The employee publication for Duke Medicine, with the quarterly Benefits section and Inquiry, the Science and Research supplement.
12
VOLUME 18 NO. 4 n inside.dukemedicine.org n April 2009 A focus on strategic priorities and opportunities is keeping the Duke University School of Nursing on a steady but cautious course in stormy economic times. Associate Dean for Finance and Administration David Bowersox said the downturn contains a “silver lining” for DUSON. In times of economic weakness, people pursue professions such as nursing, for which there is robust market demand. Last year 50,000 qualified applicants were turned away nation- ally from bachelor’s degree nursing programs. As part of a long-term strategy to address the demand, DUSON added a second cohort of more than 50 accelerated bachelor of science in nursing program students to its admission plan for fiscal year 2010. The school, which already admits 70-plus students each fall, plans to double enrollment within a few years. DUSON’s master’s degree program will see continued strong Duke University School of Nursing On a cautious, but steady, course continues on p.3 T he Duke University School of Medicine, like medical schools across the nation, faced financial pressures long before the current global economic recession. But progress in accomplishing goals set out in its 2005 strategic plan, and administrative initiatives in response to external funding declines, have put the School on a steady course through these trying times. For example, those activities have put the School in a good position to capitalize on the funding opportuni- ties of the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the “stimulus bill.” “All of our missions – education, research and clinical care – are severely continues on p.3 N early five years ago, Duke University Health System articulated a strategic plan designed to serve as a roadmap to our long-term success. This plan made a health system-wide commitment to optimizing services, improving the way entities work together and attracting the best faculty and staff. In implementing and executing the operational actions associated with the strategic plan, DUHS has made significant progress. But there have also been challenges, particularly since the onset of the global economic downturn. At a time of such financial and economic turbulence, it is important to understand that the organization has had a successful strategic plan which we continue to follow today, and that we are not simply reacting to the evolving pressures of a challenging environment. “The strategy has proven itself, and we are confi- dent we are moving in the right direction,” said Molly O’Neill, the health system’s chief strategic planning officer. “But current conditions require us to be even more careful stewards of our resources and to stay focused on making the proper strategic investments.” Competitive pressures, O’Neill added, “did not go away with the addition of economic pressures. The building blocks of the strategy — each of the goal areas — have proven appropriate for the changing environment.” The following is a review of our seven strategic priorities and how we have executed them thus far: Optimize services in Durham County DUHS recently solidified its commitment to the people of Durham County with the completion of a long-term lease extension for Durham Regional Hospital. Also, a Master Facility Plan has linked Duke University Hospital and Durham Regional in important ways through new specialty programs and transfer center enhancements to serve community continues on p.2 Duke University Health System Substantial progress toward long-term goals Duke University School of Medicine Nurturing excellence Duke Medicine strategic plans guide success in challenging times A CLEAR VISION Match Day brings stellar residents to Duke … p.6
Transcript
VOLUME 18 NO. 4 n inside.dukemedicine.org n April 2009
A focus on strategic priorities and opportunities is keeping the
Duke University School of Nursing on a steady but cautious course in stormy economic times.
Associate Dean for Finance and Administration David Bowersox said the downturn contains a “silver lining” for DUSON. In times of economic weakness, people pursue professions such as nursing, for which there is robust market demand.
Last year 50,000 qualified applicants were turned away nation-
ally from bachelor’s degree nursing programs.
As part of a long-term strategy to address the demand, DUSON added a second cohort of more than 50 accelerated bachelor of science in nursing program students to its admission plan for fiscal year 2010.
The school, which already admits 70-plus students each fall, plans to double enrollment within a few years.
DUSON’s master’s degree program will see continued strong
Duke University School of NursingOn a cautious, but steady, course
continues on p.3
The Duke University School of Medicine, like medical schools
across the nation, faced financial pressures long before the current global economic recession.
But progress in accomplishing goals set out in its 2005 strategic plan, and administrative initiatives in response to external funding declines, have put the School on a steady
course through these trying times.For example, those activities have
put the School in a good position to capitalize on the funding opportuni-ties of the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the “stimulus bill.”
“All of our missions – education, research and clinical care – are severely
continues on p.3
Nearly five years ago, Duke University Health System articulated a strategic plan designed to
serve as a roadmap to our long-term success.This plan made a health system-wide commitment
to optimizing services, improving the way entities work together and attracting the best faculty and staff.
In implementing and executing the operational actions associated with the strategic plan, DUHS has made significant progress. But there have also been challenges, particularly since the onset of the global economic downturn.
At a time of such financial and economic
turbulence, it is important to understand that the organization has had a successful strategic plan which we continue to follow today, and that we are not simply reacting to the evolving pressures of a challenging environment.
“The strategy has proven itself, and we are confi-dent we are moving in the right direction,” said Molly O’Neill, the health system’s chief strategic planning officer. “But current conditions require us to be even more careful stewards of our resources and to stay focused on making the proper strategic investments.”
Competitive pressures, O’Neill added, “did not
go away with the addition of economic pressures. The building blocks of the strategy — each of the goal areas — have proven appropriate for the changing environment.”
The following is a review of our seven strategic priorities and how we have executed them thus far:
Optimize services in Durham County
DUHS recently solidified its commitment to the people of Durham County with the completion of a long-term lease extension for Durham Regional Hospital.
Also, a Master Facility Plan has linked Duke University Hospital and Durham Regional in important ways through new specialty programs and transfer center enhancements to serve community
continues on p.2
Duke University Health System Substantial progress toward long-term goals
Duke University School of MedicineNurturing excellence
Duke Medicine strategic plans guide success in challenging times
A CLEAR VISION
Match Day brings stellar residents to Duke … p.6
Inside Duke Medicine2 April 2009
I N S I D E V O L U M E 1 8 , I S S U E 4 nCONtaCt US Campus mail: DUMC 104030 Deliveries: 2200 W. Main St., Suite 910-B, Durham, NC 27705 Phone: 919.660.1318 E-mail: [email protected]
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.
needs and help manage patient flows across Duke Medicine. The creation of hospitalist and intensivist programs has led to greater integration and improved outcomes at Durham Regional, and significant capital investments in radiation oncology, intensive care, information systems, and other services have led to improved patient access and quality of care.
DUHS has also made important commitments to community health through a myriad of projects in Durham, including the Lincoln, Walltown, Lyon Park and Holton clinics, and through Project Access, in which specialists donate time and expertise.
Duke Medicine has made significant progress in meeting the projected work-force shortage in physicians, nurses, and physician assistants through recruitment
and expansion of training programs.As always, all capital investments
are subjected to a rigorous needs assess-ment. Planning continues for a major addition to Duke University Hospital and the creation of a new Ambulatory Cancer Center, should that project receive Certificate of Need approval from the state this spring. Considering current capacity constraints and projected teaching and health care needs in a dynamic and growing region, it is essential that Duke invest in its long-term future of providing efficient and effective education, research, and patient care for the citizens of North Carolina.
Strengthen our presence in Wake County
The investments made in Wake County have begun to demonstrate the wisdom of this strategy. DUHS facilities and clinical faculty have made significant inroads and have become an important part of ad-dressing the health care needs of the county’s rapidly growing population.
Duke Raleigh Hospital has been upgraded and renovated. The new Duke Medicine Plaza specialty physician building is full, providing Wake County patients more convenient access to Duke faculty physicians.
