Inside Duke Medicine - June 2009 (Vol. 18 No. 6)

VOLUME 18 NO. 6 n inside.dukemedicine.org n June 2009

Sometimes, it seems there are as many of stories extraordinary care

at Duke University Health System as there are stars in the sky.

Here’s one story:An elderly couple had been in

an auto accident, and they had been brought to Duke University Hospital.

They needed critical care. They got that care from Mark Shapiro, M.D., and the staff members of Unit 2200.

The woman’s condition was worse than her husband’s, so Shapiro thought-fully requested that the staff bring the husband, who was on a stretcher, to her room so they could speak to each other one last time.

A week later, when the family de-cided to withdraw life support, the staff again moved the husband to the room next to his wife’s room, so that the family could be with both as they passed away within two minutes of each other.

Another shining example comes from the Birthing Center.

The team was leaving work when Juanita Hughes, RN, BSN, noticed a man yelling for help in front of the hospital.

The man’s wife was in labor and very near to delivering the baby in the car.

As Hughes delivered and took

the baby to the full-term nursery, Anne Bedoe, RN, Cathy Cronquist, RN, and Brittany Watson, RN, BSN, stayed with the mother until the EMS unit could arrive.

The baby and mother were both safe and well cared for, thanks to the team’s quick action.

For their efforts, Shapiro re-ceived the Physician Award and the team from the Birthing Center won the Team Award in Duke University Hospital’s Strength, Hope and Caring Awards. They are just a few stars rec-ognized recently.

Read even more stories of extraordinary com-

mitment in a special display on Pages 6 and 7.

m e d i c a l i n f o r m at i o n

HealthView use soars

the HealthView patient information portal passes 100,000 users. find out why it's so popular.

Page 3

Pat i e n t & fa m i ly c a r e

Waiting in comfort

an inviting new surgical waiting room and care areas improve the patient and family experience.

Page 5

r e m i n d e r

Have your voice heard

don't forget to complete the Work culture Survey by June 5. See your manager for details.

Duke University Health System’s present success propels it into the

future.That momentum comes from

concerted efforts to continually find ways to make sure the health system is healthy in years to come. For DUHS, the course to that future lies on two parallel paths.

The first is expense management. The second is strategic investment in growth opportunities. Both are important.

On the surface, belt tightening to save money might seem inconsistent with a plan to spend money on strategic projects. But it isn’t. Indeed, the two efforts are interconnected, and are crucial for assuring that DUHS can continue to provide the very best health care to a growing North Carolina community.

“There is a direct connection between how we use resources now

Two paths to the future:

see FUTURE, p.2

“There is a direct connection between how we use resources now and how we can invest in the future.”

— William J. Fulkerson Jr., M.D.

Strength, Hope & caring

Mark Shapiro, M.D., in lab coat, surrounded by the team from Duke University Hospital’s Unit 2200. Shapiro received the overall Physician Award in the hospital’s Strength, Hope & Caring recognition program. Photo by duke Photo

Expense control, strategic investment

Extraordinary stories, extraordinary people

Inside Duke Medicine

and how we can invest in the future,” said William J. Fulkerson Jr., M.D., senior vice president for clinical affairs. “Expense management and targeted investment are the two paths that we are following to that future accomplishment.”

Managing expenses

Last month, Inside Duke Medicine fea-tured a cover story about how a DUHS initiative — begun months before last fall’s onset of the global economic downturn — has allowed health system leadership to produce significant savings through close and coordinated attention to expense management and revenue enhancement opportunities. (Read “Prepared for the Future” online at http://inside.dukemedicine.org)

This initiative has been successful in allowing DUHS to identify more than $50 million in recurring savings annually. These recurring savings, and the continuing effort to find additional savings, are reinforced by two impor-tant DUHS goals — a commitment to a highly-skilled and dedicated workforce, and a dedication to not do anything that would weaken patient care or patient safety.

For example, faculty physicians worked hand-in-hand with procurement officers to make choices that would result in savings from the long list of surgical supplies the organization buys. At the same time, this effort focused on ensuring that patient care and safety remained the top priority and that the world-class care that Duke Medicine provides would not be affected.

“We are not making knee-jerk reactions to what’s happening in the economy,” said Kenneth Morris, senior vice president for finance. “We have had success following our long-term strategic plans, which call for growth to better serve the patients of our region, North Carolina and beyond. Expense management allows us to right-size the financial structure of our organization so that it can be prepared for current and anticipated conditions, and to provide resources for future growth.”

Morris said that the impetus for

initiating the expense management program last March was the result of a conviction among DUHS leaders that the health system needed to anticipate health care reimbursement reductions and other possible economic pressures.

Even before the global economic travails, DUHS leaders were thinking about the importance of saving for the future.

Strategic investments

Identifying $50 million in expense savings and revenue means there will be resources available for the major capital projects that the health system has been planning and studying.

For many years, DUHS leaders have recognized a need for greater capacities at Duke University Hospital and Duke Cancer Center. Similarly, the Duke University School of Medicine, after a long and thoughtful re-accredidation process, identified needs for more biomedical research space and a new student-focused learning center.

To support the Duke Medicine mission — excellence in patient

care, research and medical education — means investing in the infrastruc-ture and programs that underpin our success.

But it is not just about building buildings.

“The focus is always on the patients who will be cared for in these proposed facilities, as well as

the valued employees who make this possible,” Fulkerson said. “Strategic investments are really investments in patients and employees.”

