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

8/14/2019 Inside Duke Medicine - March 2009 (Vol. 18 No. 3)

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VOLUME 18 NO. 3 n insi e. u eme i ine.o n M 2009

n o w o p e n

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A ew home o he PA P og amF ili i li s ommi men o new mo els o eABOVE: Dukes Physicia Assis a P og am is ow loca ed a 800 S. Duke S . ea dow ow Du ham. PhOtO by kELLy MaLcOM

s p e C i a l s e C t i o n

Be e s

Pay FOr cOLLEgEAlthough companies and other organiza-tions are eliminating or reducing beneftsto tighten budgets during the recession,Duke has expanded its employee tuitionassistance program or aculty and sta .In January, the beneft expanded to coverup to $5,250 in tuition reimbursementand nine courses per calendar year.

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StrEtch yOUr dOLLarS

Duke Credit Union seminars are ree,and they save you money by helpingyou get a handle on household budgeting,understand fnances or receive timelyin ormation on big fnancial moves, suchas housebuying.

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Stay UP tO datE

The new Lynda.com program can helpyou stay up-to-date on emerging Weband multimedia technologies throughonline tools and tutorials availableanytime, anywhere.

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I his issue, 4 pages o ewsabou you Duke be e s

For the rst time since its creation in 1965,the Duke Physician Assistant Program hasa home o its own at the ormer Blue Crossand Blue Shield o North Carolina headquar-ters near downtown Durham.

We have our times the space we had inour previous building and all o our spacesare designed to meet the programs needs,said Patricia Dieter, MPA, PA-C, director o the PA program.

Last year, the announcement o Dukesagreement with BCBSNC to lease the buildingcame with Duke Medicines commitment to

gradual expansion plans or the program anda greater commitment to innovations in healthcare. Duke is the birthplace o the physicianassistant concept and, with Dukes commitmentto new models o care, its only tting that theprogram now has a home to match its heritage.

see DUKE PA, p.2

Ope HouseThe Duke PA program will host an Open House rom 4-6p.m. on March 12 at 800 S. Duke St. in Durham. Guidedtours and re reshments will be available.


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I side Duke Medici e Mar

I N S I d E V O L U M E 1 8 , I S S U E 3nCOntACt USCampus mail: DUMC 104030Delive ies: 2200 W. Main St.,Suite 910-B, Durham, NC 27705Pho e: 919.660.1318E-mail: [email protected]

CrEDItS Ca oo :Josh Taylor

StA Edi o :Anton ZuikerMa agi g Edi o : Mark SchScie ce Edi o : Kelly MalcomDesig e : Vanessa DeJonghI side O li e Edi o s: Bill Stagg and Erin PrattI e :Sara PortogheseCopyright 2008Duke University Health System

Inside Duke Medicine, the employeenewspaper or the Duke University HealthSystem, is published monthly by DukeMedicine News & Communications.

Your comments, story ideas and photocontributions are always welcome andappreciated. Deadline or submissionsis the second Friday o each month.

F r o M t H e C o v e r

Duke Raleigh Hospital has achieved Magnedesignation or excellence in nursing by theAmerican Nurses Credentialing Center (ANOnly 5 percent o the nations hospitals havearned this designation, the highest level o

national recognition to health care organizatthat demonstrate sustained excellence innursing care.

It is an honor to receive such prestigiousrecognition or our hospital and a testamenthe extraordinary nurses and entire hospitalteam who work together every day to providthe very best care to our patients, said DouVinsel, chie executive o fcer o Duke RaHospital. Duke University Health System isonly hospital system in the Triangle with allhospitals receiving Magnet designation. Goh p://i side.dukemedici e.o g to watvideo eaturing chie nursing o fcers romo the hospitals.

This is the highest honor a U.S. hospital careceive or its nursing program and urthersupports the exceptional skill and dedicationDuke nursing said Victor J. Dzau, M.D.,chancellor or health a airs and presidentchie executive o fcer o the Duke UniverHealth System. For all three o our hospitareceive this distinction truly signifes theworld-class care available to all o our patie

The Magnet Recognition Program recognizhealth care organizations that demonstrateexcellence in nursing practice and adherencnational standards or the organization anddelivery o nursing services. Applicants una rigorous evaluation that includes extensivinterviews and review o nursing services. DRaleigh Hospital was notifed o Magnetrecognition on Feb. 13 a ter a three-year-lonapplication process. Durham Regional Hosp

received Magnet designation in November acompleting as similar lengthy process. Thedesignation was given to Duke UniversityHospital in 2006.

We are so appreciative o the more than 22employees who were directly involved in thprocess, said Mary Gra , director o nurspecial projects and the Magnet program atDuke Raleigh Hospital.

Our nursing sta are so deserving o thisdesignation, and I am so proud to be thenursing leader o this amazing group, saidRosemary Brown, chie nursing o fcer.

Research shows there are clear benefts tohospitals that are awarded Magnet status anto the communities they serve in consumerconfdence, recruitment and retention and inmaintaining quality o care. Magnet designis maintained or our years. During that pthe ANCC monitors acilities to ensure highstandards o care continue to remain.

All 3 hospi alsow Mag e s a usIt is no secret that this country is

acing a growing shortage o primarycare physicians, and we dont yetknow how much worse this shortagewill become, said Justine Strand,DrPH, PA-C, chie o the physicianassistant division. PAs are going to bea key component in the evolution o new models o care and will be neededto ensure adequate access to care orAmericans in the uture.

PAs are an e cient and fexiblecomponent o the solution to theshortage, Strand said. We cangraduate a PA in two years, whetherprimary care or specialty.

Brandon Wyche, rst-year student,said: Its good to know that you arepreparing to do something that willultimately ll an urgent need in thecommunity.

Wyche, a ormer emergencymedical technician, was introduced tothe pro ession while working with PAsin hospitals.

The diversity o options availableto physician assistants is what initiallyattracted me to the PA program, andthe options seem to be growing almostevery day, Wyche said. You donthave to choose just one area likeemergency medicine, surgery or amilymedicine.

Under the supervision o a physi-cian, PAs take patient histories, per ormphysical examinations, order laboratory

and diagnostic studies and developpatient treatment plans. In all states,including North Carolina, PAs have theauthority to write prescriptions.

Their job descriptions are asdiverse as those o their supervisingphysicians, and may include patienteducation, medical education, healthadministration and research.

PAs work in all o the specialtieso medicine, said Perri Morgan,Ph.D., PA-C, director o physicianassistant research.

Nationally, 37 percent o PAswork in primary care. Other specialtieswhere PAs are most common includecardiovascular and orthopedic surgery,dermatology and emergency medicine.

Recent growth o the PApro ession has been dramatic, Morgan

said. The pro ession has doubled innumbers in the last decade, and tripledin the last 15 years.

There were about 74,000 PAspracticing in the United States in 2008.In North Carolina, there is about onepracticing PA or every six practicingphysicians.

Im con dent that PAs will playan integral part in revolutionizing ourhealth care system and I am excitedabout the prospects or the uture, saidChinika Reynolds, a rst-year student.

Importantly, PAs like otherphysician extenders on the modern

health care team increase patientaccess to health services by extendingthe time and skills o the physician.

Several patient satis action studieshave shown that patients are as satis edwith care provided by PAs and nursepractitioners as they are with physiciancare, Morgan said.

At Duke, the program is growing.The traditional incoming PA class sizewas 45 students. The class beginning inAugust will have 70.

The continued gradual expansiono the program is dependent on avail-able clinical rotations within DukeUniversity Health System and avail-ability o PA scholarships throughthe School o Medicine to recruit topstudents, Dieter said.

She described the new location as

more spacious and more conducive toteaching and learning.

The Duke Endowment helped sup-port the start-up cost o the expansiono the PA Program. BCBSNC providedthe renovations, and worked closelywith Duke to trans orm the historicbuilding into an energy-e cient anduser- riendly acility.

The new acility has a masterclassroom that can accommodate 90students. The master classroom in the

ormer on-campus location at HanesHouse accommodated 66 students.

The acility, at 800 S. Duke St.,

also o ers our physical diagnosissuites, where students conduct physicaldiagnosis through clinical problemevaluations with standardized patients.The visits are recorded and given to thestudents or sel -evaluation.

Other eatures o the new locationinclude a diagnostic methods lab, studyrooms and lounges or students, acultyand sta o ces, con erence rooms, andtwo kitchens available to students.

The layout o the new locationbrings students, aculty and sta together.

Be ore, we were spread out overmultiple foors and now we are all inour own space together, Reynolds said.

Her ellow student, Wyche, saidthe new acility eels worthy o thereputation o the Duke PA program. n

DUKE PA, co .

Chi ika rey olds akes a s a da dized pa ie s blood p essu e du i g a cli ical p oblemevalua io . PHOTO BY ERIN PRATT


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p r i v a C y a l e r tC a l e n D a r

Laptop computers, thumbdrives,personal digital assistants, and othermobile devices make accessingelectronic in ormation easier and

o ten more e fcient.

These portable devices may alsobe easily lost or stolen. I patientin ormation or other sensitivein ormation (Social Security numbepersonal fnancial in ormation, etc.)is stored on these portable devices,patients identity and Duke couldbe at risk.

to p eve heloss o da a:

Do not store sensitive informationon laptops or mobile devices.Use

remoteaccess

services lithe DukeMedicineVPN servivirtual PINand otherCitrixservices to

access the needed in ormation.In ormation saved on these serversis secure and backed up nightly.

If you must store information onmobile devices, encryption o thein ormation is required. Contactyour technical support person orassistance.

