Inside Duke Medicine - March 2009 (vol. 18 No. 3)

VOLUME 18 NO. 3 n inside.dukemedicine.org n March 2009

special section

Benefits In this issue, 4 pages of news about your Duke benefits

Pay for college

A new home for the PA Program Facility highlights commitment to new models of care ABOVE: Duke’s Physician Assistant Program is now located at 800 S. Duke St. near downtown Durham. Photo by kelly malcom

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or the first time since its creation in 1965, the Duke Physician Assistant Program has a home of its own — at the former Blue Cross and Blue Shield of North Carolina headquarters near downtown Durham. “We have four times the space we had in our previous building and all of our spaces are designed to meet the program’s needs,” said Patricia Dieter, MPA, PA-C, director of the PA program. Last year, the announcement of Duke’s agreement with BCBSNC to lease the building came with Duke Medicine’s commitment to

Open House The Duke PA program will host an Open House from 4-6 p.m. on March 12 at 800 S. Duke St. in Durham. Guided tours and refreshments will be available.

Although companies and other organizations are eliminating or reducing benefits to tighten budgets during the recession, Duke has expanded its employee tuition assistance program for faculty and staff. In January, the benefit expanded to cover up to $5,250 in tuition reimbursement and nine courses per calendar year.

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Stretch your dollars Duke Credit Union seminars are free, and they save you money by helping you get a handle on household budgeting, understand finances or receive timely information on big financial moves, such as housebuying.

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gradual expansion plans for the program and a greater commitment to innovations in health care. Duke is the birthplace of the physician assistant concept and, with Duke’s commitment to new models of care, it’s only fitting that the program now has a home to match its heritage. see DUKE PA, p.2

Stay up to date The new Lynda.com program can help you stay up-to-date on emerging Web and multimedia technologies through online tools and tutorials available anytime, anywhere.

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inquiry

now open

events

Research under pressure

Knightdale clinic opens

What to do in March

Find out about the basic and clinical research ongoing at Duke’s Center for Hyperbaric Medicine and Environmental Physiology.

Duke Medicine expands to Eastern Wake County with new facility.

The calendar moves to page 15 this month.

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Inside Duke Medicine

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March 2009

F RO M t h e c o v e r

All 3 hospitals now Magnet status

DUKE PA, cont. “It is no secret that this country is facing a growing shortage of primary care physicians, and we don’t yet know how much worse this shortage will become,” said Justine Strand, DrPH, PA-C, chief of the physician assistant division. “PAs are going to be a key component in the evolution of new models of care and will be needed to ensure adequate access to care for Americans in the future.” “PAs are an efficient and flexible component of the solution to the shortage,” Strand said. “We can graduate a PA in two years, whether primary care or specialty.” Brandon Wyche, first-year student, said: “It’s good to know that you are preparing to do something that will ultimately fill an urgent need in the community.” Wyche, a former emergency medical technician, was introduced to the profession while working with PAs in hospitals. “The diversity of options available to physician assistants is what initially attracted me to the PA program, and the options seem to be growing almost every day,” Wyche said. “You don’t have to choose just one area like emergency medicine, surgery or family medicine.” Under the supervision of a physician, PAs take patient histories, perform physical examinations, order laboratory and diagnostic studies and develop patient treatment plans. In all states, including North Carolina, PAs have the authority to write prescriptions. Their job descriptions are as diverse as those of their supervising physicians, and may include patient education, medical education, health administration and research. “PAs work in all of the specialties of medicine,” said Perri Morgan, Ph.D., PA-C, director of physician assistant research. Nationally, 37 percent of PAs work in primary care. Other specialties where PAs are most common include cardiovascular and orthopedic surgery, dermatology and emergency medicine. “Recent growth of the PA profession has been dramatic,” Morgan

Duke Raleigh Hospital has achieved Magnet designation for excellence in nursing by the American Nurses Credentialing Center (ANCC). Only 5 percent of the nation’s hospitals have earned this designation, the highest level of national recognition to health care organizations that demonstrate sustained excellence in nursing care.

Chinika Reynolds takes a standardized patient’s blood pressure during a clinical problem evaluation. Photo by erin pratt

said. “The profession has doubled in numbers in the last decade, and tripled in the last 15 years.” There were about 74,000 PAs practicing in the United States in 2008. In North Carolina, there is about one practicing PA for every six practicing physicians. “I’m confident that PAs will play an integral part in revolutionizing our health care system and I am excited about the prospects for the future,” said Chinika Reynolds, a first-year student. Importantly, PAs — like other physician extenders on the modern health care team — increase patient access to health services by extending the time and skills of the physician. “Several patient satisfaction studies have shown that patients are as satisfied with care provided by PAs and nurse practitioners as they are with physician care,” Morgan said. At Duke, the program is growing. The traditional incoming PA class size was 45 students. The class beginning in August will have 70. The continued gradual expansion of the program is dependent on available clinical rotations within Duke University Health System and availability of PA scholarships through the School of Medicine to recruit top students, Dieter said. She described the new location as

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“more spacious and more conducive to teaching and learning.” The Duke Endowment helped support the start-up cost of the expansion of the PA Program. BCBSNC provided the renovations, and worked closely with Duke to transform the historic building into an energy-efficient and user-friendly facility. The new facility has a master classroom that can accommodate 90 students. The master classroom in the former on-campus location at Hanes House accommodated 66 students. The facility, at 800 S. Duke St., also offers four physical diagnosis suites, where students conduct physical diagnosis through clinical problem evaluations with standardized patients. The visits are recorded and given to the students for self-evaluation. Other features of the new location include a diagnostic methods lab, study rooms and lounges for students, faculty and staff offices, conference rooms, and two kitchens available to students. The layout of the new location brings students, faculty and staff together. “Before, we were spread out over multiple floors and now we are all in our own space together,” Reynolds said. Her fellow student, Wyche, said the new facility “feels worthy of the reputation of the Duke PA program.” n

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 second Friday of each month.

“It is an honor to receive such prestigious recognition for our hospital and a testament to the extraordinary nurses and entire hospital team who work together every day to provide the very best care to our patients,” said Doug Vinsel, chief executive officer of Duke Raleigh Hospital. Duke University Health System is the only hospital system in the Triangle with all hospitals receiving Magnet designation. Go to http://inside.dukemedicine.org to watch video featuring chief nursing officers from each of the hospitals. “This is the highest honor a U.S. hospital can receive for its nursing program and further supports the exceptional skill and dedication of Duke nursing” said Victor J. Dzau, M.D., chancellor for health affairs and president and chief executive officer of the Duke University Health System. “For all three of our hospitals to receive this distinction truly signifies the world-class care available to all of our patients.” The Magnet Recognition Program recognizes health care organizations that demonstrate excellence in nursing practice and adherence to national standards for the organization and delivery of nursing services. Applicants undergo a rigorous evaluation that includes extensive interviews and review of nursing services. Duke Raleigh Hospital was notified of Magnet recognition on Feb. 13 after a three-year-long application process. Durham Regional Hospital received Magnet designation in November after completing as similar lengthy process. The designation was given to Duke University Hospital in 2006. “We are so appreciative of the more than 225 employees who were directly involved in this process,” said Mary Graff, director of nursing special projects and the Magnet program at Duke Raleigh Hospital. “Our nursing staff are so deserving of this designation, and I am so proud to be the nursing leader of this amazing group,” said Rosemary Brown, chief nursing officer. Research shows there are clear benefits to hospitals that are awarded Magnet status and to the communities they serve in consumer confidence, recruitment and retention and in maintaining quality of care. Magnet designation is maintained for four years. During that period, the ANCC monitors facilities to ensure high standards of care continue to remain.

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 Intern: Sara Portoghese Copyright © 2008 Duke University Health System

March 2009

Inside Duke Medicine

C Q ALEN & A D AR

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p r i vac y a l e r t

Beknighted – Duke Medicine opens clinic in Eastern Wake County I

n and around the Triangle, no area is growing as fast as Wake County. The population of Wake County grew by 32.6 percent— adding 204,744 people— between 2000 and 2007, according to state government estimates. Comparatively, Durham County grew by 14.1 percent and Orange County by 10.2 percent. The March 2 opening of Duke Medicine in Knightdale, a state-of-theart facility with primary care and urgent care services, is the latest example of how the Duke University Health System doug vinsel, ceo continues to make investments in Wake County. The Knightdale clinic now gives Eastern Wake County the same world-class specialty services available to patients in Durham, Raleigh, Morrisville and other communities. We asked Doug Vinsel, CEO of Duke Raleigh Hospital, to elaborate on Duke Medicine’s Wake County strategy and explain how the new Duke Medicine in Knightdale answers the growing need for health care services there.

Why open a clinic in Knightdale?