Health system leaders have been carefully and conscientiously consider-ing potential strategic investments and observing daily the conditions of the marketplace and economy. The deci-

sions to build an addition to DUH, a new cancer center and a learning center are business decisions that DUHS lead-ers continue to plan for and on which they anticipate moving forward.

Over the past several years, DUHS has been making such carefully consid-ered strategic investments.

New clinics that expand the health system’s ability to serve more patients in the growing greater Triangle region have been built in Wake County.

The health system and Durham County have deepened and reaffirmed their commitment to Durham by agree-ing to a long-term extension of the lease on Durham Regional Hospital.

A new, renovated home for the Physician’s Assistant Program has been opened near downtown Durham, which will aid a program critical to the expansion of effective new models of care. The new facility also provides space for its future growth.

And Duke HomeCare and Hospice, already providing care for more than 1,000 end-of-life patients throughout the Triangle, opened a new 12-bed Hock Family Plaza hospice facility earlier this year.

Those investments won’t be the health system’s last. As the expense management initiative has shown, every employee will have a hand in making sure DUHS saves money so we can invest in future success.

The resources we manage well, in every department, contribute to the

organization’s ability to plan for strategic growth, said Fulkerson. The two paths — expense management and strategic invest-ment — lead to that point.

“By being disciplined about expense management we optimize our organization,” Fulkerson said. “An optimized organization can iden-tify the resources needed to expand. Expansion, when we are ready, will mean even greater opportunities for those who work at Duke University Health System.” n

2 June 2009

I N S I D E V O L U M E 1 8 , I S S U E 6 nConTACT US Campus mail: duMC 104030 Deliveries: 2200 W. Main St., Suite 910-b, durham, NC 27705 Phone: 919.660.1318 E-mail: [email protected]

CREDITS Cartoon: Josh taylor

STAFF Editor: Anton Zuiker Managing Editor: Mark Schreiner Science Editor: kelly Malcom Designer: Vanessa deJongh Inside online Editors: bill Stagg and erin Pratt Copyright © 2009 duke university health System

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.

Duke University Health System has recently made several strategic investments. Just three of them are, clockwise from the upper right, Duke HomeCare & Hospice’s Hock Family Pavilion, Duke Medical Plaza Knightdale in Wake County, and the new home for the Physician Assistant Program in Durham. fIle PhotoS

“The focus is always on the patients who will be cared for in these proposed facilities, as well as the valued employees who make this possible. Strategic investments are really investments in patients and employees.”

— William J. Fulkerson Jr., M.D.

FUTURE, cont.

o n t H e c o V e r

H e a lt H S u m m i t

3June 2009 Inside Duke Medicine

HealthView, Duke Medicine’s patient

information portal, is nearly two years old now and prov-ing to be wildly successful.

The portal, at https://healthview.dukehealth.org, provides patients with an efficient, secure and easy-to-use online tool combining scheduling, clinical and billing functions.

Its suite of tools, say Duke Medicine leaders, offers patients, providers and even the U.S. health care system an exciting and empowering innovation. The numbers agree.

More than 100,000 patients are now registered on the site. They’re using it around the clock and even around the globe, logging on from near and far to check lab results, pay bills — total-ing more than $10 million so far — and schedule follow-up appointments.

Duke Medicine em-ployees and their families make up a quarter of the portal’s users, said Pete L’Engle, senior pro-gram manager for eHealth in Duke Health Technology Solutions. He is proud of the portal’s progress, and anticipating more functions — many requested by patients themselves — over the coming years.

There’s no need to wait, though. HealthView offers a number of very useful tools.

Through the portal, patients can schedule their own appointments — routine, sick or follow-up visits, as well as annual exams — at all Duke Primary Care practices, Duke Family Medicine and Duke Children’s Primary Care. And when you realize you’ve just scheduled your physical exam for the same time as your daughter’s ballet recital, just click the Cancel Appointment button and start over.

Advanced registration is also now available for many Duke clinics, so patients can fill out and update contact information prior to arriving for an appointment. That means a more efficient visit.

As an appointment day comes closer, patients receive e-mail remind-ers. Across the Private Diagnostic

Clinic, said Rex McCallum, M.D., associate medical director, no-show rates are down 10 percent. Patients who use HealthView actually miss fewer appointments than those who aren’t signed up for the system.

That’s why physicians and clinic staff have actively encouraged patients to provide their e-mail addresses. Once a patient’s email ad-dress is entered into the HealthView system, he or she can create an account and make use of the site. (HealthView is not used by Duke Medicine for marketing purposes, and won’t use patient e-mail ad-dresses for messages unrelated to a person’s medical care.)

And, soon after an appointment, patients receive e-mail messages about any laboratory results that have been posted to a person’s account. Over the last year, patients viewed one million results, with more than 300,000 of those results reports annotated by providers in eBrowser to give patients clarity on what the results meant.

Most lab results are available to patients one to seven days after the test, though providers can make results available sooner. Lipid panel tests, for example, are available

almost immediately, said McCallum, since patients who get these tests are usually familiar with them and already manag-ing cholesterol levels. But, to comply with state and federal regulations, the results of some tests, such as HIV antibody tests, are blocked entirely from HealthView.

John Anderson, M.D., chief medical officer of Duke Primary Care, said that patients and providers uniformly like HealthView.

“Patients appreciate the transparency and ef-ficiency that HealthView provides, and the physicians like the way HealthView empowers their patients to be more involved in managing their own health care,” he said.

Anderson and other Duke Medicine leaders are encouraging all

employees to use and understand the portal, and to help patients see the value of the tools there. Posters and brochures promoting HealthView are prominently displayed now through-out DUHS clinics and waiting rooms.

