VOLUME 17 NO. 7 n inside.dukemedicine.

org n July 2008

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duke difference working

Global Health PLUS A smoke-free success

Coordinating with the Chinese One year ago, Duke Medicine
government, Duke Medicine is went tobacco-free. About 1,000
sending a truckload of needed people have sought help in
medical equipment into the quitting smoking — read about
earthquake zone. Page 4 the struggle of one of them,
Rodd Mangum. Page 13
2 Inside Duke Medicine July 2008

IN S IDE S COO P ON T H E WEB

Highlighting the best health,

Genetics and Grandpa's 95 years science and employee news

from Duke Web sites

O n a recent visit to my hometown

of DeKalb, Ill., I spent a delightful
afternoon sitting with my 95-year-
fight disease, will help me stay as
sensible and spry into my nineties.
I don’t have to look too far.
■ ■ du k e b loggers

old grandfather beside a backyard In this issue of Inside Duke

waterfall. The weather was gorgeous,
bunnies were nibbling the grass and the
Cubs were winning — paradise!
Grandpa Louis Sisco, right, had
built his house 62 years ago, when
he moved out from Chicago for
easier access to his job as traveling drug
salesman for McKesson Corp. (As a
kid in the Roaring Twenties, he sold
newspapers on a downtown Chicago
street corner.)
“What’s your secret to longev-
ity?” I asked him.
“A positive attitude and a sense
of humor,” he answered right away.
I’m sure his daily walk, taken at
4:30 every morning for more than 50
years, helped, too.
These days, genetic genealogy is
a passion of mine – I’m keen to know
how the genes I’ve inherited from
my grandparents, combined with the
environment in which I’ve grown up
and pharmaceuticals developed to
Medicine, we explore how Duke
scientists and clinicians are finding
ways to personalize medicine to the
unique genomes of patients. Kelly
Malcom has two articles, about
research at the Institute for Genome
Sciences and Policy and about
From the field
treatments tailored to gene variants.
And Misha Angrist, aka GenomeBoy, More than a dozen Duke students and faculty
explains why he volunteered to make blog during their global health field experiences,
including one student who is studying lemurs
his genome available to science.
in Madagascar, and the impact the destruction
“I’ve lived a long life,” my of their habitat will have on public health.
grandpa said to me, about all the http://lemurhealth.blogspot.com/ and
genomics he knows to share. And http://globalhealth.duke.edu/education-
with that, I left him to don his fieldwork/fieldwork-blogs
headphones for the final innings of
the ballgame. n ■■RE ADINGS
– Anton Zuiker

feedback

Now it's your turn

Fuel for thought
Win a chance for prizes by telling us what you think about Inside Duke Medicine
Two Fuqua School of Business profs (shown
Earlier this year, Inside Duke Medicine changed its look and above) argue that posting a vehicle’s fuel
re-energized its content. Inquiry, a new section showcasing the efficiency in “gallons per mile” rather than
best in science and research at Duke Medicine made its debut. “miles per gallon” would help consumers make
better decisions about car purchases and
Some fast facts about Inside Duke Medicine: environmental impact. http://www.duke-
news.duke.edu/2008/06/gpmfuqua.html
• Serves employees across Duke Medicine.
• Distributes 18,000 copies. John Staddon, Ph.D., James B. Duke professor
• Is produced by the Office of Internal Communications within of psychology and brain sciences at Duke
Duke Medicine News & Communications. University, writes about how U.S. traffic
• New issues come out on the first business day of every month. signs challenge driver attention and lead to
• Can be reached by email at editorinside@mc.duke.edu more accidents, in the July/August issue of
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You’ve heard from us. Now it’s time to hear from you. doc/200807/traffic

Please go to our Web site — http://inside.dukemedicine.org — Recent Nicholas School for the Environment
follow the ‘Share your thoughts’ link, and fill out the short survey. & Earth Studies graduate Michael Stringer
created Velocommuter.org to help fight
You’ll be glad that you did. Not only will you help us improve,
global warming by encouraging people to
but survey takers who respond by Aug. 1 and leave an e-mail
leave their cars at home and bike to work –
address or telephone number will be entered into a drawing
if only for a day. http://www.nicholas.
for a $25 gift certificate to the Medical Center Bookstore. The
duke.edu/news/ns-velocommute.html
first 15 entries will also receive a Duke Medicine water bottle.
and http://www.velocommuter.org/

See page 16 for five ways to save gas.

■ ■ I N S I D E V olume 1 7 , I ssue 7
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.
Contact us
Campus mail: DUMC 104030
Deliveries: 2200 W. Main St.,
Suite 910-B, Durham, NC 27705
Phone: 919.660.1318
E-mail: editorinside@mc.duke.edu
Credits
Cartoon: Josh Taylor
Staff
Editor: Anton Zuiker
Managing Editor: Mark Schreiner
Science Editor: Kelly Malcom
Calendar Editor: Erin Pratt
Designer: Vanessa DeJongh
Intern: La-Tasha Davis
Copyright © 2008
Duke University Health System
July 2008 Inside Duke Medicine 3

C A L END A R

July/August Your insider's guide to what's

happening at Duke Medicine

do
August 8
Deadline for submissions to the 30th Annual
Employee Arts Show. Health Arts Network at Duke
(HAND) is accepting submissions from current and
former Duke University employees and volunteers until
Aug. 8. Applicants can submit up to three pieces. Win-
ners receive an award and their artwork will be shown
in the Mars Gallery of Duke North. Applications:
http://www.hr.duke.edu/events/artshow.

August 10-13
Fourth Annual Pink Ribbon Yoga Retreat for
Breast Cancer Survivors sponsored by the Duke
Cancer Patient Support Program. The retreat offers the
opportunity to relax on the beach at The Trinity Retreat
Center in Salter Path. The retreat combines yoga,
health information and healing modalities for breast
cancer survivors. Yoga experience is not necessary to
attend. http://www.pinkribbonyoga.org

Pam Isner with her winning entry from

the 2007 Employee Arts Show. Submit your
work for this year's show by August 8.
photo by health arts network at duke (HAND)
learn
July 9 10:30-11:30 a.m.
July 5 8 a.m.-12 p.m.
Introduction to Infant Massage A four-week
North Hills Farmer’s Market sponsored by Duke
series that will introduce mothers to the basics of
Raleigh Hospital. Enjoy fresh produce at North Hills
infant massage. Join Debbie Carter, International
Commons in Raleigh. The market will open July 5 and is
Association of Infant Massage, at the Teer House
planned to operate 8 a.m.-12 p.m. each Saturday through
for the class. Register: 416-3853.
early October. The market will feature fresh vegetables
and produce, as well as flowers and herbs. http://www.
northhillsraleigh.com/FarmersMarket.htm F E AT U R E D activity

July 21-25 July 10 4-5 p.m.

5-day Summer Research Courses on Spirituality,
Theology and Health Each course will focus on
how to conduct research on these topics and how to
develop an academic career. Participants will each
have 30 minutes one-on-one with Dr. Harold Koenig
and 30 minutes with another mentor of their choice.
http://www.dukespiritualityandhealth.org/
“Health Care Reform and Presidential Politics,”
the first annual Duke AHEC Program Lecture, given
by health policy expert Jonathan B. Oberlander, Ph.D.
Searle Center Lecture Hall Reception immediately Tune up your bike and hit the road for the Duke Multiple Myeloma Bike Ride on
following. The lecture is free and open to all Duke Uni- July 12. Details below. file photo
versity Health System faculty, staff, trainees, & students.
RSVP to tara.owens@duke.edu or call 684-2648