I you lap op o mobiledevice is los o s ole :

Contact your information securityo fcer or the DHTS Service Desk at684-2243.Security support personneare listed at h ps://www.iso.dukeedu/iso/isop/isl.php . Contact DukPolice at 684-2444 and RiskManagement at 684-3277.

Provide the last known location ofthe device.

Identify all patient health information or sensitive in ormation storedon the device.

Wha o do aboulos , s ole da a

q & a

March 2009 I side Duke Medici e

Bek igh ed du e Me i ineopens lini in E s e n W e coun

In and around the Triangle, no area is growingas ast as Wake County. The population o

Wake County grew by 32.6 percent adding204,744 people between 2000 and 2007,according to state government estimates.

Comparatively, Durham County grew by 14.1percent and Orange County by 10.2 percent.

The March 2 opening oDuke Medicine inKnightdale, a state-o -the-art acility with primarycare and urgent careservices, is the latestexample o how the DukeUniversity Health Systemcontinues to makeinvestments in Wake

County. The Knightdale clinic now gives Eastern

Wake County the same world-class specialtyservices available to patients in Durham, Raleigh,Morrisville and other communities.

We asked Doug Vinsel, CEO o Duke RaleighHospital, to elaborate on Duke Medicines WakeCounty strategy and explain how the new DukeMedicine in Knightdale answers the growingneed or health care services there.

Why open a clinic in Knightdale?

The establishment o a Duke Medicinepresence in Knightdale at the intersectiono Interstate 540 and US 64-Business isconsistent with our strategy o tryingto create a presence along the I-540

corridor. In looking at opportunitieswithin Wake County, Knightdale stoodout as a high-growth community withminimal existing medical services.Locating our new building at theintersection o I-540 and 64 makesaccess or patients in the northern andnortheastern tier o Wake County veryconvenient. And, the new building ison 16 acres, which certainly creates theopportunity or uture evolution o this

acility into a health campus.

I would be remiss i I didntmention the communications romthe university and the health systemon March 2 that provided a clear

update on how Duke is being impactedby the current nancial crisis. Withinthe Health System, current e ortsto manage expenses and achieve asustainable nancial structure orthe uture are critically important.But, as pointed out in the email toDuke Medicine employees, expensemanagement is only one componentthat will drive our long-term success.The other driver will be strategic,well-designed, scally disciplinedinvestments in projects that can drivegrowth the Knightdale project is agood example o this and is consistent

with our two-track approach tolong-term success.

How are Wake County residentsresponding?

The early response is encouraging;there were more than 25 appointmentsscheduled during the rst day that theappointment line was open. Bottomline: I think this is a location that willbe success ul short and long term andone that will allow or a synergisticrelationship between Duke RaleighHospital, which is just 7 miles away.

Whats special about the acility?

The acility itsel is spacious, attractiveand easily accessible. I think the thingthat is most special about the location

is the act that its a 40,000-square-oot building that, when ully rampedup, will accommodate 25 physicians 14 specialists and 11 primary caredoctors. The critical mass o primaryand specialty care will be a beacon orboth existing residents and newcomersto Wake County seeking a single sitewhere they can receive virtually all o their physician care.

What specialty care physicians will be located at Knightdale?

By late spring, Duke Medicine inKnightdale will include orthopedics,

cardiology, gastroenterology andpulmonology. Then, over the next 12to 18 months, other specialties will beadded. The mix o specialists was basedon the demographics o the area andthe gaps in specialty care that currentlyexist and are projected to continue toexist over the short to intermediateterm. Many o the specialists who willinitially work at the Knightdale clinicwill also continue to have a presence onthe Duke Raleigh Hospital campus inthe Duke Medicine Plaza.

Will the quality o care match thehigh quality across Duke Medicine?

Absolutely! Protocols and evidencedbased care practices will be consistentat this site with those at other DukeMedicine locations. Were proud to bebringing even more o Dukes world-class care closer to Wake Countysresidents.

Did Duke Medicine recruit new physicians, nurses and sta to fll the acility?

All o the physicians who will occupythe Duke Medicine o Knightdale sitewill be Duke PDC Physicians (specialtycare) or Duke Primary Care Physicians(primary and urgent care). Many o these physicians are new recruits,although some will be redeployed romwithin the Health System. Similarly,many o the sta who will supportthe practices are new Duke Medicineemployees, while others are existingemployees who have chosen to trans erto this new location. n

doug vinsel, ceo

Duke Medici e i K igh daleope ed o busi ess Mo day,Ma ch 2, 2009

Loca io : 162 Legacy Oaks Drive, Hwy 64and I-540, Knightdale, NC 27545

P ima y Ca e:Family medicine or all ages.Mon-Fri 8 a.m. 5 p.m.

U ge Ca e:Open seven days a week,8 a.m. 8 p.m.

Special y Ca e: Gastrointestinal medicine,pulmonary medicine, cardiology andorthopedics.

Appoi me s: 919-232-5205 or1-888-ASK-DUKE (375-3853)


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B u l l e t i n sa t a G l a n C e

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

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

I t F I g U r E SnI N S I d E V I E Wn

6,288The number o hours worked in

calendar 2008 by hospice volunteersat Duke Home Care & Hospice.

Source: Duke Home Care & Hospice

P I c t U r E Sn

a c c O U N t I N gn

Heal h ca e eceip sdue by Ap il 15Faculty and sta who enrolled in 2008 heor dependent care reimbursement accountsmust submit receipts or services provided

Jan. 1 through Dec. 31, 2008 to WageWorkby April 15, 2009, or reimbursement.

Claim orms and supporting documentatimust be post marked or axed to WageWoby April 15. Claims or 2008 submitted athis date will not be reimbursed.

Claim orms are available online at hh .duke.edu/ o ms , or at the HumanResources o fce, 705 Broad St. in Durha

M oney raised by the DukeHospital Auxiliary again isbene ting Duke Medicines acilities,patients and amilies.

A donation rom the auxiliarywill provide fat screen TVs or all12 patient rooms plus TVs or the

amily room and the nurses area atDuke HomeCare & Hospices new

acility on North Roxboro Roadin Durham. The acility, called theHock Family Pavilion, had its ribbon-cutting on Feb. 24.

Providing the unding to buythe TVs allowed hospice to use their

unds or other areas o the acil-ity, said auxiliary director ReneaHunnings.

We would not have been ableto provide that level o amenitywithout a committed sponsor like theDuke Hospital Auxiliary, said StarrBrowning, executive director o DukeHomeCare & Hospice. They have beena strong partner in the work we do.

The auxiliary has helped sponsor awide range o projects at Duke Hospitalsince 1950, with particular emphasison patient and amily needs. It raises

money through three gi t shops, avolunteer o ce and und-raising events.

The new hospice acilityeatures 12 private patient rooms,

24-hour skilled nursing care andan interdisciplinary team o nurses,social workers, chaplains, nursing

assistants, bereavement counselorsand volunteers.

In another gi t, the auxiliarydonated $10,000 to provide heart pa-tients with pillboxes uniquely designed

or easy opening by anyone who hasarthritis or gripping problems. n

Hospice ce e ope s wi h ce emo y, gi s

Pa icipa i g i he eb. 24 ibbo -cu i g a he ew Hock amily Pavilio hospice i pa ieacili y we e, le o igh , Ma y A Black, Duke U ive si y Heal h Sys em assis a vice

p eside o commu i y a ai s, Debo ah a d Jim Hock, Ga y Hock, DUHS CEO Vic o J.Dzau, M.D., a d s a e Se . Ve o Malo e. no pic u ed a e S a B ow i g, execu ivedi ec o o Duke Home Ca e a d Hospice, Duke U ive si y P eside richa d H. B odheada d Paul newma , DUHS vice p eside o ambula o y ca e. PHOTO BY NANCY SHAMBLEY

W O r k + F a M I L yn

i d a summe campo he kids

Are you a Duke University Health Systememployee and already wondering what to with the kids thus summer?

Its never too early too plan.

Check out the list Duke University Sta Family Programs has compiled o summecamps and programs taking place in DurhOrange and Wake counties. The list includathletic and academic camps sponsored byDuke as well as other arts and recreationcamps in the area.

Find all the details here: h p://h .dukeamily/camps.php

M I N d + b O d yn

regis e : Spi i uali y a dheal h esea ch wo kshopsThe Duke University Center or SpiritualTheology and Health is o ering two fve

research workshops on July 20-24 and Au17-21 that compress a two-year post-doct

ellowship into fve

They will be the onplaces in the worldwhere specifc trainion religion, spirituaand health research be obtained rom active in the feld onearly 25 years.

In each o the past our years, the workshhave been over-subscribed, so it is importato register now. The courses are stronglyrecommend or graduate students, researchearly in their careers, and seasoned researcwishing to shi t work into this area. There no degree requirements or participation.

Tuition scholarships are available or studewith extreme fnancial hardships andexceptional academic potential. Because ointense nature o this training, which incluindividual mentorship with Harold G. KoenM.D., and other workshop aculty, theworkshops are limited to 25 participants ea

For any questions, write koe ig@ge i.dedu , or go to: h p://www.spi i ualiheal h.duke.edu .


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By Melissa Schwa i g

Its 6:45 a.m. on a rigid Wednesdaymorning. Twelve wide-eyedneurosurgery residents sit around acon erence room table as MichaelHaglund, M.D., Ph.D., programdirector o the neurosurgery trainingprogram, steps up to a podium at the

ront o the room.But this isnt a typical lecture.