“It’s good for the organization as a whole because it’s very patient centered and also gives us a competi-tive advantage in the marketplace,” said McCallum.

Nationally, electronic medical records and online health informa-tion vaults are seeing intense development, as stimulus money from the American Recovery and Reinvestment Act of 2009, and products from Google and Microsoft, pour resources into the technologies.

Asif Ahmad, vice president of diagnostic services and chief infor-mation officer, points to the future of HealthView, which will include e-visits and secure communications between patients and their health care providers.

“With HealthView, Duke Medicine has an innovative suite of tools that puts patients in control of their health care information,” said Ahmad. n

HealthView succeeds as vital patient tool

Posters throughout Duke Medicine clinics promote the HealthView portal to patients and employees alike. duke CreAtIVe SerVICeS

new partnership, funding seeks health innovationsduke university health System’s ongoing collabora-tion with durham community groups, leaders and residents to improve health and health care access took a major step forward April 28 with the launch of a unique effort called durham health Innovations (dGI).

dhI’s starting point is awarding grants that will support 10 collaborative duhS-durham planning efforts to address major health problems in durham County. the challenges range from adolescent health, asthma, cancer and heart disease to diabetes, hIV/sexually transmitted diseases, maternal health, pain management, substance abuse and seniors' health.

After the planning phase ends in december, some of the 10 plans may be selected for further development based on their potential for offering a new approach to improving health in durham.

Partnering with the durham community in this kind of initiative is a high priority locally and a trail-blazing step nationally in changing the face of American health care.

“this is what true health care reform is all about," said Victor J. dzau, M.d., president and Ceo of duhS and chancellor for health affairs at duke university. "It’s our community taking charge of its own health with duhS offering its resources as a partner so that we can come up with the best path to better health for everyone in durham.”

the dhI initiative, announced at the 8th Annual duke/durham health Summit, and the list of health care challenges arose from months of collaboration involving hundreds of duke representatives and more than 90 community agencies, organizations, businesses and residents.

dhI reflects a commitment by duhS to create a central role for the community itself to identify problems and define ways to deal with them.

lloyd Michener, M.d., chairman of the department of Community and family Medicine, said dhI offers a new vision: widespread, community-focused care convenient to work or home, better tracking of how and where people access the health care system, what care they need, what it costs, and what the outcomes are.

the information will be shared with the community and used to constantly refine the system to make it as efficient and as effective as possible, Michener said.

“there are many community organizations that are already hard at work improving health care in durham, but we know it is not enough,” said robert Califf, M.d., director of the duke translational Medicine Institute and co-chair of the dhI oversight committee. “the solution is not going to be more money. the solution will come from better coordination of effort, use of more effective information technology and working together to identify and implement the best practices from around the world.”

funding comes from the National Institutes of health and duke Medicine. each planning project will receive up to $100,000 to be used by the end of the year. each project then will be presented and evaluated to determine whether it moves forward into the next phase.

r e S o u r c e S

B u l l e t i n Sat a G l a n c e

I N S I D E V I E W n I T F I g U r E S n

t H e B i G P i c t u r e

”“We hear all and see all, often serving as eyes, ears and helpful hands for the other hospital teams.

— Bob Kelly, former director of Environmental Services at Durham Regional Hospital. Read more on Page 8.

1,000,000The number of lab results viewed by patients

in the HealthView portal in the last year.

300,000The number of lab results annotated by

providers to give patients added information.

100,000The number of registered users in HealthView.

Source: Duke Health Technology Solutions

4 Inside Duke Medicine June 2009

rEcOgNITION n

Heart Association recognizes Duncan

the American heart Association is honoring duke’s Pamela Woods duncan, Ph.d., Pt, for her outstanding service as chair of the Associa-tion’s Stroke Council and for her many years of membership on the leadership Committee of the Stroke Council.

duncan is both the first woman and first non-phy-sician to serve as chair of the council. her two-year tenure will be complete this month. At duke, dun-can is a professor in the doctor of Physical therapy division and senior fellow

at the duke Center for Clinical health Poli-cy research and the duke university Center for Study of Aging and human development.

bridgette McNeill, AhA communications man-ager, said that duncan “has been instrumental in bringing awareness to stroke rehabilitation.”

Among her many contributions included lead-ing a collaboration of the stroke rehabilitation guidelines with Veterans Affairs and the de-partment of defense. She also spearheaded the establishment of two new committees dedicated to stroke rehabilitation — the rehabilitation Prevention and recovery Com-mittee and the Quality of Care Committee.

“She has been a strong leader in advocat-ing the mission of AhA and her tenure as the Stroke Council chair is evidence of her passion,” said John b. Ponzio, director of AhA’s Professional Membership and Science Marketing.

The Seese-Thornton Garden of Tranquility, after careful consideration and painstaking planning, has been moved east to make way for the future construction of a cancer center. The garden, inspired by Rachel Schanberg and the Duke Cancer Patient Support Program, is intended to be a serene stopping place and a refuge for loved ones to memorialize those touched by cancer. Find the calming benches and inspirational pavers of the relocated garden outside Baker House. Photo by bIll StAGG

D U k E @ W O r k n

July 1: Pay statements go electronic

Starting July 1, 2009, duke university and health System will transition to full adoption of electronic pay statements for direct deposit. employees can easily access their electronic statements via the duke@Work Web site.

the useful Web site has already been embraced by about one-third of duke’s workforce to eliminate printed pay statements and manage personal information.

the final paper statements will be distributed on June 25, 2009, for monthly-paid employ-ees and on July 2, 2009, for biweekly-paid employees.

this action is the latest in a series of steps to reduce costs in an effort to address the university's $125 million budget shortfall and to reduce our environmental impact.

eliminating paper pay statements was one of the ideas submitted by faculty and staff through the enduring a troubled economy Web site (http://www.duke.edu/economy/).