The establishment of a Duke Medicine presence in Knightdale at the intersection of Interstate 540 and US 64-Business is consistent with our strategy of trying to create a presence along the I-540 corridor. In looking at opportunities within Wake County, Knightdale stood out as a high-growth community with minimal existing medical services. Locating our new building at the intersection of I-540 and 64 makes access for patients in the northern and northeastern tier of Wake County very convenient. And, the new building is on 16 acres, which certainly creates the opportunity for future evolution of this facility into a health campus. I would be remiss if I didn’t mention the communications from the university and the health system on March 2 that provided a clear update on how Duke is being impacted by the current financial crisis. Within the Health System, current efforts to manage expenses and achieve a sustainable financial structure for the future are critically important. But, as pointed out in the email to Duke Medicine employees, expense management is only one component that will drive our long-term success. The other driver will be strategic, well-designed, fiscally disciplined investments in projects that can drive growth — the Knightdale project is a good example of this and is consistent

What to do about lost, stolen data Duke Medicine in Knightdale opened for business Monday, March 2, 2009

Laptop computers, thumbdrives, personal digital assistants, and other mobile devices make accessing electronic information easier and often more efficient.

Location: 162 Legacy Oaks Drive, Hwy 64 and I-540, Knightdale, NC 27545 Primary Care: Family medicine for all ages. Mon-Fri 8 a.m. – 5 p.m. Urgent Care: Open seven days a week, 8 a.m. – 8 p.m. Specialty Care: Gastrointestinal medicine, pulmonary medicine, cardiology and orthopedics. Appointments: 919-232-5205 or 1-888-ASK-DUKE (375-3853)

with our two-track approach to long-term success. How are Wake County residents responding?

The early response is encouraging; there were more than 25 appointments scheduled during the first day that the appointment line was open. Bottom line: I think this is a location that will be successful short and long term and one that will allow for a synergistic relationship between Duke Raleigh Hospital, which is just 7 miles away. What’s special about the facility?

The facility itself is spacious, attractive and easily accessible. I think the thing that is most special about the location is the fact that it’s a 40,000-squarefoot building that, when fully ramped up, will accommodate 25 physicians — 14 specialists and 11 primary care doctors. The critical mass of primary and specialty care will be a beacon for both existing residents and newcomers to Wake County seeking a single site where they can receive virtually all of their physician care. What specialty care physicians will be located at Knightdale?

By late spring, Duke Medicine in Knightdale will include orthopedics,

cardiology, gastroenterology and pulmonology. Then, over the next 12 to 18 months, other specialties will be added. The mix of specialists was based on the demographics of the area and the gaps in specialty care that currently exist and are projected to continue to exist over the short to intermediate term. Many of the specialists who will initially work at the Knightdale clinic will also continue to have a presence on the Duke Raleigh Hospital campus in the Duke Medicine Plaza. Will the quality of care match the high quality across Duke Medicine?

Absolutely! Protocols and evidenced based care practices will be consistent at this site with those at other Duke Medicine locations. We’re proud to be bringing even more of Duke’s worldclass care closer to Wake County’s residents. Did Duke Medicine recruit new physicians, nurses and staff to fill the facility?

All of the physicians who will occupy the Duke Medicine of Knightdale site will be Duke PDC Physicians (specialty care) or Duke Primary Care Physicians (primary and urgent care). Many of these physicians are new recruits, although some will be redeployed from within the Health System. Similarly, many of the staff who will support the practices are new Duke Medicine employees, while others are existing employees who have chosen to transfer to this new location. n

These portable devices may also be easily lost or stolen. If patient information or other sensitive information (Social Security numbers, personal financial information, etc.) is stored on these portable devices, patient’s identity and Duke could be at risk.

To prevent the loss of data: • Do not store sensitive information on laptops or mobile devices.Use remote access services like the Duke Medicine VPN service, virtual PIN and other Citrix services to access the needed information. Information saved on these servers is secure and backed up nightly. • If you must store information on mobile devices, encryption of the information is required. Contact your technical support person for assistance.

If your laptop or mobile device is lost or stolen: • Contact your information security officer or the DHTS Service Desk at 684-2243.Security support personnel are listed at https://www.iso.duke. edu/iso/isop/isl.php. Contact Duke Police at 684-2444 and Risk Management at 684-3277. • Provide the last known location of the device. • Identify all patient health information or sensitive information stored on the device.

Inside Duke Medicine

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March 2009

B ULLETINS

AT A G LAN C E

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I’m impressed with how people here can take an idea … and turn it into something big. People here are overachievers in the sense that they can make big things happen starting with relatively modest resources.

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— Nancy Andrews, M.D., Ph.D., dean of the the School of Medicine, in her inaugural State of the School address

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Health care receipts due by April 15 Faculty and staff who 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. Claim forms and supporting documentation must be post marked or faxed to WageWorks by April 15. Claims for 2008 submitted after this date will not be reimbursed. Claim forms are available online at http:// hr.duke.edu/forms, or at the Human Resources office, 705 Broad St. in Durham.

6,288 The number of hours worked in calendar 2008 by hospice volunteers at Duke Home Care & Hospice.

Source: Duke Home Care & Hospice

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Hospice center opens with ceremony, gifts

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oney raised by the Duke Hospital Auxiliary again is benefiting Duke Medicine’s facilities, patients and families. A donation from the auxiliary will provide flat screen TVs for all 12 patient rooms — plus TVs for the family room and the nurses area — at Duke HomeCare & Hospice’s new facility on North Roxboro Road in Durham. The facility, called the Hock Family Pavilion, had its ribboncutting on Feb. 24. “Providing the funding to buy the TVs allowed hospice to use their funds for other areas of the facility,” said auxiliary director Renea Hunnings. “We would not have been able to provide that level of amenity without a committed sponsor like the Duke Hospital Auxiliary,” said Starr Browning, executive director of Duke HomeCare & Hospice. “They have been a strong partner in the work we do.” The auxiliary has helped sponsor a wide range of projects at Duke Hospital since 1950, with particular emphasis on patient and family needs. It raises

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Register: Spirituality and health research workshops The Duke University Center for Spirituality, Theology and Health is offering two five-day research workshops on July 20-24 and Aug. 17-21 that compress a two-year post-doctoral fellowship into five days. They will be the only places in the world where specific training on religion, spirituality and health research can be obtained from faculty active in the field for nearly 25 years. In each of the past four years, the workshops have been over-subscribed, so it is important to register now. The courses are strongly recommend for graduate students, researchers early in their careers, and seasoned researchers wishing to shift work into this area. There are no degree requirements for participation. Tuition scholarships are available for students with extreme financial hardships and exceptional academic potential. Because of the intense nature of this training, which includes individual mentorship with Harold G. Koenig, M.D., and other workshop faculty, the workshops are limited to 25 participants each. For any questions, write [email protected]. edu, or go to: http://www.spiritualityandhealth.duke.edu.

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Find a summer camp for the kids Participating in the Feb. 24 ribbon-cutting at the new Hock Family Pavilion hospice inpatient facility were, left to right, Mary Ann Black, Duke University Health System assistant vice president for community affairs, Deborah and Jim Hock, Gary Hock, DUHS CEO Victor J. Dzau, M.D., and state Sen. Vernon Malone. Not pictured are Starr Browning, executive director of Duke Home Care and Hospice, Duke University President Richard H. Brodhead and Paul Newman, DUHS vice president for ambulatory care. Photo by nancy shambley

money through three gift shops, a volunteer office and fund-raising events. The new hospice facility features 12 private patient rooms, 24-hour skilled nursing care and an interdisciplinary team of nurses, social workers, chaplains, nursing

assistants, bereavement counselors and volunteers. In another gift, the auxiliary donated $10,000 to provide heart patients with pillboxes uniquely designed for easy opening by anyone who has arthritis or gripping problems. n

Are you a Duke University Health System employee and already wondering what to do with the kids thus summer? It’s never too early too plan. Check out the list Duke University Staff & Family Programs has compiled of summer camps and programs taking place in Durham, Orange and Wake counties. The list includes athletic and academic camps sponsored by Duke as well as other arts and recreation camps in the area. Find all the details here: http://hr.duke.edu/ family/camps.php

Inside Duke Medicine

March 2009

■ ■ P e r son a l fin a n c e

How to obtain a duplicate W-2

Q: How do you jumpstart performance?

A: A Quiz Bowl!

The 2008 W-2 forms needed to file tax returns were distributed in late January.

An employee must complete a Tax Document Request Form to request a replacement of a lost or misplaced W-2 form. This form is available on the Corporate Payroll Services Web site: http://www. payroll.duke.edu/forms/forms.php.

For more information about W-2 forms, talk with your department payroll representative, visit the Corporate Payroll Services Web site, or call 684-2642.