Haglund trans orms into a re eree asteams are ormed and the room is sud-denly lled with a competitive energythat could rival a Super Bowl match up.

This event is called Quiz Bowl,an idea conceived by Haglund, whoused an experience with his childrenas inspiration. This concept wassomething Id seen when my kids

participated in a junior Bible quiz,he explains. It makes learning un [the residents] get into it.

Quiz Bowl is not just un andgames. What started as an experimentto make the learning process moreinteresting, has turned into a success ulteaching model.

[The residents] seem to paymore attention and enjoy the riendlycompetition, Haglund explains.

Weve also seen the scores comeup a lot since we started doing this,Haglund says. He estimates that quizscores improved rom an average o 24

percent in 2007 to around 83 percentsince the Quiz Bowls began in 2008.Haglund is care ul to note that parto the improvement can be attributedto other recently launched e orts inthe department to encourage residentparticipation and make them eel moreengaged in the design and implementa-tion o the residency training program.

As the game kicks o , teams o two are ormed. Chie residents arepaired with more junior residents andmid-level residents join together.

All eyes are xed on a large projec-

tion screen as questions, photographsand diagrams begin to appear askingquestions like, Name a neuropeptideneurotransporter.

The room lls with clicking soundsas the residents begin pounding small,remote controlled buzzers in theirhands signaling their desire to answerthe question.

The questions keep coming, alongwith the enthusiastic responses o theresidents, as team a ter team comes tothe ront o the room or their turn inthe hot seats. The ormat is single roundelimination comprised o ve rounds.Three correct answers in round onemeant one team was moving on to acetheir next opponent and one team wasout o the competition.

The initial concept started twoyears ago when Cory Adamson, M.D.,Ph.D., assistant pro essor o surgeryand neurobiology, started administeringweekly quizzes to the residents. Thosewith the top scores at the end o theyear were eligible to be named residentscholar and win a cash prize.

When Haglund took over asprogram director last spring, he wantedto build upon Adamsons creativeapproach. He soon introduced QuizBowl, which takes place every threemonths and includes questions rom theweekly quizzes administered during the

prior 12 weeks.On this morning, the champion-ship round has Renee Reynolds, M.D.,and Hamid Aliabadi, M.D., squaringo against Betsy Hughes, M.D., andthe incumbent winner, Ciaran Powers,M.D., Ph.D. Following an intenseround o questioning, Powers andHughes are the victors.

No rings or trophies are awardedto the winners. Instead the winners anda guest are taken to dinner, at a restau-rant o their choosing, by Haglund andanother member o the aculty. n

Q: How do you jumps a pe o ma ce?

A: A Quiz Bowl !P O L I c I E Sn

Huma resou cespolicies upda edDuke Human Resources has updated theDuke Sta Handbook, which gives anoverview o policies and procedures. Thhandbook, which is distributed to newlyhired sta during orientation, includesseveral updates that have been incorporainto the HR Policy Manual. More in ormabout these changes, as well as an electrocopy o the handbook, can be ound ath p://h .duke.edu/policies .

c O N t I N U I N g E d U c a t I On

Save 40 pe ce ouqua busi ess cou ses

All Duke aculty and sta are eligible 40 percent tuition reduction on all non-degree executive education programs at tFuqua School o Business.

Fuqua is a premier provider o businesseducation or working pro essionals. A o programs are available, designedspecifcally or pro essionals in all stagecareer development.

Eight executive education programs areavailable throughout the year. Two newprograms available in all 2009 are:Fundamentals o Management ( or frst-timmanagers, and experienced managers with

ormal training) and High Potential Execu( or mid-level managers and executives).

Programs are held at the R. David ThomExecutive Con erence Center on Dukescampus and also at the Washington DukeInn & Gol Club.

To learn more, visit h p://www.ee. uqduke.edu , contact a client relationscoordinator at (919) 660-8011 or e-mexeced-i o@ uqua.duke.edu .

P E r S O N a L F I N a N c En

How o ob aia duplica e W-2The 2008 W-2 orms needed to fle taxreturns were distributed in late January.

In an e ort to better serve aculty and sta ,Duke University has standardized theprocess or requesting duplicate tax orms.

An employee must complete a TaxDocument Request Form to request areplacement o a lost or misplaced W-2

orm. This orm is available on the CorporatePayroll Services Web site: h p://www.pay oll.duke.edu/ o ms/ o ms.php .

This change is necessary to obtain anoriginal employee signature authorizing therequest. The ees associated with thisrequest are stated on the Tax DocumentRequest Form and remain unchanged romprior years.

For more in ormation about W-2 orms,talk with your department payroll represen-tative, visit the Corporate Payroll ServicesWeb site, or call 684-2642.

h O N O r Sn

ulke so amo g 6Sammie awa d wi e sWilliam J. Fulkerson, M.D., senior vicepresident o clinical a airs or the healthsystem, is among six people recently selected

or the 2009Sammie awards,named or distin-guished politicalscientist, educatorand human rights

activist SamuelDuBois Cook.

The winners wereannounced at the

12th annual dinner and awards ceremonyheld at the Washington Duke Inn & GolClub. All were chosen in appreciation otheir work in urthering Cooks legacy.

Fulkerson, head o the Duke HospitalDiversity Leadership group, was cited orproviding leadership in the area o diversityand inclusion, helping enhance diversityeducation, and encouraging all members toconsider the connection between diversityand patient care.

Also recognized were Peter Klop er, Ph.D.,

emeritus pro essor o biology at Duke andcivil rights advocate; Martha ShumateAbsher, associate dean or education andoutreach at Pratt School o Engineering;the Rev. Mel Williams, senior pastor at theWatts Street Baptist Church and ounder oWalltown Neighborhood Ministries Inc. andDuke seniors Dinh Phan and Flint Wang.

Named or the frst A rican-Americanaculty member at Duke, the Cook Society

was ounded in 1997 to recognize andcelebrate the A rican American presence atDuke. For more in ormation and to fnd alist o past award recipients, go to h p://www.duke.edu/web/cooksocie y .

FulKeRson

r E c O g N I t I O Nn

S oke Associa ioho o s Golds eiLarry Goldstein, M.D., pro essor o me(neurology) at Duke and the Durham VAMedical Center and director o the DukeStroke Center, was honored February by American Stroke Association with the

William FeinberAward or Excein Clinical Strok

The award honosignifcant achiement in the cliniinvestigation andmanagement ostroke.

Goldstein is a senior ellow in Dukes Cor Clinical Health Policy Research, and

principal investigator o Dukes AmericaStroke AssociationBugher FoundationCenter or Stroke Prevention Research.

Read more about the honor and Goldsteinwork at h p://i side.dukemedici e.oSearch Goldstein.

goldstein


6/16


Durham Rehabilitation Institute(DRI), located on the seventh fooro Durham Regional Hospital, providesa comprehensive, multidisciplinaryapproach to recovery. The rehabilita-tion team is dedicated to helping eachpatient regain independence and reach ahigher standard o living.

DRI sta treat patients with avariety o traumas and disorders,including strokes, spinal cord injuries,amputations, joint replacements andneuromuscular disorders. The DRI team

and rehabilitation nursing sta will tellyou that its the team approach thatmakes this possible.

In the gym, we have a multidisci-plinary team that creates a personalizedrehabilitation plan or each patientand makes sure that he or she is ableto take advantage o all the technologyand resources available, explainsRaphael Orenstein, M.D., medicaldirector o DRI.

A Mul i-Discipli a y App oach

Teamwork is essential or positiveoutcomes at DRI. The care team is

comprised o physicians, physicaltherapists, occupational therapists,therapy aides, speech therapists, reg-istered dieticians, nurse practitioners,care managers, re erral coordinators,rehabilitation nurses, certi ed nurseassistants, a licensed assistant therapistand a recreational therapist.

The teamwork starts every morningwith a group meeting at 8:30 to revieweach new patient being admitted. Thecharge nurse, nurse manager, nursepractitioner, physician, therapists, caremanagers and re erral coordinators dis-cuss each patient and become proactiveabout the resources needed or them. Aprimary nurse is assigned to each newpatient. This is unique to rehab.

The DRI care team also meetsweekly to discuss each patients shortand long term goals, and their progressto date.

We talk about how we are goingto get the patient where they need to be,which is unctioning independently andready to go home, and then togetherwe do whats needed to get there, saysSherri Pearce, BSN, MSN, director o Adult Health.

the La es tech ologySeveral o the latest advancesin rehabilitative technology areavailable at DRI, including theBiodex De-Weighing System a ully adjustable harness systemthat allows patients to practicewalking but removes as much o their weight as necessary. Thissystem gives patients opportuni-ties or exercise and also speedsrecovery and enhances ability.

Other tools are practicerooms and an automobilesimulator. There is also a practice

kitchen and a practice livingroom so patients can experimentwith tasks such as ood preparation andwheelchair maneuvers.

The technology, combined with thecomprehensive, team-oriented approachto rehabilitation, has led to DRIs beingrecognized by the Uni orm Data Systemas being in the top 10 percent nationallyin patient outcomes.

Ca e Ou side he Gym

An additional team o pro essionalsprovides care outside the Rehabilitation

gym. Unit 7-3 is the inpatient unit orDRI, and the bed capacity was recentlyexpanded rom 22 to 30 beds.

The Unit 7-3 care team includesregistered nurses, certi ed nursingassistants, dietitians and health unitcoordinators. In addition, the Food &Nutrition and Environmental sta areo ten commended or their customer-

ocused service in letters rom 7-3patients.

