purity of these life-saving drugs. That task will be made easier by a move to a new facility in the lower level of the Davison Building, said Neil Petry, assistant professor of radiology. “The Bell Building wasn’t outfitted to meet modern standards of preparation. Our new facility will have both primary and secondary engineering controls,” he explained. “Our goal is to prepare drugs that are free of contaminants to meet strict preparation standards for radiopharmaceuticals.” These engineering controls include HEPA-filtered air that is 99.9 percent free of particulates and replaced 60 times per hour. Duke’s radiopharmacists are integral to the clinical process and handle preparation, documentation and quality control of radioactive drugs. The new facility’s updated features will serve as an attractive feature to outside commercial drug developers, as well, said Petry. “Companies can be ensured that we’re meeting compliance levels in an increasingly strict regulatory environment.” The next steps to making the full upgrade include acquiring new gowns, training personnel and rewriting standard operating procedures.

HIV screening research in the Emergency Department

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he Centers for Disease Control and Prevention estimates that more than one million Americans are living with HIV. Of those, 24 to 27 percent are unaware of their HIV infection. Chuck Gerardo, M.D., associate professor of surgery in Emergency Medicine, and Charles Hicks, M.D., associate professor of medicine in the Division of Infectious Diseases, have designed a research program that includes offering free HIV screening to patients who come to the Duke University Hospital Emergency Department. Research led by the Division of Infectious Diseases discovered a higher than average number of people treated in the E.D. had undiagnosed HIV. “This information, which we gathered from anonymous blood samples, was the impetus for this testing program,” said Hicks. Patients who are over 18

to 400 patients and had 65 percent agree to be tested,” said Mehri McKellar, M.D., assistant professor of medicine.

years of age and are well enough to give consent are offered the HIV-antibody test. The simple test consists of an oral swab that is swept across the gums and that can deliver results in just 20 minutes. “So far, we’ve offered testing

tested and test positive for HIV are then administered a follow-up blood test to confirm,” said McKellar. “We also ensure that each patient who tests positive Duke researchers found that a higher than has access to a average number of people treated in the social worker and follow-up treatment E.D. had undiagnosed HIV. in the infectious The testing is being run by disease clinic. The testing itself is Partners in Caring, a collaboration strictly confidential.” between Duke Pastoral Services and The testing program is under Duke University AIDS Research IRB approval as a research study. and Treatment Center that provides Along with the gum swab, testers spiritual care to people living with collect demographic information HIV/AIDS. Additional support and vital signs. is provided by first-year medical “We’re trying to assess whether students trained in HIV counseling HIV testing in the ED should be and testing. standard procedure and whether “It’s nice to have staff trained in fever correlates with untreated HIV,” dealing with HIV/AIDS doing the said McKellar. She’s hoping the testing and this prevents overburstudy will provide data on disease dening the Emergency Department prevalence and emergency room staff. Patients who agree to be protocol. n

Inside Duke Medicine

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April 2009

PAT I E N T C A R E

OT in the NICU April is Occupational Therapy Month By Karen M. Buckmiller M.S., OTR/L

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n occupational therapist helps people be as independent as possible and maximize their performance of their “occupations,” including the things they do on a daily basis – such as getting dressed, bathing, attending school, eating, playing or driving a car. But occupational therapy is for more than adults. At Duke University Medical Center, occupational therapists work in the Neonatal Intensive Care Unit (NICU). Duke is providing current best practice in that it has seen the value in our (OT) services and the important role we play in the development of these premature and fragile infants. The NICU population includes infants who are acutely ill or premature, and who are often unstable, fragile and easily compromised by environmental conditions. Their primary “occupations” include sleeping, feeding, interacting with their parents and caregivers and use of their eyes and hands to explore their environment. OT in the NICU helps protect these fragile babies from excessive or inappropriate sensory aspects of the environment, and assists the family in fostering optimal development for their baby. That includes the development of age-appropriate occupations (i.e., feeding), sensorimotor processes, caregiver-child bonding, and neurobehavioral organization. To help foster an infant’s neuromotor development (how the brain and muscles work together) occupational therapists assist with optimal positioning of the infant in the isolette and/or crib as well as educating caregivers in supportive ways to hold the infant, including “Kangaroo Care.” Occupational therapists might also fabricate special supports in the form of splints to help manage muscle tone or range of motion. OT plays a very important role with the premature infant’s sensory system and their ability to organize and regulate the stimuli in the world around them. Often these babies have a difficult time adjusting to being outside the womb. Occupational therapists assist these infants with regulating touch, sound, and light.