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Fulkerson among 6 ‘Sammie’ award winners William J. Fulkerson, M.D., senior vice president of clinical affairs for the health system, is among six people recently selected for the 2009 “Sammie” awards, named for distinguished political scientist, educator and human rights activist Samuel DuBois Cook. The winners were announced at the 12th annual dinner and awards ceremony held at the Washington Duke Inn & Golf Club. All were chosen in appreciation of their work in furthering Cook’s legacy. FULKERSON

Fulkerson, head of the Duke Hospital Diversity Leadership group, was cited for providing leadership in the area of diversity and inclusion, helping enhance diversity education, and encouraging all members to consider the connection between diversity and patient care. Also recognized were Peter Klopfer, Ph.D., emeritus professor of biology at Duke and civil rights advocate; Martha Shumate Absher, associate dean for education and outreach at Pratt School of Engineering; the Rev. Mel Williams, senior pastor at the Watts Street Baptist Church and founder of Walltown Neighborhood Ministries Inc. and Duke seniors Dinh Phan and Flint Wang. Named for the first African-American faculty member at Duke, the Cook Society was founded in 1997 to recognize and celebrate the African American presence at Duke. For more information and to find a list of past award recipients, go to http:// www.duke.edu/web/cooksociety.

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Human Resources policies updated Duke Human Resources has updated the Duke Staff Handbook, which gives an overview of policies and procedures. The handbook, which is distributed to newly hired staff during orientation, includes several updates that have been incorporated into the HR Policy Manual. More information about these changes, as well as an electronic copy of the handbook, can be found at http://hr.duke.edu/policies.

In an effort to better serve faculty and staff, Duke University has standardized the process for requesting duplicate tax forms.

This change is necessary to obtain an original employee signature authorizing the request. The fees associated with this request are stated on the Tax Document Request Form and remain unchanged from prior years.

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Stroke Association honors Goldstein By Melissa Schwarting

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t’s 6:45 a.m. on a frigid Wednesday morning. Twelve wide-eyed neurosurgery residents sit around a conference room table as Michael Haglund, M.D., Ph.D., program director of the neurosurgery training program, steps up to a podium at the front of the room. But this isn’t a typical lecture. Haglund transforms into a referee as teams are formed and the room is suddenly filled with a competitive energy that could rival a Super Bowl match up. This event is called Quiz Bowl, an idea conceived by Haglund, who used an experience with his children as inspiration. “This concept was something I’d seen when my kids participated in a junior Bible quiz,” he explains. “It makes learning fun … [the residents] get into it.” Quiz Bowl is not just fun and games. What started as an experiment to make the learning process more interesting, has turned into a successful teaching model. “[The residents] seem to pay more attention and enjoy the friendly competition,” Haglund explains. “We’ve also seen the scores come up a lot since we started doing this,” Haglund says. He estimates that quiz scores improved from an average of 24 percent in 2007 to around 83 percent since the Quiz Bowls began in 2008. Haglund is careful to note that part of the improvement can be attributed to other recently launched efforts in the department to encourage resident participation and make them feel more engaged in the design and implementation of the residency training program. As the game kicks off, teams of two are formed. Chief residents are paired with more junior residents and mid-level residents join together. All eyes are fixed on a large projec-

tion screen as questions, photographs and diagrams begin to appear asking questions like, “Name a neuropeptide neurotransporter.” The room fills with clicking sounds as the residents begin pounding small, remote controlled buzzers in their hands signaling their desire to answer the question. The questions keep coming, along with the enthusiastic responses of the residents, as team after team comes to the front of the room for their turn in the hot seats. The format is single round elimination comprised of five rounds. Three correct answers in round one meant one team was moving on to face their next opponent and one team was out of the competition. The initial concept started two years ago when Cory Adamson, M.D., Ph.D., assistant professor of surgery and neurobiology, started administering weekly quizzes to the residents. Those with the top scores at the end of the year were eligible to be named “resident scholar” and win a cash prize. When Haglund took over as program director last spring, he wanted to build upon Adamson’s creative approach. He soon introduced Quiz Bowl, which takes place every three months and includes questions from the weekly quizzes administered during the prior 12 weeks. On this morning, the championship round has Renee Reynolds, M.D., and Hamid Aliabadi, M.D., squaring off against Betsy Hughes, M.D., and the incumbent winner, Ciaran Powers, M.D., Ph.D. Following an intense round of questioning, Powers and Hughes are the victors. No rings or trophies are awarded to the winners. Instead the winners and a guest are taken to dinner, at a restaurant of their choosing, by Haglund and another member of the faculty. n

Larry Goldstein, M.D., professor of medicine (neurology) at Duke and the Durham VA Medical Center and director of the Duke Stroke Center, was honored February by the American Stroke Association with the William Feinberg Award for Excellence in Clinical Stroke.

goldstein

The award honors “significant achievement in the clinical investigation and management of stroke.”

Goldstein is a senior fellow in Duke’s Center for Clinical Health Policy Research, and principal investigator of Duke’s American Stroke Association–Bugher Foundation Center for Stroke Prevention Research. Read more about the honor and Goldstein’s work at http://inside.dukemedicine.org. Search “Goldstein.”

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Save 40 percent on Fuqua business courses All Duke faculty and staff are eligible for a 40 percent tuition reduction on all nondegree executive education programs at the Fuqua School of Business. Fuqua is a premier provider of business education for working professionals. A range of programs are available, designed specifically for professionals in all stages of career development. Eight executive education programs are available throughout the year. Two new programs available in fall 2009 are: Fundamentals of Management (for first-time managers, and experienced managers without formal training) and High Potential Executive (for mid-level managers and executives). Programs are held at the R. David Thomas Executive Conference Center on Duke’s campus and also at the Washington Duke Inn & Golf Club. To learn more, visit http://www.ee.fuqua. duke.edu, contact a client relations coordinator at (919) 660-8011 or e-mail [email protected].

Inside Duke Medicine

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March 2009

Arou nd th e hospitals

Durham rehabilitation institute: A team approach to recovery D

urham Rehabilitation Institute (DRI), located on the seventh floor of Durham Regional Hospital, provides a comprehensive, multidisciplinary approach to recovery. The rehabilitation team is dedicated to helping each patient regain independence and reach a higher standard of living. DRI staff treat patients with a variety of traumas and disorders, including strokes, spinal cord injuries, amputations, joint replacements and neuromuscular disorders. The DRI team and rehabilitation nursing staff will tell you that it’s the team approach that makes this possible. “In the gym, we have a multidisciplinary team that creates a personalized rehabilitation plan for each patient and makes sure that he or she is able to take advantage of all the technology and resources available,” explains Raphael Orenstein, M.D., medical director of DRI. A Multi-Disciplinary Approach Teamwork is essential for positive outcomes at DRI. The care team is comprised of physicians, physical therapists, occupational therapists, therapy aides, speech therapists, registered dieticians, nurse practitioners, care managers, referral coordinators, rehabilitation nurses, certified nurse assistants, a licensed assistant therapist and a recreational therapist. The teamwork starts every morning with a group meeting at 8:30 to review each new patient being admitted. The charge nurse, nurse manager, nurse practitioner, physician, therapists, care managers and referral coordinators discuss each patient and become proactive about the resources needed for them. A primary nurse is assigned to each new patient. This is unique to rehab. The DRI care team also meets weekly to discuss each patient’s short and long term goals, and their progress to date. “We talk about how we are going to get the patient where they need to be, which is functioning independently and ready to go home, and then together we do what’s needed to get there,” says Sherri Pearce, BSN, MSN, director of Adult Health.

Kristen Tell and Kim Dao, physical therapists at the Durham Rehabilitation Institute, work with a patient at the parallel bars. Photo by tom wooters

The Latest Technology

ferent and exciting. “Our main goal is to help patients learn Several of the latest advances how to do things for themselves. in rehabilitative technology are This is different than many of available at DRI, including the the other units. It requires a lot Biodex De-Weighing System — of teaching and a different type a fully adjustable harness system of care. We consider at every that allows patients to practice turn how much we are supposed walking but removes as much of to help our patients versus how their weight as necessary. This much they are supposed to do system gives patients opportunifor themselves.” ties for exercise and also speeds On 7-3, each patient receives recovery and enhances ability. full nursing care with the same Other tools are practice medical acuity as on other Angela Webb, an occupational therapist at the Durham rooms and an automobile Rehabilitation Institute, helps a patient. Photo by tom wooters units, but in addition they must simulator. There is also a practice complete at least three hours of kitchen and a practice living therapy at the gym a day. “There gym. Unit 7-3 is the inpatient unit for room so patients can experiment is a lot of coordination that happens with tasks such as food preparation and DRI, and the bed capacity was recently between nursing and therapy — it’s kind expanded from 22 to 30 beds. wheelchair maneuvers. of like a dance,” says Perry. The Unit 7-3 care team includes The technology, combined with the Ask any team member what his comprehensive, team-oriented approach registered nurses, certified nursing or her favorite part of working at DRI assistants, dietitians and health unit to rehabilitation, has led to DRI’s being is, and he or she will tell you “it’s my coordinators. In addition, the Food & recognized by the Uniform Data System patients.” Physical therapist Kristin Tell, Nutrition and Environmental staff are as being in the top 10 percent nationally relays an experience that is common often commended for their customerin patient outcomes. at DRI, “A patient’s grandma told me focused service in letters from 7-3 Care Outside the Gym ‘thank you for giving me my grandson patients. back.’ Moments like this are what I love Regina Perry, RN, describes how An additional team of professionals about this profession.” n nursing for Rehabilitation is both difprovides care outside the Rehabilitation

Benefits

A Quarterly Supplement to Inside Duke Medicine hr.duke.edu n inside.dukemedicine.org n March 2009

va l u i n g t e a m w o r k

Coach K: Remember you’re part of the team. Page 8

financial planning

Stan Jones, a utility worker with Duke’s Housekeeping Operations, is using Duke’s employee assistance program to work toward an associate’s degree in electrical technology from Durham Tech.