Regina Perry, RN, describes hownursing or Rehabilitation is both di -

erent and exciting. Our magoal is to help patients learnhow to do things or themseThis is di erent than manythe other units. It requires a lo teaching and a di erento care. We consider at everyturn how much we are suppoto help our patients versus homuch they are supposed to d

or themselves.On 7-3, each patient rece

ull nursing care with the sammedical acuity as on otherunits, but in addition they mucomplete at least three hourstherapy at the gym a day. Th

is a lot o coordination that happensbetween nursing and therapy its ko like a dance, says Perry.

Ask any team member what hisor her avorite part o working at DRis, and he or she will tell you its mypatients. Physical therapist Kristin Trelays an experience that is commonat DRI, A patients grandma told methank you or giving me my grandsback. Moments like this are what I loabout this pro ession. n

Du ham ehabili a io i s i u e:

A eam app oach o ecove y

K is e tell a d Kim Dao, physical he apis s a he Du ham rehabili a io I s i u e, wo k wi h a pa ie a he pa allel ba s.PHOTO BY TOM WOOTERS

A gela Webb, a occupa io al he apis a he Du hamrehabili a io I s i u e, helps a pa ie . PHOTO BY TOM WOOTERS

arounD tHe Hospitals


7/16

Payi g o College

Sitting in a classroom at DurhamTechnical Community College, Stan Jones studied a blackboard lled withalgebra, ractions and word problems.

Jones, a utility worker withDukes Housekeeping Operations,paused or a moment, recalled themath ormulas he reviewed over theweek, then picked up a pencil andstarted scribbling in a notebook.

Good job, Durham Tech mathinstructor Richard Noble told Jones, ashe looked over Jones work.

Jones is participating in Dukesemployee tuition assistance programto work toward an associates degreein electrical technology rom DurhamTech. Hes among 1,000 sta and

aculty members who have enrolled inthe tuition bene t in recent years orcareer-related courses and degrees ataccredited North Carolina schools.

As part o his job at Duke, Jonescleans foors in East Campus buildingsand hopes the new skills he learns inschool will open doors to become an

electrician at Duke. When I heardabout the program, I jumped on theopportunity, said Jones, 48. Ivewanted to learn more about wiring andcircuit boards or a while.

Although companies and otherorganizations are eliminating or reduc-ing bene ts to tighten budgets duringthe recession, Duke has expanded itsemployee tuition assistance program or

aculty and sta . In January, the bene texpanded to cover up to $5,250 intuition reimbursement and nine coursesper calendar year. Employees can alsorequest a waiver to take courses ataccredited schools in other states i the courses are not o ered in NorthCarolina, or i the employees primary

work location is in another state.The tuition assistance is available

to ull-time sta and aculty with atleast two years o continuous serviceat Duke. Since 2007, Duke has reim-bursed employees nearly $1.5 million

or tuition.Lois Ann Green, director o

Duke Bene ts, said the programsupports Dukes long-term sta ng andpro essional development strategies byexpanding the internal pool o talent to

ll positions at Duke.It helps us to build a more

skilled work orce and boosts retentionbecause employees can grow and havethe opportunity to advance within

S a Jo es, a u ili y wo ke wi h Dukes Housekeepi g Ope a io s, is usi g Dukes employee assis a ce p og am o wo kowa d a associa es deg ee i elec ical ech ology om Du ham tech.

. u e.e u n insi e. u eme i ine.o n M 2009

A Qua e ly Suppleme o I side Duke Medici ebene s

Employee ui io p og am expa ds skills, adva ces p o essio al developme

F i n a n C i a l p l a n n i n G

Duke U ive si y ede al C ediU io semi a s ca helpyou s e ch dolla s du i g

he ecessio .

p g 8

see tUItIOn, p.10

H e a l t H y l i v i n G

the Mobile a me s Ma kemakes heal hie livi g easie .

p g 9

v a l u i n G t e a M w o r K

Coach K: remembe you e pao he eam.

p g 8

W en Im one, Ill ve n sso i ese ee n e e is e e nu se

wi ou vin lo o lo ns o p o .d niel ru , lini l s ssis n t e P es on ro e tisb in tumo cen e . ru is in evenin l sses al m n ecommuni colle e.


8/16

Be e s Mar

S e chi g you dolla s du i g a ecessio

Be ore an audience o severalhundred aculty and sta , MikeKrzyzewski boiled down his coachingphilosophy to one mantra:

Whether playing or Duke, or orthe USA Basketball team, You play

or the [team] letters on the ront o the jersey, he said, brushing his handproudly across his chest, not the nameon the back.

You dont just get 12 peopletogether and call it a team, he said,just like a school is not a school justbecause you have people occupyingjobs. How do you get people to worktogether?

The answer, he told employeesduring the Primetime orum in January,is taking time to develop the culture o teamwork.

Krzyzewski recalled his rstmeeting with the USA national team,long be ore he coached them in theOlympic gold-medal game lastyear. [The meeting] was notabout o ense or de ense,he said. It was about thestandards we were goingto live by.

Later, Krzyzewski cultivated thestandard o service by introducing the

national team to veterans suchas Scotty Smiley, an MBA

student at the Fuqua Schoolo Business. Smiley wasblinded in Iraq while tryingto protect his squadron rom

a car bomber. I wanted the guys tounderstand what selfess service wasabout, Krzyzewski said. Not onlyhad these guys served, they wanted toserve again. A ter the veterans spoke,the team Wade, LeBron and all werecrying. I thought, we have a chance.These guys have a heart.

Coach Ks style at Duke is notmuch di erent. Beyond the basketcourt, we talk to our guys a lot aboutcharacter, about being humble and usthe plat orm they have to help otherhe said. In answer to questions romPrimetime audience about developinteams, he stressed the importance obeing honest with each other, anddeveloping communication skills andtrust so that the rst time you talk[tough] isnt the rst time you talk.

Krzyzewski, who has coached mthan 950 basketball games at Duke,reminded the audience that the Dukename garners respect in the world, evoutside o basketball, and that the Dname elevates all o us.

We are lucky to be part o something bigger than us, he said.But always remember that Duke isgreat because o its people. Anythinany one o us does is important. An you have has the chance o being thidea that makes Duke better. Thats wwe should always act as a team to mgood things happen. n

b M s g eenW i e , O e o communi ion Se vi

the le e s o he o o he je sey

Duke me s baske ball coach Mike K zyzewski speaks wi h wome s baske ball coach Joa eMcCallie. Coach K alked abou eamwo k du i g he P ime ime employee o um i Ja ua y.

d iane Gi ord does her best tomanage money wisely. She createsa monthly budget, uses online bankingto pay bills on time and regularly setsaside money in a savings account. Butits the unexpected vehicle repairs,brokenh appliances or medical bills that drain her savings.

I put the money into the savingsaccount with the best intentions okeeping it there, but you know howthings go, said Gi ord, a clinical trialcoordinator with Duke Clinical ResearchInstitute.

Gi ord attended a recent Duke UniversityFederal Credit Union workshop on Building a

Better Budget, an important topic during theeconomic recession, which, fnancial advisorssuggest, is a good time to revisit a personalmonthly budget.

I youre paying attention to the news andvolatile market, its a scary time or everyoneright now, said Scottie Dowdy, a fnancialcounselor with Duke Credit Union. The key is tomanage your money as best as possible.

Managing money starts with preparing anaccurate and balanced budget based on net

income with these suggested budget guidelineallocations: 35 percent or housing (mortgage,rent, utilities, insurance); 25 percent or other

expenses ( ood, clothing, entertainment); 15percent or transportation (car payment, uel,maintenance); 15 percent to pay debt (creditcards, student loans); and 10 percent or savings.

When creating your budget, you should onlylist sources o income that you actually receiveon a regular basis, not overtime or bonuses,Dowdy said.

In addition to budgeting, Dowdy suggestedcreating a chart with goals or longer-term needssuch as a house or new car, and to earmark

savings toward those goals.Developing a priority list or payingdown credit cards with high interestrates is also key.

People o all income levelsare eeling the crunch, Dowdy said.Its not what you make; its how youuse what you earn, she said. A nestegg or unexpected expenses andemergencies guards against dippinginto savings, she added.

I you put money into yoursavings and then take it out to paybills or unexpected expenses, then that

is not a savings account, Dowdy said. I youknow youre going to need new tires or a new

car in the next year, start saving or it now.Gi ord, the Duke Clinical Research Institute

trial coordinator, has a new goal a ter attendingthe seminar: leave the savings undisturbed bycreating an accurate budget with an allocation

or unexpected expenses.Im determined to get on track and have

money set aside or unexpected expenses,she said. Thats my fnancial goal or 2009. nb Miss b x e , Senio W i e ,O e o communi ion Se vi es

D k C d us mt s F c s ccMa ch 17, 12:30 p.m. a he DukeC edi U io , 2200 W. Mai S .

H m b g Ma ch 24, 12:30 p.m. a heSea le Ce e

G o :to egis e o a semi a , visih p://www.duke cu.o g a d selec

semi a sig -up u de Quick Li ksse d e-mail o sco [email protected] o call (919) 660-9745.

v d See a video abou budge i g ah p://www.h .duke.edu/ a ce


9/16

o p p o r t u n i t i e s

March 2009 Be e s

A new online training resource o ered throughDukes O fce o In ormation Technology (OITenabling aculty, sta and students to learn thelatest technological tools with video tutorialsavailable anytime, anywhere. For Richard Lucicassociate chair o the Computer ScienceDepartment, the pilot program through Lynda.coo ers a convenient way or him and his studento stay up-to-date on emerging Web andmultimedia technologies.