Clear and concise instruction on the use of duke@Work is available at http://hr.duke.edu/selfservice/.

PAMELA WOODS DUNCAN, Ph.D., Pt


The surgery rooms of Duke University Hospital are beehives

of activity, but while patients there are getting top-notch care, their families are on pins and needles elsewhere in the hospital.

Now, those family members can be closer, and in a more com-fortable setting.

A plush new waiting room and a pre-operative and post-anesthesia care unit (PACU) now cater to surgical patients and their families, offering not only comfort but also areas more conducive to private conversation.

Perioperative Services unveiled the spaces in April on the third floor of Duke North in Zone 3400.

“These new spaces represent a major improvement in the hospital, and reflect our commitment to making sure all our patients and visitors have the very best experience while at Duke,” said Kevin Sowers, RN, MSN, interim CEO of Duke University Hospital.

The waiting room and PACU greatly enhance the hospital experience for families who are understandably worried about their loved ones, he said.

In the waiting room, one long wall has a large window that fills the area with natural light and provides for a warm and welcoming environ-ment. It’s a peaceful place for families as they wait, said Rebecca McKenzie, corporate associate for Perioperative Services. The room seats 141 people and features larger seating, reclining chairs, televisions and a quiet zone.

“Patients’ families like to be close to the operating room,” said McKenzie. “That was one of the guiding principles when we designed this space.”

Before and after surgery, patients and families can get even closer. All patient areas in the new pre-op and recovery area have privacy walls, which allow for secluded family visitation.

“We’re able to provide privacy to all of the patients and at the same time allow families into the patient care areas,” said Sue Ellen Thompson, clinical director of patient

flow in Perioperative Services.Patient advocate Cari Banks and

the patient visitor relation staff greet up to 100 patients and their family members each day. After welcoming the families into the patient care

areas, they ask families to complete surveys about their experiences in the surgical waiting room.

“Our new visitation policy welcomes two family members in the pre-op and post-op areas, and we are finding from the surveys that family members appreciate being included in patient care,” Banks said.

“Aside from training world class surgeons, Duke Surgery strives to provide the highest level of patient care,” said Danny Jacobs, M.D., M.P.H., chair of the Department of Surgery. “The implementation of our new surgical waiting room further

demonstrates our dedication to the patients and their families who trust in us. We want to make their experiences at Duke comforting and of the highest quality.”

Staff in the waiting room and the PACU have seen an impact on the patients. Nursing staff find that having

the family present is helpful to them and the patient.

“It’s part of the healing process for the patient and helps them relax,” said Banks.

The new pre-op and PACU areas bring not only a new environment, but new technology, too, including automated supply and medication

cabinets.“It’s been like moving from a

home built in the 1960s and 70s to state-of-the-art accommoda-tions,” said Priscilla Ramseur, administrative director of Duke North Operating Rooms.

The new PACU has 51 beds, four isolation rooms and four core workstations in the middle of the patient rooms. “The best part is it all flows well together, and it brings us closer to the

patients,” Ramseur said. The changes, she said, are lead-

ing to a higher sense of pride among the care teams. “I’ve heard so many positive comments from staff saying that this is definitely a reflection of the reputation of Duke.” n

Bringing families together

ABoVE: The new surgical waiting room provides a comfortable and spacious place for families to stay close to their loved ones in surgery. Photo erIN PrAtt BELoW: Betty Pearce, clinical nurse III, cuts the ribbon at the opening of the new area. Photo duke Photo

New waiting rooms and pre-op areas offer comfort, privacy

“We want to make patient experiences at

Duke comforting and of the highest quality.“

Patient & family care

E V E N T n

national Exhibit comes to Duke

Against the odds: Making a Difference in Global Health Aug. 3 – Sept. 11

“Against the odds: Making a difference in Global health,” a touring exhibit from the National library of Medicine, will be on display at the duke Medical Center library from Aug. 3 – Sept. 11.

the exhibit focuses on six areas in global health: community health, food for life, action on AIdS, the legacy of war, preventing disease, and global collaboration. the project is also a call to action to knowledge centers, academic and community leaders, students, and citizens to get involved in solving preventable health issues, while celebrating what has already been accomplished.

the exhibit includes compelling visual art that captures, explores, and furthers understanding of the social aspects of global health and is attached to a comprehensive website of activities, information, and resources. for more details, go to http://apps.nlm.nih.gov/againsttheodds/exhibit/index.cfm.

A variety of participatory events highlighting duke’s global health research, service and education projects will take place during the exhibit. In September, a reception will be held for students, faculty and staff hosted by the duke Medical Center library and Archives, the duke Global health Institute, and the hubert yeargan Center for Global health.

the reception will be held in the exhibit space, and will include short presentations, a digital display of photographs and stories from current faculty and students in the field, maps of duke’s sites in the world, and opportunities for informal conversation with prominent global health leaders on campus.

for more information about the exhibit and related activities, please contact Megan Von Isenburg, [email protected].