Salute to Occupational Therapists To recognize the invaluable service provided by Occupational Therapists (OTs) and Occupational Therapy Assistants (COTAs), April is recognized as Occupational Therapy Month. Take time this month to recognize them throughout Duke University Health System: • Acute and Critical Care at Duke University Hospital (Adult and Pediatric services) • Durham Regional Hospital (Acute Care, Acute Rehabililitation • Duke Health Raleigh Hospital (Acute Care, Outpatient) • Person Memorial Hospital (Acute Care, Outpatient, Skilled Nursing Facility) • Duke Health Community Care (Home Health) • Hand Rehabilitation (Duke Clinic) • Functional Capacity Evaluation/Work Conditioning (Duke Clinic) • Children’s Health Center (Specialty Clinics) • Amyotrophic Lateral Sclerosis (ALS) Clinic, Pain Clinic, Muscular Dystrophy Clinic, Movement Disorder Clinic at Moreene Road • Adult Outpatient Rehabilitation (Duke Clinic, Lenox Baker) including driving evaluations and low vision • Pediatric Outpatient (Specializing in developmental, feeding and sensory processing disorders at Lenox Baker) • Ergonomics Division, Occupational and Safety Office (OESO) Ergonomic evaluations, office evaluations, return to work program and safe patient handling.

Occupational therapy and Speech therapy work together as a feeding team in Duke’s NICU. Feeding is not just about the infant being able to eat enough food to get the nutrients they need to grow. Occupational therapy focuses on the quality of the feeding skills, which includes suckswallow-breathe coordination and the ability for an infant to maintain a calm organized state during a feed. OT’s role in the NICU is probably best described by the recent story of beautiful twin girls. These precious babies were born prematurely at only 25 weeks gestation. Baby Girl A was born weighing

Did you know occupational therapists work with infants? Babies have ‘occupations,’ too — sleeping, feeding and parental bonding.

Service to Community In recognition of OT month the Occupational Therapy staff would like to suggest that all step out and help someone this Spring season by donating gently used/new gym shoes for adults and children. These will be donated to the Durham Rescue Mission to help dress those in need in the Durham Community. Donations may be turned in at Room 6218, Duke North (PT/OT gym) during April.

1.7 pounds and Baby Girl B weighing 1.6 pounds. OT became involved when they had reached the age of 32 weeks. Therapists educated the parents on how sensitive these two little ones were to noise, light and touch. Their parents were taught ways to help support their daughters to tolerate being a part of this busy world. One of the first goals for the girls, when they were big enough, was to tolerate coming out of their isolettes to cuddle with mom and dad and remain stable. Once that goal was achieved we helped them to be able to suck on their pacifiers while outside the isolette. As they achieved these goals we were able to gradually start introducing the bottle and breastfeeding one to two times a day, using a special nipple and certain feeding strategies. With each successful feeding experience we were

able to progress the girls to attempting to feed more often. Both girls are now taking a majority of their required nutrition by bottle and/or breast, are less reliant on feeding tubes and will be discharging home in the near future. Occupational therapists in the NICU at Duke do their best to serve the infants and their families by providing the best match or fit between the infant and the NICU environment as well being sensitive to family circumstances, priorities/goals, concerns and cultural beliefs. After discharge, many of these premature infants continue to require intervention to help assist their development. This continuum of care can be provided through Duke’s Special Infant Care Clinic, communitybased early intervention services, as well as through the outpatient facility at Lenox Baker Children’s Hospital. n

Inside Duke Medicine

April 2009

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C ALENDAR

April

Your insider's guide to what's happening at Duke Medicine

give

do

April 4 2 p.m. Run for a Change! Charity 5K run/walk to fight HIV/AIDS around the world. Al-Buehler Trail. After the walk, there will be an outdoor celebration at the Washington Duke’s Presidential Terrace with free food, live music and prizes for the top donors. All proceeds go to support programs supported by the Duke University’s Global Health Institute and Health Inequalities Program. Details and registration: http://www.gccforchange.org/5k