These technologies change rapidly just keepiup as new versions come along can be a real timsink, said Lucic, who includes the videos as pao a class he teaches in the In ormation Scienceand In ormation Studies (ISIS) program.

Lucic is among more than 200 Duke aculty,sta and students who have participated inOITs Lynda.com pilot since it was launched October. Lynda.com o ers more than 30,000online training courses on topics ranging romMicroso t Word and Excel to Web design andcomputer programming.

OIT is providing a limited number o individaccounts or Duke users during the yearlongpilot. Sta and aculty can review the trainitutorials online ( rom Duke or at home) or cause designated workstations at the ACTWarehouse lab, Multimedia Project Studios, thCenter or Instructional Technology and the L

in Perkins Library. Tutorials in PHP, DreamweavMicroso t Excel and PowerPoint have been amthe most popular with Duke sta , who comprisabout 75 percent o program participants to datesaid Christine Vucinich, OITs training coordina

As more jobs throughout the university and healsystem demand technology skills, online trainincan help users at all levels, Vucinich said.

Online training provides an opportunity to getquick questions answered and or sta at anylocation to get the training they need when theyneed it, not weeks or months later, she said.

The training helped Terry Banfch get up to speeduring a recent Microso t Word upgrade in DukLaw Schools Alumni & Development O fce. Itproved use ul as she transitioned into a new job

a trainer in Central Developments IT departmen

Everything and anything is there, and its there any time, even i youve just got fve minutes tospend, Banfch said. Its a great tool or giving

olks the essential training and tips that can helpmake our work lives more e ective and e fcie

OIT will gather user eedback this spring toevaluate whether the program will be imple-mented on an ongoing basis next all.

b c bonne

Go O li e: Mo e i o ma io abou OIts oli e ech ology ai i g p og am is a h pwww.oi .duke.edu/help/ ai i g/o li e/

G ab a d go a he ga de sMo ile me s m e m es e l e in e sie

Lea mo e a d e oll i he mobile a me s ma ke a h :// .h .d k . d /m b m k o co acJaso Ho ay a (919) 681-0504 o J .H @d k . d

Lea la es ech ologyh ough Ly da.com

Joyce Newtons o ce is astones throw rom the summerDuke Farmers Market. But as asta specialist with the PediatricNeonatology Department, shedoesnt always have time ormarket shopping.

Thats why shes a an o theDuke Mobile Farmers Market. Shesigns up or both the summer and

winter mobile market to get resh,local vegetables nearly all yearround.

It is so convenient, she said.I just drive to Duke Gardens a terwork on Tuesdays, and a box o veg-gies is waiting. I really miss the ewweeks between growing seasons.

With the mobile market, acultyand sta pre-pay or produce andpick up their share o the harvestonce a week. This year, seven local

armers/vendors will provide ruit,vegetables and fowers, with deliver-ies starting April 7 at Duke Gardens

(with one armer deliveringto Durham RegionalHospital). The produce,price, size o share andnumber o delivery weeksvary among armers.

My husband and Iare local potters, so werecognize the importanceo supporting communitybusinesses, Newton

said. And the armersintroduce us to vegetableswe might otherwisenever see like purplecaulifower rom Vollmerarms. That was di erent!

More than 300 employeesparticipated in the 2008 mobilemarket, organized by LIVE FOR

LIFE, Dukes employee wellnessprogram. Based on employee

eedback, LIVE FOR LIFE made the

ollowing enhancements this year: Most farmers offer payment plans

to reduce the up- ront cash layout. Britt Farms will begin pickup at 3

p.m. to make it more convenientor employees who work an early

shi t. Other armers will o erpickup rom 4 p.m. to 6 p.m.

Rosies Plate, a restaurant special -izing in gluten- ree, shell sh- reeand peanut- ree ood, will o er

resh, local, organic meals-to-go.Farmers accept customers on

a rst-come basis until they reachcapacity. nb M s a. g eenW i e , O e o communi ion Se vi es

esh ood is o be had a he Duke Mobile a me s Ma ke .

t e me s in o u e us o ve e les we mio e wise neve see li e pu ple ulifowe .t w s i e en !Jo e New on, s spe i lis wi e Pe i i Neon olo dep men

Meals o go amobile ma kerosies Pl e o e s es en ees,si e is es, s l s, soups, sn s

n esse s o e-ou .

E wee , emplo ees n o eoo om rosies Pl e up o one

in v n e o du es Mo ileM e . View e menu n o eonline rosiesPl e. om o ll(919) 833-0505.


10/16

0 Be e s Mar

Edi o :Leanora Minai(919) [email protected]

Assis a Vice P eside : Paul S. Grantham(919) [email protected]

Benefts is published quarterly byDukes O fce o CommunicationServices as a supplement to InsideDuke Medicine . Benefts invitesyour eedback and suggestions

or uture story topics. Please call(919) 681-4533 or send e-mail towo ki [email protected]

bene s

Duke as they expand their skills,she said.

Results show the program ismeeting Dukes goals o getting adiverse group o employees to utilizehigher education opportunities andencouraging managers to help sta develop career goals.

In a recent survey o sta andaculty who participated in Dukes

employee tuition assistance program,87 percent said knowledge gained byusing the bene t will help them betterper orm in their jobs; in a similarsurvey o Duke managers, 85 percentagreed that the bene t helped improveemployee per ormance.

The bene t program evolvedrom the 2003 recommendations o

the Womens Initiative, which calledor greater opportunities or pro es-

sional development. It was designed toprovide more employees with oppor-tunity or pro essional development byo ering reimbursement or classes noto ered at Duke or access to coursesat local community and state collegeswith lower tuition.

Be ore the program was intro-duced, only courses at Duke werecovered. Today, the program o ersemployees more options, includingevening classes at community colleges.Durham Tech, University o North

Carolina at Chapel Hill and NorthCarolina Central University are nowamong the most utilized schools.

As a result o the expandedprogram, participation and diversityo enrollment have increased rom320 sta and aculty with an averagesalary o $66,172 in 2006, to 549employees with an average salary o $53,060 in 2008. Minority enrollmentincreased rom 19 percent in 2006 to40 percent in 2008.

Since we expanded the programto include other schools, theres been alot more participation among non-

exempt employees, skilled labor sta and minorities, which is wonder ulbecause we want all Duke employeesto have the opportunity to developpro essionally, Green said.

Adding community colleges makesit easier or healthcare workers andnon-exempt employees with non-traditional schedules to tap into thetuition bene t, Green said.

Take Jones, the utility worker withDukes Housekeeping Operations.Hes a ather o our who works thethird-shi t at Duke rom 11:30 p.m.

to 8 a.m. and attends evening classesseveral times a week at Durham Tech.Going back to school is challenging,he said, but the rewards o careerdevelopment are priceless. When hegraduates in about two years, he willbe the rst person in his immediate

amily to receive a college degree.Its a lot o hard work to be back

in school with a ull-time job andamily, but Im learning a lot o skills,

said Jones, who joined Duke in 2004.

Patricia Agbai, a health unit coor-dinator in Duke University HospitalsHeart and Lung Transplant Unit, isalso tapping into the tuition bene t tolearn new skills that will expand herresponsibilities at Duke.

Shes pursuing a bachelors degreein social work at Shaw University, her

rst degree. Shes on track to graduatelater this year.

In working with patients in theTransplant Unit, the social work skillsIm learning will allow me to help

amilies who are coping with majormedical challenges even more, Agbaisaid. When Im done, I want to be awealth o knowledge or Duke to use.

Although most Duke employeesuse the tuition bene t at local colleges,there is growing demand or the tuitionprogram in satellite o ces. To addressthis, Duke expanded the program thisyear to allow employees to apply or awaiver to attend accredited out-o -stateschools in speci c circumstances.

Thats especially help ul oremployees in highly-specialized eldswho might not be able to nd thecourses they need in North Carolina,

Green said.And with the way Duke is

growing globally, this will also help theincreasing number o Duke sta and

aculty based outside the state.Convenience is a big actor

or Daniel Rudd, a clinical sta assistant at The Preston Robert TischBrain Tumor Center at Duke. Hestaking evening classes at AlamanceCommunity College, near his home in

Prospect Hill in Caswell County.When Im done, Ill have anassociates degree and be a registerednurse without having a lot o loans topay o , Rudd said.

In addition to using the EmployeeTuition Assistance Program, Ruddis hoping to eventually enroll inDukes new Registered Nurse TuitionAssistance Program to continuedeveloping his skills.

Its great that Duke assistsemployees who want to advance theircareers, Rudd said. I love helpingthe patients at Duke. By using thetuition assistance program to get mydegree, I will be able to do even moreto help others.

This semester, Jones, the utilityemployee in housekeeping, is takingtwo courses in English and math atDurham Tech.

Nowadays, almost every machineor appliance has electronic componentsand circuit boards, he said. When

I get my degree, Ill be able towork on those. n

b Miss b x e , Senio W i e , O e ocommuni ion Se vi es

tUItIOn, co .

W en Im one, I w n oe we l o nowle eo du e o use.

P i i a i, e l uni oo in o ,he n Lun t nspl n Uni

t a cb h mb2008 p c

$1,036,673 tui io paid by Duke

549 S a a d acul y e olled

88 Pa icipa s a Du ham tech

75 Pe ce o emale pa icipa s

$53,060 Ave age sala y o pa icipa s

38 Ave age age o pa icipa s

9.45 Ave age yea s o se vice

v dSee a video abou he ui io be ewi h Ask the Expe a h :// .h .d k . d /

t tr mb m Read program details at h p://ww

h .duke.edu/ ui io

Discuss professional development wityour supervisor to determine coursesrelated to your current job orcontinued career growth at Duke.