O N L I N E n

Calendar connectionthe Calendar page is absent from Inside duke Medicine this issue, but that doesn’t mean you have to stay inside all month.

be sure to visit these sites for plenty of details about activities, events, fitness opportu-nities and health

information seminars across duke university and health System:

Events@Duke http://calendar.duke.edu

DukeHealth.org http://www.dukehealth.org/events

EVEnTS

TUES

7


r e c o G n i t i o n

The Strength, Hope, and Caring program was developed to honor employees

whose extraordinary care reflects the ideals that are valued in our organization.

Duke University Hospital launched the innovative program in 2004. The goal was to highlight members of the team whose ac-tions epitomized service excellence through telling the stories of the impacts employees had on the lives of our patients and on our team.

This unique method of recognizing superior service delivery is now becoming an integral part of Duke University Health System’s rewards and recognition programs.

Last month, the winners of the annual overall Strength, Hope and Caring awards at Duke University Hospital and the DUHS Ambulatory Care Services Division were recognized at a gala event.

It is an honor to share their extraordi-nary stories with you here.

Strength, Hope and caring Overall Awards

Stars of our system

Assistant Director of Pharmacy Mike Canale, MS, RPh, went above and beyond when he drove to the airport to pick up an urgently needed medication and then personally delivered the medication to the hospital pharmacy.

overall Award WinnersDuke University Hospital Jennifer Satterwhite, nursing Care Assistant Neonatal Intensive Care unit years of Service: 18

Clinical Award

one night, Jennifer, a nursing care assistant in the Neona-tal Intensive Care unit and a member of the bereavement committee, “tended to the needs of (three grieving) families by providing them with whatever they needed,” wrote her nominator. “Jennifer deserves the Strength, hope, and Caring Award because in one night she gave more than 100 percent.”

Mike Canale, MS, RPh Assistant director, Pharmacy years of Service: 5

Non-Clinical Award

Mike's nominator wrote: “one of our patients needed a medication that had to be (urgently) flown in. Mike voluntarily drove to the airport to pick up the medication and delivered it to the hospital pharmacy that evening, staying many extra hours beyond his work shift. Not only did he deliver the medication, he took the time to explain the preparation process.”

Jennifer DeVries, Rn, MSn, CnS, nnP Advanced Clinical Practice years of Service: 8

Leadership Award

Jennifer created a program in the duke Intensive Care Nursery (ICN) called "keep your eye on the target" to reduce cases of retinopathy of prematurity (roP), a prevent-able form of blindness. her nominator wrote: “As a result (of the program), the duke ICN has the lowest roP rate in the network, and her program is now a model for many ICNs across the country.”

Anne Bedoe, Rn; Cathy Cronquist, Rn; Juanita Hughes, Rn, BSn; and Brittany Watson, Rn, BSn birthing Center

Team Award

the team members were leaving work when Juanita noticed a man yelling for help in the front of the hospital. his wife was in labor and very near to delivering the baby in the car. As Juanita delivered and took the baby to the full-term nursery, Anne, Cathy, and brittany stayed with the mother until the eMS unit could arrive. the baby and mother were both safe and well cared for, thanks to everyone's quick actions.

Mark Shapiro, MD Associate director, trauma, Critical Care, General Surgery years of Service: 2

Physician Award

due to a car accident, an elderly couple was critically ill in the emergency department. dr. Shapiro requested that the staff bring the husband to his wife's room so they could speak to each other one last time. And when the family decided to withdraw life support for the couple, the staff moved the husband to the room next to his wife’s room so that the family could be with both as they passed away within two minutes of each other.

Jennifer DeVries, Rn, MSn, CnS, nnP, demonstrated her foresight and initiative when she created a program that helped reduce rates of a preventable form of blindness at the Duke ICn, and became a model for similar programs throughout the country.


PhotoS by duke uNIVerSIty PhotoGrAPhy

LEFT: Michelle Edwards, Jennifer Asbell, Carey Unger, and Gavin Britz, M.D., displayed compas-sion, stamina, and a positive attitude on an especially challenging day.

BELoW LEFT: A real superstar, Kim Harward, LPn, received three nominations in one quarter.

BELoW RIGHT: Patient Advocate David Myers' responsive care was noted by two different nominators.

LEFT: Mark Shapiro, M.D., shown here with the extraordinary team from 2200, was recognized for his leadership that ensured the delivery of compassionate and thoughtful care to an elderly couple critically injured in a car accident.

RIGHT: Dr. Michael Smrtka's quick response and attentive patient care stood out and inspired his nominators to recognize him for his actions.

Duke University Health SystemAmbulatory Care Services Division

Michelle Edwards Clerical Manager, Clinic 1J/1G, oral Surgery Jennifer Asbell Nurse Manager, duke health Center at Morreene road Carey Unger health Center Administrator, Clinic 1l and Morreene road Gavin Britz, M.D. Surgery–Neurosurgery

Team Award

this team was nominated for their efforts in making sure patient care continued to be the number-one priority during a particularly challenging day. their nominator wrote that several of them came in on their day off and maintained positive attitudes throughout their shifts.

Kim Harward, LPn durham Pediatrics, North duke Street years of Service: 28

Clinical Award

kim received three nominations in one quarter. one of her nominators wrote: “… she reminds us daily of why we went into medicine and why we are still here. We are lucky to have her inspiring presence with us every day and would be poorer people without her.”

David Myers Patient Advocate years of Service: 2

Administrative Award for Ambulatory Services

david received two nominations, both from oncology patients and their families. one nominator wrote: “he is incredibly professional and competent and has been a pleasure to work with. It is a testimony to duke that you have such employees throughout all levels of the institution.”