F E AT U R E D activity
July 29 11:30 a.m.-1:30 p.m.
Raleigh Chamber of Commerce Executive
Women’s Luncheon Jan Hargrave, nonverbal com-
munications expert and author of Let Me See Your
Body Talk and Strictly Business Body Language, will
address personality types, strategies for working with
others and body language. Attendees will identify
ways to bring out the best in others. Attendees will
also learn how to listen to the “full body” to eliminate
distractions and improve concentration. The luncheon
presented by Duke Raleigh Hospital will be at the
Hilton in North Raleigh. Register: http://www.
raleighchamber.org
August 5 6:30-8 p.m.
“Baby Meets Bowser” Barbara Shumannfang,
author of Happy Kids, Happy Dogs will provide helpful
tips to prepare your dog for the new baby. Teer House.
Register: 416-3853.
July 17 6:30-8 p.m.
Health Benefits of a
Vegetarian or Vegan Diet
Explore how to meet your nutrient
needs with a more plant-based diet
with speaker, Leslie Gaillard. Teer
House. Register: 416-3853
July 18 8:30 a.m.-5:30 p.m.
8th Annual Highlights from ASCO “The Era of Per-
sonalized Cancer Treatment,” a symposium for medi-
cal oncologists, hematologists, radiation oncologists,
surgical oncologists, pharmacists, nurse practitioners and
physician assistants. The Umstead Hotel, Cary. Details
and registration: http://cancer.duke.edu/
July 21 6 -8 p.m.
Grilling Without the Gas. Food tasting. Discover
how to cook with coals and enjoy all your favorite
recipes with speaker John D. Howe. Teer House.
Register: 416-3853
give
July 26 10 a.m.-7 p.m.
“Fore the Patients,” Wana Kaye Rhodes
Memorial Golf Tournament to benefit the Duke
Cancer Patient Support Program. Golfers of all skill
levels are invited to attend. National Golf Club in
F E AT U R E D activity Pinehurst. Details: 684-4497
July 12 8 a.m.-3 p.m.
Duke Multiple Myeloma Bike Ride presented
by the Division of Cellular Therapy.
Participate in a 50K or 100K bike ride, from the
Cameron Stadium through rural Durham and Orange How to submit:
Counties. Multiple myeloma is the second most Send calendar listings to
common cancer of the blood. About 60,000 new editorinside@mc.duke.edu
patients are diagnosed every year in the U.S. with the
disease. Environmental factors and toxin exposure may Want more info?
play a role in the epidemiology of this cancer, but the
Visit us online at http://inside.
exact causes are still uncertain. Chemotherapy and
dukemedicine.org.
stem cell transplants remain the preferred treatment for
multiple myeloma, but new treatments and drugs are The Calendar is a monthly selection of
being developed. Registration fees support families and events that feature the best of
patients at the Multiple Myeloma Center at Duke, as well happenings at Duke and Duke Medicine.
support research and treatment against this disease.
http://dukemultiplemyelomabikeride.com
4 Inside Duke Medicine
A T A G L A NCE
“
She's going to go to kindergarten. She's
going to do great.
■■INSIDE JOKE
g l o b al h e alth
Duke Medicine sends supplies to China quake zone
By Bill Stagg
D uke University Health System has
donated a truckload of medical
supplies to help hospitals and health
centers in China in their ongoing
efforts to treat earthquake victims.
Hundreds of thousands of people
were injured or developed illnesses as
a result of the May 12 earthquake in
Sichuan province.
The equipment and supplies,
gathered through Duke’s Global Health
PLUS (Placement of Life-changing
Usable Surplus) program, include a
portable operating table, anesthesia
machines, patient monitors, dialysis
machines, ECG monitors, exam tables
and thousands of isolation gowns,
latex gloves and face masks.
The outreach effort was coordi-
nated through the Chinese Embassy
in Washington, which provided
Duke with a list of the most-needed
medical supplies at this stage of the
crisis. Armstrong Relocation, Duke’s
contracted relocation company, is
donating its services to transport the
equipment to a central distribution
point. The equipment then will be
shipped to China through Gifts in Kind
” – Duke's Louise Markert, M.D., Ph.D., speaking to the News
& Observer about the prognosis of 1-year-old Jayla Turner,
who underwent a thymus transplant developed by Markert.
A damaged bank in the city of Bei Chuan stands amidst rubble in the aftermath of the
recent earthquake in China. Photo courtesy of wikimedia commons
International, which has partnered
with UPS to deliver relief donations
from many corporations to China.
“The earthquakes in China present
a real humanitarian crisis for all of us,”
said Michael Merson, M.D., director
of the Duke Global Health Institute.
“Global Health PLUS allows us to
respond to the urgent needs of our col-
leagues overseas in a way that will help
strengthen the country’s health system
■ ■ it f igures
8,620,667
Hospital lab procedures
during 2007 fiscal year.
That’s more than
4 every minute
Source: http://www.dukehealth.org
long after another disaster captures the
world’s attention.”
The Duke Global Health PLUS
program makes surplus medical
equipment and supplies from DUHS
available to educational, research and
service projects overseas sponsored by
Duke faculty members.
Individuals can make financial do-
nations at http://www.studentaffairs.
duke.edu/earthquake/index.html n
July 2008
BU L L E T IN S
News briefs, notices, events,
and the IDM Book Club
■ ■ processes
1 committee replaces 4
In June, Duke University Health System rolled
its four separate product standardization
committees — teams that reviewed the
products used by nurses at the various
hospitals and clinics — into one committee.
The Duke Medicine Product and Equipment
Review Team, says Interim Director of Patient
Resource Management Mary O’Brien, will
optimize product and equipment utilization by
evaluating and standardizing existing and new
products important to Duke Medicine Nursing
Care and Allied Health Services. Requests will
be tracked through a centralized database.
The review committee’s oversight will lead to
improved patient safety, consistency in clinical
practice, and lower total cost, says Jane
Pleasants, assistant vice president for
procurement and supply chain management.
O’Brien and Steve Finch serve as chair and
co-chair. For more information, see http://
www.procurement.duke.edu
■■HONOR S
Health System earns
AHA’s platinum rating
Duke Medicine has been recognized by the
American Heart Association as a Platinum
Start! Fit-Friendly Company.
The elite status recognizes the Health
System’s ongoing efforts to provide a “culture
of corporate wellness.” The culture includes
supporting lifestyle improvements, such as
increased physical activities.
For example, hundreds of
Duke Medicine people
participated in the Start!
Walking at Work Day
in April.
The Platinum Level is the
highest level of recognition from
the American Heart Association
Start! Movement. Duke can now use the
Start! logo, pictured above, when promoting
AHA events.
■ ■ R an k ings
Duke Medicine among
best places work in IT
For the second year, Duke University Health
System has been ranked on Computerworld
magazine’s annual list of 100 Best Places to
Work in IT.
The magazine noted that the health system
requires round-the-clock information
technology support, “and its IT workers are
given the technology they need to make that
support happen.”
http://www.computerworld.com
July 2008
■ ■ D onations
Aflac presents
proceeds to Duke
Aflac presented the Duke Pediatric Blood and
Marrow Transplant (PBMT) Family Support
Program with a check for $18,458 from the
proceeds of the 2007 Aflac Holiday Duck sales.
Joanne Kurtzberg, M.D., director of the PBMT,
along with Lindsey Kearns, director of the
Family Support Program, received the check on
May 28 in the Children’s Health Center.
In addition, the Family Support Program
collaborated with local representatives of
the Columbus, Ga.-based insurer to raise
almost $9,000.
■ ■ S a f et y
New warning system
being installed
This summer, a new outdoor warning system
will be installed at Duke that will feature
seven strategically placed, pole-mounted
sirens, including on the medical campus.
The units will have speakers that can blast
warning tones and recorded or live voice
messages to instantly alert students, faculty,
staff and visitors during life-threatening
emergencies.
“This is part of a multi-layered notification
system designed to address one audience —
people outdoors — so they can take
immediate action,” said Aaron Graves,
associate vice president for Campus Safety
and Security. “The outdoor warning system
will be supplemented with e-mail alerts, text
messaging and police runners.”
Designed by Federal Signal Corp. in Illinois,
Duke’s outdoor warning system may be
tested occasionally in the coming months to
help familiarize people with tones that will be
used during actual emergencies such as a
tornado sighting or an armed and dangerous
person on campus.
“We will use the system to give you rapid
instruction to go inside, take shelter in a
secure location or take some other action for
your safety,” Graves said.
Inside Duke Medicine
Teamwork first
On June 2, neurosurgeon Allan Friedman, M.D., and a team of
clinicians and staff operated on U.S. Sen. Edward M. Kennedy. Said
Friedman, “The surgery was a success.”
By Allan H. Friedman, M.D.
W hat makes Duke University
a special place to work are
not the achievements of any one
individual, but Duke’s culture of
collaboration. It is the sum total of
the efforts of each of the members of
the Duke team that attracts visitors
from around the world.
This point was exemplified a few
weeks back when U.S. Sen. Edward
Kennedy and his family chose to come
to the Preston Robert Tisch Brain
Tumor Center at Duke for surgical
treatment of his brain tumor.
While the national media focused
its attention on the care given to
Sen. Kennedy, it should be noted that
the senator’s care differed very little
from the care given any patient that
comes to the Preston Robert Tisch
Brain Tumor Center at Duke. From
the clean, inviting environment to the
internationally recognized medical
expertise to the friendliness of the
staff, Duke distinguishes itself among
the medical institutions of this country.
The care given Sen. Kennedy was
administered by a Duke team that
always plays its “A” game.
While many members of the Duke
family contributed to the senator’s
care, there are certain individuals
who had extensive contact with the
senator and his wife. Cecil Borel,
M.D., led an outstanding anesthesia
team that shepherded the senator
through his awake brain operation,
as they have done in countless other
cases before the senator.
James Harvey Carter, PA-C,
monitored the senator’s neurological
functions as the operation proceeded.
The senator’s general medical
care was supervised by Christopher
O’Connor, M.D., director of the Duke
Heart Center. Larry Allen, M.D., and
the neurosurgical house staff adminis-
tered the senator’s medical care from
his admission history and physical
examination through his discharge.
The neurosurgical ICU staff and
the team of dedicated nurses that
cared so well for him and all of our
patients provided their trademark
high-quality care in their usual
friendly manner.
Hospital COO Kevin Sowers,
R.N., and his administrative team
took care of the senator’s special
needs, such as special security and the
accommodation for the senator’s staff.
Cathy Ebersohl and Susan
Barrella orchestrated the senator’s
discharge. Of course, the senator’s
oncologic care was overseen by the
senior members of the Preston Robert
Tisch Brain Center: Henry Friedman,
M.D.; Darell Bigner, M.D., Ph.D.;
David Reardon, M.D.; John Sampson,
M.D., Ph.D.; James Vredenburgh,
M.D., and Annick DesJardins, M.D.
The Duke team used this
opportunity to show the world the
outstanding care given to all patients
at Duke University Hospital. n
Friedman is Guy L. Odom
professor of neurological surgery,
neurosurgeon-in-chief at Duke
Hospital and deputy director of the
Preston Robert Tisch Brain Tumor
Center at Duke.
5
■■PROCEDURES
New way for vendors
to check-in
Effective June 1, vendor representatives are
required to comply with a new procedure
for checking in prior to entering clinical areas
within all Duke University Health System
acute and ambulatory care facilities.
Vendors calling on Duke Medicine should:
1. Register with Status Blue, a Web-based
service that requires evidence of competence
and completion of required training.
2. Check in at a designated computer upon
arrival at Duke.
3. Display at all times the Status Blue
Identification Badge printed upon registration.
Employees are asked to visually check the
representative’s badge to assure alignment
between competency level and the services
provided by the representative in support
of patient care decisions, along with the
expiration date. Check this site to validate
a vendor’s information: https://www.
status-blue.com/StatusBlue/Static/
Content/Default.aspx
ID M BOOK C L UB
Duke gets better
Atul Gawande is a surgeon at Brigham and
Women’s Hospital in Boston, and medical
writer for The New Yorker — his latest article
is a fascinating exploration of why we itch,
and the new theories
about how the brain
perceives the body.
Gawande’s articles are
collected in two books,
Complications: A
Surgeon’s Notes on an
Imperfect Science, and
Better: A Surgeon’s Notes
on Performance (Picador, 2008). A copy of
Better recently made its way onto the desk of
Michael Cuffe, M.D., vice dean for medical
affairs and vice president for medical affairs.
“This book is a gripping look at how
physicians around the world are finding
ways to improve their care,” says Cuffe.
“There are some good lessons in here for us
at Duke Medicine.”
Cuffe shared the book with his office
colleagues, who are helping him to launch a
new quarterly newsletter for the Duke
Medicine physician community.
Because of his writings about performance,
Gawande was asked by the World Health
Organization to head an international task
force that devised a safety checklist with 22
items spread over three stages: before,
during and after an operation.
Inside Duke Medicine soon will explore how
Duke is using similar checklists and other
evaluation measures to improve perfor-
mance. Contact us if you have examples or
case studies.
6 Inside Duke Medicine July 2008