Download the Employee TuitionAssistance Program application ath p://www. h .duke.edu/ o msand complete it with your s upervisor.

Complete and return the applicationby mail or ax be ore the frst day oeach class to request reimbursement.

If approved, Duke Bene ts will send ae-mail with your eligibility confrmatiand reimbursement request orm.

Within 60 days of completing eachclass, submit to Duke Benefts a copyo the e-mail confrmation, proo o C or better in coursework and areimbursement request orm com-pleted by the school attended.

F F c :The cost o books is not covered. Andi you voluntarily terminate employmewithin two years o receiving more tha$2,500 in tuition reimbursement, youmust repay 50 percent o the amountover $2,500.


11/16

n e w s F e a t u r e

the Scie ce & resea ch Suppleme o I side Duke Medici e

VOLUME 18 NO. 3 n insi e. u eme i ine.o n M 2009

Mo e ha jus he be dsBy Kelly Malcom

C lad in swim trunks and neopreneslippers, Jason, a medical student,climbed out o the chamber, drip-ping wet. Care ul not to disturb thecatheters put into his arms to measurehis blood pressure and pulmonaryarterial pressures, he walked into anadjacent room to recuperate rom hisunderwater exercise.

Jason had answered the call or tvolunteers to assist in a clinical studyto understand immersion pulmonaryedema, a condition that causes somedivers lungs to suddenly ll with fuid.

The condition is li e-threateningand has caused some swimmers anddivers to die, said principle investigatorRichard Moon, M.D., pro essor o an-esthesiology and medical director o theDuke Center or Hyperbaric Medicineand Environmental Physiology. Werestill unclear as to what causes pulmo-nary edema but it could be related tohigh pressures in the pulmonary artery

or de ciencies in the way some peopleclear their lungs o fuid.This Navy- unded study is just

one example o the ongoing basicand translational research projectsat the Center.

The acility, located in DukeSouth, contains an impressive series o chambers, the largest o which can holdup to 12 patients plus sta , as well aswater tanks or physiological studies.In an area resembling the controlroom o a submarine, physicians andtechnicians constantly monitor oxygen

levels, pressure, and patient conditionin each chamber. Hyperbaric oxygen isadministered or a variety o medicalconditions, including most amously,decompression illness, colloquiallyknown as the bends.

Scuba divers and people who workin pressurized environments who returnto normal atmospheric pressure andaviators and astronauts who rapidly

transition to low pressure environmentscan develop bubbles o nitrogen gasin their tissues. Symptoms can includeskin rashes, joint pain, and more serioussymptoms such as blurred vision and

disorientation. Sever decompressionsickness can be li e threatening.

Treatment requires the admin-istration o 100 percent oxygen ina pressurized hyperbaric chamber,usually or one or more periods o 4-6 hours. Duke University MedicalCenter is also where the Divers AlertNetwork (DAN), a network thatprovides educational and emergencyin ormation or recreational diversinternationally, got its s tart. Dukephysicians routinely consult or DANand Dukes hyperbaric acility is open

or emergencies 24 hours a day, sevendays a week. Dukes chamber is the

largest civilian acility in the worldDukes acility is not just

another hyperbaric chamber, said John Freiberger, M.D., MPH, assistapro essor o anesthesiology. It is aunique acility where investigatorsreadily research the e ects o extenvironmental conditions on humanphysiology. Current projects deal wtopics ranging rom molecular biol

to the ill patients bedside and all stror an in-depth understanding o th

biology o oxygen and other metabgases and their clinical applicationsFreiberger is currently investigating

the use o hyperbaric oxyor the treatment o jaw

necrosis in patients who hareceived certain drugs orchemotherapy that inhibitbone cell growth.

In addition, he has a pistudy to diagnose chronic

carbon monoxide (CO) exposure andexamine possible prevention e orts

medically underserved populations.Hyperbaric oxygen is o tenprescribed or victims o house reor suicide attempts who are acutelyexposed to elevated CO, becausein addition to its known immediatetoxic e ects, CO can have devastatlong-term neurological consequencei not treated immediately. This hasimportant public health implicationsbecause even low levels o chronicCO intoxication may lead to subtlebut signi cant changes in neurologic

Ou s u ies un e mu omn l zin e e e s o p essu ize

sui s on NaSa s on u s o usinox en o elp n e p ien s. Jo n F ei e e , M.d., MPh

ssis n p o esso o nes esiolo

see HYPErBArIC, p.12

A ibody oHIV discove edBy Michelle Gailiu

Duke researchers have or the frst timeisolated an important antibody in humanserum that could potentially play a key role inthe design o an AIDS vaccine.

The research appears as a highlighted eatureonline in the Journal o Virology .

The 2F5-like antibody is one o the goldstandards or what an HIV vaccine needs toinduce, but no one had ever ound it be orecirculating in the blood o in ected patients,says Georgia Tomaras, PhD, associatepro essor o surgery, immunology andmolecular genetics and microbiology in theDuke Human Vaccine Institute and the seniorauthor o the study.

The 2F5 antibody is especially valuablebecause previous research has shown it cansuccess ully neutralize 80 percent o transmit-ted HIV viruses.

Now that researchers have ound the antibodyin circulating blood, Tomaras says they mightbe able to fnd ways to duplicate or enhance it,thereby boosting the bodys de ense system.

2F5-like antibodies belong to a class oimmune cells called broadly neutralizingantibodies, one o the bodys most power ulresponses to in ection. Only a small raction opatients with HIV make these antibodies and

they typically appear many months a ter initialtransmission o the virus at a point whenscientists eel it is too late to do much good.

Tomaras, working closely with lead authorXiaoying Shen, led a team o researchers whoexamined the antibodies present in 300patients in ected with HIV-1. They ound onlyone patient who had developed 2F5-likeantibodies, supporting the notion that theyare, indeed, very rare.

Researchers discovered that the 2F5-likeantibody was potent enough to block multiplestrains o HIV in the laboratory, but research-

the Duke Ce e o Hype ba ic Medici e a d E vi o me al Physiology esea ch u s he gamu om he e ec s o va ious p essu es

o he huma body o he i fue ce o oxyge a d ca bo dioxide o cellula o ga elles. PHOtOS COUrtESY HYPErBArIC MEDICInE

see HIV, p.12

HIV-1 buddi g om cul u ed lymphocy e.Mul iple ou d bumps o cell su ace

ep ese si es o assembly a d buddi g ovi io s. PHOTO COURTESY WIKIPEDIA COMMONS


12/16

2 I qui y Mar

Scie ce Edi o : Kelly Malcom

Inquiry eatures science and research-related news items rom Duke MedicineNews and Communications and otherDuke departments. To submit content,contact us at edi o i [email protected]

unction i exposure persists over time.Epidemiologic research has shown

that certain populations, especiallyrecent Hispanic immigrants, may bemore likely than other ethnic groups tobe exposed to chronic, low-level COexposure through the use o generatorsor cooking grills indoors. This studyseeks to document CO exposure anddevelop strategies or prevention in allpopulations vulnerable to this disease.

Although CO is a knowntoxin, it is also a normal product o metabolism and may have importantroles in cell signaling. Researchers at

Dukes hyperbaric center areutilizing the acility to examinethe e ects o carbon monoxideand oxygen on mitochondria,the powerhouse o the cell.

CO at high levels inficts damagethrough oxidative stress, says HagirB. Suliman, Ph.D., assistant pro essoro anesthesiology. At low doses,though, CO has an important role incell signaling. Certain chemotherapydrugs, such as doxorubicin, cancause mitochondrial damage andcardiac cell death. Suliman and her

colleagues have ound that exposureto low levels o CO can promote thebiogenesis o mitochondria, a processthat may be intimately involved with

the underlying mechanisms o woundhealing and aging.

Dukes hyperbaric acility is spe-cial because o its commitment to bothquality clinical care and to high-caliberresearch, said Freiberger. Our stud-ies run the gamut rom analyzing thee ects o low atmospheric pressure onNASA astronauts to using hyperbaricoxygen to help cancer patients healchronic wounds. We have the clinicaland scienti c depth to gure out howto make people better in a rational andreproducible way. n

HYPErBArIC, co .

du es pe i ili is openo eme en ies 24 ou s ,

seven s wee .

An immune system response thatis critical to the rst stages o ghting o viruses and harm ul

bacteria comes rom an entirelydi erent direction than most scientistshad thought, according to a ndingby researchers at the Duke UniversityMedical Center.

This nding will have importantimplications in vaccine science andautoimmune disease therapy develop-ment, said Michael Gunn, M.D.,

an immunologist and cardiologist atDuke and senior author o the studypublished in Nature Immunology.

Type 1 helper (TH1) T cellimmune responses are critical orthe control o viruses and certainbacteria. Immunologists have gener-ally believed that TH1 responses areinduced by rare immune cells, calleddendritic cells. When activated byin ection or vaccination, the dendriticcells were thought to move romperipheral tissues into lymph nodesto stimulate T cell responses.

The Duke researchers ound,

however, that the dendritic cells thatstimulate TH1 responses didnt comerom peripheral tissues, but rather

arose rom monocytes, a common celltype in the blood, that moved directlyinto lymph nodes a ter in ection.

The result speaks to the mostbasic principles o immune responseto pathogens, Gunn said. It mayalso explain the poor results we haveseen in attempts to develop e ectivedendritic-cell vaccines.