Michael Smrtka, M.D. Clinic 1J years of Service: 3

Provider Award

When a patient fainted, Smrtka immediately responded and stayed with her until she could be transported to the emergency department. his nominators wrote: “he did everything to make her comfortable even though his clinic (time) was over.” Smrtka was also thoughtful to a transplant patient, who was inside most of time, by helping her enjoy a trip outdoors.

Inside Duke Medicine June 2009

o n t H e J o B

8

When a patient leaves the inpatient unit, it is the beginning of a

new challenge for Liz Wilkerson in Environmental Services.

As a housekeeper who handles discharge on units 5 and 7, Wilkerson is responsible for one of the most critical elements of patient care—making sure the room is clean for the next patient.

Wilkerson is part of the Envi-ronmental Services (EVS) Team at Durham Regional Hospital. Seventy-seven in number, this team works around the clock—cleaning every inch of Durham Regional’s 453,289 square-foot facility, including Lincoln Community Health Center.

The EVS team sees their work not only as essential for creating a healthy environment for patients, but also as an opportunity to make each patient they see feel less anxious.

“We try to see things through the eyes of the patient. They can often be very afraid, and we do what we can to make people feel safe,” said Fannie Edmundson, housekeeper.

The EVS team keeps infection control and prevention at the top of their mind as they clean the hospital. A good example is what’s required for a room discharge. As Wilkerson cleans room 7124, she takes care to complete each step with precision and within the required 30-minute timeframe. (See sidebar for her routine.)

Vance Eichelberger is a floater who does whatever task is needed to help the team. He is often called to clean the rooms designated as an isolation discharge. He follows the proper Isolation Room Cleaning Discharge Procedures to include washing of walls and changing of cubicle curtains.

In the Critical Care Unit, Tonya Teague, housekeeper, has different responsibilities. She cleans the whole unit, including patient rooms while the patients are in the room and after they are discharged. If she has extra time, Teague helps answer phones, brings items to the patient and assists the nurses with moving patients.

“This is my unit, and I want to help out as much as possible,” said Teague.

Fannie Edmundson, housekeeper on Psychiatry, feels that it makes a big difference for patients that EVS sweeps and mops each patient room every day, after asking the patient if they have any allergies.

“Having their floors mopped seems to make patients feel better,” she said.

Every day, patient hallways in the hospital are auto scrubbed by Gary Brook.

On the first floor of the hospital lies the “hub” of EVS activity. Judy Yarbrough, administrative assistant, takes phone calls and monitors the Discharge Bed Board System. With

this computer system, Yarbrough sees when discharge requests come through and how long it takes. She can see who is busy and whose room is in progress.

“On a typical day, we have a request for 15 discharges in the system at one time to be completed within 80 minutes,” said Yarbrough. “It can be a lot of juggling. We often have to pull another person to help depending on what’s happening. For instance, if we get a call for a spill, I page whoever is closest to it.”

Through the night

Environmental Services second and third shifts have a total of 24 employ-ees. They work primarily on cleaning the Operating Room, Emergency Department, Labor & Delivery, ancil-lary areas (like Radiation Oncology, Radiology Department, Lab, Special Services, Medical Records), lobbies,

inpatient rooms, discharges, isolation rooms and anything that is requested.

“You have to be ready to go in an instant for anything that comes up,” said James Sessoms, second shift supervisor.

Juan Rios, who handles trash collection for the hospital, begins at

2:30 pm each day collecting trash. He goes to all the nurse stations, soil holds and offices and takes the items to the trash dump-ster. It takes a full shift for Rios to complete the task

for the whole hospital. In a typical day, he walks three to five miles.

Going the Distance

The average number of discharges at DUH each day is about 62, with the majority on first and second shifts. The team cleans about five to 10 isolation rooms a day. In addition to completing all the discharges, isolation cleaning, floors, soil hold, cleaning all the inpatient rooms, EVS gets requests all day for things that come up.

“You have to be ready for the next request in an instant,” said Sessoms.

This work is completed with a smile and kind word. EVS’s customer courtesy scores have steadily increased in the last two quarters.

“We think this is due to training focused on seeing the hospital through the eyes of a patient,” said Bob Kelly, former EVS director.

“The EVS team member is one of approximately 70 hospital employees the typical inpatient encounters during a four-day hospital stay. This is a lot of people, and there is a lot of anxiety for each patient. Our team has an enor-mous opportunity to calm the patient’s fears by being a pleasant, familiar part of their stay and providing comfort.”

Often, patients ask EVS to help them with things that are unrelated to cleaning, and they either assist or find the appropriate person who can assist.

“We are an extension of every care team. We go into every room and talk to every patient. We hear all and see all—often serving as eyes, ears and helpful hands for the other hospital teams,” said Kelly. n

Durham Regional environmental team goes the distance

Leslie Poole and Judy Yarbrough use computer software to schedule and track hospital cleanings. Photo by toM WoSterS

30 minutes to cleanbefore she begins cleaning a room, liz Wilkerson first enters her employee number via phone into the tracking system. this is how eVS can tell where employees are and determine who can best help out when needed. She then sprays and wipes the phone with dispatch, a hospital spray disinfectant, and begins her routine:

•Removesallitemsthatcanbemovedfrom the room, including the Alaris IV line, linens and towels.

•Emptiesthetrashfromroomandbathroom.

•SpraysthebedthoroughlywithDispatchand lets it set for at least two to three minutes while completing other tasks.

•CleansthetraywithDispatchbothinsideand outside the drawer.

•DuststheTVandlightfixtures.

•Spraysandwipestheclock,bedbuttons,vents, light switches and support railings.