ON T H E CO V ER

The genome gets personal

By Kelly Malcom and Kendall Morgan

I n 2003, scientists deciphered the 3

billion units of DNA that make up
the human genome for the first time.
■ ■ f urther coverage
For more on how genetics may change
Researchers continue to uncover new the way physicians prescribe drugs,
ongoing clinical trials in genomics, and one
links between DNA and disease every- blogger's personal experience with genetic
day and — given advances in genome testing, see Inquiry (pages 7 -10).
technologies — the pace of those
discoveries will only increase.
“Over the past three years alone, that a genomic test result can’t provide a
there have been hundreds of new diagnosis. It can really only give you an
genetic findings related to more than 40 idea of risk,” explained Sullivan.
complex diseases that we never knew
about before,” says Geoff Ginsburg, Now what?
M.D., Ph.D., director of the Center Despite the promise for personalizing
for Genomic Medicine at the Institute medicine and the ever increasing amount
for Genome Science and Policy (IGSP). of scientific data available, the connec-
“These findings may one day help tion between particular gene variants in
physicians single out certain individuals the genome and the risk for many of the
as candidates for early health interven- most common diseases remains rather
tions or closer monitoring.” limited so far. As David Goldstein, direc-
Duke is on the cutting edge of the tor of the IGSP’s Center for Population
field of genomic medicine, says Ginsburg. Genomics and Pharmacogenetics and
Basic research in the IGSP and other co-PI of the new project, has said, “We
departments is resulting in important remain in a situation where we have
advances in genomics with potential very little that is clinically actionable.”
direct applications to medical practice. In other words, Ginsburg added, “based
In one effort to bring those discover- on population information, I may be able
ies to the clinic, he plans to launch a to tell you that you have a 20 percent
study within the coming months that chance of developing diabetes. A genome
will integrate genetic testing for diabetes test, right now, may tell you that you have
susceptibility with traditional clinical a 22 percent chance. That’s not much
Beth Sullivan, Ph.D., of the IGSP, poses with photographs of her family. She says she has considered
care at two Duke outpatient clinics. The more than I could have told you before.”
the potential impact of her genomic testing on her loved ones. Photo by la-tasha davis
goal is to find out if this information Despite these caveats, knowing
lends patients the motivation they need company based in California, in an their genetic material (in this case a patient’s genetic risk for disease
to adopt healthier lifestyles. effort to help individuals learn more and extracted from blood) tested for gives physicians another tool to make
Ginsburg and other members of do more with their test results.) selected genetic markers, called single heath care more refined and precise,
the IGSP are also working with the Researchers at the IGSP have also nucleotide polymorphisms or SNPs, says Ginsburg. The extent to which
Executive Health Program at the Duke launched a study, called the Duke known to increase the risk of certain this information can lead to changes
Center for Living to explore the use of Personal Variome Project, to find out diseases, including breast cancer, heart in a patient’s attitude about his or
genetic testing and genomic counseling, what is it that early adopters of personal disease, diabetes and Alzheimer’s her health is a question the Personal
in combination with a detailed familial genomics hope to gain by knowing disease. Afterward, participants can Variome Project and Ginsburg’s
genetic risk assessment, as part of a what’s “written” in their DNA. And choose whether or not they want to diabetes studies are trying to answer.
more comprehensive health assessment what, if anything, they will do with the receive their various test results. Willard said, “The Duke Personal
and strategic health plan. information once they’ve got it. It’s a decision fraught with a lot of Variome Project is as much a social
The effort is the emotion, says study participant Beth experiment as a scientific one.”
first, as far as the Sullivan, Ph.D., assistant professor of While the full health benefits of
“I'll have to decide, will I share my results
researchers know, molecular genetics and microbiology. genome testing have yet to be realized,
with my family? Will I tell my doctor?“ specifically aimed to “I’ve always been interested in my DNA Duke researchers are finding ways
explore participants' and I know that certain diseases run in which genes may help personalize
For the curious with a cool grand perceptions about their genomes and in my family. I personally have chosen medicine today. Researchers at the
to spend, many direct-to-consumer com- the impact that their genomic informa- to see my results. But then I’ll have IGSP and Duke Comprehensive Cancer
panies are now offering whole genome tion will have on them. “It is clear that to decide, will I share them with my Center are leading clinical trials to
scans. Send in a tube of your saliva some among us, whatever the motiva- family? Will I tell my doctor?” test the utility of genomic ‘signatures’
and get back a whole genome profile tion, are ready to test their genomes. After this initial phase, Willard of a patient’s tumor for guiding the
that can reveal information about your But why?” said Huntington Willard, hopes to expand the project to include treatment of breast, lung, and prostate
ancestry and risk of developing certain Ph.D., IGSP director and a principal groups in the broader Duke and Durham cancer (see Inquiry, pg. 7).
diseases. (In fact, Duke’s Executive investigator of the project. communities. The challenge will be Ultimately, Ginsburg said, a genome
Health Program is offering the personal The 14 participants in the project’s educating non-geneticists about their scan may become as standard as
genomics profiles from Navigenics, pilot phase, all from within the Duke genomes and the limitations of genomic measuring blood pressure in a routine
a direct-to-consumer genome testing genomics community, will each have testing. “It’s important to understand check-up with your doctor. n

