VOLUME 17 NO. 12 n inside.dukemedicine.

org n December 2008

Durham
Innovative programs advance missions, serve neighbors
By Bill Stagg

Caring for

fIlE pHOTO

Approval sought for Cancer Center expansion
By Duke Medicine News and Communications In mid-November, Duke University Health System filed a certificate of need (CON) with the State of North Carolina for construction of a proposed 265,000-square-foot cancer center that would expand and consolidate Duke’s comprehensive outpatient cancer services and research facilities. The project also calls for renovating 14,400 additional square feet of the existing Morris Cancer Clinic in Durham. The requested expansion and renovation would cost an estimated $235 million. The proposed expansion would allow Duke to grow its teaching, training and research programs in order to remain competitive as a national educational and research leader. The project seeks to create a comprehensive patient- and family-centered facility to meet the projected statewide demand for oncology services. The goal is to improve and streamline access by putting adult cancer services, currently separated in various locations throughout the medical center, under one roof. “This expansion would allow Duke to keep pace with the growing demand, locally and statewide, for the kind of sophisticated, leading-edge cancer services that we are committed to providing to the people of North Carolina,” said Victor J. Dzau, M.D., chancellor for health affairs and CEO of Duke University Health System. “We will continue our planning related to this project in hopes of receiving an approval from the CON see CANCER CENTER, p.10

astway Elementary is one of Durham’s most challenged public schools. Many of its challenges have less to do with education than with social and health issues that cling to poverty’s coattails. But brighter days lie ahead thanks to students from the Duke University School of Nursing, who are helping Eastway children and families cope with an array of complex health education needs. A few blocks away sits the long-abandoned former Holton Middle School, a tattered monument to a neighborhood’s decline. With the help of Duke University Health System (DUHS), however, Holton’s days of despair are numbered. Come August, a renovated Holton is scheduled to

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reopen as a recreation center/vocational school – with a 2,600-square-foot community wellness center staffed and run by Duke health care providers. DUHS already has donated $250,000 for design and construction-related costs. Services will be provided to Durham patients regardless of their ability to pay. And, thanks to an effort spearheaded by DUHS, Duke and community doctors are donating specialty care to uninsured people through a new program called Project Access. That’s not all. From clinics and wellness centers in several Durham public schools, to programs for young mothers who are recovering drug addicts, to working with Durham’s burgeoning Latino community on physisee CARING, p.2

working

inquiry

recognition

From truck to tray
Find out what it takes to feed hudreds, every day, at a Duke hospital. Page 9

in plain sight
Duke researchers are looking into health risks posed by environmental toxins. Page 7

Magnet achieved
Durham regional Hospital achieves a status gained by few u.S. hospitals. Page 11

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Inside Duke Medicine
on tHe cover

December 2008

CARES, cont.
cal and mental health issues – Duke Medicine is not just in the Durham community, but of the Durham community. In all, DUHS devotes $8 million yearly to community outreach and donations and $42.5 million to charity care as part of the total of $180.6 million it devotes to community benefits funding. The three efforts above are among many that illustrate Duke’s commitment to the well-being of the community where Duke Medicine’s people work and which many of them call home. Eastway The Eastway effort is part of a program called “Raising Health, Raising Hope.” Nursing students work with families as part of a Child and Family Support Team comprising a social worker, school nurse, guidance counselor, principal and assistant principal. The team creates individualized solutions for each student to succeed in the classroom. “Raising Health, Raising Hope is an opportunity for the Duke nursing students to assist their community in addressing health education issues while learning how to create a support network for a diverse, underserved population,” said Rosa M. Solorzano, M.D., M.P.H., associate director of Duke School of Nursing’s Global and Community Health Initiatives. The nursing students also conduct other activities, such as eye screenings for Eastway children. Focus groups of families, which are largely poor and African-American or Latino, told the team that hygiene, mental health, violence, attention deficit/hyperactivity disorder, nutrition, oral health, asthma and puberty were the critical issues for the health education curriculum. Holton The Holton Center renovation is part of an ongoing effort to revitalize one of Durham’s most impoverished areas, Northeast Central Durham. The Holton building is owned
Senior physician extender Kaitlyn Granda of the Division of Community Health examines Royal Steele in the Walltown Neighborhood Clinic on Broad Street. pHOTO BIll STAGG

Duke Medicine in Durham
Primary care Wellness Centers in four public schools, serving mostly low-income youngsters: Watts, Glenn and powe elementaries, and Southern High. Clinics provide medical and mental health services during the school year. Elementary clinics also provide bilingual mental health services. Just for us/Promising Practices, providing primary care, case management, nutrition counseling and occupational therapy services for elderly and disabled adults. Lyon Park Clinic, a neighborhood clinic providing primary care to low-income Durham patients in a community center in Durham's West End, in conjunction with lincoln Community Health Center. Walltown Neighborhood Clinic, providing primary care to low-income patients in Durham’s Walltown neighborhood, in conjunction with lincoln. Durham Community Health Network, in-home chronic-disease management, patient support, health education and patient advocacy to 19,000 Medicaid patients at eight Duke and community primary care practices. Local Access to Coordinated Healthcare (LATCH), providing bilingual in-home health education on chronic disease, patient support, and patient advocacy to 11,500 uninsured Durham residents. Learning Together, providing health education in selected public schools, assistance in applying for public benefits, and support to Duke’s partner agencies. Chronic Disease Education, with materials prepared for and taught to physical education teachers of Durham middle and high school children. ALMA (Amigas Latinas Motivando el Alma), research program to train latinas in mental health coping skills and teaching the skills to peers. BieneSTAR, a bilingual mental health service for latino families and children enrolled in the elementary school wellness clinics. African American Health Improvement Partnership, a community-based research program serving adult patients with diabetes through church-based support groups, in-home diabetes coaching and education. AACoRN, a research project to reduce pediatric obesity by testing better ways of improving food choices by children and parents, in partnership with the John Avery Boys & Girls Club.

in Durham who don’t have health insurance has nearly doubled since 2004, from 15 percent to 27 percent. Though they live within a few miles of one of the world’s leading medical centers, they often have no reliable way to take advantage of Duke Medicine’s excellent health services. “Duke Medicine devotes $180.6 million to That’s where Project Access comes in. Duke community benefits funding every year.“ Medicine, Durham County and community health care professionals launched The wellness center will operate a collaboration last July to improve weekdays manned by Duke medical access to specialty care for uninsured providers and staff. It will offer people who seek primary care at primary care services to community Lincoln Community Health Center. members, as well as to vocational Duke Medicine specialists and the school students whose parents enroll them as clinic patients. The center will health system are donating their time, have six exam rooms, a nurse’s station expertise and resources for 2,000 episodes of specialty care, including and reception area. inpatient or surgical care, said William “We are proud to be responsive to J. Fulkerson Jr., M.D., senior vice needs expressed by the Durham community and honored to provide primary president for clinical affairs. “The intent is to reduce barriers and preventive medical care to our patients and neighbors,” Victor J. Dzau, so physicians at Lincoln can refer patients who are unable to pay to M.D., chancellor for Health Affairs at specialists before emergencies arise,” Duke University, health system CEO, Fulkerson said. “Patients need better, said in making the donation. easier access to specialty care when a Project Access serious need arises, in a way that will Duke Medicine’s effort to limit the possibility that disease will eliminate health care disparities go untreated until it reaches a crisis worldwide is a challenge, even in level and patients seek care by going Durham – “The City of Medicine.” to the emergency room.” n The number of working adults by the Durham Public Schools, but is being renovated jointly by the schools, the city, the county and DUHS. The health system will operate the wellness center on the first floor, in planned partnership with Lincoln Community Health Center.
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.