•Dustmopsthefloor.

•Carefullyremovescordsbehindfurniture.

•Cleanstheshower,toilet,baseboards,chair rail and window ledge.

•Removesthefootofbedandthebedframe to clean it.

•Cleanscordsfromallremotes,pumps,blood pressure cuffs, and cleans all handles, cabinets, mirrors and dry erase board.

•Makesthebedandmopsthefloor.

•Signsoutviaphoneandthencleansthephone again.

Wilkerson finishes by leaving a card stating she cleaned the room along with a number to call for assistance or comments.

“We try to see things through the eyes

of the patient. They can often be very

afraid, and we do what we can to make

people feel safe.“— Fannie Edmundson, housekeeper

i n m e m o r i a m f e at u r e

The Science & Research Supplement to Inside Duke Medicine

VOLUME 18 NO. 6 n inside.dukemedicine.org n June 2009

Responding to Swine FluBy Kelly Malcom

Christopher Woods, M.D. MPH, was at a conference in Italy when

reports of a novel strain of flu began appearing in Mexico in late April. One of his first phone calls went to colleague Brett Caram, M.D., with whom he’d done research on respira-tory infectious diseases at the Durham VA Medical Center.

Caram, too, had learned about the flu outbreak from email messages and infectious diseases listservs and already was busy pulling together information to discuss with leaders within the Duke Division of Infectious Disease. Colleagues Dennis Clements, M.D. and Dan Sexton, M.D. agreed that she would be the go-to person for expertise, representing both the Health System and the VA.

“Based on her research interests and experience, she was best suited to take the lead on providing the necessary clinical expertise for coordinating a response to a potential outbreak,” said Woods, associate professor of medicine in the Division of Infectious Diseases.

Caram and Woods are just two examples of an impressive array of infectious diseases experts at Duke.

From leadership of the Center for HIV/AIDS Vaccine Immunology to ongo-ing virus research at the Duke-NUS Graduate Medical School in Singapore, Duke is well poised to address the threats posed to human health by

pandemic flu and other diseases.Caram and the infectious diseases

team worked with local and state hospital and public health care officials, including Duke’s new public health epidemiologist Robert Willis, RN, and Jessica Thompson, director of emergency preparedness and plan-ning, to review and refine a response plan should the need arise.

“Brett really stepped up to the plate to provide invaluable leadership and clinical expertise during an intense period of emergency preparations,”

said Monte Brown, M.D., vice presi-dent of administration.

The Health System and VA have several emergency response measures in line for dealing with a potential outbreak of pandemic influenza and

other health threats, measures developed over the past ten years in response to several national and international events.

“With the events surrounding 9/11 and the subsequent anthrax attacks, followed a few years

later by SARS and avian flu, Duke, worked with local, state, and national public health institutions to develop plans for responding to biological and other threats to the health of our community,” said Woods.

When the novel A:H1N1, or swine flu, began appearing in states surround-ing North Carolina, Caram and Woods had the difficult task of reassuring patients and Duke-affiliated health care providers, as well as providing up-to-

the Health System and Va's expert infectious diseases team helped to coordinate an effective response against

the possibility of a pandemic flu outbreak. PHOTO ILLUSTrATION BY VANESSA DEJONgH

see FLU, p.10

noted researcher Schanberg dies

Saul Schanberg, M.D. Photo CourteSy

of SChANberG fAMIly

“Things were changing every 24 hours.

And on top of that, we were battling news

channels delivering all sorts of mixed

messages. It was important that we provide

accurate and rapid information.”

— Brett caram, M.D.

Internationally renowned neuroscientist and physician, Saul Schanberg, M.d., Ph.d., 76, died peacefully at home on May 15 after a long fight with cancer.

dr. Schanberg was assistant director of the behavioral Medicine research Program for several years and held a Career Scientist Award from the National Institute of Mental health for much of his career. he was professor of pharmacology and cancer biology at duke until November 2008 and served as chair of the department of Pharmacology from 1988 to 1991.

Schanberg is globally recognized for his ground-breaking research on the importance of touch in normal growth and development, finding that specific types of touch led to better health and shorter hospital stays for premature infants. his discoveries changed the way hospitals and clinics all over the world care for premature babies.

In addition, his research focused on identi-fying the biological mechanisms involving central nervous system regulation of onto-genic growth and development of cell and organ systems.

he is survived by his wife of over 50 years, rachel Schanberg, retired founder and director of the duke Cancer Patient Support Program; and his daughter laura Schanberg, M.d. Associate Professor and Co-Chief duke division of Pediatric rheumatology. he is also survived by his sister, betty dyer.

At Saul’s request, donations can be made to the duke Cancer Patient Support Program eNdoWMeNt in memorium, duMC 3139, durham, N.C. 27710.

Schanberg’s discoveries

changed the way hospitals

and clinics worldwide care

for premature babies.

f e at u r e

In early July, Duke will say goodbye to a landmark

historical building. Piece by piece, the Bell Building, once home for 60 years to dedi-cated students, researchers, and employees, will come down.

But don’t expect a giant, swinging wrecking ball. The building’s proximity to Duke University Hospital necessitates a careful demolition process. The demolition contractor, D.H. Griffin, one of the companies that facilitated the excavation of the World Trade Center site, will take the lead at bring-ing the building down while salvaging as much reusable material as possible.