April 24 11 a.m – 2 p.m. Duke Farmers Market Opening Day The 9th season of the Duke Farmers Market opens with an Earth Day Celebration. Visit tents of 11 farmers and vendors and 5 healthy lunch vendors. See demonstrations on healthy cooking, nutrition and gardening topics. The market is open from 11 a.m. – 2 p.m. every Friday from April 24 – July 31 and 11 a.m. – 2 p.m. every other Friday from August 14 – September 25. The market will be closed July 3. Located outside the Medical Center Bookstore, on the walkway between Duke Hospital and Duke South Clinic. Details: http://www.hr.duke.edu/farmersmarket/

April 25 7 a.m. – 12 p.m. Angels Among Us – 5K Join families and friends whose lives have been touched by a brain tumor for the 5K and Family Fun Walk. This event raises money to support the Preston Robert Tisch Brain Tumor Center. Angels Among Us is a celebration of life, strength, courage and commitment, and has become a national event, with thousands coming from all across the country to volunteer, participate, and make a difference. This year's event will be held at the corner of Erwin Road and Flowers Drive on the Duke Medical Center campus. Details and registration: http:// www.angelsamongus.org/ April 25 6:30 p.m. An Evening of Hope hosted by the Duke Cancer Center and the North Carolina Lung Cancer Partnership Join us for a magical night filled with delicious hors d'oeuvres, magnificent art exhibits, and an opportunity to win fabulous prizes – all coming together to shine a light on lung cancer awareness. Semi-formal attire requested. The Nasher Museum of Art. Purchase tickets: www. NationalLungCancerPartnership.org/NC May 2 9 a.m. – 12:30 p.m. 9th Rainbow of Heroes Walk Supporting the Duke Pediatric Blood and Marrow Transplant Family Support Program. The walk commemorates and celebrates all the PBMT patients and their families. It is a reunion for patients, families, nurses, therapists, doctors, volunteers and supporters. Refreshments, music, and activities for everyone are provided. Rain or shine. There is no admission charge. Duke Center for Living Campus. Details: http://www.rainbowofheroeswalk.org May 2 Family Health Ministries presents: Celebrate Haiti! Join us for a night of Haitian food, art, dance and music and help build a health center in Leogane, Haiti. Fuqua School of Business, Winter Garden. Details: http://www.familyhm.org/ CelebrateHaiti2009.html

April 25 9 a.m. – 2 p.m. Plant and Crafts Festival Join Sarah P. Duke Gardens as it celebrates 75 years of showcasing the beauty of nature. The Gardens and guest vendors will sell an array of plants appropriate for this region, including plants featured in Duke Gardens. Local artisans will sell garden-related gift items. You can also get horticultural advice from the staff and Durham County Master Gardeners. Details: 668-3611 April 26 11 a.m. – 1 p.m. Duke University Hospital Service of Remembrance to remember those who have been cared for at Duke. Family and staff are invited to attend. Details: 684-4750 World Voice Day is April 5. Learn how to care for your voice and hear from the experts of the Duke Voice Care Center. Details below. illustration by vanessa dejongh

learn April 5 12 – 5 p.m. World Voice Day with the Duke Voice Care Center Join the world-class specialists of the Duke Voice Care Center for a vocal health fair. Learn how to care for your voice and hear a panel discussion with voice experts. Admission is free. Renaissance Raleigh Hotel at North Hills. Details: 1-888-275-3853 April 8 12 – 1 p.m. School of Nursing Office of Research Affairs Conference Series DaiWai Olson, Ph.D., will present “Critical Care Chaos: Is Nursing Research the Answer?” Refreshments will be served. DUSON, Room 1014.

April 23 5:30 – 7 p.m. Duke Integrative Medicine Seminar: Managing Pain with Acupressure and Acupuncture Join experts for this free seminar and learn proven healing strategies for chronic pain. Center for Living Campus. Details: 416-3853 May 4-5 Visual Thinking: How Do Visual Communication Technologies Affect Learning and Knowledge Retention in the Sciences and Humanities? A workshop for Duke faculty that will focus on developing a set of visual teaching strategies, evaluating learning with visualizations and a visit to Duke's virtual reality theater. Sponsored by Duke Center for Science Education, Duke Center for Instructional Technology, and the Visual Studies Initiative. CIEMAS Schiciano Auditorium. Registration deadline is April 24. Register: http://cit. duke.edu/events/calendar.do

May 3 11:30 a.m. National Cancer Survivor’s Day Celebration Duke Center for Cancer Survivorship invites you to join us for the 2009 National Cancer Survivor’s Day Celebration at Duke. Bryan Center. Register: http://www.dukehealth.org/events/cancersurvivorsday

How to submit: Send calendar listings to [email protected]

Want more info? Visit us online at http://inside. dukemedicine.org The Calendar is a monthly selection of events that feature the best of happenings at Duke and Duke Medicine.