Also, clinical programs led by Duke faculty, such as the new and growing neurosurgery program, are
driving the success of Duke Raleigh Hospital. Investments
in cancer services, orthopaedics and cardiology, as well as state-of-the-art imaging technology, are improving the access to the latest in Medicare care in the community.
New facilities have opened in the Brier Creek area, Knightdale, Morrisville and north Raleigh.
reorient multidisciplinary programs
The new Duke Heart Center has facilitated greater collaboration and effectiveness among the many specialty care areas in the center, as well as among its faculty. The changes have improved the patient experience and aligned the whole organization around a single goal: patient-centered care.
Plans for similar realignments that break down organizational barriers and support patient-centered care are underway in other clinical areas, including cancer.
Enhance pediatric services
The $7 million, 13-bed, pediatric cardiology intensive care unit – the
first in the state – opened at Duke University Hospital in January.
The Division of Pediatric Blood and Marrow Transplantation continues to pioneer the use of umbilical cord blood stem cells and extend this lifesaving therapy across the country.
The Duke University Hospital intensive care nursery is being reconfigured to increase capacity, and Duke University Hospital and Durham Regional Hospital are collaborating on neonatal care.
Duke Children's Consultative Services has expanded in Wake County through new offices in Duke Medicine Plaza in Raleigh.
Build a structure for ambulatory care
Substantial progress has been made in developing a distinct operating infrastructure for ambulatory care that has resulted in substantial improve-ments in patient satisfaction, and tremendous success in the reporting of quality outcomes in outpatient services. The strength of our ambulatory care platform and services is now regarded as essential to the well being of the patient and the organization.
attract, retain and reward talented faculty and staff
The health system’s clear vision starts with the patient, which we value most above all. We cannot provide the quality care they demand and deserve without quality employees. To recruit and retain the very best, Duke offers excellent benefits and widely-recognized programs for professional development.
Last fall, Advance for Nurses
magazine rated the health system as a workplace that excels in opportunities for continuing education, tuition reimbursement and rewards and recognition.
Also, the Employee Tuition Assistance Program benefit increased in January to $5,250 per year to help employees get the education needed to advance their careers.
Duke’s clinical faculty has grown significantly over the past few years and further expansion is planned over the next several years. Duke University Hospital and the Duke University School of Medicine continue to be recognized as among the top ten institutions in the country due to outstanding work done every day by our faculty and staff.
Building upon the strength of the Duke name
Advertising, community outreach and media relations campaigns over the past two years to build brand aware-ness for Duke Medicine, and its clinical faculty, have been effective.
Those efforts have contributed to Duke’s national reputation for excel-lence and focused our organizational strength in support of our mission: “To transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.”
Summing up
We have a clear vision that guides our work toward future success, even in this ever-changing and challenging global economic environment.
The successes show we are headed in the right direction, but now more than ever the economic environment must be monitored for any signal that would require a course adjustment.
We remain mindful that our success today is built upon the excel-lent work done by our current and past Duke Medicine employees; and it is that solid commitment to our ideals that will guide Duke Medicine success-fully into the future. n
We have a clear vision that guides our work
toward future success, even in this challenging
global economic environment.
Duke University Hospital. fIlE PHOtO
continued from p.1
Duke University Health System
enrollment, and the new Doctor of Nursing Practice Program has two qualified applicants for every avail-able seat.
“We’re meeting societal needs and doing our part to strengthen Duke Medicine,” Bowersox said of DUSON, where tuition creates over 80 percent of revenue.
The School continues to execute its long-term strategic plan, he said, and has a clear vision for future success.
“We have excellent coordination among forward-thinking administra-tive and faculty leaders, as well as a committed staff, who are driving our continued success,” Bowersox said.
Within those long-term goals, DUSON plans to pursue eight to 10 strategic faculty hires in the coming year to help support planned growth.
Two new positions reflect the strategic plan’s call for incorporating technology innovations into academic programs. A director of educational excellence and an educational technologist will help faculty with the latest Web-based teaching technologies.
“Using technology to strengthen our distance-based and online programs is at the core of what we do and differentiates us from our peer schools,” Bowersox says. “We are seen nationally as a technology leader.”
Another goal calls for translating nursing research into improved nursing care delivery, through creation of the Duke Nursing Translation Institute. The institute, in Duke South, plans to add professionals dedicated to improv-ing models of care based upon the latest nursing research.
A concern moving forward is student financial support. While scholarships from DUSON’s endow-
ment are cushioned from the economy in the very short term — with payouts pegged to a three-year average return — 60 percent of ABSN students rely on private loans.
DUSON’s proposed fiscal year 2010 budget is balanced and conserva-
tive, reflecting almost no investment earnings income for operations. Meanwhile, non-essential spending is on hold and the 2010 budget keeps most non-salary expenses at 2009 levels, aiming to avoid impacting students, research or clinical practice.
Bowersox sees DUSON as well-positioned. Leadership is closely monitoring its financial status, and the national and global economies, to keep expenses in line and to fully meet the needs of those who would like a DUSON education.
“The dean and five associate deans of our school agreed as a team soon after the economic downturn began what we valued most. We reaffirmed our strong commitment to focus on two goals — balancing the budget and prioritizing resources to the areas of most significant strategic importance, with students at the top of the list,” he said. n
3April 2009 Inside Duke Medicine
“We've been very thoughtful and strategic
around where our constrained resources
are utilized.“ — Dean Nancy Andrews, M.D., Ph.D.
stressed by external regulatory and funding pressures,” said Dean Nancy Andrews, M.D., Ph.D. “But we have a clear strategy that, together with our outstanding faculty and staff, will guide us in making the decisions and the critical investments we need to make to ensure our continuing success.”
The School has the advantages of a strong health system, a world-class faculty and a very balanced research portfolio, she said.
The School has been affected in three ways: Reduced distributions from endowments, lowered expectations for philanthropic support, and, most importantly, a flat NIH budget.
But, in reviewing the School’s strategic plan initiatives, said Dean Andrews, it is clear that, despite the economy, the School has continued to focus resources on its core objectives.
Examples of this progress include the strengthening of the Medical Scientist Training Program that supports M.D./Ph.D. students, and the School’s role in creating the University-wide Global Health Institute, Duke Translational Medicine Institute, Duke Institute for Brain Sciences and investment in core facilities.
“We’ve been very thoughtful and
strategic around where our constrained resources are utilized,” said Andrews.
Indeed, much of the strategic plan and subsequent efforts of the school’s administration, said Andrews, have been student- and faculty-focused.
“We’re trying hard to be faculty friendly,” said Scott Gibson, executive vice dean for administration. “It’s a bal-ance between investing in new programs in strategic areas of emphasis – which is important to our growth as a top tier school – and supporting the faculty and programs that got us here in the first place. We have to do both.”
Gibson points to numerous activities that grew out of the strategic plan, and continue even in these tight economic times. These include Dean’s Office bridge funding to promising
investigators, improved assistance and mentoring for faculty who receive NIHK-Awards, improvements to
research administration, and a forth-coming faculty work-life initiative led by Chancellor Victor J. Dzau, M.D.
Still, the School has had to make tough choices.
“We have had to make adjust-ments to our internal economy in response to the new economic situation, which actually started several 4-5 years ago when the budget for the National Institutes of Health flattened after a period of tremendous growth. These changes were essential to our ability to stabilize our financial picture,” said Gibson.
Earlier this year, the School implemented a number of expense man-agement actions, followed by changes to its overhead allocation methodology, implementation of a gift assessment and a one-time balance assessment — structured as a loan — for discretionary funds greater than $500,000.