n I N S I D E VO LU M E 17, I S S U E 12

CoNTACT uS Campus mail: DUMC 104030 Deliveries: 2200 W. Main St., Suite 910-B, Durham, NC 27705 Phone: 919.660.1318 E-mail: editorinside@mc.duke.edu CREDITS Cartoon: Josh Taylor

STAff Editor: Anton Zuiker Managing Editor: Mark Schreiner Science Editor: Kelly Malcom Calendar Editor: Erin pratt Designer: Vanessa DeJongh Copyright © 2008 Duke University Health System

December 2008

Inside Duke Medicine

3

c ALenDAr

December
learn
Dec. 3 4:30-6 p.m. University Seminar on Global Health Series Tom Quinn, director of Johns Hopkins Center for Global Health, will present the sixth talk in the series, “Infectious Diseases: Continuous Threats to Global Health.” The event is free, but registration is appreciated. John Hope Franklin Center. Free parking is available in the Pickens Lot across the street. Light refreshments will be served. Register: http://globalhealth.duke.edu/ news-events/calendar Dec. 8 6:30-8:30 p.m. Grief and the Holidays The holidays can be an especially difficult time of the year when you are grieving. This workshop will offer helpful strategies for self-care and explore the possibility of creating new family rituals and traditions. Teer House. Details and registration: 416-3853 Dec. 16 8 a.m.-12 p.m. New Investigator Training for those new to research or new to research at Duke. Erwin Square, 8th Floor Traning Room. Continental breakfast will be served. Register: http://crso.som.duke.edu/modules/ crso_resrch/index.php?id=14 Jan. 14 4:30-6 p.m. University Seminar on Global Health Series with Daniel Schmitt, Department of Anthropology and Anatomy at Duke. The event is free, but registration is appreciated. John Hope Franklin Center. Free parking is available in the Pickens Lot across the street. Light refreshments will be served. Register: http://globalhealth.duke.edu/news-events/calendar

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

give
Dec. 4 5:30 p.m. Tree of Hope Lighting Ceremony for the Duke Cancer Patient Support Program (DCPSP). The Tree of Hope honors those individuals facing cancer, those who have faced cancer and those who have made a difference in their lives. You can honor or remember a loved one with a light on the tree and their named will also be written in the Book of Honor in the DCPSP lobby. The ceremony begins in the DCPSP’s lobby with a special recognition for this year’s Light of Hope, Marie Palmer, a now retired, 10-year DCPSP staff member. Then the group will move to the Seese-Thornton Garden of Tranquility for the tree lighting. For information about honoring someone with a light on the tree, contact the DCPSP at 684-4497. Dec. 5 6 p.m. 19th annual Duke Children’s Teddy Bear Ball to benefit the Duke Children’s Hospital & Health Center This premier black-tie gala marks an evening full of the essence of the holidays. It begins with cocktails and a silent auction. Guests browse more than 300 silent auction items, each paired with a loveable teddy bear. As in previous years, guests will be invited to partake in a wine tasting being sponsored by Nomacorc. The highlight of the evening is the live auction, featuring exclusive trips, spirit events and this year’s favorite Duke Children’s Quilt, “Flights of Fancy.” The quilt presentation will be followed by dessert and dancing to the music of The Casablanca Orchestra. The best part…it’s all for the children! Details: http://www.dukechildrens.org/ Dec. 6 10:30 a.m. Jingle Bell Run A fun walk/run to support the Arthritis Foundation. The run will take place at St. Mary’s School in Raleigh. If you are interested in joining the Duke Team, contact Stacy Ardoin at stacy.ardoin@duke. edu. For more information about the race, contact Jeanne Bennett at jeanne@capdev.com or 971-5394.

Suncatchers are given to all Duke employees every year during the holidays. This year’s design is pictured above. See below for details on the Duke Holiday Reception for staff and faculty. IMAGE prOVIDED BY DUKE HUMAN rESOUrCES Dec. 2 7-9 p.m. Duke Chorale Christmas Concert This holiday tradition begins with seasonal music on the carillon and for organ. Admission is one non-perishable food item. Duke Chapel. Details: 660-3333 Dec. 4 2-4 p.m. Duke Holiday Receptions 2008 In the Bryan Center Von Canon Room. Details: Staff & Family Programs, 684-9040 Dec. 9 7-8 p.m. Duke Choral Christmas Concert All are invited to attend this annual Christmas concert—the favorite of many. Admission is one non-perishable food item for the needy of the Durham community. Duke Chapel. Details: 681-9488 Dec. 10 10 a.m.-2 p.m. Holiday Arts Sale sponsored by the Health Arts Network at Duke (HAND). Come shop for gifts among handcrafted items from local artisans and support the arts in the hospital. Duke South Food Court Corridor Dec. 12 4-5 p.m. Sound the Bright Flutes!: Seasonal Music for Early Woodwinds Trio Rossignol (Patricia Petersen, Karen Cook and Douglas Young) will discuss the recorder from its inception through the contemporary period. Come hear a bit about the instrument’s history and repertory, and listen to some delightful seasonal music for the recorder! Pieces for other early winds, such as cornetto, shawm and curtal will also be included. Music will include medieval English carols, French Noels, settings by Praetorius of familiar German Christmas hymns and more. Perkins Library Rare Book Room. Admission is free. Details: 660-3333 Dec. 18 12-2 p.m. Duke Chapel by Candlelight Annual Open House The public is invited to enjoy the beauty of the Chapel by candlelight, featuring seasonal organ music and Christmas decorations. Visitors are invited to come for any portion of the open house. Details: 681-9488 Dec. 19 12-1 p.m. Osler Literary Roundtable Annual Holiday Reading Share something you have written or someone else has written about the holidays or the winter season. Or just come listen to others share. Refreshments will be served. South Clinic Room 1993

do
Dec. 1 2-4:30 p.m. Duke Holiday Receptions 2008 Staff and faculty are cordially invited to join your friends and colleagues at the Duke Holiday Reception in the Searle Center Lecture Hall. Details: Staff & Family Programs, 684-9040 Dec. 1-2 11 p.m.-12:30 a.m. (Dec. 2) Duke Holiday Receptions 2008 For Third Shift Duke Holiday Reception at the Duke Hospital-Atrium Cafeteria. Details: Staff & Family Programs, 684-9040 Dec. 2 10 a.m.-2 p.m. Holiday Arts Sale sponsored by the Health Arts Network at Duke (HAND). Come shop for gifts among handcrafted items from local artisans and support the arts in the hospital. Duke South Food Court Corridor

How to submit:
Send calendar listings to editorinside@mc.duke.edu

Want more info?
Duke Health events: http://www.dukehealth.org Duke University events: http://calendar.duke.edu

4

Inside Duke Medicine
At A g L A n c e BuLLetinS

December 2008

A merry heart doeth good like a medicine.
— traditional
n IT fIgURES

News briefs, notices, events, and The Book Club
n H O L I Day f U N

n INSIDE JOKE

2,726
cardiovascular MRIs performed by the Duke Heart Center in fiscal 2007, a rate of more than

Jingle Bell Run to fight arthritis
Join the Duke Medicine team for the Jingle Bell run to support the Arthritis foundation, at 10:30 a.m. Dec. 6 at St. Mary’s School in raleigh. Duke Team contact: Stacy Ardoin, stacy. ardoin@duke.edu

7
per day, every day of the year. (The projection for fiscal 2008 is more than 3,000 MRIs, among the highest annual volumes in the world.)
Source: Duke Heart Center, 2008 report.