A nitrogen molecule bonded with an
oxygen molecule.
‘Missed’ biochemical
pathway important
in virtually all cells
By Mary Jane Gore
A new study by Duke University
researchers provides more
evidence that the nitric oxide system
in the life of a cell plays a key role
in disease, and the findings point to
ways to improve treatment of illnesses
such as heart disease and cancer.
The nitric oxide system in cells is
“a major biological signaling pathway
that has been missed with regard to
the way it controls proteins,” and
it is linked to cancer and other dis-
eases when the system goes awry, said
Jonathan Stamler, M.D., of the depart-
ments of medicine and biochemistry.
In the body, nitric oxide (pictured
above) plays a role in the transport
of oxygen to tissues and physiological
activities such as the transmission of
nerve impulses, and the beating of the
heart. When things go wrong with the
nitric oxide system, bad things can
happen in bodies, according to recent
studies. For instance, there may be too
little nitric oxide in atherosclerosis and
there may be too much in Parkinson's
disease; there may not be enough nitric
oxide in sickle cell disease and there
may be too much in some types of
diabetes, Stamler said.
The new findings, which Stamler
said change understanding of how
the nitric oxide system is controlled,
appear in the May 23 issue of the
journal Science.
“What we see now for the first
time is that there are enzymes that are
removing nitric oxide from proteins to
control protein activity,” Stamler said.
“This action has a broad-based effect,
frankly, and probably happens in
virtually all cells and across all protein
see NITRIC OXIDE, p.9
The Science & Research Supplement to Inside Duke Medicine
VOLUME 17 NO. 7
FE A T URE
Duke researchers are leading the way to tailoring treatments based on a patient's DNA. FILE PHOTOs
From genes to drugs
By Kelly Malcom
T hrough a rigorous system of testing
and clinical trials, pharmaceuticals
come to market. If a drug works in a
test group, it’s then extrapolated that
the same treatment will work in the
population at large. However, not
everyone responds to every drug in the
same way, especially when it comes to
more complex diseases like cancer.
This trial-and-error approach to
prescribing drugs may eventually change
in the face of genomic research now
underway at Duke.
In 2006, a research team led by
Anil Potti, Ph.D. and Joseph Nevins,
Ph.D., of the Department of Genetics
published a paper in the journal Nature
demonstrating that the genetic profiles
of cancer patients’ tumors could predict
their response to chemotherapy.
The new tests have the potential
to save lives and reduce patient’s
exposure to the toxic side effects of
chemotherapy, Potti said.
Within the past few months, Kelly
Marcom, M.D., a medical oncologist,
building on his collaboration with
Nevins and the Institute for Genome
Science and Policy (IGSP), has
launched clinical trials that will test
n inside.dukemedicine.org
these findings in breast cancer patients.
The IGSP is now actively recruiting
patients with early stage breast cancer
to see whether genetics can be used by
a physician to determine if a tumor
will respond to a particular treatment
and identify tumors more likely to
recur. Similar trials will investigate this
approach to chemotherapy in patients
with lung cancer and prostate cancer.
Phillip Febbo, M.D., a medical
oncologist, is leading other trials to
test anti-cancer drugs in patients with
advanced prostate cancer. In one trial on
the horizon, called Metastisis at Duke, or
MAD, researchers will collect biopsies
from participating patients, perform
genomic analysis of the samples and
run a panel of chemotherapy predictors,
resulting in a report that will be given to
the patients’ oncologists.
“The question we’re trying to an-
swer is how the information provided
by genetics will be used in general
oncology practice,” said Febbo. The
trial, which will be supported
financially by the Health System, will
provide a novel approach to the care of
cancer patients at Duke, he said.
Beyond cancer, researchers
within the IGSP’s Center for Genomic
n July 2008
Medicine are looking for connections
between genetics, predisposition
to diseases like diabetes, and drug
response in HIV and hepatitis C, just to
name a few.
“By overlaying genetics and
genomics with the current practice of
medicine, we’ll be able to make medical
decisions that are more right for the
given patient,” said Geoff Ginsburg,
M.D., the center’s director.
Elsewhere at Duke, researchers are
looking at the connection between our
genes, our behavior, and disease.
Redford Williams, M.D., of the
Department of Psychiatry, is looking at
the association between genes, environ-
ment, and the stress response. Williams
found that people with a genetic
variant responsible for the control
of serotonin levels, when combined
with a poor household environment,
were at greater risk for high blood
pressure and elevated heart rate during
stressful periods. In the future, the
added information provided by these
individual’s genetic profiles could lead
to combination therapies for high blood
pressure and serotonin control.
Genes can even predict who can quit
see GENES, p.9
8 Inquiry
NEW S
Reya and Ehlers Earn Thomas Langford Award
T annithsha Reya, Ph.D. of the
Department of Pharmacology
and Cancer Biology and Michael
Ehlers, Ph.D. of the Department of
Neurobiology have been selected for
Duke University’s Thomas Langford
Lectureship Award.
This program was initiated eight
years ago as a tribute to the memory
of Thomas Langford, former Divinity
School faculty member, dean, and
provost, who embodied the highest
university values of scholarship,
teaching, collegiality, and the
Scientists discover how cells move a critical protein
By Mary Jane Gore
N
early every cell in the body
has a primary cilium, a crucial
antenna-like protrusion that pro-
cesses signals and cellular responses.
Defects in the cilium are linked
with a wide variety of illnesses and
disorders including cancer, blindness,
polycystic kidney disease and others.
Scientists at Duke University
Medical Center have found the
pathway through which a signaling
protein called Smoothened (Smo) can
move into the primary cilium, a discov-
ery that could eventually translate into
therapeutic treatments for cancer.
“This is the first time that
anyone has shown how cell surface
receptors like Smo get into the cilium
where they must reside to signal
properly,” said first author Jeffrey
Kovacs, Ph.D., a post-doctoral
fellow in the Duke Departments of
Medicine and Immunology.
Improper Smo signaling is known
to result in formation of tumors, yet no
treatments directed at Smo activity are
currently available. Smo is a member
of a large family of cell surface
receptors termed G-protein coupled
receptors, or GPCRs, first described by
co-author Robert J. Lefkowitz and his
group. Members of the GPCR family
are the targets of about 60 percent
of drugs that are on the market to
treat clinical conditions, Kovacs said.
Figuring out exactly which mecha-
nisms govern Smo signaling could lead
to treatments, he said.
In this latest study, the team
tannithsha reya, ph.d. michael ehlers, ph.d.
promotion of faculty excellence and
community. The annual Langford
Lectureship series is designed to
The antenna-like primary cilium (orange) processes signals from the body's cells.
image provided by j. kovacs
found that beta arrestin proteins are
responsible for moving Smo to the
primary cilium.
“The beta arrestin molecules
mediate the interaction of the protein
Smo with a motor protein that liter-
ally grabs the Smo and moves it to
the primary cilium,” said Lefkowitz,
M.D., James B. Duke Professor of
Medicine and investigator of the
Howard Hughes Medical Institute.
“We knew that the beta arrestins
interacted with Smo, but we didn't
fully appreciate the complexity of
this interaction until now.”
“The next step in our research is
to look for ways that other GPCRs
provide Duke’s faculty with an op-
portunity to hear about the ongoing
scholarly activities of their recently
promoted colleagues.
As recipients, Reya and Ehlers
will deliver lectures about their
research to an interdisciplinary audi-
ence and receive a $1,000 research
stipend. Reya’s research focuses on
understanding the mechanisms that
regulate hematopoietic stem cell fate
and self-renewal. Ehlers focuses on
the interface of cell biology and neural
circuit plasticity. n
are put into position, not just
Smoothened,” Kovacs said. “We want
to know how these receptors signal in
a movement-dependent way. This may
give us an idea about how different
molecules work to turn on or turn off
the signaling pathways” that cause
these abnormal clinical conditions.
Lefkowitz theorized and
discovered GPCRs years ago. His
laboratory later discovered beta
arrestins, named for their ability to
turn off or “arrest” the receptors'
activity. Recently, the lab has been
discovering ways in which beta
arrestins turn on signaling pathways
as well as turning them off. n
July 2008
NARSAD names four Duke
young investigators
Four Duke University scientists have been given
Young Investigator Awards by NARSAD, the
world's leading charity dedicated to mental
health research. They are among 220 early-
career scientists in the United States and 11
other countries who will receive $60,000 from
NARSAD over the next two years to advance
their research on psychiatric disorders. The Duke
investigators are William E. Copeland, Ph.D.,
assistant professor of medical psychology;
Shih-Chieh Lin, M.D., Ph.D., a postdoctoral
fellow in neurobiology; Peter J. Nicholls, M.D.,
a research associate in biological psychiatry, and
Xiaodong Zhang, Ph.D., an assistant professor
of biological psychiatry at Duke and the NUS
Graduate Medical School in Singapore.
HHMI awards Duke Researchers
The Howard Hughes Medical Institute (HHMI)
has recognized several members of the Duke
community in its recent batch of awards.
Congratulations are extended to:
Mark Onaitis, M.D., assistant professor of
thoracic surgery, for receiving an Early Career
Physician-Scientist award. Onaitis is part of
Department of Cell Biology Chair Brigid
Hogan’s lab, and he’ll use his five-year grant
to study how mutations in adult stem cells
might lead to lung cancer.
Duke medical students Jessica Chang and
Caroline Yeager for receiving HHMI-NIH
Research Scholars Program awards that will
send them to the NIH campus in Bethesda,
MD, for hands-on biomedical research.
Several Duke medical students for receiving
Research Training Fellowships to support their
individual research plans and lab work: Rex
Cheng, Mackenzie Cook, Divakar Gupta,
Mohamad Halawi, Michael Hodavance,
John Lewis, Tina Tailor and Sima Yazdani.
Awards from Singapore
Faculty at the Duke-NUS Graduate Medical
School have recently been honored by the
Singapore Ministry of Health and The Agency
for Science, Technology and Research in an
effort to boost the pool of clinician scientists
and translational researchers in Singapore.
Michael Chee Wei Liang, M.B.B.S., a
cognitive neuroscientist and David M. Virshup,
M.D., program director for cancer and stem
cell biology, received the Singapore Translational
Research Investigator Award. Ong Sin Tiong,
MBBch, a hematologist and oncologist,
received the Clinical Scientist Award.
Science Editor: Kelly Malcom
Inquiry features science and research-
related news items from Duke Medicine News
and Communications and other Duke
departments. To submit content, contact us
at editorinside@mc.duke.edu
July 2008
First-ever recording of blood vessel development
By Mary Jane Gore
A new microscope system that can
take 3-D pictures of an embryonic
mouse organ over 24 to 48 hours has
shown Duke Medical Center research-
ers the first glimpse of the formation of
blood vessels during development.
Among other things, a team lead
by cell biologist Blanche Capel, Ph.D.,
has found a previously unknown
mechanism in the formation of blood
vessels that may help scientists better
understand how a tumor rallies a
blood supply to its aid.
Using mice that have blood vessel
cells marked by green fluorescence,
the cell biologists studied vessels that
supply mouse gonads. These are the
embryonic organs that give rise to
ovaries or testes later in development.
The scientists’ novel system for
studying development using time-lapse
microscopy and tiny samples of tissue
shed new light on the dynamic process
of organ formation. This system
answered key questions about how the
vasculature gets fitted into the organ
as it forms, Capel said. Before this,
scientists could only image one point
in development at a time.
The striking new images became
Aziz wins Sarnoff Fellowship
H amza Aziz, a graduate medical
student, has received the
Sarnoff Fellowship from the Sarnoff
Cardiovascular Research Foundation.
He did his third year research
project with Aimee Zaas, M.D.,
Geoffrey Ginsburg M.D., Ph.D., and
John Perfect, M.D., as mentors. He
has worked on a project developing
gene expression
signatures of a
fungal infection
(invasive
candidiasis) in
a mouse model
and is currently
validating the
findings. He’s
HAMZA AZIZ
received an
IDSA (Infectious Diseases Society
of America) Student Travel Award
to present his research at the 48th
Annual ICAAC/IDSA meeting in
Washington DC in October 2008.
With the fellowship, Aziz will
take an additional year to pursue
more laboratory research. n
Inquiry 9
GENES, continued
smoking and those who can’t. Jed
Rose, Ph.D., of the department of
biological psychiatry and the Center
for Nicotine and Smoking Cessation
Research was part of a team of re-
searchers that compared the genes of
smokers who had successfully kicked
the habit to those who failed to
quit. They found clusters of positive
results in gene variants present more
frequently in the successful quitters.
In a subsequent study, Rose and
others found genetic markers that
correlated with successful quitting
with the use of nicotine replacement
therapy or a drug called bupropion.
Cross section of a developing male testis shows characteristic structures including testis Their work now revolves around
cords (red clumps of germ cells), a large coelomic blood vessel (pink), and other branching confirming these initial findings.
blood vessels with the gonad (blue). Photo copyright 2008 National Academy of Sciences, U.S.A. Whether for cancer, high blood
the cover story of the Proceedings of the process represents a possible way for pressure, or smoking cessation,
National Academy of Sciences and were growing tumors to access a blood doctors are looking toward genet-
assembled into a time-lapse movie. supply, by commandeering a mecha- ics to help tailor their treatment
The Duke team was surprised by nism similar to the ones organs use to options and make the practice of
the vigorous cell movements involved recruit vessels into the tumor.” medicine more personalized.
in the development of male gonads. She pointed out that a blood supply
“In the male gonad, the major blood is critical to a growing tumor, and this How To Get Involved
vessel in the adjacent tissue comes may be an important mechanism in the If you are a cancer patient, learn how
apart and the individual blood vessel formation of blood vessels in tumors to get involved in clinical trials at Duke
cells move to a new location, and that scientists have not appreciated investigating genomics and cancer by
reassemble into new vessels inside the before. “That is an exciting finding,” visiting http://genomestohealth.org. n
testis,” Capel said. “This breakdown Capel said. n
NITRIC OXIDE, continued
classes. Nitric oxide is implicated
in many disease processes. Sepsis,
asthma, cystic fibrosis, Parkinson’s
disease, heart failure — all of these
diseases are linked to aberrant
nitric-oxide-based signaling.”
An important factor that
previously wasn't appreciated, he
said, is that the target of nitric
oxide in disease is different in every
case. The finding of how nitric
oxide binding to proteins is regu-
lated opens the field for new
refinement in biochemical research,
said Stamler.
“Now we will need to study
Pilot International gives gift to Bryan whether the aberrant cell signals
are a matter of too much nitric
Alzheimer's Disease Research Center oxide being produced and added
to proteins or not enough being
The Pilot International Foundation Club of Charlotte has given $50,000 to the Joseph and removed from proteins,” he said.
Kathleen Bryan Alzheimer's Disease Research Center. The foundation was established in 1975 to “It is not simply a matter of too
support the community-based work of Pilot Clubs by promoting the awareness and prevention of much or too little nitric oxide being
brain-related disorders, and improving the lives of those affected by such disorders, through
in cells, but rather how much is
education, volunteerism, financial support and research. Pictured: Judy Breaud, 2007-2008 Pilot
International President, Kathleen Welsh-Bohmer, Ph.D., Director and Principal Investigator, Joseph being added or taken away from
and Kathleen Bryan Alzheimer's Disease Research Center, and Margaret Gilbert and Peggy Jessup, specific proteins, which is quite a
of the Pilot Club of Charlotte. different thing.” n
10 Inquiry July 2008