These measures were necessary for the School to shore up its budget over the next years.
The strategic plan has been en-hanced by work to streamline research administration. The Research Adminis-tration Continuous Improvement (RACI), an initiative begun in 2007, involves University and School of Medicine senior leadership and faculty and staff advisors in ongoing efforts to make administrative functions as efficient as possible and investigator-friendly. An example of this work is the streamlined process for account code creation, the reduction in budget requirements for modular grants and the
soon-to-be-released research portal.“This initiative was designed to help
all researchers, and it has put us in very good condition to prepare for the ARRA economic stimulus,” said Gibson.
Meanwhile, students continue to be a primary focus of the School, which has embarked on a moderniza-tion of learning facilities. Last fall, a high-tech Gross Anatomy Lab and Fresh Tissues Lab were opened in the lower level of Davison Building.
And, the School is proceeding with plans to build a learning center, supported by a $35-million donation by The Duke Endowment last year. However, because of the economic situation, the School has had to defer plans to build a state-of-the-art research building.
“With our top-notch faculty and a committed staff working together on our shared strategic vision, we will make progress despite the tough environment,” said Dean Andrews. n
continued from p.1School of Nursing
continued from p.1School of Medicine
AT A G L A N C E
I N S I D E J O K E n I t f I g U r E S n
L E A d E r s h i p
Pickett appointed Durham regional CMO
”“I value the other people I work with.— Rick Gray, clinical research assistant.
Read more of what he had to say on page 7.
38%In voluntary health assessments, 38
percent of Duke's employees reported consuming the recommended 5-9 servings
of fruits and vegetables per day.
Find out more about the Duke Farmer's Market, a great
source for fruit, vegetables and other good-for-you things, on Page 7.
Source: lIVE fOr lIfE
4 Inside Duke Medicine April 2009
Lisa Clark Pickett, M.D., co-director of the critical care unit at Durham
Regional Hospital, has been appointed chief medical officer for that hospital. Her appointment, effective April 1, will help Durham Regional continue
to build the highest quality medical care for patients there.
“Dr. Pickett is highly respected by the medical staff and completely knowl-edgeable about our high priority areas of focus in
the hospital, specifically our surgical services and patient care services,” said Kerry Watson, chief executive officer of Durham Regional Hospital (DRH).
In her new role, Pickett will oversee the implementation of several of DRH’s strategic initiatives, including clinical patient care, improved physician relations and a continuing improvement in surgical services.
“There are a number of potential areas for new collaboration between Durham Regional Hospital and the rest of the Health System that utilize the best of both institutions, and I am eager to help facilitate these ventures,” said Pickett.
William Fulkerson, Jr., M.D.,
senior vice president for clinical affairs for DUHS, has known Pickett since she first came to Duke.
“She brings a tremendous amount of dedication and patient centeredness to her practice, and she’s respected by all who have worked with her,” said Fulkerson. “As CMO, she will be a very effective liaison with the administration to the medical staff at Durham Regional because of her values and her focus. She’s been a champion for quality and will continue to advance measures of safety and quality at
DRH among the medical staff and the administration.”
Pickett has been an intensivist at Durham Regional since 2001, and is currently the chief of the Division of General Surgery, the surgical director for the Critical Care Unit for Durham Regional Hospital and the graduate education medical director for surgery. She was instrumental in the recent renovation of the ICU/CCU at Durham Regional, which resulted in a state-of-the-art 22-bed unit.
The CMO role will be reduced
from a near full-time position to a part-time position, said Watson, allowing Pickett to continue her clinical duties as a general surgeon.
“It is my view that a CMO can be more effective if they have the ability to continue to be an active and practicing member of the medical staff,” said Watson. “So, some of the lower priority administrative duties will be reassessed, allowing Dr. Pickett to focus on the high-priority areas of supporting physician practice and medical practice management.”
Pickett identifies physician relations as one of her top concerns as she begins this new role.
“I’m looking forward to getting to know the community physicians better, and to help enhance and reinforce the relationship of our hospital to those physicians. The greatest challenge of the CMO role is to help our entire, diverse medical staff feel like one team, with a single mission of excellent patient care,” she said.
Pickett is an assistant professor of Medicine at Duke University Medical Center and is certified in critical care medicine and surgery. She attended Harvard Medical School, and completed a Critical Care fellowship at Duke University Medical Center Surgical Intensive Care Unit in 1998. n
r E S O U r c E S n
New parks guide supports fun, healthy habitsThe Partnership for a Healthy Durham, in partnership with Duke Medicine, has created a new brochure that highlights many of Durham County’s parks, trails and amenities so that more people become aware of and access these free and low-cost resources.
Download the brochure for free — in English or Spanish — at: http://www.healthydurham.org
O N t h E M O V E n
DUMC Instrument Shop movesEngineering and Operations has announced that the Medical Center Instrument Shop has relocated from the Bell Building to the Old Best Products building, at 3438 Hillsbor-ough Road in Durham. To find it, look for the blue canopy.
Hours of operation are 7:30 a.m.-4 p.m., Monday-Friday. Phone: 684-3464.
LISA CLARK PICKETT, M.D.
Durham Regional Hospital. fIlE PHOtO
5April 2009 Inside Duke Medicine
By Jim rogalski
Paul and Sue Rosenau have a special photograph of their
granddaughter Makayla. She is two months old, dressed in a yellow outfit with a yellow ribbon tied about her silky brown hair. A wide smile graces her face, which is further accented by sparkling blue eyes.
It is the only photo they have of their granddaughter smiling.
Within a month of that photo being taken, Makayla was diagnosed with Krabbe disease, a rare neurodegenerative disorder affecting the central and peripheral nervous system. Most babies with Krabbe disease die within two years.
Makayla was no exception.“You feel so helpless that there is
nothing you can do to make things better,” Sue says. “My heart died the day she was diagnosed, and again when she died.”
Where they once felt helpless as they watched Makayla’s physical abilities slowly deteriorate, the working-class couple now feel empowered that they can do something significant to combat this devastating disease that affects an estimated one in 100,000 newborns.
Last May, the Rosenaus, of Waseca, Minn., won the $180 million Powerball lottery five years to the day of Makayla’s death.
The Rosenaus have donated an initial $250,000 to Duke Medicine to establish the Legacy of Angels Fund in Makayla’s honor. It sup-ports the ground-breaking research of Duke’s Joanne Kurtzberg, M.D., director of the Duke Pediatric Blood and Marrow Transplant Program and professor of pediatrics
and pathology. “We feel Dr. Kurtzberg is a
champion for children. Duke is the place doing the largest amount of research and we are excited that we can help.”
In 1993, Kurtzberg was the first-ever to perform an unrelated cord blood transplant on a leukemia patient. She discovered that umbilical cord blood transplantation can be an effective treatment for Krabbe disease when caught presymptomatically.
“The Rosenau’s generosity en-ables us to explore Krabbe research in new directions and hopefully come up with alternatives in detecting the disease early and improving the child’s quality of life as soon as possible,” Kurtzberg says.
The Rosenaus also are establish-ing their own nonprofit, The Legacy of Angels Foundation. Its mission is to find both a better treatment and a cure for Krabbe disease; to promote and expand the Newborn Screening Program throughout the nation; and to further research in finding a cure for cystic fibrosis.
“We got blind-sided by this disease,” Paul says. “We knew noth-ing about it at first but got involved with other families going through it. We were all trying to find answers. We came to Duke because it’s the best in the world for this disease.”