n H O L I Day I D E a S

Auxillary dishes up holiday convenience
You can save money and avoid the lines this holiday season by having your holiday ham or turkey delivered to Duke in time for the holidays. As an added convenience, you can pay through payroll deduction. Duke Hospital Auxiliary and Heavenly Ham are teaming up to make it possible. Duke Auxiliary supports projects at Duke Hospital through fundraising efforts. To order, see robert at the Bouncing Ball in the Children’s Hospital or call 668-4112 for more information. Christmas orders should be placed by Dec. 17. pick up Christmas orders from 7-9 a.m. and 3-5 p.m. in the parking lot behind Duke Children’s on Dec. 22

n pICTURES

n VOLUNTEERINg

Do the write thing
The Duke Writing in the Disciplines program and Office of Alumni Affairs have launched the Duke Writing project, an educational experiment that aims to bring Duke alumni and employees together with current Duke students. The Writing project offers students the opportunity to get feedback on class writing assignments from people with relevant experience. By participating, members of the broader Duke community can play a direct role in helping students develop the communication and reasoning skills that are so important for their success in both professional and civic life. The time commitment for volunteers is low — no more than three to four hours over the course of a semester. find out more: http://www.dukealumni. com/thereaderproject

Jump!
More than 250 creative pictures and compelling stories were submitted for Duke’s second annual “My Health. My life.” photo contest. The entries were funny, artistic and inspiring. Chris Hildreth, director of Duke University photography, chose the grand-prize winner: Joni Harris of the Capital Budget Office. “Of all the entries, this photograph literally ‘jumped out’ to me,” said Hildreth. “I love the four subjects suspended in midair each with their own unique pose, but as a group, evoking a sense of harmony, family, and togetherness.” Joni Harris had this to say about why her health matters to her: “With a family history of high blood pressure and diabetes, and a friend’s recent death to cancer, I don’t take my health for granted. I exercise routinely and have lost 10 pounds.” The photo shows her nieces during an annual family vacation: (left to right): Zari Wilson, Alex Miller, Sydney Stephens, and Samiiah Wilson. See a gallery of contest submissions by going to http://inside. dukemedicine.org and searching “photo contest.”

December 2008

Inside Duke Medicine

5

n COLL aBOR aTIONS

n EVENTS

Med Center Library blog seeking contributors
Calling all bloggers and writers! Interested in exploring issues in medicine, nursing, information, research and education? Here is your opportunity. The Medical Center library is seeking guest bloggers for the library’s Crossroads blog. Topics for posts could include: • Making evidence-based practice a reality. • Spotlighting significant new articles from the literature • Using technology in health care • Life as a student or clinician. • Other topics of interest. No previous blogging experience is required. Guest bloggers will receive free interlibrary loan privileges or copy cards for their participation. Interested? Questions? Contact Megan von Isenburg at megan.vonisenburg@ duke.edu or (919) 660-1131.

Paterson to deliver Carter Lecture
The 2009 Harriet Cook Carter lecture — an annual lecture series begun by the School of Nursing’s Class of 1963 to commemorate the life of Harriet Cook Carter and her work on behalf of the Duke and Durham communities – will feature Barbara paterson, ph.D. paterson is an r.N., professor and Tier 1 Canada research Chair in Chronic Illness at the University of New Brunswick. paterson will address assumptions about what people with chronic illness need and want, and future directions for nursing science that considers the most recent evidence about what is needed to support and sustain self-management of chronic illness. The 2009 Harriet Cook Carter lecture will be held Jan. 28.

New Morrisville Clinic has opened

T

he new Morrisville Clinic, offering primary care, specialty care and urgent care, opened Nov. 10 not far from RDU airport. The clinic is located at 10950 Chapel Hill Road. Duke Urgent Care Morrisville is open 8 a.m.-8 p.m., every day of the year. Duke Primary Care and Duke Medicine will be open 8 a.m.-5 p.m., Monday through Friday. Cardiology and orthopedic specialty care will be coming soon.

Download a copy of the new Duke Medicine Closer to You Location Map, which is being distributed throughout the Triangle and shows more than 100 Duke clinics spread across North Carolina by going to http://inside.dukemedicine. org and entering “location map” in the search field. For additional information about Duke Medicine clinics, visit http:// www.dukehealth.org.

tHe Book cLuB

Building up
n EDUC aTION

free therapy for breast cancer survivors
An innovative exercise and recreation therapy program based at the University of North Carolina at Chapel Hill, in partnership with the Duke Center for Cancer Survivorship will offer a free educational session for breast cancer survivors on Dec. 8, from 5–8 p.m. The session will be held in the Stedman Nutrition Center, on the Duke Center for living Campus, located off Erwin road in Durham. The Get rEAl & HEEl education session will focus on teaching participants to use exercise and recreation therapy to manage cancer treatment-related symptoms such as pain, anxiety and fatigue; and to improve quality of life. The session is open to all breast cancer survivors, whether recently diagnosed or a long-term survivor. To enroll in the free education session or for more information about Get rEAl & HEEl, contact Jennifer Cashion at (919) 962-1222, or email: cashion1@email. unc.edu, before Dec. 2.

A

Beary beautiful
gain this year, hundreds of Duke Medicine employees with a passion for decorating teddy bears took the annual challenge to help raise money for Duke Children’s Health Center. The 19th-annual Teddy Bear Ball was Dec. 5, at the Durham Marriott and Civic Center downtown. Ten entries were selected out of a highly creative group. Here are the winners by category:

By day, Tim pennigar roams Duke Medical Center as a high-energy project manager for maintenance and construction. When he’s not busy gussying up the courtyard at Duke North, finding creative ways to recycle materials and in general looking for new ways to keep Duke Medicine green, he likes to relax with a good book. Tim recently took a literary busman’s holiday by picking up How Buildings Learn (Viking, $30), written in 1994 by Stewart Brand. “It’s a fascinating look at how buildings adapt over time when constantly refined and reshaped by their occupants,” says Tim. “Mr. Brand sort of ‘kicks the stuffing’ out of the typical approach to building design — challenging the architectural community to mature from being artists of space to becoming artists of time.” The thought-provoking premise challenges architects, historians, real estate professionals and people in general to think in terms of a building’s life, not just its original intentions. Buildings, Brand contends, adapt as their use changes over time between their birth and their demise, but not all adapt well. One of the most fundamental questions Brand asks is why some buildings gain beloved status and others don’t. In 1997, the BBC aired a three-hour documentary based on the book.
— Bill Stagg

See more photos of the entries at http://inside. dukemedicine.org Search for “teddy bear.”

Best in Show: lynn pope, perioperative Services-Eye Center. Beary Beautiful: Vicki Burnett, radiation Oncology. Home & Garden: Vicki Beard, Adriana El Calamawy, Betsy faucette, Donna Withrow, patient Visitor relations. Clothing & Jewelry: Vivian Jordan, Operations Improvement. Dining & Entertainment: Susan B. Cole, Hospital Service Access Management. Children’s Corner: lynn pope, perioperative Services-Eye Center. Deck the Walls: Samantha Carpentier, Outpatient registration. Sports & Recreation: Caroline Hollingsworth, radiology. Children’s Art: Jerelyn Moffel, peds Bone Marrow. Trips & Getaways: Courtney Jenkins, Williams Unit.