Inside Duke Medicine

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April 2009

G OOD ID E A S

If we only listened to our mothers The doctor of nursing practice (DNP) is a newly approved degree within the nursing profession and here at Duke. Duke has the only DNP program in North Carolina. This semester, DNP students are taking a course taught by Nancy Short, DrPH, MBA, RN, titled, “Transforming the Nation's Health,” and learning about health policy issues. As part of this course, DNP students like Mary Ann Fuchs, MSN, RN, chief nursing and patient care services officer of Duke University Hospital and Duke University Health System, wrote opinion editorials on health issues. Here, Fuchs tackles hand washing:

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s a child, who does not remember the phase “don’t forget to wash your hands?” Simple? Yes, and incredibly important. In fact I am sure that we each heard that phrase multiple times from our mothers. My mother, who was a great supporter of cleanliness died from leukemia a couple of years ago. She received intensive treatments that made her very ill and prone to infection. She spent months in the hospital over the last two years of her life. I found the nurses, physicians and staff who cared for her very skilled and caring. Clearly they were experts who understood the role of preventing infections in such vulnerable patients. My mom was lucky — she never got an infection while she was hospitalized. Other patients are not so lucky. In fact, the Centers for Disease Control and Prevention estimate that each year about 10 percent (or 1.7

million) of patients in hospitals will catch an infection. These infections called “nosocomial infections” may contribute to the death of about 90,000 patients a year in the United States. Patients who do not die from an infection must spend on average 4-5 additional days in the hospital for treatment. These infections increase medical expenses by approximately $4.5 billion per year. One third of nosocomial infections are considered to be preventable. The most frequent way infections are spread to patients is by the hands of health care providers. In fact, proper hand cleaning is the single most important, simplest, and least expensive means of preventing infections. Sounds so easy, right?

procedures and risks; not enough perceived time; unavailability of sinks and cleaning supplies; and lack of role models to reinforce proper behaviors. These reasons are not acceptable and the practice of hand washing is under scrutiny. The Centers for Medicare and Medicaid Services and other insurance providers such as Blue Cross and Blue Shield are instituting measures to prevent hospitals from being paid for services that result in patients acquiring infections when hospitalized. As well, President Obama has allocated $50 million in the economic stimulus plan Decreasing preventable infections by for states to hand washing could potentially save the develop methods U.S. health care system $1 billion a year. to reduce health care-related Unfortunately, there is a problem infections. with hand washing in hospitals. It is In North Carolina, the General estimated on average that across the Assembly recently introduced House U.S., health care providers in hospiBill 296. This bill will provide just tals only wash their hands about 40 over $1.1 million to support the percent of the time. This poor rate of evaluation of infections in hospitals. hand washing alone is estimated to The bill will specifically support cost $1 billion per year. systems to monitor infections, There are many reasons for provide training programs for lack of hand washing in hospitals. hospital staff and develop methods These reasons may include: lack of by which hospitals will publically knowledge of infection prevention report infections acquired in their

facilities. While I personally support all of these initiatives, it does seem very silly that we would spend $50-plus million to reinforce hand washing activities in hospitals. It seems to me that with all of the other priorities and national economic needs we could use these dollars for better purposes. If we could decrease preventable infections just by hand washing we could potentially save the health care system $1 billion per year. This said, let’s go back to our hands. Health care professionals have the responsibility to ensure the safety of patients in their care — it is the right thing to do. Patients trust us with their lives. Procedures to assure behaviors that support hand washing must be reinforced. Patients and families, ask your health care providers if they have washed their hands. Stop them from touching you when you see that they haven’t. Health care providers — become champions to assure the prevention of infection in your patients. We should role model the hand-washing behaviors that our mothers taught us so long ago. We would want that for our own mothers, our families and ourselves — why not for all of those in our care. n

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