Paying for College Employee tuition program expands skills, advances professional development

S

itting in a classroom at Durham Technical Community College, Stan Jones studied a blackboard filled with algebra, fractions and word problems. Jones, a utility worker with Duke’s Housekeeping Operations, paused for a moment, recalled the math formulas he reviewed over the week, then picked up a pencil and started scribbling in a notebook. “Good job,” Durham Tech math instructor Richard Noble told Jones, as he looked over Jones’ work. Jones is participating in Duke’s employee tuition assistance program to work toward an associate’s degree in electrical technology from Durham Tech. He’s among 1,000 staff and faculty members who have enrolled in the tuition benefit in recent years for career-related courses and degrees at accredited North Carolina schools. As part of his job at Duke, Jones cleans floors in East Campus buildings and hopes the new skills he learns in school will open doors to become an

“When I’m done, I’ll have an associate’s degree and be a registered nurse without having a lot of loans to pay off.” Daniel Rudd, clinical staff assistant at The Preston Robert Tisch Brain Tumor Center. Rudd is taking evening classes at Alamance Community College.

electrician at Duke. “When I heard about the program, I jumped on the opportunity,” said Jones, 48. “I’ve wanted to learn more about wiring and circuit boards for a while.” Although companies and other organizations are eliminating or reducing benefits to tighten budgets during the recession, Duke has expanded its employee tuition assistance program for faculty and staff. In January, the benefit expanded to cover up to $5,250 in tuition reimbursement and nine courses per calendar year. Employees can also request a waiver to take courses at accredited schools in other states if the courses are not offered in North Carolina, or if the employee’s primary

work location is in another state. The tuition assistance is available to full-time staff and faculty with at least two years of continuous service at Duke. Since 2007, Duke has reimbursed employees nearly $1.5 million for tuition. Lois Ann Green, director of Duke Benefits, said the program supports Duke’s long-term staffing and professional development strategies by expanding the internal pool of talent to fill positions at Duke. “It helps us to build a more skilled workforce and boosts retention because employees can grow and have the opportunity to advance within see TUITION, p.10

Duke University Federal Credit Union seminars can help you stretch dollars during the recession. Page 8

H e a lt h y l i v i n g

The Mobile Farmers Market makes healthier living easier. Page 9

Benefits

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March 2009

Stretching your dollars during a recession D

iane Gifford does her best to manage money wisely. She creates a monthly budget, uses online banking to pay bills on time and regularly sets aside money in a savings account. But it’s the unexpected – vehicle repairs, brokenh appliances or medical bills – that drain her savings. “I put the money into the savings account with the best intentions of keeping it there, but you know how things go,” said Gifford, a clinical trial coordinator with Duke Clinical Research Institute. Gifford attended a recent Duke University Federal Credit Union workshop on “Building a Better Budget,” an important topic during the economic recession, which, financial advisors suggest, is a good time to revisit a personal monthly budget. “If you’re paying attention to the news and volatile market, it’s a scary time for everyone right now,” said Scottie Dowdy, a financial counselor with Duke Credit Union. “The key is to manage your money as best as possible.” Managing money starts with preparing an accurate and balanced budget based on net

income with these suggested budget guideline allocations: 35 percent for housing (mortgage, rent, utilities, insurance); 25 percent for other expenses (food, clothing, entertainment); 15 percent for transportation (car payment, fuel, maintenance); 15 percent to pay debt (credit cards, student loans); and 10 percent for savings. “When creating your budget, you should only list sources of income that you actually receive on a regular basis, not overtime or bonuses,” Dowdy said. In addition to budgeting, Dowdy suggested creating a chart with goals for longer-term needs such as a house or new car, and to earmark

savings toward those goals. Developing a priority list for paying down credit cards with high interest rates is also key. People of all income levels are “feeling the crunch,” Dowdy said. “It’s not what you make; it’s how you use what you earn,” she said. A “nest egg” for unexpected expenses and emergencies guards against dipping into savings, she added. “If you put money into your savings and then take it out to pay bills or unexpected expenses, then that is not a savings account,” Dowdy said. “If you know you’re going to need new tires or a new car in the next year, start saving for it now.” Gifford, the Duke Clinical Research Institute trial coordinator, has a new goal after attending the seminar: leave the savings undisturbed by creating an accurate budget with an allocation for unexpected expenses. “I’m determined to get on track and have money set aside for unexpected expenses,” she said. “That’s my financial goal for 2009.” n By Missy Baxter, Senior Writer, Office of Communication Services

Duke Credit Union Seminars Ten Steps to Financial Success March 17, 12:30 p.m. at the Duke Credit Union, 2200 W. Main St.

Homebuying March 24, 12:30 p.m. at the Searle Center

Go Online: To register for a seminar, visit http://www.dukefcu.org and select “seminar sign-up” under Quick Links; send e-mail to scottie.dowdy@duke. edu or call (919) 660-9745.

Video See a video about budgeting at http://www.hr.duke.edu/finance

The letters on the front of the jersey B

efore an audience of several hundred faculty and staff, Mike Krzyzewski boiled down his coaching philosophy to one mantra: Whether playing for Duke, or for the USA Basketball team, “You play for the [team] letters on the front of the jersey,” he said, brushing his hand proudly across his chest, “not the name on the back. “You don’t just get 12 people together and call it a team,” he said, “just like a school is not a school just because you have people occupying jobs. How do you get people to work together?” The answer, he told employees during the Primetime forum in January, is taking time to develop the culture of teamwork. Krzyzewski recalled his first meeting with the USA national team, long before he coached them in the Olympic gold-medal game last year. “[The meeting] was not about offense or defense,” he said. “It was about the standards we were going to live by.”

Duke men’s basketball coach Mike Krzyzewski speaks with women’s basketball coach Joanne McCallie. Coach K talked about teamwork during the Primetime employee forum in January.

Later, Krzyzewski cultivated the standard of service by introducing the national team to veterans such as Scotty Smiley, an MBA student at the Fuqua School of Business. Smiley was blinded in Iraq while trying to protect his squadron from

a car bomber. “I wanted the guys to understand what selfless service was about,” Krzyzewski said. “Not only had these guys served, they wanted to serve again. After the veterans spoke, the team – Wade, LeBron and all – were crying. I thought, ‘we have a chance. These guys have a heart.’ ”

Coach K’s style at Duke is not much different. “Beyond the basketball court, we talk to our guys a lot about character, about being humble and using the platform they have to help others,” he said. In answer to questions from the Primetime audience about developing teams, he stressed the importance of being honest with each other, and developing communication skills and trust “so that the first time you talk [tough] isn’t the first time you talk.” Krzyzewski, who has coached more than 950 basketball games at Duke, reminded the audience that the Duke name garners respect in the world, even outside of basketball, and that the Duke name elevates all of us. “We are lucky to be part of something bigger than us,” he said. “But always remember that Duke is great because of its people. Anything any one of us does is important. An idea you have has the chance of being the idea that makes Duke better. That’s why we should always act as a team to make good things happen.” n By Marsha Green Writer, Office of Communication Services