e ssa y

Genomics and the secret ingredient

By Misha Angrist, Ph.D. And isn’t this what physicians have

I was the guinea pig, the objet d’art.

At the end of May I was at
the World Science Festival in New
York, the lone civilian on a panel
with a handful of famous scientists
to talk about, among other
things, my genome.
Partly by design, partly by
accident, I have become something of
a poster child for personal genomics
(albeit sometimes a reluctant one).
It began when I decided to write a
book on personal genomics after
reading about Harvard geneticist
George Church, DNA sequencing
pioneer and founder of The Personal
Genome Project. The PGP seeks to
recruit a group of people willing to
share their genomic data as well as
information about their health. The
idea is that by studying a cohort that
is not concerned about privacy, PGP
researchers are not put in the awk-
ward position of having to guarantee
the confidentiality of those they’re
studying. Not only that, by having
access to subjects’ medical records,
scientists wouldn’t have to study
genomes in a vacuum. Strings of A’s,
G’s, T’s and C’s (the DNA alphabet)
are not of much use to human health
or understanding human biology if
you can’t link them to human traits.
The PGP began by recruiting
ten subjects willing to make their
genomic and health data public. I am
one of those 10.
As a first step, Church’s team
genotyped the 10 of us for 500,000
markers that tend to vary among
people — these markers are called
“single-nucleotide polymorphisms,”
or SNPs (“snips”). They are the
same types of markers that new
The author and his daughter, Lena, who has half his DNA. Photo provided by the author
personal genomics companies —
deCODEme, 23andMe and
Navigenics among them — are
charging people $1000 or more to
type in order to learn their genomic
risks for various conditions such as
heart disease and diabetes. I was also
typed (for free) for the Navigenics
panel of 900,000 markers.
Of the 17 conditions Navigenics
considers “vetted” for reporting back
to customers, my own genomic risk
estimates were not terribly surprising.
Most notably I am at increased risk
for type 2 diabetes, obesity and heart
attack. My father had a quadruple
bypass at age 60 and his father died
of a heart attack at age 50. There is
heart disease on my mother’s side
as well. In other words, Navigenics
confirmed what I already knew: that
I ought to go back to the gym and
lay off the Ben & Jerry’s. (Alas, I had
hoped to take up smoking, too —
damn you, Navigenics!)
And herein lies one of the
chief complaints about these
services. Because they measure risk
for complex, common conditions
like heart disease, the advice one
gets — eat right, exercise, don’t
smoke — tends to be of the generic
variety, no matter one’s genotype.
At the World Science Festival,
fellow panelist and UNC geneticist
Jim Evans said as much (indeed, a
large fraction of the clinical genetics
community shares this view). Why,
they ask, does someone need to drop
a thousand bucks just to learn this
sort of commonsensical stuff?
Of course, no one does and,
understandably, many will choose not
to. But it’s possible that incorporating
these risk estimates into a portrait
of one’s overall health can serve as a
motivator and perhaps offer a clearer
view of the path toward prevention.
been agitating for over the last several
decades?
The other mitigating factor is
time. I look at my genomic data
as a savings bond. It may not be
worth much today, but barring the
scientific equivalent of a sub-prime
meltdown, I have little doubt it will
play a substantive part in my health
and perhaps my children’s health in
the next few years. I don’t think it’s
outlandish to predict that a genome
scan will soon be a routine part
of our checkups. As the price for
genotyping and sequencing falls and
as we learn what these variants mean,
I don’t see how it cannot.
People often assume that be-
cause of what I’m doing and because
I write a blog called GenomeBoy,
that I must be a starry-eyed genome
worshipper. But if anything, getting
genotyped has reminded me how
much more we are than our DNA.
All of those common-sense behavior
changes actually matter. We are
the products, finally, of our genes
and our environments. And there is
nothing mystical about either.
Recently I took my kids to
see Kung Fu Panda (spoiler alert)
and had an epiphany. When the
pudgy panda finally opens the
sacred scroll that will tell him how
to defeat the bad guy, he sees only
his own reflection. “There is no
secret ingredient,” he realizes.
And for most of us, so it is with
our genomes. n
Misha Angrist is assistant
professor of the practice at the Duke
Institute for Genome Sciences &
Policy. Read his blog at http://www.
genomeboy.com.