“It’s our hope and dream to help save other families and children from going through this,” Sue says. “If we help to save one child it is worth it.” n
For information about contribut-ing to Kurtzberg’s research through the Legacy of Angels Fund at Duke Medicine, contact Tom Kosempa at 919-667-2602.
lotto winners pass luck to needy children
M E N U S n
Hungry? Check out ‘What’s Cooking’Asiago crusted chicken. Green beans with sesame seeds. Potato leek soup.
If you’ve been reading Inside Online, you know those delicious things have been
recently offered for lunch in Duke University Health System’s
hospital eateries.
To keep you up to date on this important topic, Inside Online – the employee news Web site for Duke Medicine, provides links to weekly menus every Monday morning.
The links provide full menus for Duke North’s Atrium Café, the Food Court in Duke Clinic and the cafeterias at Durham Regional Hospital and Duke Raleigh Hospital.
Go to http://inside.dukemedicine.org and look for the blue salad bowl logo.
Paul and Sue rosenau endowed the legacy of angels fund to support Duke research into pediatric disease. PHOTO BY JON GARDINER
t O Y O U r h E A L t h n
Wear your sneakers to workDuke Medicine will team up with the American Heart Association to get employees moving on April 8, the National Start! Walking Day. This event is part of a new national movement that encourages employees to live longer, stronger lives by adopting a comprehensive walking and nutrition program.
Chancellor Victor J. Dzau invites all Duke Medicine employees to wear sneakers or walking shoes to work on April 8, and to join together in one of three lunchtime walks or one of three evening Live for Life walking events.
For those who join us at the lunch hour walks on April 8, Duke Medicine will provide refreshments and Live For Life will give away Live For Life dollars to randomly chosen participants for use in their store.
lunch hour walks:
Durham regional Hospital – 12 p.m. Join us at the employee entrance for a one-mile walk around the perimeter of the hospital grounds.
Duke Clinic – 12 p.m. Gather on the Baker House lawn for a 1.2-mile walk through Duke Gardens.
Duke raleigh Hospital – 11:30 a.m. Meet on the front lawn for a one-mile walk around the medical campus.
Evening walks, provided by lIVE fOr lIfE:
Durham regional – 5 p.m. Meet at the employee entrance for a one-mile walk.
East Campus wall – 5:30 p.m. Meet for a 1.7-mile walk.
Wallace Wade Stadium/West campus – 5:30 p.m. Meet for a 2.9 mile walk.
r E S E A r c h n
Symposium on Duke-Singapore collaborationR. Sanders Williams, M.D., senior vice chancellor for academic affairs, will convene East Meets West: Singapore-Duke Research Collaborations from 8 a.m.-4 p.m. on Thursday, May 7 in the Levine Science Research Center Auditorium.
The symposium will feature the research synergies between Duke and Singapore-based colleagues, with presentations on research and potential areas of collaboration involving infectious diseases, health services, cancer, neurosciences, cardiometabolics, education and other clinical research.
Register by sending a message before April 24 to Patricia O’Brien, [email protected]
S U S t A I N A B I L I t Y n
Duke observes Earth Month
With an eye toward Earth Day on April 22, Duke is hosting a month-long series of events to continue raising awareness about green living. Earth Month@Duke
Environmental Markets Symposium Series: Carbon Offsets 1:30-5:30 p.m., Friday, April 10 9 a.m. to 12:30 p.m., Saturday, April 11 French Family Science Center Information: http://tinyurl.com/ch7t63
free Compost Surplus 3-6 p.m., Tuesday, April 7 9 a.m.-noon, Saturday, April 11 Gate 12, Duke Forest
Garbology: See how much trash could have been recycled 10:30 a.m. to 1:30 p.m. Friday, April 10 Main quad, West Campus
h U M A N r E S O U r c E S n
Submit 2008 health care receipts by april 15Faculty and staff enrolled in 2008 health or dependent care reimbursement accounts must submit receipts for services provided from Jan. 1 through Dec. 31, 2008, to WageWorks by April 15, 2009, for reimbursement.
Claim forms and supporting documentation must be postmarked or faxed to WageWorks by April 15. Claims for 2008 submitted after this date will not be reimbursed.
Claim forms are available online at http://hr.duke.edu/forms, or at the Human Resources office, 705 Broad St. in Durham.
E d u C AT i o N
When Match Day envelopes were opened across the country last
month, Duke University Medical Center’s residency training directors were elated to learn that all of Duke’s slots were filled up. That good news capped off a system-wide effort to recruit some of the most competitive candidates from among the nation’s graduating medical students.
Duke was the institution of choice for 163 high-caliber students, who will begin their graduate medical education at Duke this summer. Match Day is the annual day in March when graduating medical students across the country learn where they will spend the next three to seven years of their training.
“The applicants come from excel-lent schools all over the country,” said John Weinerth, M.D., associate dean of graduate medical education (GME). He said Duke invigorated its efforts to attract the best and the brightest candidates by promoting Duke’s richly varied GME opportunities.
That was echoed by Harvey Jay Cohen, M.D., chair of the Department of Medicine. Cohen said he was pleased with the very strong applicant pool and even more pleased with the ultimate cohort that matched to the department.
“We went to considerable lengths in the recruitment process to explain what our program is about, and to have candidates meet with the residents currently in the program,” said Cohen.
The department received 3,354 applications, and interviewed 407 candidates for its 51 slots. House staff, faculty members and School leaders, including Dean Nancy Andrews, M.D., Ph.D. and Chancellor Victor J. Dzau, M.D., also met with the candidates to share what attracted them to Duke.
“One of the key things that people always look at is the character of both the house staff and faculty here, and how they interact,” said Cohen. “I think the applicants got a good feel for this being a place where people enjoy working together.”
After last year’s match, Weinerth commissioned a survey to determine
what factors could be accentuated to ensure Duke’s competitive appeal to top students.
“We learned that more personal contact, better communication about the advantages for spouses and families, and sharing the special aspects of Durham would improve our recruit-ment,” said Weinerth.
Even Hollywood played a part, with the NBC television drama E.R. in January featuring a storyline in which a Duke Medicine clinical faculty member — wearing an official Duke name badge, no less — praised Duke and Durham as a great place to train, live and raise a family.
The extra attention to recruitment efforts paid off.
“It’s an extreme blessing to be matched to Duke,” said Christopher Jones, a medical student from the University of California at San Francisco. “What Duke is doing in orthopaedics is amazing, and my prayers were answered.”
Jones matched to Duke’s ortho-paedic residency training program, and will spend the next five years here. He credited his decision to a warm and inviting welcome from William T. Hardaker, Jr., M.D., director of the program, and Jim Nunley, M.D., chief of orthopaedic surgery, as well as the smart facilities, didactic curriculum and Duke’s storied sports and under-graduate academic traditions.
Duke’s well-deserved reputation is key to continued success at Match Day, said Michael Cuffe, M.D., vice dean for medical affairs.
“Our success is directly at-tributable to the strengths of our departments, and the commitment and excellence of our current faculty, house staff, and educators,” said Cuffe.
The widely recognized excellence of Duke’s clinical faculty and the School of Medicine, a commitment to GME through endowed funds, and recent initiatives such as the Global Residency Program and a new MD/MBA management track have only made Duke a more desirable institu-tion at which to train, he said.
Up to five of the new residents may qualify for that new management track, said Dev Sangvai, M.D., MBA, associate program director of the Duke Medicine Management and Leadership Pathway for Residents. This track will combine rigorous clinical training with formal project-based rotational op-portunities across the system — clinical care, research, and education.