March 2009

Benefits

Grab and go at the gardens Mobile farmers market makes healthy eating easier

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oyce Newton’s office is a stone’s throw from the summer Duke Farmers Market. But as a staff specialist with the Pediatric Neonatology Department, she doesn’t always have time for market shopping. That’s why she’s a fan of the Duke Mobile Farmers Market. She signs up for both the summer and winter mobile market to get fresh, local vegetables nearly all year round. “It is so convenient,” she said. “I just drive to Duke Gardens after work on Tuesdays, and a box of veggies is waiting. I really miss the few weeks between growing seasons.” With the mobile market, faculty Fresh food is to be had at the Duke Mobile Farmers Market. and staff pre-pay for produce and pick up their share of the harvest once a week. This year, seven local “The farmers introduce us to vegetables we might farmers/vendors will provide fruit, otherwise never see — like purple cauliflower. vegetables and flowers, with deliveries starting April 7 at Duke Gardens That was different!” (with one farmer delivering Joyce Newton, staff specialist with the Pediatric Neonatology Department to Durham Regional Hospital). The produce, following enhancements this year: price, size of share and • Most farmers offer payment plans number of delivery weeks Meals to go at to reduce the up-front cash layout. vary among farmers. mobile market • Britt Farms will begin pickup at 3 “My husband and I Rosie’s Plate offers fresh entrees, p.m. to make it more convenient are local potters, so we side dishes, salads, soups, snacks for employees who work an early recognize the importance and desserts for take-out. shift. Other farmers will offer of supporting community Each week, employees can order pickup from 4 p.m. to 6 p.m. businesses,” Newton food from Rosie’s Plate up to one • Rosie’s Plate, a restaurant specialsaid. “And the farmers day in advance of Duke’s Mobile izing in gluten-free, shellfish-free introduce us to vegetables Market. View the menu and order and peanut-free food, will offer we might otherwise online at RosiesPlate.com or call fresh, local, organic meals-to-go. never see — like purple (919) 833-0505. Farmers accept customers on cauliflower from Vollmer a first-come basis until they reach farms. That was different!” capacity. n LIFE, Duke’s employee wellness More than 300 employees program. Based on employee participated in the 2008 mobile By Marsha A. Green feedback, LIVE FOR LIFE made the Writer, Office of Communication Services market, organized by LIVE FOR

Learn more and enroll in the mobile farmers market at http://www.hr.duke.edu/mobilemarket or contact Jason Horay at (919) 681-0504 or [email protected]

9

opportunities

Learn latest technology through Lynda.com A new online training resource offered through Duke’s Office of Information Technology (OIT) is enabling faculty, staff and students to learn the latest technological tools with video tutorials available anytime, anywhere. For Richard Lucic, associate chair of the Computer Science Department, the pilot program through Lynda.com offers a convenient way for him and his students to stay up-to-date on emerging Web and multimedia technologies. “These technologies change rapidly – just keeping up as new versions come along can be a real time sink,” said Lucic, who includes the videos as part of a class he teaches in the Information Science and Information Studies (ISIS) program. Lucic is among more than 200 Duke faculty, staff and students who have participated in OIT’s Lynda.com pilot since it was launched in October. Lynda.com offers more than 30,000 online training courses on topics ranging from Microsoft Word and Excel to Web design and computer programming. OIT is providing a limited number of individual accounts for Duke users during the yearlong pilot. Staff and faculty can review the training tutorials online (from Duke or at home) or can use designated workstations at the ACT Warehouse lab, Multimedia Project Studios, the Center for Instructional Technology and the Link in Perkins Library. Tutorials in PHP, Dreamweaver, Microsoft Excel and PowerPoint have been among the most popular with Duke staff, who comprise about 75 percent of program participants to date, said Christine Vucinich, OIT’s training coordinator. As more jobs throughout the university and health system demand technology skills, online training can help users at all levels, Vucinich said. “Online training provides an opportunity to get quick questions answered and for staff at any location to get the training they need when they need it, not weeks or months later,” she said. The training helped Terry Banfich get up to speed during a recent Microsoft Word upgrade in Duke Law School’s Alumni & Development Office. It also proved useful as she transitioned into a new job as a trainer in Central Development’s IT department. “Everything and anything is there, and it’s there at any time, even if you’ve just got five minutes to spend,” Banfich said. “It’s a great tool for giving folks the essential training and tips that can help make our work lives more effective and efficient.” OIT will gather user feedback this spring to evaluate whether the program will be implemented on an ongoing basis next fall. By Cara Bonnett

Go Online: More information about OIT’s online technology training program is at http:// www.oit.duke.edu/help/training/online/

Benefits

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TUITION, cont. Duke as they expand their skills,” she said. Results show the program is meeting Duke’s goals of getting a diverse group of employees to utilize higher education opportunities and encouraging managers to help staff develop career goals. In a recent survey of staff and faculty who participated in Duke’s employee tuition assistance program, 87 percent said knowledge gained by using the benefit will help them better perform in their jobs; in a similar survey of Duke managers, 85 percent agreed that the benefit helped improve employee performance. The benefit program evolved from the 2003 recommendations of the Women’s Initiative, which called for greater opportunities for professional development. It was designed to provide more employees with opportunity for professional development by offering reimbursement for classes not offered at Duke or access to courses at local community and state colleges with lower tuition. Before the program was introduced, only courses at Duke were covered. Today, the program offers employees more options, including evening classes at community colleges. Durham Tech, University of North Carolina at Chapel Hill and North Carolina Central University are now among the most utilized schools. As a result of the expanded program, participation and diversity of enrollment have increased – from 320 staff and faculty with an average salary of $66,172 in 2006, to 549 employees with an average salary of $53,060 in 2008. Minority enrollment increased from 19 percent in 2006 to 40 percent in 2008. “Since we expanded the program to include other schools, there’s been a lot more participation among nonexempt employees, skilled labor staff and minorities, which is wonderful because we want all Duke employees to have the opportunity to develop professionally,” Green said. Adding community colleges makes it easier for healthcare workers and non-exempt employees with nontraditional schedules to tap into the tuition benefit, Green said. Take Jones, the utility worker with Duke’s Housekeeping Operations. He’s a father of four who works the third-shift at Duke from 11:30 p.m.

Tuition Assistance by the numbers

Tips for Tuition Reimbursement

2008 Participation

• Read program details at http://www. hr.duke.edu/tuition

$1,036,673 Tuition paid by Duke 549 Staff and faculty enrolled 88 Participants at Durham Tech 75 Percent of female participants $53,060 Average salary of participants 38 Average age of participants

“When I’m done, I want to be a wealth of knowledge for Duke to use.” Patricia Agbai, health unit coordinator, Heart and Lung Transplant Unit

to 8 a.m. and attends evening classes several times a week at Durham Tech. Going back to school is challenging, he said, but the rewards of career development are priceless. When he graduates in about two years, he will be the first person in his immediate family to receive a college degree. “It’s a lot of hard work to be back in school with a full-time job and family, but I’m learning a lot of skills,” said Jones, who joined Duke in 2004. Patricia Agbai, a health unit coordinator in Duke University Hospital’s Heart and Lung Transplant Unit, is also tapping into the tuition benefit to learn new skills that will expand her responsibilities at Duke. She’s pursuing a bachelor’s degree in social work at Shaw University, her first degree. She’s on track to graduate later this year. “In working with patients in the Transplant Unit, the social work skills I’m learning will allow me to help families who are coping with major medical challenges even more,” Agbai said. “When I’m done, I want to be a wealth of knowledge for Duke to use.” Although most Duke employees use the tuition benefit at local colleges, there is growing demand for the tuition program in satellite offices. To address this, Duke expanded the program this year to allow employees to apply for a waiver to attend accredited out-of-state schools in specific circumstances. “That’s especially helpful for employees in highly-specialized fields who might not be able to find the courses they need in North Carolina,”

March 2009

• Discuss professional development with your supervisor to determine courses related to your current job or continued career growth at Duke. • Download the Employee Tuition Assistance Program application at http://www. hr.duke.edu/forms and complete it with your supervisor.

9.45 Average years of service

• Complete and return the application by mail or fax before the first day of each class to request reimbursement.

Video

• If approved, Duke Benefits will send an e-mail with your eligibility confirmation and reimbursement request form.

See a video about the tuition benefit with “Ask The Expert” at http://www. hr.duke.edu/tuition

Green said. “And with the way Duke is growing globally, this will also help the increasing number of Duke staff and faculty based outside the state.” Convenience is a big factor for Daniel Rudd, a clinical staff assistant at The Preston Robert Tisch Brain Tumor Center at Duke. He’s taking evening classes at Alamance Community College, near his home in Prospect Hill in Caswell County. “When I’m done, I’ll have an associate’s degree and be a registered nurse without having a lot of loans to pay off,” Rudd said. In addition to using the Employee Tuition Assistance Program, Rudd is hoping to eventually enroll in Duke’s new Registered Nurse Tuition Assistance Program to continue developing his skills. “It’s great that Duke assists employees who want to advance their careers,” Rudd said. “I love helping the patients at Duke. By using the tuition assistance program to get my degree, I will be able to do even more to help others.” This semester, Jones, the utility employee in housekeeping, is taking two courses in English and math at Durham Tech. “Nowadays, almost every machine or appliance has electronic components and circuit boards,” he said. “When I get my degree, I’ll be able to work on those.” n By Missy Baxter, Senior Writer, Office of Communication Services

• Within 60 days of completing each class, submit to Duke Benefits a copy of the e-mail confirmation, proof of a “C” or better in coursework and a reimbursement request form completed by the school attended.