RE S E A RC H @ DUKE c l i n i c al t r i als th e a b st r a c t

Picture this Join up Your voice

Green fluorescent dye reveals Duke has a wide range of The new School of Medicine
the presence of cells deep within ongoing clinical trials that you faculty newsletter, The Abstract,
the brain of a mutant mouse may qualify to take part in. has launched. To submit faculty
that represent a growing tumor. To see a list of trials, visit news and information, contact
See other riveting research http://www.dukehealth.org/ abstract@mc.duke.edu
images at http://www.research. clinicaltrials
duke.edu
July 2008
pat i e n t c a r e
6 rights in 6 months
Focus on: 1. The Right Patient
This is the first of six articles examining
the medication use process.
C onsider this: A patient by the name of Joe
Smith comes to the hospital.
He gets his patient ID band placed properly,
is admitted to Room 12 on one of the floors, and
completes the admission process with the nursing,
medical and support staff. He has an antibiotic
ordered, and his nurse brings it to his room to
administer it. She asks the patient his name, and
he tells her he’s Joseph Smith. She administers the
medication as ordered. A while later, the nurse
realizes that the antibiotic was actually supposed
to go to another Joe Smith, who is in Room 22.
What went wrong here? Why, anyone can
make a mistake like that, right? Although it
may seem that giving a medication to the Right
Patient should be a simple process, it isn’t always.
Situations like the one noted here can be avoided
by following basic guidelines and principles —
the 6 Rights of the Medication Use Process:
1. Right Patient
2. Right Drug
3. Right Dose
4. Right Route
5. Right Time
6. Right Outcome
At Duke, we have also identified a set of
nonnegotiable critical behaviors that reinforce
these 6 rights: Using two identifiers when order-
ing, preparing or dispensing a medication and
transcribing orders for medications; using name
alerts for patients with similar sounding names;
and minimizing interruptions when involved in
any part of the medication administration process.
A s part of the ongoing efforts to promote medi-
cation safety at Duke University Hospital,
the Medication Safety Education Committee, in
conjunction with the Medication Safety Leaders
of the system, has developed the “6 Rights in 6
Months” campaign to help raise awareness about
safe medication administration practices. The
campaign was developed to highlight best prac-
tices for all people who take part in the medication
administration process, not just the frontline med
giver. This month the focus is on the Right Patient.
The term Right Patient takes on various,
different meanings for the diverse groups involved
throughout the entire medication administration
process. For a physician or prescriber, it means
using “double identifiers”— two of either the
medical record number (MRN), patient name, or
patient date of birth (DOB) — instead of just one
Inside Duke Medicine
6 Rights of the
Medication Use Process :
1 ) Right patient
2) Right drug
3) Right dose
4) Right route
5) Right time
6) Right outcome
of these identifiers when ordering medications and
being aware of having the correct patient on the
order screen when entering orders into CPOE.
For the pharmacy technician processing
and filling orders, it means not using a room
number to identify a patient, but, instead, using
a complete name and MRN. For the nurse at
the bedside giving medications, it means using
“double identifiers” properly and making sure to
use the “name alerts” when there is more than
one patient with the same or similar names on
the floor. And for the patient, it means not being
uncomfortable with asking the nurse about the
medications they are receiving.
Everyone has an active role in helping assure
we have the safest delivery of medications.
“The effectiveness and beauty of the 6 Rights
lies in how it takes something so complex — a
200-plus-step process from first order to patient
administration — and shows us the simple root
behaviors that, when done each and every time,
help minimize the possibilities of committing errors.
Basic, simple, and effective — “A winning
combination!” said John Howe, RN, co-chair of
the Mediation Safety Education Committee.
Continue to look for other installments of
“6 Rights in 6 Months” information. Share the
information with co-workers and patients. Ask
colleagues how they help ensure that they have
the Right Patient. Because to ensure the safest
processes are followed consistently, we must all
work together. n
11
FIR S T P ER S ON
Q&A with Kenneth Morris
The economy is in the news. At Duke
Medicine, it is Ken Morris’ job as chief
financial officer to help chart the health
system’s fiscal course. In that role, he
directs accounting, financial planning and
budgeting, as well as overseeing patient
accounting, billing and registration,
insurance, and managed care contracting.
How is the health system doing financially?
So far over this fiscal year, health system
financial results have been strong. We
expect to finish the year slightly ahead of
budget. Volumes, however, in some business
lines have grown more
slowly than expected.
What does this
mean for the next year?
Targets for the new fiscal
year have been set higher,
so that we have money
to fund our work and,
kenneth morris
importantly, our capital
construction projects. That higher target,
some $100 million, is based on realizing more
income through growth in the volume of the
work that we do.
We are pleased that the Congress has
approved continuation of the state
disproportionate share payments to North
Carolina hospitals - which had been at risk.
Though not approved in time to be put
into the budget, we now expect to receive
this revenue through April 2009. Since the
program will again be set to expire before
the end of the next fiscal year, we can’t
count on them every year going forward.
Achieving our targets, therefore, depends on
meeting growth commitments.
How will the tough economy affect Duke
Medicine?
The environment is expected to be more
difficult. We expect after the election in
November that Congress will turn to
the federal budget and the federal deficit
and that there will be pressure to reduce
payments to hospitals. When there is an
economic downturn, and people are out
of jobs and insurance, there is a higher
impact on us. There will have to be a
concerted effort on our part to bring
increasing efficiency to care delivery and the
management of resources. We also have an
obligation to minimize costs to our patients
while providing top quality care.
What does this mean for the health system’s
expansion efforts?
With government approval of the Major
Hospital Addition, we will be spending
significant resources on construction. It is
likely that the health system will incur debt
in support of the project. This expansion is
a strategic decision to help ensure the future
growth of the enterprise.
Interview by Mark Schreiner
12
working
Born to RN
$5,000 referral bonus nets nurses for Duke hospitals
By Elizabeth Michalka
W hen Carolyn Juettner and her
husband bought a 96-year-old
farmhouse in 2005, it required renova-
tion, but progress was slow with a
tight budget and birth of their first
child. Then, Juettner received the first
half of a $5,000 bonus from Duke,
and construction picked up.
The money was enough to refin-
ish hardwood floors and construct
a toy box that doubles as a window
seat. Now Juettner enjoys curling up
on the cozy seat in her Chapel Hill
home to read about animals to her
2-year-old son, Jack.
The remodeling was possible
because Juettner, a clinical nurse in
the Intensive Care Nursery at Duke
Hospital, simply referred a fellow
nurse and friend, Simone Christiano,
to work at the hospital.
“I wanted to bring good, expe-
rienced staff here,” said Juettner, 39,
who has worked as a nurse for 18
years. “If you’re in nursing, and you’re
working next to someone, you want
them to be reliable.”
Eight years ago, Duke University
Health System created the Nurse
Referral Program. It encourages
nurses like Juettner to recruit other
nurses — who are in critically short
supply across the country — to work
at Duke Hospital. The program has
expanded, and today, any Duke
employee can cash-in on $5,000 by
referring a qualified nurse who joins
one of Duke’s three hospitals, includ-
ing Durham Regional Hospital and
Duke Raleigh Hospital.
“We knew word-of-mouth was
the best recruitment mechanism, and
Duke nurses can sell the organiza-
tion,” said Mary Ann Fuchs, R.N.,
chief nursing and patient care officer
for the Health System.
The program is an important
recruitment tool that also improves
retention by paying the bonus in two
installments — half when the new
nurse completes a 90-day orientation
period and half after completing the
first year. Recruitment and retention
are increasingly important in light of a
national nursing shortage, Fuchs said.
Hospitals are short about 116,000
registered nurses nationally, resulting
Inside Duke Medicine
Simone Christiano was one of 649 nurses hired at Duke Medicine in 2007. She was referred by
friend and Duke nurse Carolyn Juettner. Photo courtesy of working @ duke
in a national vacancy rate of 8.1
percent, according to a report released
by the American Hospital Association
in July 2007.
Duke University Health System
often uses higher cost temporary
staff to fill nursing vacancies, which
are slightly higher at Duke than
the national average. Fuchs said
she hopes the referral program will
help reduce the need for temporary
staff by increasing the number of
permanent Duke nurses.
“We’re actually very lucky
because due to our reputation, we
receive a lot of applicants,” Fuchs
said. “We hire about 500 nurses a
year, some of whom are returning
to Duke after taking time to pursue
advanced nursing degrees. We’re also
growing as an institution and need
more nurses for that expansion.”
Return on investment
Although the $5,000 is an enticing
benefit, Duke nurses like Juettner said
making a referral is about more than
just money.
“Simone and I worked together in
New Jersey years ago, and I knew she
was a good nurse,” Juettner said.
That personal accountability
makes the Nurse Referral Program
work, said Sylvia Alston, associate
chief nursing officer for Recruitment
and Hospital Administrative Systems.
“The nurse who is referred also
feels some accountability because
they don’t want to disappoint the
person who referred them,” Alston
July 2008
Duke Medicine Hosts
Nursing Expo
Duke Medicine hosts its second annual
national Nursing Expo, Aug. 3-4.
Details: http://www.dukenursing.org
How the $5,000 Bonus Works
Faculty and staff of Duke University and
Health System are eligible to receive $5,000
for successfully referring a nurse to work at
Duke Medicine. The referral program
applies only to nurses hired at Duke
University, Durham Regional and Duke
Raleigh hospitals. The $5,000 incentive is
contingent upon the referred nurse’s
acceptance of a job offer. It is paid in
installments — $2,500 after referred nurses
complete their 90-day trial period, and
$2,500 after a year of continuous service.
Other limitations and exceptions apply.
For complete guidelines, review the Nurse
Referral Program policy, and download
the referral form online at http://www.
hr.duke.edu/referanurse, or call (800)
232-6877
said. “Both people’s reputations
are tied to it.”
Alston said it’s become tougher to
find experienced nurses, like Simone
Christiano, for many reasons, includ-
ing increased demand nationally, an
aging workforce, and because nurses
are moving on to second careers. But,
recruitment numbers are up at Duke,
and Alston attributes that success, in
part, to the Nurse Referral Program,
which was expanded to make all
faculty and staff eligible. Also, the
bonus rose from $2,500 to $5,000 in
2007. Last year, 175 faculty and staff
used the program to refer nurses, and
649 total nurses were hired.
With about 370 open nursing
positions across all organizations
in Duke University Health System,
it’s important to attract qualified
entry-level nurses.
Duke Medicine will host the next
Nursing Expo on Aug. 3 and 4 at the
Durham Marriott at the Civic Center.
Alston is hoping at least 200 people
attend. As a result of last year’s expo,
59 nurses were hired.
This article first appeared in
Working@Duke. n
July 2008
working
A year without tobacco
By Erin Pratt
M ost people wake up to the
buzzing of an alarm clock and
head straight for the shower or a
toothbrush, but Rodd Mangum, 47,
went straight to his pack of cigarettes
and lit up his first one for the day.
His first of 60 to be exact.
Mangum, who began smoking
at age 21, was smoking three packs of
cigarettes a day.
On May 20, Mangum, a courier
for the Carolinas Cord Blood Bank at
Duke, began his morning routine
differently. He omitted his first and
other 59 cigarettes of the day. May 20
was the quit date Mangum set during
his classes in the QuitSmart program
with Duke’s LIVE FOR LIFE.
The QuitSmart program offers a
series of three classes that are based on
two philosophies. First, the participant
must begin to define himself as a
non-smoker versus someone who is
not smoking currently. “This opens the
mind to behavior change, which is the
second part of the class — willingness
to try new behavior,” said Diane
Dunder, health education specialist
who teaches the classes.
The biggest step for participants
who decide to quite smoking through
the program is actually showing up to
the first class, Dunder said.
“Arriving to the first class is a bold
move,” she said. “The following three
weeks will be the hardest.”
Mangum decided enough was
enough after a weekend trip with his
family to Myrtle Beach, S.C.
“I realized I didn’t smoke that
much on the trip, but then as soon as
we got back in town I stopped to buy
cigarettes,” he said. After talking about
it with his wife, Mangum decided it
was time to quit smoking.
“I sleep better, smell better, taste better,
and I don't use as much cologne.“
Mangum learned about QuitSmart
through one of his co-workers at Duke
who also participated in LIVE FOR
LIVE tobacco cessation programs.
Similar trends have developed
among employees since Duke
Medicine and health systems and
hospitals throughout the Triangle
made the commitment to be tobacco
free starting July 4, 2007.
Since the policy was announced in on the plan developed for his brand he
October 2006, more than 1,000 Duke
Inside Duke Medicine
Rodd Mangum believes "by quitting smoking, I'm saving my life." Photo by erin pratt
employees have participated in a
tobacco cessation program through
LIVE FOR LIFE.
In January, LIVE FOR LIFE
tobacco cessation programs were
opened to employees’ dependants on
their health insurance polices.
“I have at least one couple in each
class now,” Dunder said.
Addiction
Mangum has acid reflux disease which
was worsened by his use of tobacco
products. He slept sitting up at night
to avoid choking. Even though he
knew the smoking was affecting his
health and quality of life, Mangum like
many other smokers was addicted.
Tobacco contains the chemical,
nicotine, which is highly addictive and
has complex effects
on the body and
brain, according to
the Duke Center
for Nicotine and
Smoking Cessation Research.
Dunder said QuitSmart uses a
method called “nicotine fading” to help
participants with the initial nicotine
withdrawal. This helps the participant
adjust to lower levels of the drug.
Mangum smoked Newport King
cigarettes which gave him 1.5 mil-
ligrams of nicotine per cigarette. Based
was scheduled to switch to three
different brands over three weeks.
“I didn’t even have to buy the last
brand,” he said. “I was at the point
that I didn’t have a desire to smoke
anymore.”
Mangum said the QuitSmart
program gave him the tools he needed
and a good foundation to begin the
process of quitting.
“I learned how to change my
habits,” he said. The process has not
been easy and he continues to rely on
his “quit team,” a group of family,
friends, and co-workers that help him
remain committed to being a
nonsmoker.
One of Mangum’s co-workers
gives him coffee stirrers to chew on
when he gets anxious. “When she sees
me, she asks how I am doing and if I
need anymore,” he said.
Since quitting smoking, Mangum
said his health has already improved.
“I sleep better at night, smell better,
taste better, and I do not use as much
cologne.”
Mangum was spending $3,285 a
year on cigarettes. “Now I will use
that money to buy gas,” he said.
Mangum is not the only one
benefiting from the absence of tobacco
in his life. His 13-year-old daughter,
who complained about having to go to
school smelling like cigarette smoke, is
happy for her father and glad his
vehicle smells better.
“I wanted to extend my life for my
family,” Mangum said. n
13
technology
Unity is coming
Voicemail system brings new
features
Summer brings warmer
weather and, for many
Duke Medicine people
this year, new voicemail.
Over the next few
months, Duke’s Office of
Information Technology will install Unity, a
new voice mail system, on many telephones
throughout Duke Medicine.
Hundreds of users have already switched to
the new system. Many more, including those
in Duke Hospital and Duke University Medical
Center, will be switched over this summer.
While the switch-over may bring some
temporary inconvenience, the Unity system
will provide new, powerful tools that will
make communicating easier and more
effective.
Here are some answers to questions about the
voicemail conversion:
Why is this happening?
The aging Octel and Audix systems have
reached the end of their useful lifecycles.
Neither system will allow for upgrades.
How is Unity different from my
current system?
Unity voice mail offers all the features of your
current voice mail. You can retrieve messages
from any telephone. New IP phones feature
an online Duke telephone directory. What
makes Unity different are the upgrades that
are coming. Those include links between
voicemail messages and e-mail, instant
messaging and mobile devices.
How will I know when my voicemail
has changed?
Look for an e-mail message well in advance of
the changeover. Your manager will also have
information about the switch. On the day of
the switch, look for OIT professionals in your
work area who will be available to answer
questions.
Will I need to do anything?
Yes. When your service is switched over, you
will need to activate your voicemail system in
order to receive messages. After dialing in,
you will be directed to create a password and
record a greeting.
What about my stored messages?
This is important – stored messages from your
current voicemail system will not be trans-
ferred to Unity. However, your old voicemail
account and password will be active for 30
days after the switch-over should you need to
access saved messages.
Where can I find more information?
Read all about the new Unity system at
OIT’s voicemail Web page:
http://oit.duke.edu/voicemail
14 Inside Duke Medicine July 2008