Events

High fives

School of Nursing News

research News

Today’s Top News

Inside Scoop School of Medicine News
Hr News

Inquiry profiles global Health Ethics Arts, Culture & Medicine Lives

6

Inside Duke Medicine
PAt i e n t c A r e gooD iDeAS

December 2008

Remember to encrypt e-mail

Right response
The sixth part of 'Six Rights in 6 Months' patient safety series.
of getting the right response from the patient. n 1897, a young girl by the name of Virginia Examples of steps to help assure the right response O’Hanlon asked a question to the editor of the might include: New York Sun that resulted in one of the classic • For prescribers: Considering age, disease state, responses of all time. Trivia buffs may remember other medications taken for each patient to obtain her question, which goes like this: the best therapeutic result for any medication. “I am 8 years old. Some of my little friends say • For nurses: Knowing onset, peak and duration of that there is no Santa Claus. Papa says if you see it each medication being administered. Anticipate in the Sun, it’s so. Please tell me the truth. Is there a the expected response and appropriate monitorSanta Claus?” ing/care which may be required. Of course, the classic response was “Yes, • For pharmacists: Considering the effects of Virginia. There is a Santa Claus.” Although herbal preparations, naturopathics, over the the editor’s response was much more involved counter medications, etc., on the patient’s than just that famous line, he understood how medication regimen. important the right response • For patients and family members: was going to be. Asking about expected and Every day, physicians, adverse results of any new nurses, pharmacists, and medication. The nurses and technicians at Duke Medicine physicians are always willing to understand the importance of 6 Rights of the answer your questions. Medication Use Process : their hard work helping our Another part of making safe patients experience the right choices in the medication delivery 1 ) Right patient response to the medications process consists of remembering a 2) Right drug that they receive while in few “non-negotiable behaviors,” 3) Right dose our care. including always taking and using A question that is often the medication administration 4) Right route asked in the hospital is record with you to obtain and 5) Right time “How can we maximize the administer medications, taking safety of our medication use 6) Right response medications in the original processes?” The short answer packaging into the patient’s room, is “Follow the 6 Rights of labeling any medication prepared Medication Administration.” at the time of preparation and But, similar to the editor’s reviewing or returning to the last response to Virginia’s quesstep prior to any interruptions that tion, there is more to it than may occur in the process. These behaviors and safety just a couple of sentences. And the real answer is in steps are considered important enough to be included being aware and carrying out the sub-steps in each each month, even as we focus on a different “Right.” of those 6 Rights when prescribing, processing, Throughout the six months of our “6 Rights in administering or teaching patients about their 6 Months” effort, the Medication Safety Education medications. Committee has stressed the importance of the basics In 2006, a landmark report from the Institute of effective processes, combined with vigilance by of Medicine of the National Academies started a all persons in the process to maximize the safety of nationwide drive to maximize medication safety. our medication use processes. The study noted that approximately 1.5 million And just as Virginia was searching for the right people are harmed by medication errors each year, response, helping assure that the patient experiences with an estimated cost of of $3.5 billion per year. the Right Response to their medications is an The medication safety leaders at Duke continue important part of our job at Duke. to work to maximize safety and minimize the Maximizing safe medication delivery processes possibility of error in the medication use process. is always the right response. n Part of this commitment is the “6 Rights in Six Want to know more about the Medication Months” campaign. Safety Education Committee and its efforts? This month, the focus is on the Right Response. Contact committee coordinator John Howe, RN at As with each of the 6 Rights, there are howe0003@mc.duke.edu , or visit the Medication multiple steps and considerations for each member Safety Web site at: http://PatientMedSafetyEd. of the health care team involved in the process duhs.duke.edu/
By John Howe, RN, BSN, CAP

Throughout Duke University Health System operations, there are occasions when protected health information (pHI) or other sensitive electronic information is sent by e-mail. A typical transaction might include the patient’s account and medical record information, home address and phone number, even the patient’s name. providers and patients may also communicate with each other by e-mail. To protect patients’ privacy and confidentiality, e-mails containing pHI or other sensitive information must be encrypted. When using e-mail, members of the Duke workforce are required to use lotus Notes or iNotes, which are DHTSsupported encrypted email accounts. Know your features. Click “sensitive electronic information” before sending pHI by lotus Notes. The communication of pHI by personal e-mail accounts (AOl, Hotmail, Outlook, etc.) is prohibited, as is the automatic forwarding of e-mails outside of Duke Medicine.

I

How to encrypt e-mail
To encrypt protected health information when sending an email on lotus Notes, click the “Sensitive Electronic Information” box prior to sending a message.

It is important to remember that you are responsible for taking reasonable steps to control uses and disclosures of pHI by applying the minimum necessary rule. “Minimum necessary” means including in an e-mail only the amount of pHI necessary for the purpose of the communication. Complying with the minimum necessary communication requirements includes de-identifying the pHI as much as possible. for example, when pHI is sent via e-mail, the e-mail should not reference the patient’s name if there are other identifiers, such as a medical record number or an account number, available. If it is necessary to include pHI in an e-mail, the e-mail should only be sent to those who have a “need to know” the information. E-mails containing pHI may not be forwarded within or outside Duke Medicine, and pHI should never be used in the subject line of an e-mail as the subject line is not encrypted even when the sensitive electronic information box is checked. for further guidance on this topic, go to https://email.duhs.duke.edu/secureemail/ or, see the DUHS Electronic Communication policy, the DUHS Mobile Computing and Storage Devices policy, or contact rob Adams, information security officer, at rob.adams@ duke.edu.

The Science & Research Supplement to Inside Duke Medicine
VOLUME 17 NO. 12 n inside.dukemedicine.org n December 2008

newS

F e At u r e

ADHD drugs don’t increase genetic damage
Two widely prescribed medications to treat attention deficit hyperactivity disorder (ADHD) do not cause genetic damage associated with an increased risk for developing cancer. A study, conducted in collaboration with researchers at the National Institutes of Health, countered a previous report that raised concern in the medical community. Biomarkers associated with an increased cancer risk had been found in blood samples from a small study of children taking methylphenidate. “The new findings should help alleviate some of the concerns that were raised by the previous study,” says Scott Kollins, ph.D., study co-author and director of Duke’s ADHD program. “However, we need to continue to study the long-term effects of these medications and expand our analyses to include older patient populations.”

Children are often vulnerable to health effects posed by environmental contaminants. ILLuSTRATIoNS BY VANESSA DEJoNGH

Alberts seminar
Bruce Alberts, ph.D., former president of the National Academies of Science and current editor-in-chief of Science Magazine, will be giving a special seminar titled “Making Science Out of Science Education: Strategies for Success in This Critical Enterprise for the World’s future,” Jan. 30 at 1:30 p.m. in lSrC’s lOVE Auditorium. There will be opportunities for students and post-docs to meet with him as well.

Health dangers: hidden in plain sight
By Kelly Malcom

I

Science Web links
School of Medicine Dean Nancy Andrews, M.D., ph.D., addresses the challenges facing the next generation of physician scientists in the most recent issue of HHMI Bulletin, a Howard Hughes Medical Institute publication. “It’s time for schools and others to step up and relieve the social and economic pressures that threaten this important career path,” she says. To read the full article, visit the HHMI Bulletin Web site at http://www.hhmi.org/bulletin/nov2008/ perspectives/advocate.html. • • • read an article by the IGSp’s Kendall Morgan on the use of new technology to study genetics at a system-based level. Visit http://research. duke.edu/robobio/. • • • led by Brigid Hogan, ph.D., frS, of the Department of Cell Biology and Tannishtha reya, ph.D., of the Department of pharmacology and Cancer Biology, The Duke Stem Cell and regenerative Medicine program aims to bring together scientists and clinical investigators studying stem cells and their remarkable therapeutic potential. See their newly launched Web site at http://www.stemcell.duke.edu/.