Fast Facts: The cost of books is not covered. And if you voluntarily terminate employment within two years of receiving more than $2,500 in tuition reimbursement, you must repay 50 percent of the amount over $2,500.

Benefits Benefits is published quarterly by Duke’s Office of Communication Services as a supplement to Inside Duke Medicine. Benefits invites your feedback and suggestions for future story topics. Please call (919) 681-4533 or send e-mail to [email protected] Editor: Leanora Minai (919) 681-4533 [email protected] Assistant Vice President: Paul S. Grantham (919) 681-4534 [email protected]

The Science & Research Supplement to Inside Duke Medicine VOLUME 18 NO. 3

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inside.dukemedicine.org

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March 2009

F EATURE

HIV-1 budding from cultured lymphocyte. Multiple round bumps on cell surface represent sites of assembly and budding of virions. photo courtesy wikipedia commons

Antibody for HIV discovered By Michelle Gailiun Duke researchers have for the first time isolated an important antibody in human serum that could potentially play a key role in the design of an AIDS vaccine. The research appears as a highlighted feature online in the Journal of Virology. “The 2F5-like antibody is one of the gold standards for what an HIV vaccine needs to induce, but no one had ever found it before circulating in the blood of infected patients,” says Georgia Tomaras, PhD, associate professor of surgery, immunology and molecular genetics and microbiology in the Duke Human Vaccine Institute and the senior author of the study. The 2F5 antibody is especially valuable because previous research has shown it can successfully neutralize 80 percent of transmitted HIV viruses. Now that researchers have found the antibody in circulating blood, Tomaras says they might be able to find ways to duplicate or enhance it, thereby boosting the body’s defense system. 2F5-like antibodies belong to a class of immune cells called broadly neutralizing antibodies, one of the body’s most powerful responses to infection. Only a small fraction of patients with HIV make these antibodies and they typically appear many months after initial transmission of the virus — at a point when scientists feel it is too late to do much good. Tomaras, working closely with lead author Xiaoying Shen, led a team of researchers who examined the antibodies present in 300 patients infected with HIV-1. They found only one patient who had developed 2F5-like antibodies, supporting the notion that they are, indeed, very rare. Researchers discovered that the 2F5-like antibody was potent enough to block multiple strains of HIV in the laboratory, but researchsee HIV, p.12

The Duke Center for Hyperbaric Medicine and Environmental Physiology research runs the gamut from the effects of various pressures on the human body to the influence of oxygen and carbon dioxide on cellular organelles. photoS courtesy HYPERBARIC MEDICINE

More than just ‘the bends’ By Kelly Malcom

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lad in swim trunks and neoprene slippers, Jason, a medical student, climbed out of the chamber, dripping wet. Careful not to disturb the catheters put into his arms to measure his blood pressure and pulmonary arterial pressures, he walked into an adjacent room to recuperate from his underwater exercise. Jason had answered the call for fit volunteers to assist in a clinical study to understand immersion pulmonary edema, a condition that causes some divers’ lungs to suddenly fill with fluid. “The condition is life-threatening and has caused some swimmers and divers to die,” said principle investigator Richard Moon, M.D., professor of anesthesiology and medical director of the Duke Center for Hyperbaric Medicine and Environmental Physiology. “We’re still unclear as to what causes pulmonary edema but it could be related to high pressures in the pulmonary artery or deficiencies in the way some people clear their lungs of fluid.” This Navy-funded study is just one example of the ongoing basic and translational research projects at the Center. The facility, located in Duke South, contains an impressive series of chambers, the largest of which can hold up to 12 patients plus staff, as well as water tanks for physiological studies. In an area resembling the control room of a submarine, physicians and technicians constantly monitor oxygen

largest civilian facility in the world. “Duke’s facility is not just another hyperbaric chamber,” said John Freiberger, M.D., MPH, assistant professor of anesthesiology. It is a unique facility where investigators can readily research the effects of extreme environmental conditions on human physiology. Current projects deal with topics ranging from molecular biology to the ill patient’s bedside and all strive for an in-depth understanding of the biology of oxygen and other metabolic gases and their clinical applications. Freiberger is currently investigating the use of hyperbaric oxygen “Our studies run the gamut from for the treatment of jaw analyzing the effects of pressurized necrosis in patients who have received certain drugs for suits on NASA astronauts to using chemotherapy that inhibit oxygen to help cancer patients.“ bone cell growth. John Freiberger, M.D., MPH In addition, he has a pilot assistant professor of anesthesiology study to diagnose chronic carbon monoxide (CO) exposure and disorientation. Sever decompression examine possible prevention efforts in sickness can be life threatening. medically underserved populations. Treatment requires the adminHyperbaric oxygen is often istration of 100 percent oxygen in prescribed for victims of house fires a pressurized hyperbaric chamber, or suicide attempts who are acutely usually for one or more periods of exposed to elevated CO, because 4-6 hours. Duke University Medical in addition to its known immediate Center is also where the Divers Alert toxic effects, CO can have devastating Network (DAN), a network that long-term neurological consequences provides educational and emergency if not treated immediately. This has information for recreational divers important public health implications internationally, got its start. Duke because even low levels of chronic physicians routinely consult for DAN CO intoxication may lead to subtle and Duke’s hyperbaric facility is open but significant changes in neurological for emergencies 24 hours a day, seven days a week. Duke’s chamber is the see HYPERBARIC, p.12 levels, pressure, and patient condition in each chamber. Hyperbaric oxygen is administered for a variety of medical conditions, including most famously, decompression illness, colloquially known as “the bends.” Scuba divers and people who work in pressurized environments who return to normal atmospheric pressure and aviators and astronauts who rapidly transition to low pressure environments can develop bubbles of nitrogen gas in their tissues. Symptoms can include skin rashes, joint pain, and more serious symptoms such as blurred vision and

Inquiry

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Although CO is a known toxin, it is also a normal product of function if exposure persists over time. metabolism and may have important Epidemiologic research has shown roles in cell signaling. Researchers at Duke’s hyperbaric center are Duke’s hyperbaric facility is open utilizing the facility to examine for emergencies 24 hours a day, the effects of carbon monoxide and oxygen on mitochondria, seven days a week. the powerhouse of the cell. that certain populations, especially “CO at high levels inflicts damage recent Hispanic immigrants, may be through oxidative stress,” says Hagir more likely than other ethnic groups to B. Suliman, Ph.D., assistant professor be exposed to chronic, low-level CO of anesthesiology. At low doses, exposure through the use of generators though, CO has an important role in or cooking grills indoors. This study cell signaling. Certain chemotherapy seeks to document CO exposure and drugs, such as doxorubicin, can develop strategies for prevention in all cause mitochondrial damage and populations vulnerable to this disease. cardiac cell death. Suliman and her

HYPERBARIC, cont.

colleagues have found that exposure to low levels of CO can promote the biogenesis of mitochondria, a process that may be intimately involved with the underlying mechanisms of wound healing and aging. “Duke’s hyperbaric facility is special because of its commitment to both quality clinical care and to high-caliber research,” said Freiberger. “Our studies run the gamut from analyzing the effects of low atmospheric pressure on NASA astronauts to using hyperbaric oxygen to help cancer patients heal chronic wounds. We have the clinical and scientific depth to figure out how to make people better in a rational and reproducible way.” n

A new direction for immune response A

n immune system response that is critical to the first stages of fighting off viruses and harmful bacteria comes from an entirely different direction than most scientists had thought, according to a finding by researchers at the Duke University Medical Center. “This finding will have important implications in vaccine science and autoimmune disease therapy development,” said Michael Gunn, M.D., an immunologist and cardiologist at Duke and senior author of the study published in Nature Immunology. Type 1 helper (TH1) T cell immune responses are critical for the control of viruses and certain bacteria. Immunologists have generally believed that TH1 responses are induced by rare immune cells, called dendritic cells. When activated by infection or vaccination, the dendritic cells were thought to move from peripheral tissues into lymph nodes to stimulate T cell responses. The Duke researchers found, however, that the dendritic cells that stimulate TH1 responses didn’t come from peripheral tissues, but rather arose from monocytes, a common cell type in the blood, that moved directly into lymph nodes after infection. “The result speaks to the most basic principles of immune response to pathogens,” Gunn said. “It may also explain the poor results we have seen in attempts to develop effective dendritic-cell vaccines.” Gunn previously had identified a particular protein, known as a

March 2009

1st Annual Human Research Protections Program Workshop

Improving Research Quality All those involved in clinical research at Duke including investigators, coordinators, and administrators are encouraged to attend this workshop. Featured guest speakers will include: Greg Koski, PhD, MD, CPI, professor of anesthesiology at the Harvard School of Medicine, speaking on Investigators’ Role in a Model HRPP. Gregg Fromell, MD, executive director of the Office of Human Research at the University of Pennsylvania, speaking on How to Engage Your Investigator in the HRPP Process. Gigi McMillan, BA, of the Children’s Brain Tumor Foundation, speaking on Investigators’ Interactions with Vulnerable Populations: Specific Considerations. When: April 29 12:00 pm-4:30 pm OR April 30 7:30 am-12:00pm Where: Searle Center For more information and to register: http://crso.som.duke.edu/

HIV, continued ers say they are not entirely clear if it played any part in controlling the virus in the patient who carried it.