A P P OIN T M EN T S A W A RD S

Leadership change aligns Becky Kitzmiller, a Duke School of Nursing

clinical organizations
On July 1, William Fulkerson, M.D., became
senior vice president, clinical affairs, for the
Duke University Health System. In this new
role, Fulkerson is charged with implementing
the health system
strategic plan that
focuses on growth,
alignment and
efficiency.
He will be responsible
for driving integra-
tion and alignment
between ambulatory
services and hospital-
WILLIAM FULKERSON, M.D.
based services across
Duke University
Hospital, Durham Regional Hospital and Duke
Raleigh Hospital, as well as the physician
practice plan. His focus will be improving the
effectiveness, efficiency, collaboration and
synergy among all components of the clinical
enterprise, and positioning Duke Medicine for
growth as we undertake the major program-
matic and facilities expansion of the Duke
University Health System.
This new structure will enable Fulkerson,
medical school Dean Nancy Andrews, M.D.,
Ph.D., and DUHS CEO Victor J. Dzau, M.D., to
work together as an effective and efficient
team. Kevin Sowers, R.N., chief operating
officer for Duke University Hospital, will serve
as interim hospital CEO.
Chameides and Lyerly get
museum appointments
North Carolina Gov. Mike Easley has appointed
Bill Chameides, dean of the Nicholas School
of the Environment and Earth Sciences at
Duke University, and H. Kim Lyerly, M.D.,
director of the Duke Comprehensive Cancer
Center in Durham, to the N.C. State Museum
of Natural Sciences Advisory Commission. The
commission formulates policies for the
advancement of the museum and assists
in promoting and developing wider and more
effective use of the museum as an educa-
tional, scientific and historical institution.
Commission members serve four-year terms.
Other appointments
Boyd Carlson has been appointed associate
chief information officer for application
development and Patient Revenue
Management Organization-IT. Boyd will
provide leadership in the development of
mission critical applications across Duke
Medicine and will continue directing the
PRMO-IT team.
Ph.D. student, has been awarded a teaching
mini-grant from the Duke Graduate School.
She will develop an online orientation/
introductory module for graduate nursing
students to achieve informatics competencies
necessary to use the Gerontological Learning
Objects Repository being launched through
the work of Center of Excellence in Geriatric
Nursing Education.
Lincoln Community Health Center
Pharmacy was recently identified by the
Department of Health and Human Services
as one of the leading pharmacies in the
nation for excellence in Patient Safety and
Clinical Pharmacy Services. LCHC Pharmacy
was one of only five community health
centers recognized, and the only one in
the Southeast.
Full celebration for HAFS Mark Toles, a Duke School of Nursing Ph.D.
student, has been selected as a 2009-2011
John A. Hartford Nursing Pre-doctoral Scholar
in Academic Geriatric Nursing. He is one of
Duke University Health System CEO Victor J. Dzau, M.D., cuts the ribbon to open the fifteen scholars who will receive a scholarship
Hospital Addition for Surgery at Duke University Hospital last month. The addition covering tuition and fees of up to $50,000
provides space for new operating rooms and new patient reception and family waiting per year for two years.
areas. Dzau, center, was joined by Mark Newman, M.D., chairman of the Department
of Anesthesiology; Mary Anne Fuchs, R.N., chief nursing and patient care services officer Carolyn Scott, R.N., of Durham Regional
for the health system; Kevin Sowers, R.N., chief operating officer and interim CEO of Hospital, was named the first Professional
Duke Hospital; Chief Medical Officer Steve Olson, M.D.; and Greg Georgiade, M.D., vice Caregiver of the Year for American Cancer
chairman of the Department of Surgery. DUKE UNIVERSITY PHOTO Society’s Relay for Life of Durham County.
Pampering and healing at Duke Cancer patients' Spa Day
All-day pampering was part of the Duke
Cancer Patient Support Program’s first
“Spa Day” on June 11.
Patients enjoyed reflexology, manicures
and, massage at the Morris Cancer Clinic
(top photos).
Wanda McDevitt, a breast cancer survivor
from Durham, selects a wig from The
Butterfly Boutique (bottom photo).
“I have been looking for a white wig, and
I finally found one,” said McDevitt, who
plans to wear it to her 44th high school
reunion this summer.
Photos by erin pratt

Bruce Kennedy has a new role as assistant vice

president for marketing and creative services.
He will oversee a merger of Marketing and
Creative Services that seamlessly blends a range
of marketing communications resources, from
planning and strategy to graphic design and
Web services.