n early 2007, pet owners across the U.S. were left grief-stricken and seeking answers as their pets began dying after eating tainted pet food. The culprit, a chemical called melamine used in the production of plastics, would soon be implicated in the hospitalizations of thousands of infants in China who had ingested tainted milk powder. These poisonings and others from imported and domestically produced products led to a tightening of safety restrictions by the U.S. Consumer Product Safety Commission and the development of this year’s Consumer Product Safety Improvement Act. Duke, through collaborations between the School of Medicine and the Nicolas School of the Environment, has been integrally involved in assessing the health risks posed by various materials and environmental toxins. Research here is helping to develop standards under which Congress acts on behalf of consumers. Woodhall Stopford, M.D., MSPH, of the Department of Community and Family Medicine and the Division of Occupational and Environmental Medicine, has worked at Duke for over 20 years, developing risk assessments for products. “When I began in the early 80s, I was looking at the safety of children’s art materials,” he explained. “Things began to change during that period as more and more adult artists were

the potential for adverse neurological affects that the EPA withdrew acceptability of the use of chlorpyrifos in the home,” said Slotkin. Slotkin’s research is funded by the EPA’s Superfund project, a federally funded program to clean up toxic waste. Research by his lab, and by Levin’s lab, which looks at the potential adverse behavioral effects of toxicant exposures, is rapidly redefining which chemicals are considered safe. “We are sort of the fire marshals of science in that our job is to adequately vet these tens “a study by the Epa showed that of thousands of compounds every school age child has residues that are in wide use,” said of a type of insecticide in their urine.“ Levin. He cited a Columbia University study that found that children living in Manhattan had Ph.D., of the Department of the highest known concentrations of Pharmacology and Cancer Biology, and insecticide in their bodies and that this Ed Levin, Ph.D., of the Department exposure was in turn having negative of Psychiatry are also using animal effects on IQ and behavior. “When models to determine how exposures the insecticides were replaced with less to substances like lead, pesticides and toxic substances, such as boric acid, cigarette smoke affect children, who are at greatest risk for adverse health effects. those effects declined,” he said. Slotkin and Levin suspect that the “A recent study by the increased incidence of neurobehavioral Environmental Protection Agency conditions such as autism and ADHD showed that every school age child may be directly related to chemical contains residues of organophosphates, exposures. These organophosphates a type of insecticide, in their urine,” insecticides disrupt normal neurorevealed Slotkin. “Up until five or six logical development by blocking the years ago, organophosphates were the breakdown of a neurotransmitter most widely used type of pesticide. called acetylcholine, Levin explained. It was partially based on our work demonstrating that these chemicals had see ToXIC, p.8 developing cancer as a result of exposure to heavy metals.” It was then that the first Consumer Product Safety Act became law, requiring review and labeling of art materials. An important component of Stopford’s research is a risk assessment technique called modeling, which determines tolerable exposure levels and likely exposure amounts using animal models that are then extrapolated to people. Researchers Theodore Slotkin,

8

Inquiry

December 2008

Lactic acid found to fuel tumors
team of researchers at Duke University Medical Center and the Université catholique de Louvain (UCL) in Belgium has found that lactic acid is an important energy source for tumor cells. In further experiments, they discovered a new way to destroy the most hard-to-kill, dangerous tumor cells by preventing them from delivering lactic acid. “We have known for more than 50 years that low-oxygen, or hypoxic, cells cause resistance to radiation therapy,” said senior co-author Mark Dewhirst, DVM, Ph.D., professor of radiation oncology and pathology at Duke. “Over the past 10 years, scientists have found that hypoxic cells are also more aggressive and hard to treat with chemotherapy. The work we have done presents an entirely new way for us to go after them.” Many tumors have cells that burn fuel for activities in different ways. Tumor cells near blood vessels have adequate oxygen sources and can either burn glucose like normal cells, or lactic acid (lactate). Tumor cells further from vessels are hypoxic and inefficiently burn a lot of glucose

A

to keep going. In turn, they produce lactate as a waste product. Tumor cells with good oxygen supply actually prefer to burn lactate, which frees up glucose to be used by the less-oxygenated cells. But when the researchers cut off the cells’ ability to use lactate, the hypoxic cells didn’t get as much glucose. For the dangerous hypoxic cells, “it is glucose or death,” said Pierre Sonveaux, professor in the UCL Unit of Pharmacology & Therapeutics and lead author of the study, published in the Nov. 20 online edition of the Journal of Clinical Investigation. He formerly worked with Dr. Dewhirst at Duke. The next challenge was to discover how lactate moved into tumor cells. Because lactate recycling exists in exercising muscle to prevent cramps, said the Center’s deputy director Marie Lynn Miranda, Ph.D. Miranda, whose primary appointment is with the Nicholas School, works closely with School of Medicine

the researchers imagined that the same molecular machinery could be used by tumor cells. “We discovered that a transporter protein of muscle origin, MCT1, was also present in respiring tumor cells,” said Dewhirst. The team used chemical inhibitors of MCT1 and cell models in which MCT1 had been deleted to learn its role in delivering lactate. “We not only proved that MCT1 was important, we formally demonstrated that MCT1 was unique for mediating lactate uptake,” said Professor Olivier Feron of the UCL Unit of Pharmacology & Therapeutics. Blocking MCT1 did not kill the oxygenated cells, but it nudged their metabolism toward inefficiently burning glucose. Because the glucose was used more abundantly by the better-oxygenated cells, they used up most of the glucose before it could reach the hypoxic cells, which starved while waiting in vain for glucose to arrive. “This finding is really exciting,” Dewhirst said. “The idea of starving hypoxic cells to death is completely novel.” n

Early studies may hold key to male contraception
The fusion of sperm and egg succeeds in mammals because the sperm cells hyperactivate in progressively more alkaline environments of the female reproductive tract before encountering the egg, and one fast-moving sperm drives on through the egg’s fertilization barrier. Mammals have sperm with a tail that reacts when calcium ions enter a microscopic channel in the tail, that then makes the sperm go into overdrive. In fact, four genes are needed to produce the so-called CatSper ion channel in the sperm tail that hypermotivates the sperm. The CatSper genes may someday be targeted in a male contraceptive: no calcium-ion channel gene = no sperm hyperactivity = no fertilization (infertility related to the gene blockage has been proven in mice). The interesting thing is that mammals, reptiles, sea urchin, and even some primitive lower invertebrates, animals without backbones, have all of these four genes, while birds, insects, worms, frogs, and most fish species, do not, says co-author Xingjiang Cai, M.D., ph.D., of the Duke Department of Cell Biology and the Duke Department of Medicine, in the Division of Cardiology. He and co-author David E. Clapham, M.D., ph.D., have worked to learn more about the evolution of the sperm-specific ion channels. Their genomics study was designed to address the physiological significance of the CatSper channels and sperm hyperactivation across animal species using genomic databases to track evolutionary paths of the genes that contribute to this channel. “One of the important things about studying this particular ion channel (on the sperm) is that targeting these genes should not affect any other ion channel in the body. Other ion channels are important in heart function and in other organs,” Cai said. “The idea that this sperm ion channel could be blocked for a human male contraceptive is interesting.” A contraceptive drug used specifically in men with no side effects would be very appealing, he said.