Duke researchers have found that the immune response against infection begins differently than previously thought. file photo

chemokine, that stimulates the migration of activated dendritic cells from peripheral tissues to lymph nodes. The researchers generated a TH1 response in laboratory mice that lacked this chemokine with influenza viruses. “We really thought the mice would not be able to generate much of an immune response at all,” Gunn said, because they wouldn’t be able to mobilize dendritic cells. “The mice, however, had increased TH1 responses. We knew we had to find what was really causing the response.” One scientist who knew about these findings told Gunn the group would “never figure this out” because their findings were so unconventional. To solve the mystery, the Duke team studied several different types of mice, which were missing other chemokines or chemokine receptors.

They found that mice without the Ccr2 chemokine receptor that controls the migration of inflammatory monocytes had much lower accumulation of monocyte-derived dendritic cells and TH1 responses. The scientists concluded that there is a blood-derived lymph node dendritic cell type that has a key role in developing acute T-cell responses. “For so long, dendritic cells from tissues were the obvious answer,” Gunn said. “We found out that that’s not always the case.” The team now plans to look at the blood-derived dendritic cells under different conditions to see if they may have other activities. “We observed the activity of these cells after TH1inducing stimuli, like influenza,” Gunn said. “Next we’d like to study other types of immune stimuli to see how the cells respond.” n

The scientists were also struck by another discovery: The 2F5-like antibodies arose concurrently with particular autoantibodies that may be a clue as to why these antibodies developed in this person and not in others. “Tomaras and her team have created the opportunity for us to isolate and study the immune cells that enabled the production of this very rare antibody,” says Barton Haynes, MD, director of the Duke Human Vaccine Institute. “Our goal will be to understand how to trigger these cells to routinely make these kinds of antibodies before infection occurs.” The research was funded by the National Institutes of Health and the Duke Center for AIDS Research.

Science Editor: Kelly Malcom Inquiry features science and researchrelated news items from Duke Medicine News and Communications and other Duke departments. To submit content, contact us at [email protected]

Inquiry

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March 2009

Drug combo may be effective against deadly melanoma

B

y targeting and disabling a protein frequently found in melanoma tumors, doctors may be able to make the cancer more vulnerable to chemotherapy, according to early results of a clinical study conducted by researchers in the Duke Comprehensive Cancer Center. “In this pilot study, we gave patients with advanced extremity melanoma a compound that had been shown in pre-clinical studies to weaken melanoma tumors by targeting a protein expressed on the surface of the cancer cells. When chemotherapy was then given by infusion, it was much more effective compared to chemotherapy given alone,” said Douglas Tyler, M.D., a surgeon at Duke and the Durham Veterans Affairs Medical Center, and senior investigator on this study. “Not only was the treatment well tolerated but a surprising number of this small group of patients had their

tumors completely disappear.” The researchers discussed their findings in an oral presentation on March 6 at the Society of Surgical Oncology annual meeting, and results of the study have been accepted for publication in the journal Cancer. The study was funded by Adherex Technologies, the company developing the compound that was tested in combination with chemotherapy, the United States Department of Veterans Affairs, the Duke Institute for Genome Sciences & Policy, and the Duke Comprehensive Cancer Center Data from 16 patients treated at Duke and the University of Texas MD Anderson Cancer Center were examined for this study. Half of them experienced a complete response — or an obliteration of cancer — as a result of treatment, Tyler said. The compound — called ADH-1 — was delivered intravenously and the chemotherapy

“Not only was the treatment well tolerated but a surprising number of this small group of patients had their tumors completely disappear.” Douglas Tyler, M.D., surgeon and senior investigator on the study

given under surgical conditions, through the artery and vein in the affected limbs. Melanoma often affects people on their extremities, with a common scenario being a mole that appears on the foot and then spreads up the leg. Up to ten percent of patients with extremity melanoma develop multiple recurrences in the extremity that cannot be treated with surgery alone. “These early results are very exciting because metastatic melanoma is

one of the most deadly cancers and one which is typically very unresponsive to therapy,” said Georgia Beasley, M.D., a surgical resident at Duke and lead author on this study. “The next step will be to continue testing the efficacy of this treatment in more patients, here and at other centers.” A larger phase II trial involving 46 patients with advanced extremity melanoma, using the same combination of drugs, was designed to try and better define the response rate in this population, Tyler said. This trial has recently completed recruiting patients and data will be forthcoming, he said. The incidence of malignant melanoma is increasing at a rate faster than any other cancer, with 60,000 new cases expected to be diagnosed this year in the United States. Melanoma that has spread beyond the primary site is rarely curable, and treatment options are limited. n

Genetic link between anger and health problems M

en with a common genetic variant produce more than twice as much of a hormone known to increase blood pressure and blood sugar when they are angry, according to researchers from Duke University Medical Center. The findings, presented March 6 at the American Psychosomatic Society’s annual scientific meeting, shed more light on the notion that stress can trigger physiological changes that result in the development of cardiovascular disease and type 2 diabetes. “We know that emotional stress can lead to negative health outcomes but our goal with this study was to obtain a better understanding of the biological mechanisms behind this phenomenon,” says Redford Williams, M.D., director of Duke’s Behavioral Medicine Research Center and study co-author. Researchers analyzed variants of serotonin receptor genes, which regulate effects of the neurotransmitter serotonin on emotions and physical functions, including levels of the stress hormone cortisol. “We looked at specific points along a cascade of events,” says

Stephen Boyle, Ph.D., study co-author. “Serotonin is processed in the brain and controls the release of cortisol by the adrenal grand. Cortisol is known to stimulate the production of glucose and makes the influence of adrenaline more pronounced.” Researchers measured cortisol in two blood samples taken from 41

men. One sample was collected during a five-minute resting period and the other during five-minutes when they described a recent event in their lives that made them angry. Men with common variants of one of the serotonin receptor genes (5HTR2C) had increased cortisol production when recalling a situation

that made them angry. One of those variants was associated with an average increase in cortisol that was more than twice as large (70 pg/ml vs. 30 pg/ml) when compared with men possessing the other variant of the same gene. “Interestingly, one of the genetic variants associated with a prominent affect on cortisol production is also known to alter the amount of receptor protein the gene makes,” says Williams. “This tells us that this variant is a strong candidate to be responsible for the findings we observed.” “This work may provide a clearer understanding of the genetic and environmental factors that combine to put some men at greater risk for developing increased belly fat, type 2 diabetes and cardiovascular disease,” adds Boyle. The next phase of research will study large samples of people to determine if men with the genetic variant associated with larger cortisol responses to anger seen in this study are more likely to develop type 2 diabetes or cardiovascular disease. The research was supported by a grant from the National Heart, Lung and Blood Institute. n

Inquiry

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March 2009

ESSAY

Lawmakers need a crash course in science By Susanne B. Haga, IGSP

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he more than 50 rookie congressional members who headed to Washington in January face a steep learning curve on complex and, probably, unfamiliar subjects, from foreign policy to the budget appropriations process. Many of these topics will involve science in one form or another — from scientific evidence underpinning a specific policy to decisions influencing the direction, investment and advancements in our country’s scientific enterprise. Consider that more than $38 billion was spent by the federal government in 2007 for healthrelated research and more than $2 billion for energy research and technologies. That’s not as high as the numbers attached to the stimulus package but large enough to get our attention when it comes to educated decision-making. President Barack Obama has stated that he aims to promote scientific research and incorporate scientific evidence into policy debates. This re-emergence of science as a national policy priority requires a level of informed engagement that hasn’t been seen in Washington in some time. From medicine and health care to food safety, energy, space and the environment, science will play a key role in many of the policies our legislators will propose and debate. Members of Congress possess a range of backgrounds, including ministers, sheriffs, farmers and accountants. More than 40 percent hold law degrees, but only 8 percent

all new Conservative members of Parliament after the next elections, specifically to address politicians’ lack of scientific expertise. Shadow Science Minister Adam Afriyie, the architect behind these new courses, says, “By building a base of scientific knowledge among politicians and officials, we aim to strengthen the role of science in policy making.” Although the official orientation for our new congressmen has already taken place, it isn’t too late to impart some knowledge about subjects they almost certainly will be voting on. A good starting point would be with the scientific groups that already visit Capitol Hill to present workshops and seminars. The need for education works in both directions: the scientistpoliticians, for instance, should be brushing up on Economics 101. Although public policy is With a better base of scientific knowledge, members of Congress and rarely based on scientific evidence other politicians will be better equipped to make informed decisions on science-related policy. ILLUSTRATION BY VANESSA DEJONGH alone, it no doubt could benefit from improved dialogue between fundamental understanding of hold a medical or doctorate degree experts and policymakers. Even how research is conducted and with formal training in science and seemingly unrelated policies on the strengths and weaknesses the scientific process. immigration and defense will have With the exception of a small implications for “The re-emergence of science as a national group of doctors and scientists, the scientific remost members of Congress lack search enterprise. policy priority requires a level of informed the background to understand the Let us be engagement that hasn’t been seen in process of science and the subtle sure that our nuances that justify investments in policymakers are Washington in a long time.“ science and engineering or changes making informed inherent in any scientific dataset. in existing priorities. decisions, for these decisions may The Conservative Party in Great What to do? We should take well impact generations to come. Britain recently announced that a lesson from the British and Susanne B. Haga is a senior policy analyst it will include classes on scientific encourage all freshman members and an assistant research professor in the methodology and basic concepts of Congress to take a crash course Institute for Genomics Science & Policy at Duke University. n in the orientation activities for in science to equip them with a