“While many Duke students choose to continue their medical education in another location, a significant number of our graduates chose to stay with us,” said Weinerth.
Twenty-six Duke graduates will remain here for their residencies, while others will complete their training at
Harvard University, the University of Michigan, UCLA, Stanford, Johns Hopkins and other schools.
“Our students did quite well, with most matched to highly competitive fields or programs,” said Ed Buckley, M.D., vice dean for education.
All of Duke’s 102 graduating medical students matched to top-level residency programs, in specialties from internal medicine to pediatrics to neurosurgery.
The National Matching Resident Program reports that this year was the biggest Match Day on record, with more than 15,000 graduating medical students applying. n
6 Inside Duke Medicine April 2009
“It's an extreme blessing to be matched to Duke. What Duke is doing in orthopaedics is amazing, and my prayers were answered.“ christopher Jones, medical student from Uc-San francisco
lEft: Peering into the future? a Match Day envelope just before the OK to open. PHOTO BY JARED LAZARUS
BElOW: Duke University Medical Center residency training programs will be full with a new cohort of 163 top-notch medical school graduates. INFOGRAPHIC BY
VANESSA DEJONGH
Match Day brings stellar residents to Duke
Match day: Assignments for new Duke residents
Internal Medicine 45
Anesthesiology 14 Emergency Medicine 8
Family Medicine 3 Medicine-Preliminary 6 Med-Prelim/Neurology 3 Neurological Surgery 3 Neurology 4
8 Orthopaedic Surgery 8 Otolaryngology 2 Pathology 4 Dermatology 3
Psychiatry 7 Radiology-Diagnostic 12 General Surgery 7
Your annual salary is just one part of your total compensation at Duke.
For most faculty and staff, Duke also pays a portion of health insurance, helps with retire-ment nest eggs and offers other valuable benefits such as life insurance and tuition assistance.
Your personalized benefits statement will arrive by mail at your home by early May, providing an overview of the value of your total compensation package, which includes salary and benefits.
“In today’s economy, it is essential for each Duke faculty and staff member to become more familiar with the benefits connected to their job,” said Kyle Cavanaugh, vice president of Human Resources at Duke.
“I believe that Duke’s combination of direct pay, benefits — and a supportive work environment — makes Duke an unbeatable place to work.”
On average, for every dollar an employee earns, Duke contributes about 25 cents in addi-tional benefits. This includes financial provisions such as insurance or retirement plans, as well as investments in discounts, wellness programs and other opportunities.
Each employee’s total compensation package is unique, based on individual choices. To highlight elements that comprise total compensation, at right is a chart showing what a total compensation package might look like for a typical monthly-paid employee earning a $56,182 salary. n
More than a paycheckUnderstanding your net worth at Duke
a complete pay package76% Salary
9% Health Insurance/Employee Health Services
7% Faculty/Staff Retirement Plan Contribution
6% Social Security/Government Programs
1% Disability Insurance/Group Life Insurance
1% Educational Assistance
Watch a video with employees about the value of working at
Duke at http://www.hr.duke.edu/value
“I enjoy working with people. I really like that interaction when new patients come in or if families need to know where to go. It’s fun.” Peggy Holmes, service associate, Patient Information Services, 4 months at Duke
“the opportunities that Duke offers are amazing. You could start off in housekeeping and end up a director if you have the goal for it. Duke gives you the tools to get there.” Juanita Johnson, staff assistant, Multicultural Center, 5 years at Duke
“I value the other people I work with. We’re the kind of people that share interests in the same things. the benefits are also great. the health care plan pays for itself.” rick Gray, clinical research assistant, Thoracic Oncology, 1 year at Duke
“I value the retirement plan because it’s extra money, and the more, the better. If you don’t have enough of your own money, then you have that to fall back on because of Duke. It’s something we’ll need when we do retire. We don't want to retire, then have to come back to work.” laShosta Parham, lead food service worker, Duke Dining Services, 12 years at Duke
PEggy hoLMES
RICK gRAy
What do you value about working at Duke?
Monthly UpdateBy taking a proactive approach to your life and taking advantage of Duke’s wellness programs, you can prevent disease and become healthier.
Here are just a few of the wellness benefits available to you as a Duke University Health System employee:
Duke run/Walk club It’s not too late to join the Run/Walk Club.
The club welcomes runners of all speeds, abilities and interest levels. Although many of the members in the club run or walk just for fun, some set personal goals that they pursue throughout the year. Whether you are preparing for a race, just love to be outdoors, or need a kick in the pants just to get you out the door, the Duke Run/Walk club is a great step to get and keep you motivated.
The Run/Walk Club meets on Mondays and Wednesdays, 5:30 p.m.-6:30 p.m. at East Campus (across from Whole Foods) and at West Campus (in front of Wallace Wade Stadium). The Run/Walk Club also meets at Durham Regional Hospital from 5–6 p.m. at the employee entrance.
Can’t make it to a weekly group session? Sign up for the Independent Run/Walk Club, and log your sessions online. Register now at http://www.hr.duke.edu/runwalk/
Become a Locavore Locavores eat local food whenever possible. It’s better for the environment, the local economy, and your health. At the Duke Farmers Market, buy locally grown fruits and vegetables, watch cooking demos by our Duke Chefs and get healthy recipe ideas. The Duke Farmers Market opens April 24th from 11:00 a.m.-2 p.m. and is held every Friday through the end of July, except for July 3.
The Market is located in front of the Medical Center Bookstore next to the walkway connecting Duke University Hospital and Duke Clinic.
Find out more: http://www.hr.duke.edu/eohs/livelife/market.html
go mobile marketingCan’t make it to the Friday Farmers
Market at Duke? Sign up for the Duke Mobile Market and let local farmers share their weekly harvest with you. Pre-purchase a share and
each Tuesday the farmer will have your produce ready for pick up at the
Duke Gardens. For more info, visit http://www.hr.duke.edu/mobilemarket
F E AT u r E
the Science & research Supplement to Inside Duke Medicine
VOLUME 18 NO. 4 n inside.dukemedicine.org n April 2009
the bright side of radiationBy Kelly Malcom
Radiation, despite its dangerous reputation, has a wide range
of medical uses. It comes down to a matter of dose.
Small doses of radioactive tracers introduced into the body can help radiologists identify metabolic abnor-malities. At higher doses, radiation can be used to kill cancer cells and treat other disease.
“Duke has been at the forefront of developing and utilizing radiation for clinical purposes,” said Edward Coleman, M.D., vice chair of the Department of Radiology and chief of Nuclear Medicine.
Pinpointing a disease’s location within the body is crucial to optimizing treatment, he said.
Radionuclide imaging, like positron emission tomography (PET), can help physicians measure impor-tant bodily functions, such as glucose metabolism and blood flow. A posi-tron is a particle that gives off gamma rays that can be used to produce an image. Combining different methods of imaging allows for an accurate picture of a disease’s advancement.
“The type of imaging that has risen to the forefront is PET imaging, which is used every day primarily as a tool in diagnosing and managing
cancers,” said Michael Zalutsky, Ph.D., professor of Radiology and Radiation Oncology.
Prior to a PET scan, a patient is either injected with, swallows, or inhales a radiopharmaceutical that will then accumulate in the body, illuminating areas of particularly high cell metabolism.
“One of the most common radiopharmaceuticals used in PET is fluorine-18-FDG, otherwise known as F-18,” said Neil Petry, assistant professor of Radiology.