ToXIC, cont.
The brain is then unable to form the correct connections between neurons so important for normal functioning. “Another important part of our lab is the development of potential treatments for exposure. We’re trying to determine the mechanisms by which these compounds exert their influence and then use those clues to develop treatment interventions.” Their work and the work of other researchers interested in environmental medicine at Duke is being supported by the Center for Comparative Biology of Vulnerable Populations, led by Richard T. Di Giulio, Ph.D., director of the Superfund Basic Research Center at Duke. One of the means of support includes pilot project funding. This year, two projects were winners of the prestigious ONES, or Outstanding New Environmental Scientist, award, given by the National Institute of Environmental Health Sciences. “This is really a quite a remarkable achievement for an institution to receive two of these awards in the same year,”

and other contaminants in the home. Thomann studies ways to engineer buildings, including Duke’s hospitals, so that exposures to fungal spores and other contaminates are reduced for employees and especially “We’re trying to determine the patients with compromised immune systems. mechanisms by which these With chemicals being compounds exert their influence.“ so pervasive within our everyday environment, and an faculty to address environmental jusincreased reliance on imported goods tice issues throughout North Carolina from China and other countries, what and the country. can be done to avoid potential adverse For example, she teamed with health effects? Wayne Thomann, M.D., of the Continued government oversight Department of Community and is key, say Duke’s environmental Family Medicine and the Division researchers. Indeed, they acknowledge of Occupational and Environmental the often-difficult task of monitoring Medicine, to look at air quality thousands of compounds for safety but within North Carolina homes and its stress that more research is imperative. resulting effects on the health of the Said Levin, “The health damage is occupants. According to the Children’s occurring; we can’t close our eyes and Environmental Health Initiative, a pretend it isn’t happening. It may be program led by Miranda, asthma and expensive and laborious but it has to be allergies have an unequal impact on done. If we’re going to have a modern specific subsets of the population, industrialized society we’re going to including minorities and poor families, have to protect against these risks.” n and can be due to the presence of mold

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 editorinside@mc.duke.edu

December 2008

Inside Duke Medicine

9

working

from truck to tray, DRH food & Nutrition delivers
Special to Inside Duke Medicine

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hat does it take to deliver three meals to the more than 220 patients and approximately 1,100 visitors and staff who dine in the Durham Regional Hospital cafeteria each day? Observe the Food & Nutrition team in action, and you have witnessed a finely-tuned orchestra. With each employee hitting an essential note in the complicated—yet harmonious— production, this “orchestra” delivers the right ingredients to the right patient at the right time, while at the same time running a restaurant and catering business 24 hours a day, 365 days a year. Here’s a typical morning in the life Rochelle Brown restocks food in the Durham Regional Hospital cafeteria. of Sam Powell, who begins each day pHOTO BY TOM WOOTErS unloading and preparing food so the “orchestra” can work their magic.

who pulls and tracks all the orders, saw that Ms. Bailey is a diabetic. She called Jennifer, who is a registered dietitian, to see if Ms. Bailey can have a shake. The food services team—from the cook to the patient menu technician— is responsible for ensuring that each patient receives the proper meal. Many times, the diet ordered by the physician will restrict salt or sugar either on the tray or cooked in the food. Jennifer is part of an interdisciplinary team that works with physicians to care for patients. “It’s an orchestra every day. If one part is missing, it throws everything off,” says Jennifer.

10 a.m.
• The cafeteria is closed and the team begins to clean and prepare for lunch. Monica and Rochelle set up the salad bar and Rochelle makes sandwiches. • Phyllis cleans every table and replenishes silverware. • Trudie Watson prepares the daily lunch special. • James Walker, Ingredient Control Cook, prepares the entrées. He adds ingredients for every meal so the cooks can prepare the meal. • Chris and Vince begin cooking lunch for patients and the cafeteria.

5 a.m.
• Sam begins unloading groceries from the delivery truck. Approximately 500 boxes of bread, milk and other groceries are delivered to DRH almost every day and placed in the appropriate storage. While unloading, Sam greets Mary Humphrey who is making fresh baked brownies from scratch for patients. Close by, Rochelle Brown is making sandwiches for the cafeteria and all the catering events for the day while Monica Ford is putting the salad bar together for lunch.

Here to Serve
Here’s the grocery order for Durham regional Hospital’s annual buffet and breakfast for employees, volunteers and retirees: • 390 pounds of turkey • 343 pounds of ham • 400 pounds of potatoes • 72 gallons of yams • 8 pounds of marshmallows 4 to cover the yams • 360 pounds of green beans • 990 slices of bacon • 80 pounds of eggs • 1,440 rolls • 105 pounds of cornbread stuffing • 120 pounds of cranberry sauce • 96 quarts of eggnog • 1,152 slices of chocolate cake • 60 pecan pies • 170 pounds of cheesecake

6 a.m.
• Sam continues to unload the groceries and stock. • He meets cook Vince Battle, who has been prepping and cooking breakfast for the cafeteria since 5, while Chris Decosta prepares and cooks breakfast for patients. • Rhonda Modlin stocks chips, drinks and supplements. Next, she will pull items from cold storage and refrigeration for her co-workers who are preparing lunch. She will pull all pizzas for the cafeteria and the patients who ordered pizza for lunch.

Then, consider that all this cooking goes on while the food & Nutrition team feeds patients and visitors in the cafeteria as usual.

11 a.m.
• And, the beat goes on. In about another hour, Sam will finish unloading 500 boxes from the truck, and will have placed them in storage rooms. He will then help bring boxes to the food preparers and cooks, and he will determine what inventory he needs to order for tomorrow. At 7 a.m., 11 a.m. and 4 p.m. every day, the “orchestra” delivers its “music” to the 220 waiting patients and approximately 1,100 visitors and staff who dine in the hospital cafeteria. This happens 1,095 times a year regardless of conditions. “Often, all it takes for someone’s day to turn around is a smile and comforting word,” says Andrew Hennis, Food & Nutrition director. “And in addition to the organized chaos of food preparation, our team delivers that smile and comforting word— nourishment for the soul.” n

While they bake, she cooks the non-entrée items and cuts and boils potatoes for patient and cafeteria entrées.

7 a.m.
• The patient tray line in the kitchen begins. That’s where Lafayette Artis, Sheila Bobbitt, Teresa Harding, Ophelia Hall, Barbara Giles and Ariel Moore prepare every patients’ breakfast plate, along with silverware, drinks and napkins. The trayline operates two hours for each meal. When the line is not running, the team cleans dishes. • While Sam continues to unload the truck, he greets patient menu technicians Shamera Boykin, Sherri Couch, Nina Emmons, Shanaya Foster, Calina

6:30 a.m.
• The cafeteria opens for breakfast. • Phyllis Cadlet begins serving breakfast while Catherine Joyner and Beverly Simpson run the cash registers. • Hazel Pringle prepares the deli bar for lunch. • Mary places brownies in the oven.

Hobson, Frenchie Roscoe and Derek Walker who collect the breakfast trays for patients. There are five patient menu technicians on each shift. They deliver trays to patients three times a day. Each technician has one or two units, and will deliver all meals for that unit. And, he or she will take each patient’s order with a handheld digital device. When the team finishes breakfast delivery, they come back for the lunch trays, and start the whole process again.

8 a.m.
• Chris and Vince begin cleaning the grills for lunch. • In the Diet Office, Krystal Lubitz and Jennifer Young discuss a Ms. Bailey’s milkshake. From a computer, Krystal,

10

Inside Duke Medicine
working
n CELEBR aTIONS n TRaffIC aLERT

December 2008

2008 holiday receptions schedule
Join other Duke staff and faculty for free refreshments and entertainment during this year’s holiday celebrations. Enjoy the sights, sounds and flavors of the season from 2-4:30 p.m. Dec. 1 in the Searle Center; 2 p.m.-4 p.m. Dec. 4 in the Bryan Center; and 11 p.m.-12:30 a.m. Dec. 1 in the Duke Hospital Atrium Cafeteria. Also during the holiday season, full-time faculty and staff will receive a Duke suncatcher as a gift for their contributions and service. The 2008 Duke Suncatcher, distributed through Staff & family programs to offices, pays tribute to “Trustworthiness,” one of Duke’s guiding principles. See the suncatcher, and find information about other holiday events on page 3.