LE C TURE

EVENT

ONLINE

Chancellor’s Lecture

Research Career Day

Duke Articles

Clay Christensen, Harvard professor and author of The Innovator’s Dilemma, speaks on “The Innovator’s Prescription: The Future of Academic Medicine and Health Care.” March 11 at 10:30 a.m. Geneen Auditorium at Duke’s Fuqua School of Business.

The first research Career Day will be held on Wed, May 6. To register, visit https://research careerday.wufoo.com/forms/ duke-medicine-research-careerday-registration/. Registration will be open until April 15.

A list of the most recent articles by Duke authors added to the PubMed (MEDLINE) database is updated every Sunday and can be found at http://www.mclibrary.duke.edu/pubsupport/ dukeauthors

Inside Duke Medicine

March 2009

15

C ALEN D AR

March

Your insider's guide to what's happening at Duke Medicine April 1 8:30 a.m. - 4:30 p.m. Duke HomeCare and Hospice presents a grief conference with nationally renowned speaker and grief counselor Alan Wolfelt for both professionals and lay people. Sarah B. Duke Gardens Pavilion. There is a $100 fee to register. Six nursing contact hours or 0.6 CEUs will be awarded. Register: http://dhch.duhs.duke.edu/wysiwyg/downloads/Brochure_wilderness_of_grief.pdf

give March 14 10 a.m. “Scope Us Out” 5K Run/Walk Join Duke Gastroenterology to raise money and support the fight against colon cancer. Registration is $15 and forms are due by March 6. Registration includes t-shirt, goodie bag, and box lunch. Duke Forest Al Buehler Cross Country Trail in Durham. Register: http://www.dukehealth.org/ events/20090128164313538 March 28 10 a.m. 2009 Second Annual Triangle Kidney Walk Duke Medicine is helping fight chronic kidney disease as a premier sponsor of the Triangle Kidney Walk. The 5K non-competitive walk will raise money and awareness about kidney disease. Research Triangle Park Headquarters. Details: 388-1602 or http://www.trianglekidneywalk.org Attend a seminar on “Race, Genetics and Health,” on March 18. This is the sixth in a monthly series that discusses the role of “racial” differences in explaining health disparities. Details below. illustration by vanessa dejongh

do March 9 5:30-6:30 p.m. LIVE FOR LIFE’s Run/Walk Club starts its 12week session with a new breathing techniques session at 5 p.m. each Wednesday and strength training class at 5 p.m. each Monday and Wednesday. Staff and faculty in the club meet 5:30-6:30 p.m. every Monday and Wednesday. Beginners meet at the East Campus track, across from Whole Foods on Broad Street. Advanced runners and walkers gather in front of Wallace Wade Stadium on West Campus. Details: hr.duke.edu/runwalk March 12 4-6 p.m. Duke University Physician Assistant Program Open House in celebration of the new facility on 800 S. Duke St. in Durham. Guided tours and light refreshments. RSVP: [email protected] or 681-3159 March 22 12-4 p.m. Free Family Day at the Nasher Museum of Art

Celebrate “Escultura Social: A New Generation of Art from Mexico City” with live entertainment, hands-on projects and gallery hunts. Limited tickets available at the door only. Details: 684-3314 March 24 5:30- 6:30 p.m. Duke Run/Walk Club Workshop – Prepping for Races Whether you are planning on participating in a 5K run/walk race, competing in a triathlon or running a marathon, preparation is a must. Meg Pomerantz, director of the Duke Faculty Club, will discuss the trials and tribulations from her own experience of training as well as teaching the group what works best for your race of choice. Wallace Wade Stadium, Alumni Box

learn March 18 12 p.m. DUSON Research Conference Series with Sharron Docherty, Ph.D. and Debra Brandon, Ph.D. A series designed to stimulate discussions and showcase emerging issues in nursing and research. Open to

nursing school faculty and students, Duke Investigators, and DUHS nurses interested or engaged in research. Clipp Research Building, Room 1017 March 18 5:30-7:30 p.m. Race, Genetics and Health Seminar Series The sixth seminar in the monthly series under the theme of Race, Genetics and Health will be presented by Fatimah Jackson and will focus on her method of group classification. These seminars are a forum for the systematic examination of the role of “racial” differences in explaining health disparities. Dinner provided. RSVP, by March 11: [email protected] March 18 6:30- 8:00 p.m. Duke Integrative Medicine Free Information Session We invite you to a free information session to explore Duke Integrative Medicine. In our state-ofthe-art healing environment, our expert physicians and therapeutic staff will share information about our unique approach to healthcare--and how it can make an enduring difference in your life. Light refreshments will be served. Center for Living, Integrative Medicine Building, Room AB. Details: 681-2958

March 29 9 a.m. - 12 p.m. Build Blue and True 5K Come run a 5K in support of Habitat for Humanity and your favorite rival Duke or UNC. Cost is $20. All proceeds will go toward Habitat for Humanity of Durham and Chapel Hill. Location: UNC Ranson-Hamrick Cross Country course in Chapel Hill. Details: 668-5700

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

16

March 2009

on the web

Just a few of your colleagues who’ve received High Fives:

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way line’s daily uke n O e id s In D igh Fives is g the good work of in iz n g of reco rved . employees on of the well-dese Medicine st few t a selecti Here’s jus olleagues over the la en to c praise giv h Five st one Hig ine. a le t a months. s e line giv kemedic Inside On /inside.du :/ p tt h k c . Che every day igh erves a H s re. e o d m o r h fo w g n or side w a perso . Go to In t the m If you kno r fo t n e ur comm ct” link a Five, use o lick on the “Conta ge. dc e home pa Online an n li n O e Insid top of the

H

Steven Adair, Duke Raleigh Security, make sure patients, visitors and staff are safe:

A patient tells why Shelley McNair, clinical nurse IV at Duke University Hospital, is a true asset to Duke:

“Long after most employees have gone home and into the evening while others are working, this officer is checking doors (377 of them each night), reminding employees to lock up and go home and giving assistance to customers who find their way to Duke Raleigh in the wee hours of the morning. For five years, he has been making sure that the campus is safe and secure so that those sharing the shift can do their work free from worry.”

“Shelly hustles nonstop to help me get through these difficult days. She takes the time to bathe me and does so with much care and compassion — like I am her mother. She is a true asset to Duke!”

Arista Stewart, mammography technologist at Duke University Hospital, helped a patient feel at ease: “Arista was so kind and sensitive. She made me feel at ease. I have been going to her for the past three years. She is wonderful and awesome.”

A patient thanked the entire CCU staff at Durham Regional Hospital, especially Mark Branch, M.D.: Our “family … would like to personally THANK YOU for the excellent, professional care you gave our father from Sept. 24th - Oct. 7th. The Lord truly blessed us, and our father, during this time with ‘our angels of care’ he provided. Your heartfelt concerns for our father (your patient) … could be seen and felt by the family. Our hearts and prayers go out to the CCU family. Thank you! Thank you! Thank you! May God bless you as you care for other families the way you cared for ours and in your everyday life!”

Monette Mabolo, of Duke Raleigh Nursing, was praised for bring her unit closer together: “Monette Mabolo pays attention to what we say and to what matters most to us. She continues to come in early to interact with the night shift and provide them with leadership and support as well. To foster camaraderie between the nurses and nursing assistants, she has them give report to each other at the beginning of the shift or whenever there are abnormal vital signs that the nursing assistants note. As a result, our unit has become more closely knit as a team.”

Jolly John, clinical nurse II on 5300 at DUH, made a lasting impression on a patient’s mother: “Jolly has been a blessing to my daughter and myself while in the hospital. She was very attentive and showed so much care and concern. My daughter remembered her name out of all nurses that took care of her. We love you, Jolly!”

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