Gunn previously had identi eda particular protein, known as a

chemokine, that stimulates themigration o activated dendriticcells rom peripheral tissues to lymphnodes. The researchers generateda TH1 response in laboratory micethat lacked this chemokine withinfuenza viruses.

We really thought the micewould not be able to generate much

o an immune response at all, Gunnsaid, because they wouldnt be ableto mobilize dendritic cells. Themice, however, had increased TH1responses. We knew we had to ndwhat was really causing the response.

One scientist who knew aboutthese ndings told Gunn the groupwould never gure this out becausetheir ndings were so unconventional.

To solve the mystery, the Duketeam studied several di erent typeso mice, which were missing otherchemokines or chemokine receptors.

They ound that mice without theCcr2 chemokine receptor that controlsthe migration o infammatory mono-cytes had much lower accumulation o monocyte-derived dendritic cells andTH1 responses.

The scientists concluded thatthere is a blood-derived lymph nodedendritic cell type that has a key role

in developing acute T-cell responses.For so long, dendritic cells romtissues were the obvious answer,Gunn said. We ound out that thatsnot always the case.

The team now plans to look atthe blood-derived dendritic cells underdi erent conditions to see i they mayhave other activities. We observedthe activity o these cells a ter TH1-inducing stimuli, like infuenza,Gunn said. Next wed like to studyother types o immune stimuli to seehow the cells respond. n

A ew di ec io o immu e espo se

Duke esea che s have ou d ha he immu e espo se agai s i ec io begi sdi e e ly ha p eviously hough . FILE PHOTO

ers say they are not entirely clear i it playany part in controlling the virus in the

patient who carried it.The scientists were also struck by anotherdiscovery: The 2F5-like antibodies aroseconcurrently with particular autoantibodiethat may be a clue as to why theseantibodies developed in this person and nin others.

Tomaras and her team have created theopportunity or us to isolate and study thimmune cells that enabled the productiono this very rare antibody, says BartonHaynes, MD, director o the Duke HumaVaccine Institute. Our goal will be tounderstand how to trigger these cells toroutinely make these kinds o antibodiesbe ore in ection occurs.

The research was unded by the NationalInstitutes o Health and the Duke Center AIDS Research.

HIV, co i ued

1s A ual Humaresea ch P o ec io sP og am Wo kshopImp ovi g resea ch Quali y

All those involved in clinical research atDuke including investigators, coordinatorand administrators are encouraged toattend this workshop.

Featured guest speakers will include:

G eg Koski, PhD, MD, CPI , pro essor anesthesiology at the Harvard School oMedicine, speaking on Investigators Roin a Model HRPP.

G egg omell, MD , executive directorthe O fce o Human Research at theUniversity o Pennsylvania, speaking onHow to Engage Your Investigator in theHRPP Process.

Gigi McMilla , BA, o the Childrens

Brain Tumor Foundation, speaking onInvestigators Interactions with VulnerablPopulations: Specifc Considerations.

Whe : April 29 12:00 pm-4:30 pm ORApril 30 7:30 am-12:00pm

Whe e: Searle Center

For more in ormation and to register:h p://c so.som.duke.edu/


13/16

3 I qui y Mar

Men with a common genetic vari-

ant produce more than twice asmuch o a hormone known to increaseblood pressure and blood sugar whenthey are angry, according to researchers

rom Duke University Medical Center.The ndings, presented March 6 at

the American Psychosomatic Societysannual scienti c meeting, shed morelight on the notion that stress cantrigger physiological changes that resultin the development o cardiovasculardisease and type 2 diabetes.

We know that emotional stresscan lead to negative health outcomesbut our goal with this study was toobtain a better understanding o thebiological mechanisms behind thisphenomenon, says Red ord Williams,M.D., director o Dukes BehavioralMedicine Research Center and studyco-author.

Researchers analyzed variants o serotonin receptor genes, which regu-late e ects o the neurotransmitterserotonin on emotions and physical

unctions, including levels o the stresshormone cortisol.

We looked at speci c pointsalong a cascade o events, says

Stephen Boyle, Ph.D., study co-author.Serotonin is processed in the brainand controls the release o cortisol bythe adrenal grand. Cortisol is knownto stimulate the production o glucoseand makes the infuence o adrenalinemore pronounced.

Researchers measured cortisolin two blood samples taken rom 41

men. One sample was collected duringa ve-minute resting period and theother during ve-minutes when theydescribed a recent event in their livesthat made them angry.

Men with common variants o one o the serotonin receptor genes(5HTR2C) had increased cortisolproduction when recalling a situation

that made them angry. One o those

variants was associated with an averincrease in cortisol that was more thatwice as large (70 pg/ml vs. 30 pg/mwhen compared with men possessingthe other variant o the same gene.

Interestingly, one o the genetvariants associated with a prominenta ect on cortisol production is alsoknown to alter the amount o receptprotein the gene makes, says WilliaThis tells us that this variant is astrong candidate to be responsible othe ndings we observed.

This work may provide a clearunderstanding o the genetic and envronmental actors that combine to pusome men at greater risk or developincreased belly at, type 2 diabetes acardiovascular disease, adds Boyle.

The next phase o research wilstudy large samples o people todetermine i men with the geneticvariant associated with larger cortisoresponses to anger seen in this study more likely to develop type 2 diabeteor cardiovascular disease.

The research was supported by grant rom the National Heart, Lungand Blood Institute. n

Ge e ic li k be wee a ge a d heal h p oblems

By targeting and disabling a protein

requently ound in melanomatumors, doctors may be able to makethe cancer more vulnerable to chemo-therapy, according to early results o a clinical study conducted by research-ers in the Duke ComprehensiveCancer Center.

In this pilot study, we gavepatients with advanced extremitymelanoma a compound that had beenshown in pre-clinical studies to weakenmelanoma tumors by targeting aprotein expressed on the sur ace o thecancer cells. When chemotherapy wasthen given by in usion, it was much

more e ective compared to chemo-therapy given alone, said DouglasTyler, M.D., a surgeon at Duke andthe Durham Veterans A airs MedicalCenter, and senior investigator on thisstudy. Not only was the treatmentwell tolerated but a surprising numbero this small group o patients had their

tumors completely disappear.The researchers discussed their

ndings in an oral presentation onMarch 6 at the Society o SurgicalOncology annual meeting, and resultso the study have been accepted orpublication in the journal Cancer.The study was unded by AdherexTechnologies, the company developingthe compound that was tested incombination with chemotherapy, theUnited States Department o VeteransA airs, the Duke Institute or GenomeSciences & Policy, and the DukeComprehensive Cancer Center

Data rom 16 patients treated

at Duke and the University o TexasMD Anderson Cancer Center wereexamined or this study. Hal o themexperienced a complete response oran obliteration o cancer as a resulto treatment, Tyler said. The compound called ADH-1 was deliveredintravenously and the chemotherapy

given under surgical conditions, throughthe artery and vein in the a ected limbs.

Melanoma o ten a ects people ontheir extremities, with a common sce-

nario being a mole that appears on theoot and then spreads up the leg. Up to

ten percent o patients with extremitymelanoma develop multiple recurrencesin the extremity that cannot be treatedwith surgery alone.

These early results are very excit-ing because metastatic melanoma is

one o the most deadly cancers andwhich is typically very unresponsivtherapy, said Georgia Beasley, M.Da surgical resident at Duke and leadauthor on this study. The next stepwill be to continue testing the e cao this treatment in more patients, hand at other centers.

A larger phase II trial involving46 patients with advanced extremitymelanoma, using the same combinato drugs, was designed to try and bede ne the response rate in this popultion, Tyler said. This trial has recentlycompleted recruiting patients and datwill be orthcoming, he said.

The incidence o malignant mnoma is increasing at a rate aster any other cancer, with 60,000 newcases expected to be diagnosed thisyear in the United States. Melanomthat has spread beyond the primarysite is rarely curable, and treatmentoptions are limited. n

D ug combo may be e ec ive agai s deadly mela omaNo onl w s e e menwell ole e u su p isin num e o issm ll oup o p ien s

ei umo s omple elis ppe .

dou l s t le , M.d., su eon n senioinves i o on e s u


14/16

e s s a y

By Susa e B. Haga, IGSP

The more than 50 rookiecongressional members whoheaded to Washington in January

ace a steep learning curve oncomplex and, probably, un amiliarsubjects, rom oreign policy tothe budget appropriations process.Many o these topics will involvescience in one orm or another rom scienti c evidence under-pinning a speci c policy to decisionsinfuencing the direction, investmentand advancements in our countrysscienti c enterprise.

Consider that more than $38billion was spent by the ederalgovernment in 2007 or health-related research and more than$2 billion or energy research andtechnologies. Thats not as highas the numbers attached to thestimulus package but large enoughto get our attention when it comesto educated decision-making.

President Barack Obama hasstated that he aims to promotescienti c research and incorporatescienti c evidence into policy de-bates. This re-emergence o scienceas a national policy priority requiresa level o in ormed engagement thathasnt been seen in Washington insome time.

From medicine and health careto ood sa ety, energy, space andthe environment, science will play akey role in many o the policies ourlegislators will propose and debate.Members o Congress possess arange o backgrounds, includingministers, sheri s, armers andaccountants. More than 40 percenthold law degrees, but only 8 percent

hold a medical or doctorate degreewith ormal training in science andthe scienti c process.

With the exception o a smallgroup o doctors and scientists,most members o Congress lackthe background to understand theprocess o science and the subtlenuances that justi y investments inscience and engineering or changesin existing priorities.