Lane restrictions on Erwin Road
Commuters who use Erwin road in Durham, take note: Erwin road may be narrowed to one lane between Morreene road and laSalle Street for a road improvement project overseen by Duke’s facilities Management Department. The lane closing will likely cause traffic congestion during peak travel times such as morning rush hour. Motorists are urged to allow more travel time, use extra caution in the construction zone and to consider alternate routes. The work is part of a major project to enhance intersections along Erwin road. During this phase, new turn lanes are being added.

Employee discounts

J

n EDUC aTION

Medical Spanish classes scheduled
Here’s a great opportunity: join us for classes geared towards spoken Spanish and tailored to your needs. Starting on Jan. 19 and continuing through March 26, 10-week courses will be offered by El Centro Hispano through the HISpAmericano Institute in collaboration with Duke School of Nursing and the latino Health project at Duke University. The two-hour classes will be held once a week as follows: • evel 1 : No previous Spanish knowledge L required. Monday, 5:30-7:30 p.m., at Duke South in Durham. Wednesday, 3:30-5:30 p.m., at Durham regional Hospital. • evel 2: Prerequisites: basic grammar, simple L medical dialogues. Tuesday, 5:30-7:30 p.m. - Duke South Thursday, 3:30–5:30 p.m. - Durham regional Hospital • evel 3: Prerequisites: verbs, present tense, L numbers, direct and indirect pronouns and medical vocabulary. Wednesday, 5:30-7:30 p.m. - Duke South • evel 4: Prerequisites: verbs, past tense and L command, idiomatic expressions and medical vocabulary. Class is available upon request The cost is $200 per student. Book not included (but $10 off when you bring a new student). payment by check or credit card. No refunds. register now to ensure your place. Info: Adriana at (919) 680–3333

oAnn Kempel (shown above at left, with friends), an administrative assistant for the Department of Biochemistry, and her husband, Ken, visited Biltmore twice during the holidays and once in the spring. And, they plan on visiting again on New Year’s Day. Employee discounts, available to Duke faculty and staff, made it possible. The largest privately owned home in the U.S., Biltmore’s 250-room French-style chateau

is a popular Asheville attraction. Kempel bought her tickets through Duke’s PERQS program. Through Duke’s discount, faculty and staff save $9 on adult admission. Children under 10 are admitted free of charge. That’s just one of many discounts. Find out more by going to http://www.hr.duke.edu/discounts or reading posts from resident savings expert “Dr. Discount” at http://inside.dukemedicine.org n

n aLTERNaTIVES

Mobile farmers Market continues through winter
Summer may be over, but you don’t have to forgo fresh, local produce. Duke staff and faculty can enroll in the Mobile farmers Market, which will continue through the fall and winter season. The fall/winter Mobile Market, organized by lIVE fOr lIfE, includes broccoli, cauliflower, squash and other produce from Brinkley farms in Creedmoor; lettuce and arugula from Coon rock farm and flowers from fernrock flower farm, both in Hillsborough. Orders can be picked up from 4 p.m. to 6 p.m. on Tuesdays at the Sarah p. Duke Gardens. for more information and to join, visit http://hr.duke.edu/mobilemarket or call (919) 684-3136, extension 1.

CANCER CENTER, cont.
division. Duke is committed to continuing to be a national and international leader in cancer-related patient services and clinical and basic research.” New cancer cases are projected to increase by 21 percent in the greater Triangle over the next five years and 13 percent in North Carolina as a whole. Today, more than 65 percent of adult cancer patients and 78 percent of childhood cancer patients survive five years beyond diagnosis, creating a vast and growing number of cancer survivors, who require follow-up and supportive care. “Clinicians and researchers at Duke and other institutions have made so many advancements and are seeing so many more patients reach survivorship, and if you combine the growing number of survivors with the growing number of newly diagnosed people, we can expect to see a real explosion in demand for our services,” said Kevin Sowers, r.N., M.S.N., chief operating officer and interim CEO of Duke University Hospital. “This expansion really reflects our attempt to meet that need.” If approved, the new facility would house clinical programs in all areas of ambulatory cancer care, including clinic space, infusion therapy, radiation oncology, imaging, lab services, pharmacy services, genetic counseling and patient support services, including educational, nutritional and social work resources.

The new building would be located next to the existing Morris Cancer Clinic, which is part of the Duke South clinic building. Construction would occur at the same time as construction on the expansion of Duke University Hospital, but the projects would be phased so that patient care and research can continue without interruption, Sowers said. More than 75 percent of cancer patients seen at the Duke Comprehensive Cancer Center in 2007 were residents of North Carolina. Duke currently serves patients from all but one of North Carolina’s 100 counties. Its clinical services are consistently ranked among the nation’s best. A CON request is required by the state for any proposed hospital facilities expansion. If approved, it is hoped construction would begin in July 2009. The project is estimated to take three years to complete. “We are aware that this project is conditional upon approval by the state,” Sowers said. “We hope that the reviewers of the request will recognize that consolidating and expanding our cancer services is necessary for us to be able to meet the cancer care need that is projected for North Carolina. This project is of great importance to people who will be diagnosed with cancer in the future, and is also important to the field of oncology as Duke researchers continue to make basic and clinical discoveries that are changing the lives of people with cancer.” n

n pERSONaL fINaNCE

free seminars on spending, retirement
If current economic conditions have you concerned about credit, debt and retirement, the Duke federal Credit Union may have a free financial seminar for you. December seminars include: • Refinancing, 6:30-8 p.m. Dec. 2, in the Teer House • Building a Better Budget, 12:30-1:30 p.m. Dec. 2, in the Searle Center • Creditability: Build a Strong Credit History, 6:30-8 p.m. Dec. 9, Teer House • Retirement Strategies for Women, 12:301:30 p.m. Dec. 9, in the Searle Center To register, visit http://www.dukefcu.org and select “seminar sign-up” under Quick links. You can also register by sending e-mail to scottie.dowdy@duke.edu or calling (919) 660-9745.

December 2008

Inside Duke Medicine

11

AnnounceMentS
Jeffrey R. Marcus, M.D., has been named assistant vice-chair for pediatric surgical affairs in the Department of Surgery, department Chair Danny O. Jacobs, M.D., announced. In the newly established position, Marcus will represent 13 surgeons in eight surgical sections and hopes to become a bridge between the departments of surgery, pediatrics and the Medical Center in a way that will further Duke’s commitment to pediatric surgical care. “Dr. Marcus is a talented surgeon and leader, and I look forward to working with him to enhance the already strong collaboration between surgeons, pediatricians, and other pediatric providers,” said Joseph St. Geme, M.D., chair of the Department of pediatrics. Marcus is a board-certified plastic surgeon whose interests focus on the correction of facial deformities and aesthetic facial enhancement for children and adults. In addition to his new position, Marcus is also surgical director for Duke Children’s Hospital, director of Duke’s Cleft Team and Craniomaxillofacial Trauma program, and an assistant professor at Duke University Medical School. Mary Ann fuchs, chief nursing and patient care services officer for Duke university Health System; Audrey Neal, Durham Regional Hospital Magnet coordinator; and Gloria McNeil, Peggy Baker and Margaret Cheek spread the word last month that DRH had achieved Magnet status. pHOTO COUrTESY Of DUrHAM rEGIONAl HOSpITAl