Mary Holtschneider, assistant clinical

professor and director of the Center for
Nursing Discovery at the School of Nursing,
has been elected to the NC League of
Nursing Board of Directors.
July 2008
A W A RD S
Strength, Hope and Caring:
Third-quarter awards
The following people from ambulatory
clinics were recognized during by the
Strength, Hope and Caring program
during the third quarter:
Physician/Non-Physician Provider Award:
Corbin Peterson, P.A., Dermatology
Peterson assists with laser therapy on patients
with vascular birthmarks, and has a passion
for working with the pediatric population.
Non-Clinical Award:
Darphine White,
Financial Care Counselor, Clinic 1F
A patient wrote that White “always treated us
with the utmost patience, care and respect.”
Clinical Award:
Lisha Johnson, N.A.,
North Duke Street Clinic
Johnson was recognized for her expertise,
kindness and willingness to help a patient and
his family.
Team Award:
Janice Thorpe, Client Service Rep.
William Hunt, Phlebotomist
Sally Guilmart, Nurse Manager, Clinic 1J
The team pulled together when an out-of-town
patient needed labs drawn late in the day.
DUFCU’s Berry named
professional of the year
Dan Berry, chief operating officer of Duke
University Federal Credit Union was chosen
as Professional of
the Year by the
National
Association of
Federal Credit
Unions (NAFCU).
Berry and other
winners in
NAFCU’s 2008
dan berry award programs
will be honored in
conjunction with
NAFCU’s 41st Annual Conference this
month in San Diego. He holds an MBA
from Duke University and has served as
Duke Credit Union’s COO since 2002.
Top Performer Award
The Durham Rehabilitation Institute
(DRI) received the National 2008 Top
Performer Award from Uniform Data System
for Medical Rehabilitation (UDSMR) in
recognition of outstanding rehabilitation
program performance. This award was based
on the Functional Independence Measure
(FIM) change from admission to discharge
and the percent of patients who are
discharged to the community once
rehabilitation is complete. These scores are
based on the patients’ functional and
cognitive abilities. DRI exceeded expectations
for 2007 with a score of 96th percentile, the
highest score in the southeast region.
Inside Duke Medicine
‘We decided to
make one’
Patients, caregivers work together on special therapeutic project
Special to Inside Duke Medicine
A s a recreational therapist, Betsy
Roy is always looking for creative
ways to provide activities for patients
that they may also do at home.
When Rehabilitation patients at
Durham Regional Hospital’s Durham
Rehabilitation Institute wanted a
pingpong or pool table, Roy thought it
would provide a fun way for patients to
build back some of their functionality.
“We didn’t have the budget to
purchase a table, so we decided to
make one,” said Roy. “We wanted
a table that functions as a pingpong
table on one side and a pool table
on the other.”
Engineering workers provided
the materials and Steve Montel, from
Engineering, cut and crafted the wood.
“Making the table was thera-
peutic for our patients who sanded
and painted the wood,” said Roy.
“Not only was it fun, but it required
problem-solving and coordination.
The patients figured out how we were
going to make one side a pool table
and one a pingpong table.”
While the team is still working on
the pool table construction, patients
have had their completed pingpong
table for a month.
“Patients play ping pong to
improve their balance, hand-eye
Got news? Bounce it to us. Send photos and news of
awards and appointments to editorinside@mc.duke.edu
Patients, therapists and operations
workers at Durham Regional Hospital
worked together to build a game table
for patients at the Durham Rehabilitation
Institute. Photo COURTESY DURHAM
REHABILITATION INSTITUTE
coordination and mobility skills. It’s a
great activity to incorporate some of
those skills. And, it’s fun,” said Roy.
She adds that the table construc-
tion was a great collaboration
between the patients, Engineering and
therapy disciplines.
She sent special thanks to
therapists Jeff Forsythe, Steve Montel
and Matt Painter, for helping with this
project. n
15
■ ■ L ives
In memoriam
The following employee and retiree deaths
have been reported:
May
Dorothy Harris, a former gastroenterol-
ogy employee, died May 14. Harris
worked at Duke from 1962 to 1987.
Donna Ribet, an assistant vice president
for budgeting and cost allocations, died
May 23. Ribet began work at Duke in
1973.
Valentina Neplioueva, M.D., Ph.D., a
surgery research scientist , died May 27.
Neplioueva began work at Duke in 1995.
April
Pamela Parker, a former employee on
surgical unit 6100, died April 22. Parker
worked at Duke from 1958 to 1994.
James Carroll, a former medical center
engineering and operations employee,
died April 23. Carroll worked at Duke
from 1973 to 2005.
Mary Jarman, a former medical center
employee, died April 9. Jarman worked at
Duke from 1955 to 1979.
Hazeline Bowman, a former health
system employee, died April 15. Bowman
worked in the health system from 1971 to
2002.
Margaret Eidson, a former operating
room employee, died April 19. Eidson
worked at Duke from 1962 to 1976.
Agnes Stephenson, a former billing and
collections employee, died April 29.
Stephenson worked at Duke from 1982 to
1986.
March
Frances Norris, a patient resource
management worker, died March 2.
Norris started work at Duke in 1980.
John Milligan, a cytology employee, died
March 8. Milligan began work at Duke in
1990.
Regina Lawson, a PRMO employee, died
March 11. Lawson started work at Duke
in 1977.
Clark Rivinoja, a psychiatry department
researcher, died March 13. Rivinoja began
work at Duke in 2006.
Judy Carlson, a patient resource
management employee, died March 16.
Carlson began work at Duke in 1975.
Ardell Farrington, a former medical
center employee, died March 18.
Farrington worked at Duke from 1967 to
1980.
Annie Edwards, a radiology employee,
died March 18. Edwards began work at
Duke in 1980.
16 Inside Duke Medicine July 2008

work + life

gas prices
GOTCHA?
I
n mid-June, $4 gasoline became a reality in the Triangle.
Duke Medicine has programs that employees can use right now to cut fuel
costs and help the environment. These are just a beginning. Duke Medicine
leaders, staff and faculty are seeking further ways to address this problem.

5 ways to save gas at Duke:

ngh
dejo

1 Enhanced Carpool Program access to any unreserved parking area at Duke. TT

ssa

Parking and Transportation Services has pays for gas and insurance, and arranges, oversees,
ane

and pays for all maintenance. Riders pay a monthly

nv

developed new carpool incentives that provide FREE

tio

parking in a preferred Duke lot for four or more fare based on the average daily round-trip mileage.
tra

participants. Each member also receives 12 daily passes TT can assist in finding commuting partners.
us
ill

http://triangletransit.org/vanpool/
for access to the group’s preferred lot and 12 for any
remote lot. Three participants pay $4 monthly per
person and receive a designated space in a preferred
lot with 12 daily passes for each member in a
preferred lot and 12 for any remote lot.
4 Mileage Reimbursement
Duke reimburses employees for business-related
mileage when it is necessary for employees to drive
http://parking.duke.edu/carpool their personal vehicles. The reimbursement rate, which
is set by the Internal Revenue Service, is 50.5 cents.

2 Rideshare
Two people who drive together
can share one permit and divide
the cost of the permit. Participants
receive up to 24 daily parking
passes when they drive alone.
Additional daily passes may be
purchased for $3 each. The 24
day passes include 12 passes for
a preferred lot and 12 for any
remote lot. http://parking.duke.edu/
transportation/Rideshare_2008.htm
Employees wishing to request reimbursement for
business-related travel must submit a Miscellaneous
Reimbursement Form. Forms should only be submitted
after reaching a minimum of $25 in expenses.
http://www.finsvc.duke.edu/gap/m200-021.html
5 Flexible Work Options
One way to save on gas is through flexible
work options. Flexible work arrangements are
appropriate for some, but not all jobs. Options
such as telecommuting or a compressed work
week can reduce the need to drive to campus every
day. Employees should first discuss with their

3 Vanpool
Employees or students who live
and work near each other and who share
approximately the same work hours can take
advantage of a vanpool through the Triangle
Transit (TT), which offers passenger vans for an
inexpensive and stress-free commute option. TT
vans do not require a parking permit and have
supervisor whether a flexible work arrangement is
a possibility. If it is, the employee should work with
the supervisor to develop a plan. A flexible work
arrangement must be reviewed and approved by an
employee’s supervisors to ensure the arrangement
continues to support the department’s goals and
that the job is appropriate for a flexible arrangement.
More info: http://www.hr.duke.edu/flexwork n

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