F-18 has a short half-life of only two hours, which means it takes only four hours to decay. It’s useful in iden-tifying cancers because cancerous cells metabolize sugar faster than normal ones. Thus, the radioactive F-18 will concentrate in cancer more and show up as a “hot spot” on an image.
“Surgeons can then use that information to determine a course of treatment,” said Petry. Other commonly used radionuclides include I-131 sodium iodide, which is used to image the thyroid, and technetium-
99m, which is used for imaging of the kidneys, bones, brain, heart and other structures.
Duke is a leader in the developing field of targeted radiotherapy, which uses radiation delivered directly to a diseased organ. Zalutsky and his colleagues have developed pioneer-ing treatments using radio-labeled
antibodies to target brain tumors. Paul Suhocki, associate professor of Radiology, is work-ing with radioactive spheres injected directly through blood vessels to the liver to target
tumor cells while sparing vulnerable normal cells.
Despite their many medical uses, radionuclides can be notoriously difficult to come by. They must be created and are most commonly made in what is known as a cyclotron. A cyclotron is a particle accelerator that spins atoms in a circular magnetic field. Duke has a small cyclotron located in Duke South that is used to create radionuclides in support of clinical PET studies, most commonly, F-18.
However, the short half-life of F-18 limits its use for certain functions.
“Most of the work being done in the U.S. is using a very limited
Despite its reputation, carefully measured doses of radiation provide a wide range of helpful medical uses. fIlE PHOtOS
see raDIatION, p.9
Enzyme protects against heart attacksMice born without a certain enzyme can resist the normal effects of a heart attack and retain nearly normal function in the heart's ventricles and still-oxygenated heart tissue, according to a study by researchers at Duke University Medical Center.
The findings raise the possibility of a therapy that could stimulate the growth of blood vessels and limit damage from a heart attack as well as prevent an attack from occurring at all, the scientists said.
“There were blood vessels everywhere in these mice born without the enzyme," said Jonathan Stamler, M.D., professor of medicine and biochemistry and author of the study published in the online Proceedings of the National Academy of Sciences on March 27. "The hope is that this discovery someday could result in a therapy for new blood vessel growth that could be a sort of natural bypass in humans.”
less invasive treatment for Parkinson’s A novel stimulation method, the first potential therapy to target the spinal cord instead of the brain, may offer an effective and less invasive approach for Parkinson’s disease treatment, according to pre-clinical data published in the journal Science by researchers at Duke University Medical Center.
Researchers developed a prosthetic device that applies electrical stimulation to the dorsal column in the spinal cord. The device was attached to the surface of the spinal cord in mice and rats with depleted levels of the chemical dopamine – mimicking the biologic characteristics of someone with Parkinson’s disease along with the impaired motor skills seen in advanced stages of the disease.
When the device was turned on, the dop-amine-depleted animals’ slow, stiff movements were replaced with the active behaviors of healthy mice and rats.
“We see an almost immediate and dramatic change in the animal’s ability to function when the device stimulates the spinal cord,” says senior study investigator Miguel Nicolelis, M.D., Ph.D., the Anne W. Deane Professor of Neuroscience at Duke.
Small doses of radioactive tracers
introduced into the body can help
identify metabolic abnormalities.
b r i E F s
Inquiry 9April 2009
HIV screening research in the Emergency Department
The Centers for Disease Control and Prevention estimates that more
than one million Americans are living with HIV. Of those, 24 to 27 percent are unaware of their HIV infection.
Chuck Gerardo, M.D., associate professor of surgery in Emergency Medicine, and Charles Hicks, M.D., associate professor of medicine in the Division of Infectious Diseases, have designed a research program that includes offering free HIV screening to patients who come to the Duke University Hospital Emergency Department.
Research led by the Division of Infectious Diseases discovered a higher than average number of people treated in the E.D. had undiagnosed HIV. “This information, which we gathered from anonymous blood samples, was the impetus for this testing program,” said Hicks.
Patients who are over 18
years of age and are well enough to give consent are offered the HIV-antibody test. The simple test consists of an oral swab that is swept across the gums and that can deliver results in just 20 minutes.
“So far, we’ve offered testing
to 400 patients and had 65 percent agree to be tested,” said Mehri McKellar, M.D., assistant professor of medicine.
The testing is being run by Partners in Caring, a collaboration between Duke Pastoral Services and Duke University AIDS Research and Treatment Center that provides spiritual care to people living with HIV/AIDS. Additional support is provided by first-year medical students trained in HIV counseling and testing.
“It’s nice to have staff trained in dealing with HIV/AIDS doing the testing and this prevents overbur-dening the Emergency Department staff. Patients who agree to be
tested and test positive for HIV are then administered a follow-up blood test to confirm,” said McKellar.
“We also ensure that each patient who tests positive has access to a social worker and follow-up treatment in the infectious
disease clinic. The testing itself is strictly confidential.”
The testing program is under IRB approval as a research study. Along with the gum swab, testers collect demographic information and vital signs.
“We’re trying to assess whether HIV testing in the ED should be standard procedure and whether fever correlates with untreated HIV,” said McKellar. She’s hoping the study will provide data on disease prevalence and emergency room protocol. n
Duke researchers found that a higher than
average number of people treated in the
E.D. had undiagnosed hIV.
selection of radionuclides, ones that can be made conveniently and easily. What is needed is to have access to the array of radionuclides with different lifetimes, energy spectra and chemistries,” said Zalutsky.
For example, he said, a radionuclide-tagged antibody clears slowly from the body compared to a radioactive sugar.
“If you wanted to do PET with an antibody, it would clear so slowly the images from F-18 would not be useful. However, there is a wide range of radionuclides that are currently unavailable but have been demon-strated in lab studies to have potential treatment uses.”
Several national agencies, includ-ing the National Cancer Institute and the National Academy of Sciences, have identified the need for increased production of radionuclides for research and clinical use in the U.S.
Based on these recommendations,
Dr. Zalutsky and Victoria Christian, chief operating officer of Duke Translational Research Institute, are working with several institutional part-ners at the North Carolina Research Campus(NCRC) in Kannapolis to develop a pilot biomedical accelerator complex (BAC) intended to produce these key research radionuclides to support clinical research at Duke and across the nation.
“The BAC is a way to leverage the resources and scale of the NCRC to create a resource for radiochemistry and targeted radiotherapy that would more than meet the growth needs of Duke, and include North Carolina-based institutions like UNC-CH, N.C. State and others, as well as institutions throughout the U.S.,” she said.
Meanwhile, Duke’s Center for Molecular and Biomolecular Imaging is bringing together researchers from radiology, biomedical engineering, oncology and other basic and clinical disciplines to discover new ways to non-invasively diagnose and treat disease. n
raDIatION, continued
New radiopharmacy moves to DavisonDuke’s radiopharmacy has long been located in the famed Bell Building through a heavy door laden with radioactive warning labels.
While the name may seem foreboding, every precaution is taken by employees to minimize exposure and to maintain the purity of these life-saving drugs. That task will be made easier by a move to a new facility in the lower level of the Davison Building, said Neil Petry, assistant professor of radiology.
“The Bell Building wasn’t outfitted to meet modern standards of preparation. Our new facility will have both primary and secondary engineering controls,” he explained. “Our goal is to prepare drugs that are free of contaminants to meet strict preparation standards for radiopharmaceuticals.”
These engineering controls include HEPA-filtered air that is 99.9 percent free of particulates and replaced 60 times per hour.