Posthumous honors for Lawrence Katz
The late lawrence Katz, ph.D., was honored by the Society for Neuroscience during its recent annual meeting. “These science achievement awards span the field of neuroscience, honoring those early in their career as well as senior scientists, and those who promote the advancement of women in the field,” said Eve Marder, ph.D., society president. Katz was inducted into the patricia Goldman-rakic Hall of Honor. This posthumous Hall of Honor recognizes sustained exceptional achievements in neuroscience as evidenced by publications, inventions, and/or awards, as well as a demonstrated high degree of imagination, innovation, and initiative in the pursuit of neuroscience, and a dedication to facilitating the advancement of women in neuroscience. Katz died from melanoma in November 2006. His scientific accomplishments were recognized by his being named a Howard Hughes Medical Institute Investigator in 1996 and the James B. Duke professor of Neurobiology at Duke University in 1998. Katz made seminal discoveries in cortical development and circuitry with an emphasis on the visual system. He defined novel aspects of neurotrophin signaling and regulation in the central nervous system; designed and developed new technologies and methods that transformed fields ranging from photostimulation to fluorescent latex microspheres to biolostics; and most recently provided fundamental insight into the functional organization of the olfactory system. During his time at Duke, Katz trained many students and postdoctoral fellows, many of whom have gone on to conduct their own high-quality research at prestigious institutions around the world. Stephen Shea, ph.D., a postdoctoral fellow who worked with Katz, said: “larry was so inventive, energetic, and charismatic, that he didn’t just make his lab fun – he made his entire field more fun. My time working for him will undoubtedly always stand as a true highlight of my scientific career, and I will carry his influence with me wherever I go.”

Durham Regional Hospital achieves Magnet status

D

recognition
Jonathan Etter, M.D., of the Duke Eye Center, won first-place honors in the sixth annual Ophthalmology Times resident Writer’s Award program. Etter received the award Nov. 9. The program was sponsored through an unrestricted educational grant from Advanced Medical Optics (AMO). Etter placed first among 14 entries received from participants representing ophthalmic teaching institutions from across the country and, for the first time, a Canadian institution, the University of Toronto. His presentation was titled “fungal keratitis: enhancing antifungal delivery with femtosecond laser-assisted keratectomy.” Etter’s mentor was Alan N. Carlson, M.D.; 2008 marked the second consecutive year that one of Carlson’s residents earned the top spot in the competition. The resident Writer’s Awards program is designed to encourage excellence in writing and presentation skills among residents. • • • Ellen Durham Davis, clinical nurse specialist, has been named to Vanderbilt University’s School of Nursing’s Top 100 leaders. The honorees were cited for making a significant impact in the world of health care and nursing. The Top 100 leaders list comprises individuals in virtually every aspect of health care. The common denominator is their affiliation with Vanderbilt, either as faculty member, alumnus or volunteer.

urham Regional Hospital achieved Magnet designation for excellence in nursing from the American Nurses Credentialing Center (ANCC). Only 5 percent of the nation’s hospitals have earned the designation, which is intended to recognize hospitals that provide the highest level of nursing care. “Durham Regional nurses provide exceptional care every day to hundreds of patients,” says Durham Regional CEO Kerry Watson. “It is an honor Durham Regional has been selected to join this elite group of nursing organizations that provide superior care.” Announcement of the recognition on Nov. 17 was the result of a threeyear application and evaluation process that included interviews with more than 500 nurses, physicians, and staff, as well as examination of nearly 2,200 pages of documentation, said Peggy Baker, Ed.D., R.N., Durham Regional Hospital’s interim chief nursing and patient care services officer. “This is the highest honor a U.S. hospital can receive for its nursing program, and it recognizes the innovative, first-rate care patients receive at Durham Regional Hospital and Duke Medicine,” said Victor J. Dzau, M.D., chancellor for health affairs and president and CEO of Duke University Health System. “Achieving magnet status is a testament to the knowledge and dedication our nurses bring to their profession.” The announcement adds another Magnet recognition to the health system. Duke University Hospital achieved Magnet status in 2006.

Prior to and during the Durham Regional site visit, examiners from the American Nurses Credentialing Center, the credentialing arm of the ANA, reviewed documentation about patientto-nurse ratios and evaluated the results of patient satisfaction surveys. In addition, they reviewed the number of nurses certified in specialty areas and advancement in the clinical ladder, and analyzed nurse-led initiatives intended to improve the hospital work environment, Baker said.

“This honor recognizes the
innovative, first-rate care patients receive at Durham Regional Hospital.“
Magnet designation lasts four years, during which time the ANCC monitors the hospital closely to ensure it maintains high standards of care. Magnet hospitals often are able to attract and retain the best-trained nurses, according to ANCC information about the Magnet Recognition Program. “Being designated a Magnet organization is recognition for the teamwork of not only the nurses, but also our physicians, staff and volunteers who care for our patients and families,” said Baker. “The award isn’t just for nursing — it’s for the entire hospital.” Attaining Magnet recognition will allow Durham Regional to maintain and grow its already strong base of registered and certified nurses, Baker said. n

LiveS
read remembrances of these dedicated colleagues: Page Anderson, M.D., a member of the Duke School of Medicine faculty for 35 years. J. Alexander McMahon, a trustee and faculty member who advised Duke University over four decades. Search their names at http://inside.duke medicine.org to find photos, life stories and information about memorials.

12

Inside Duke Medicine
on tHe weB

December 2008

Just a few of your colleagues who’ve received High fives:
Yvette Meggs offers a hearty praise for Duke Raleigh Hospital, where Meggs, RN, CN IV, works as a post-op nurse in same day surgery: “I enjoy the closeness of staff within Duke raleigh. You can walk in the door and know everyone and receive one-on-one attention from nurses, physicians and administration. Duke raleigh is a ‘user-friendly’ hospital.” Antron Green, patient transporter, played a key role in a patient’s recovery: “Antron’s warm smile, gentle spirit and helpful hand provided a calming effect for my anxiety. Over the past two months at Duke, his steady touch during transfers contributed to my healing as much as others with clinical training.”

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Comment from patient’s daughter about Jennifer Richmond, nursing care assistant II, Emergency Department: “Jennifer was totally amazing! She provided words of encouragement to our family. Jennifer was a complete stranger and, somehow, she made us exceptionally comforted and assured that we had done the right thing. We wanted to let you all know what an angel and jewel from heaven that you have in your midst.”

Jo Ellen Holt, clinical nurse on 2300 and DUSON graduate student, used cell phone technology to help a patient with a difficult task. Here’s what colleague Helen gordon had to say: “Jo put together a stunning presentation that was delivered to DUSON faculty in the ABSN program about the virtues and features of the iphone to enhance patient care. Jo gave an example of teaching a patient a complicated dressing change by photographing the dressing change on the patient’s cell phone. The patient was able to do the dressing change because of the pictures and the audio messages that Jo recorded for him. She is innovative and knows how to use the technology to strengthen patient care. Give this young woman and great nurse a BIG HIGH fIVE!”

a patient’s mother praised Eric Horowitz, M.D., in neonatology, for going the extra mile to keep the family informed: “Eric was wonderful when our son was born. We couldn’t have imagined anyone better. He did such an incredible job of caring for our son and keeping us informed. He gave us many updates (good and bad) throughout the night, which was so appreciated. He went out of his way to make us feel comfortable and at ease during a very stressful time.”

a patient’s parent was impressed with the preparation and knowledge of Carolyn Juettner, CN II, Neonatal Intensive Care Unit: “Carolyn has operated far above expectations, and her knowledge is exceptional. This was very evident during doctors’ rounds; she had prepared for every question, and she made positive suggestions and contributions. Carolyn has provided exceptional communication to my wife and me and has been of immense support.”

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