What to do? We should takea lesson rom the British andencourage all reshman memberso Congress to take a crash coursein science to equip them with a

undamental understanding o how research is conducted andthe strengths and weaknesses

inherent in any scienti c dataset.The Conservative Party in GreatBritain recently announced thatit will include classes on scienti cmethodology and basic conceptsin the orientation activities or

all new Conservative members oParliament a ter the next electiospeci cally to address politicianlack o scienti c expertise.

Shadow Science Minister AA riyie, the architect behind thenew courses, says, By buildingbase o scienti c knowledge ampoliticians and o cials, we aimstrengthen the role o science inpolicy making.

Although the o cial orienttion or our new congressmen halready taken place, it isnt too lto impart some knowledge aboutsubjects they almost certainly wbe voting on. A good starting powould be with the scienti c grouthat already visit Capitol Hill topresent workshops and seminarsThe need or education worksin both directions: the scientist-politicians, or instance, should brushing up on Economics 101.

Although public policy israrely based on scienti c evidenalone, it no doubt could bene t

rom improved dialogue betweeexperts and policymakers. Evenseemingly unrelated policies onimmigration and de ense will ha

implications the scienti c rsearch enterpr

Let us besure that ourpolicymakersmaking in or

decisions, or these decisions mwell impact generations to comeSus nne b. h is senio poli n l

n n ssis n ese p o essoIns i u e o genomi s S ien e & Poldu e Unive si . n

4 I qui y Mar

l e C t u r e

Ch c l cClay Ch is e se , Ha va dp o esso a d au ho o TheInnovators Dilemma , speaks othe I ova o s P esc ip io :the u u e o Academic Medici ea d Heal h Ca e. Ma ch 11 a10:30 a.m. Ge ee Audi o ium aDukes uqua School o Busi ess.

e v e n t

r ch C Dthe s esea ch Ca ee Daywill be held o Wed, May 6. to

egis e , visi h :// chc d . .c m/ m / d k -m d c - ch-c -d - g / . regis a iowill be ope u il Ap il 15.

o n l i n e

D k a cA lis o he mos ece a iclby Duke au ho s added o hePubMed (MEDLInE) da abase isupda ed eve y Su day a d cabe ou d a h :// .mc -b .d k . d / b / d k h

w h b b c fc k dg , m mb C g dh c b b d m k m d d c

c c - d c .ILLUStrAtIOn BY VAnESSA DEJOnGH

Lawmake s eed a c ash cou se i scie ce

t e e-eme en e o s ien e s n ion lpoli p io i equi es level o in o meen emen sn een seen inW s in on in lon ime.


15/16

Ma ch you insi e 's ui e o w 'sppenin du e Me i ine

C a l e n D a rC a l e n D a r


doMa ch 9 5:30-6:30 p.m.live FoR liFe R /Wa k c bstarts its 12-week session with a new breathing techniques ses-sion at 5 p.m. each Wednesday and strength trainingclass at 5 p.m. each Monday and Wednesday. Sta

and aculty in the club meet 5:30-6:30 p.m. everyMonday and Wednesday. Beginners meet at the EastCampus track, across rom Whole Foods on BroadStreet. Advanced runners and walkers gather in ronto Wallace Wade Stadium on West Campus.d a :hr. k . /r wa k

Ma ch 12 4-6 p.m.d k u r y Phy a A a Pr ramop H in celebration o the new acility on800 S. Duke St. in Durham. Guided tours and lightre reshments.RsvP: M r .W y@ k .

r 681-3159

Ma ch 22 12-4 p.m.Fr Fam y day a h na h r M m f Ar

Celebrate Escultura Social: A New Generation o Artrom Mexico City with live entertainment, hands-on

projects and gallery hunts. Limited tickets availableat the door only.d a : 684-3314

Ma ch 24 5:30- 6:30 p.m.d k R /Wa k c b W rk h p Prepping orRaces Whether you are planning on participatingin a 5K run/walk race, competing in a triathlon orrunning a marathon, preparation is a must. MegPomerantz, director o the Duke Faculty Club, willdiscuss the trials and tribulations rom her ownexperience o training as well as teaching the groupwhat works best or your race o choice.Wa aWa s a m, A m B x

learnMa ch 18 12 p.m.duson R ar h c f r s r with Shar-ron Docherty, Ph.D. and Debra Brandon, Ph.D. A se-ries designed to stimulate discussions and showcaseemerging issues in nursing and research. Open to

nursing school aculty and students, Duke Investiga-tors, and DUHS nurses interested or engaged inresearch.c pp R ar h B , R m 1017

Ma ch 18 5:30-7:30 p.m.Ra , g a H a h s m ar s rThesixth seminar in the monthly series under the themeo Race, Genetics and Health will be presented byFatimah Jackson and will ocus on her method ogroup classifcation. These seminars are a orum orthe systematic examination o the role o racialdi erences in explaining health disparities. Dinnerprovided. RSVP, by March 11: a. a -kh r @ k .

Ma ch 18 6:30- 8:00 p.m.d k i ra M Fr i f rmas We invite you to a ree in ormation sessionto explore Duke Integrative Medicine. In our state-o -the-art healing environment, our expert physiciansand therapeutic sta will share in ormation about ourunique approach to healthcare--and how it can makean enduring di erence in your li e. Light re reshmentswill be served. Center or Living, Integrative MedicineBuilding, Room AB.d a : 681-2958

Ap il 1 8:30 a.m. - 4:30 p.m.d k H m car a H p pr a

f r with nationally renowned speakegrie counselor Alan Wol elt or both pro eand lay people. Sarah B. Duke Gardens PaviliThere is a $100 ee to register. Six nursing chours or 0.6 CEUs will be awarded.R r:h p:// h h. h . k . /wy wy / w

a /Br h r _w r _ f_ r f.p

giveMa ch 14 10 a.m.s p u o 5K R /Wa kJoin DukeGastroenterology to raise money and supportthe fght against colon cancer. Registration is$15 and orms are due by March 6. Registratincludes t-shirt, goodie bag, and box lunch. DForest Al Buehler Cross Country Trail in DurR r: h p://www. k h a h. r /

/20090128164313538

Ma ch 28 10 a.m.2009 s A a tr a K y Wa

Duke Medicine is helping fght chronic kidneydisease as a premier sponsor o the Triangle Walk. The 5K non-competitive walk will raisand awareness about kidney disease. ResearcTriangle Park Headquarters.d a : 388-1602h p://www. r a k ywa k. r

Ma ch 29 9 a.m. - 12 p.m.B B a tr 5KCome run a 5K in supo Habitat or Humanity and your avorite ror UNC. Cost is $20. All proceeds will go towHabitat or Humanity o Durham and Chapecation: UNC Ranson-Hamrick Cross Countryin Chapel Hill.d a : 668-5700

how o su mi :Send calendar listings to

r @m . k .

W n mo e in o?Visit us online ath p:// .

k m . r

The Calendar is a monthly selectiono events that eature the best ohappenings at Duke and Duke Medicine

A e d a semi a o race, Ge e ics a d Heal h, o Ma ch 18. this is he six h i a mo hly se ies ha discusses he ole o acialdi e e ces i explai i g heal h dispa i ies. De ails below. ILLUSTRATION BY VANESSA DEJONGH


16/16

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F db cktell us w ou in h p://i side.dukemedici e.o g . cli on a ou

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S eve Adai , du e r lei Se u i ,m e su e p ien s, visi o s n s

e s e:

Long a ter most employees have gonehome and into the evening while othersare working, this o fcer is checkingdoors (377 o them each night),reminding employees to lock up and gohome and giving assistance to custom-ers who fnd their way to Duke Raleighin the wee hours o the morning. Forfve years, he has been making sure thatthe campus is sa e and secure so thatthose sharing the shi t can do theirwork ree rom worry.

Jus a ew o you colleagues whove

eceived High ives:

Jolly Joh , lini l nu se II on 5300 dUh, m e l s in imp ession

on p ien s mo e :

Jolly has been a blessing to my daughterand mysel while in the hospital. She wavery attentive and showed so much careand concern. My daughter rememberedher name out o all nurses that took careo her. We love you, Jolly!

Mo e e Mabolo , o du e r leiNu sin , w s p ise o in euni lose o e e :

Monette Mabolo pays attention towhat we say and to what mattersmost to us. She continues to come inearly to interact with the night shi tand provide them with leadership andsupport as well. To oster camaraderiebetween the nurses and nursingassistants, she has them give report toeach other at the beginning o the shi tor whenever there are abnormal vitalsigns that the nursing assistants note.As a result, our unit has become moreclosely knit as a team.

a p ien n e e en i e ccUs du m re ion l hospi l,espe i ll Ma k B a ch, M.D. :

Our amily would like to personallyTHANK YOU or the excellent, pro es-sional care you gave our ather rom Sept.24th - Oct. 7th. The Lord truly blessed us,and our ather, during this time with ourangels o care he provided. Your heart eltconcerns or our ather (your patient) could be seen and elt by the amily. Ourhearts and prayers go out to the CCU

amily. Thank you! Thank you! Thankyou! May God bless you as you care orother amilies the way you cared or oursand in your everyday li e!

A is a S ewa , m mmo pe nolo is du e Unive si

hospi l, elpe p ien eel e se:

Arista was so kind and sensitive. Shemade me eel at ease. I have beengoing to her or the past three years.She is wonder ul and awesome.

a p ien ells w Shelley Mcnailini l nu se IV du e Unive si

hospi l, is ue sse o du e:

Shelly hustles nonstop to help me getthrough these di fcult days. She takesthe time to bathe me and does so withmuch care and compassion like I amher mother. She is a true asset to Duke!

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

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