Duke’s radiopharmacists are integral to the clinical process and handle preparation, documentation and quality control of radioactive drugs.
The new facility’s updated features will serve as an attractive feature to outside commercial drug developers, as well, said Petry. “Companies can be ensured that we’re meeting compliance levels in an increasingly strict regulatory environment.”
The next steps to making the full upgrade include acquiring new gowns, training personnel and rewriting standard operating procedures.
“PEt imaging is used every day as a tool in diagnosing
and managing cancers.“ – Michael Zalutsky, Ph.D.
By Karen M. Buckmiller M.S., Otr/l
An occupational therapist helps people be as independent as pos-
sible and maximize their performance of their “occupations,” including the things they do on a daily basis – such as getting dressed, bathing, attending school, eating, playing or driving a car.
But occupational therapy is for more than adults.
At Duke University Medical Center, occupational therapists work in the Neonatal Intensive Care Unit (NICU). Duke is providing current best practice in that it has seen the value in our (OT) services and the important role we play in the development of these premature and fragile infants.
The NICU population includes infants who are acutely ill or pre-mature, and who are often unstable, fragile and easily compromised by environmental conditions. Their primary “occupations” include sleeping, feeding, interacting with their parents and caregivers and use of their eyes and hands to explore their environment.
OT in the NICU helps protect these fragile babies from excessive or inappropriate sensory aspects of the environment, and assists the family in fostering optimal development for their baby. That includes the develop-ment of age-appropriate occupations (i.e., feeding), sensorimotor processes, caregiver-child bonding, and neurobe-havioral organization.
To help foster an infant’s neuromotor development (how the brain and muscles work together) occupational therapists assist with optimal positioning of the infant in the isolette and/or crib as well as educat-ing caregivers in supportive ways to hold the infant, including “Kangaroo Care.” Occupational therapists might also fabricate special supports in the form of splints to help manage muscle tone or range of motion.
OT plays a very important role with the premature infant’s sensory system and their ability to organize and regulate the stimuli in the world around them. Often these babies have a difficult time adjusting to being outside the womb. Occupational therapists assist these infants with regulating touch, sound, and light.
Occupational therapy and Speech therapy work together as a feeding team in Duke’s NICU. Feeding is not just about the infant being able to eat enough food to get the nutrients they need to grow. Occupational therapy focuses on the quality of the feeding skills, which includes suck-swallow-breathe coordination and the ability for an infant to maintain a calm organized state during a feed.
OT’s role in the NICU is probably best described by the recent story of beautiful twin girls. These precious babies were born prematurely at only 25 weeks gestation.
Baby Girl A was born weighing
1.7 pounds and Baby Girl B weighing 1.6 pounds.
OT became involved when they had reached the age of 32 weeks.
Therapists educated the parents on how sensitive these two little ones were to noise, light and touch. Their parents were taught ways to help support their daughters to tolerate being a part of this busy world.
One of the first goals for the girls, when they were big enough, was to tolerate coming out of their isolettes to cuddle with mom and dad and remain stable. Once that goal was achieved we helped them to be able to suck on their pacifiers while outside the isolette.
As they achieved these goals we were able to gradually start introducing the bottle and breastfeeding one to two times a day, using a special nipple and certain feeding strategies. With each successful feeding experience we were
able to progress the girls to attempting to feed more often. Both girls are now taking a majority of their required nutrition by bottle and/or breast, are less reliant on feeding tubes and will be discharging home in the near future.
Occupational therapists in the NICU at Duke do their best to serve the infants and their families by providing the best match or fit between the infant and the NICU environment as well being sensitive to family circumstances, priorities/goals, concerns and cultural beliefs.
After discharge, many of these premature infants continue to require intervention to help assist their development. This continuum of care can be provided through Duke’s Special Infant Care Clinic, community-based early intervention services, as well as through the outpatient facility at Lenox Baker Children’s Hospital. n
Ot in the NIcUApril is Occupational therapy Month
Service to communityIn recognition of OT month the Occupational Therapy staff would like to suggest that all step out and help someone this Spring season by donating gently used/new gym shoes for adults and children. These will be donated to the Durham Rescue Mission to help dress those in need in the Durham Community. Donations may be turned in at Room 6218, Duke North (PT/OT gym) during April.
Did you know occupational therapists work with infants? Babies have ‘occupations,’ too — sleeping, feeding and parental bonding.
Salute to Occupational therapistsTo recognize the invaluable service provided by Occupational Therapists (OTs) and Occupa-tional Therapy Assistants (COTAs), April is recognized as Occupational Therapy Month. Take time this month to recognize them throughout Duke University Health System:
• Acute and Critical Care at Duke University Hospital (Adult and Pediatric services)
• Durham Regional Hospital (Acute Care, Acute Rehabililitation
• Duke Health Raleigh Hospital (Acute Care, Outpatient)
• Person Memorial Hospital (Acute Care, Outpatient, Skilled Nursing Facility)
• Amyotrophic Lateral Sclerosis (ALS) Clinic, Pain Clinic, Muscular Dystrophy Clinic, Movement Disorder Clinic at Moreene Road
• Adult Outpatient Rehabilitation (Duke Clinic, Lenox Baker) including driving evaluations and low vision
• Pediatric Outpatient (Specializing in developmental, feeding and sensory processing disorders at Lenox Baker)
• Ergonomics Division, Occupational and Safety Office (OESO) Ergonomic evalua-tions, office evaluations, return to work program and safe patient handling.
10 Inside Duke Medicine April 2009
pAT i E N T C A r E
april Your insider's guide to what's happening at Duke Medicine
11April 2009 Inside Duke Medicine
C A L E N d A rC A L E N d A r
giveapril 4 2 p.m.Run for a Change! Charity 5K run/walk to fight HIV/AIDS around the world. Al-Buehler Trail. After the walk, there will be an outdoor celebration at the Washington Duke’s Presidential Terrace with free food, live music and prizes for the top donors. All proceeds go to support programs supported by the Duke University’s Global Health Institute and Health Inequalities Program. Details and registration: http://www.gccforchange.org/5k
april 25 7 a.m. – 12 p.m.Angels Among Us – 5K Join families and friends whose lives have been touched by a brain tumor for the 5K and Family Fun Walk. This event raises money to support the Preston Robert Tisch Brain Tumor Cen-ter. Angels Among Us is a celebration of life, strength, courage and commitment, and has become a national event, with thousands coming from all across the country to volunteer, participate, and make a differ-ence. This year's event will be held at the corner of Erwin Road and Flowers Drive on the Duke Medical Center campus. Details and registration: http://www.angelsamongus.org/
april 25 6:30 p.m.An Evening of hope hosted by the Duke Cancer Center and the North Carolina Lung Cancer Partnership Join us for a magical night filled with delicious hors d'oeuvres, magnificent art exhibits, and an opportunity to win fabulous prizes – all coming together to shine a light on lung cancer awareness. Semi-formal attire requested. The Nasher Museum of Art. Purchase tickets: www.NationalLungCancerPartnership.org/NC
May 2 9 a.m. – 12:30 p.m.9th Rainbow of heroes Walk Supporting the Duke Pediatric Blood and Marrow Transplant Family Support Program. The walk commemorates and celebrates all the PBMT patients and their families. It is a reunion for patients, families, nurses, therapists, doctors, volunteers and supporters. Refreshments, music, and activities for everyone are provided. Rain or shine. There is no admis-sion charge. Duke Center for Living Campus. Details: http://www.rainbowofheroeswalk.org
May 2 Family health Ministries presents: Celebrate haiti! Join us for a night of Haitian food, art, dance and music and help build a health center in Leogane, Haiti. Fuqua School of Business, Winter Garden. Details: http://www.familyhm.org/Celebratehaiti2009.html
learnapril 5 12 – 5 p.m.World Voice Day with the Duke Voice Care Center Join the world-class specialists of the Duke Voice Care Center for a vocal health fair. Learn how to care for your voice and hear a panel discussion with voice experts. Admission is free. Renaissance Raleigh Hotel at North Hills. Details: 1-888-275-3853
april 8 12 – 1 p.m.School of Nursing office of Research Affairs Conference Series DaiWai Olson, Ph.D., will pres-ent “Critical Care Chaos: Is Nursing Research the Answer?” Refreshments will be served. DUSoN, Room 1014.
april 23 5:30 – 7 p.m.Duke Integrative Medicine Seminar: Managing Pain with Acupressure and Acupuncture Join experts for this free seminar and learn proven healing strategies for chronic pain. Center for Living Campus. Details: 416-3853
May 4-5 Visual Thinking: how Do Visual Communication Technologies Affect Learning and Knowledge Retention in the Sciences and humanities? A workshop for Duke faculty that will focus on developing a set of visual teaching strategies, evaluating learning with visualizations and a visit to Duke's virtual reality theater. Sponsored by Duke Center for Science Educa-tion, Duke Center for Instructional Technology, and the Visual Studies Initiative. CIEMAS Schiciano Auditorium. Registration deadline is April 24. Register: http://cit.duke.edu/events/calendar.do
doapril 24 11 a.m – 2 p.m.Duke Farmers Market opening Day The 9th season of the Duke Farmers Market opens with an Earth Day Celebration. Visit tents of 11 farmers and vendors and 5 healthy lunch vendors. See demonstra-tions on healthy cooking, nutrition and gardening topics. The market is open from 11 a.m. – 2 p.m. every Friday from April 24 – July 31 and 11 a.m. – 2 p.m. every other Friday from August 14 – September 25. The market will be closed July 3. Located outside the Medical Center Bookstore, on the walkway be-tween Duke Hospital and Duke South Clinic. Details: http://www.hr.duke.edu/farmersmarket/
april 25 9 a.m. – 2 p.m.Plant and Crafts Festival Join Sarah P. Duke Gardens as it celebrates 75 years of showcasing the beauty of nature. The Gardens and guest vendors will sell an array of plants appropriate for this region, including plants featured in Duke Gardens. Local ar-tisans will sell garden-related gift items. You can also get horticultural advice from the staff and Durham County Master Gardeners. Details: 668-3611
april 26 11 a.m. – 1 p.m.Duke University hospital Service of Remem-brance to remember those who have been cared for at Duke. Family and staff are invited to attend. Details: 684-4750
May 3 11:30 a.m.National Cancer Survivor’s Day Celebration Duke Center for Cancer Survivorship invites you to join us for the 2009 National Cancer Survivor’s Day Celebration at Duke. Bryan Center. Register: http://www.duke-health.org/events/cancersurvivorsday
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.
World Voice Day is april 5. learn how to care for your voice and hear from the experts of the Duke Voice Care Center. Details below. ILLUSTRATION BY VANESSA DEJONGH
G o o d i d E A s
12 Inside Duke Medicine April 2009
Your say: inside online
Last month, we asked for thoughts on what to name the world's eco-nomic ailment. See the clever results at http://inside.dukemedicine.org
online any time
You can download a PDf of this issue, suitable for emailing or printing, at http://inside.dukemedicine.org
Next issue
the next print edition will appear in May. the deadline for submissions for that issue is april 15.
If we only listened to ourmothers
Decreasing preventable infections by
hand washing could potentially save the
U.S. health care system $1 billion a year.
The doctor of nursing practice (DNP) is a newly approved degree within the nursing profession and here at Duke. Duke has the only DNP program in North Carolina. This semester, DNP students are taking a course taught by Nancy Short, DrPH, MBA, RN, titled, “Transforming the Nation's Health,” and learning about health policy issues.
As part of this course, DNP students like
Mary ann fuchs, MSN, rN, chief nursing and patient care services officer of Duke University Hospital and Duke University Health System, wrote opinion editorials on health issues. Here, Fuchs tackles hand washing:
As a child, who does not remem-ber the phase “don’t forget to
wash your hands?” Simple? Yes, and incredibly important. In fact I am sure that we each heard that phrase multiple times from our mothers.
My mother, who was a great supporter of cleanliness died from leukemia a couple of years ago. She received intensive treatments that made her very ill and prone to infection. She spent months in the hospital over the last two years of her life. I found the nurses, physi-cians and staff who cared for her very skilled and caring. Clearly they were experts who understood the role of preventing infections in such vulnerable patients. My mom was lucky — she never got an infection while she was hospitalized.
Other patients are not so lucky. In fact, the Centers for Disease Control and Prevention estimate that each year about 10 percent (or 1.7
million) of patients in hospitals will catch an infection. These infections called “nosocomial infections” may contribute to the death of about 90,000 patients a year in the United States. Patients who do not die from an infection must spend on average 4-5 additional days in the hospital for treatment. These infections increase medical expenses by ap-proximately $4.5 billion per year.
One third of nosoco-mial infections are considered to be preventable. The most frequent way infections are spread to patients is by the hands of health care providers. In fact, proper hand cleaning is the single most important, simplest, and least expensive means of preventing infections. Sounds so easy, right?
Unfortunately, there is a problem with hand washing in hospitals. It is estimated on average that across the U.S., health care providers in hospi-tals only wash their hands about 40 percent of the time. This poor rate of hand washing alone is estimated to cost $1 billion per year.
There are many reasons for lack of hand washing in hospitals. These reasons may include: lack of knowledge of infection prevention
proce-dures and risks; not enough perceived time; unavailability of sinks and cleaning supplies; and lack of role models to reinforce proper behaviors. These reasons are not acceptable and the practice of hand washing is under scrutiny.
The Centers for Medicare and Medicaid Services and other insurance providers such as Blue Cross and Blue Shield are instituting measures to prevent hospitals from being paid for services that result in patients acquiring infections when hospitalized. As well, President Obama has allocated $50 million
in the economic stimulus plan for states to develop methods to reduce health care-related
infections. In North Carolina, the General
Assembly recently introduced House Bill 296. This bill will provide just over $1.1 million to support the evaluation of infections in hospitals. The bill will specifically support systems to monitor infections, provide training programs for hospital staff and develop methods by which hospitals will publically report infections acquired in their
facilities. While
I personally support all of
these initiatives, it does seem very silly that
we would spend $50-plus million to reinforce hand washing activities in hospitals. It seems to me that with all of the other priorities and national economic needs we could use these dollars for better purposes. If we could decrease preventable infections just by hand washing we could potentially save the health care system $1 billion per year.
This said, let’s go back to our hands. Health care professionals have the responsibility to ensure the safety of patients in their care — it is the right thing to do. Patients trust us with their lives. Procedures to assure behaviors that support hand washing must be reinforced.
Patients and families, ask your health care providers if they have washed their hands. Stop them from touching you when you see that they haven’t. Health care providers — become champions to assure the prevention of infection in your patients. We should role model the hand-washing behaviors that our mothers taught us so long ago. We would want that for our own mothers, our families and ourselves — why not for all of those in our care. n