“Several items from the building have been removed and reused elsewhere, include a cage washer, electrical switch gear, card readers, fire extinguishers, and more,” said Brendan Robinson, capital project

manager of Facility Planning, Design, and Construction. “All the furniture in the building has either been relocated with the occupants or sent to Duke’s asset disposition warehouse for donation to local charities. We are trying to recycle 95 percent of the demolished materials.”

The Office of Environmental Safe-ty (OESO) is actively working with the

contractors to ensure the safe-ty of the demolition workers, as well as the adjacent buildings. “As in any demolition project, safety is of the utmost concern and every effort will be made to ensure the safety of personnel and property,” said Robinson. With that in mind, the entire site will be fenced off, with signage to direct pedestrian traffic away from the site.

The empty building will first be disinfected. The whole process is being overseen by OESO to assure the safety of the

workers, staff and visitors,” said Gary Tencer, assistant director of OESO. The building will be dismantled from within with walls, floors, and other materials removed first.

Once that process is complete the actual demolition of the building will begin in late June to early July with about a two-month duration.

The contractors will use dust control measures, including misting water and pre-filtration, to protect the surround-ing buildings and equipment.

The Bell Building cornerstone, plaques and entranceway will be preserved.

“While Duke is losing a building that’s played a significant role in its history, we’re excited to embark on this step toward progress,” said Robinson. n

To find a list of the Bell Building’s former occupants’ new locations—and read an article about the building’s research legacy—visit http//inside.dukemedicine.org.

10 Inquiry June 2009

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 [email protected]

date definitions and suggestions from the Centers for Disease Control and Prevention (CDC).

“Things were changing every 24 hours. And on top of that, we were battling 24-hour news channels that were delivering all sorts of mixed messages,” said Caram. “It was important that we provide rapid and accurate communication.” Caram was interviewed by the local media, and helped to deliver updates to the community.

Said Woods, “It’s kind of a trade-off — you want heightened awareness but at the same time you don’t want people to overreact. I think

we did a good job at keeping that balance.”

The infectious diseases team worked with the clinical microbiol-ogy laboratory to quickly bring new diagnostic technology on line

to most accurately test specimens from suspected flu patients.

“Using gold-standard PCR technology, we were able to determine whether a patient had influenza A

or B, and to begin to separate out potential novel cases from lingering cases of seasonal flu,” said Caram.

Samples were then sent to the state lab and, if necessary, the CDC for further sub-typing to see if they were indeed A:H1N1.

Woods and Caram applauded the work of Employee Health, under the leadership of George Jackson, as well as Duke Medicine admin-istrators in helping to facilitate a coordinated response to the swine flu threat, including communication with ambulatory services, Duke Raleigh Hospital, Durham Regional Hospital and Duke University affiliated physi-cians throughout the region.

“Duke employees can rest assured that they are in good hands when it comes to emergency response,” said Woods. This sentiment was echoed in a message sent out on May 7 by Chancellor Victor J. Dzau, M.D., detailing the robust preparation and coordination of the infectious diseases

team, employee health, local and state health officials and the Duke administration.

The deft coordination of the flu emergency response teams was especially evident as Duke’s com-mencement approached, directly in the middle of the outbreak. Woods, with the help of Michael Merson, M.D., director of the Duke Global Health Institute, worked closely with vice president for student affairs Larry Moneta, Ed.D. to ensure the safety of

the graduates and visitors.“We’ve learned a number of

valuable lessons and recognized areas for improvement over the past few weeks,” said Caram.

Added Woods: “Ultimately, we are better prepared for what may happen later this year or the following winter, whether it’s related to this current strain or not. We have the expertise and the flexibility to adapt to the unique challenges presented by each novel outbreak.” n

FLU, cont.

Tips for avoiding the flufor important tips on remaining healthy through the flu season and during pandemic flu, visit http://www.duke.edu/flu2009/index.html

Advice from Duke and state officials advised patients visiting doctor's offices with flu

symptoms to wear masks as a precautionary measure. fIle Photo

Saying goodbye to the Bell Research Building

The Bell Building will be carefully demolished in early July. Photo by MArk SChreINer

BREtt CARAM, M.D.

c o n n e c t i o n S


Symposium highlights Singapore-Duke collaborations

r e S e a r c H n e W S

cancer and diet link

Diets light in carbohydrates appear to slow prostate tumor growth, according to work by Stephen Freedland, M.D. Read more about the findings along with other research news at http://www.dukehealth.org/Healthlibrary/news.

o n l i n e t o o l S

myresearch

The new MyResearch portal, accessible to all faculty through the Duke@Work self-service website (http://work.duke.edu), offers consolidated access to Duke-sponsored research admin-istration systems, research news, and important Web sites.

m u lt i m e d i a

research@duke

Watch a video about how the lungs filter out potential harmful viruses, bacteria and pollutants at http://research.duke.edu/.

With Duke-NUS Graduate Medical School Singapore

moving to a state-of-the-art new tower and about to welcome its third class of medical students, founding dean R. Sanders Williams, M.D. and current dean Ranga Krishnan, M.B., Ch.B., wanted to feature another aspect of Duke’s presence in Singapore.

So, they convened “East Meets West: Singapore-Duke Research Collaborations,” a day-long symposium held in the Levine Science Research Center in May. That meeting explored the various research programs and shared projects that are bridging the faculty here in Durham and 9,864 miles away in the island nation of Singapore.

Williams, senior vice chancellor for health affairs, was a skeptic when first presented with the idea of creating a Duke medical school overseas. Now he’s an ardent advocate of the global outreach of the Duke medical faculty.

“The opportunity to partner with Singapore to create Duke-NUS has turned out to be a golden one for Duke, and more and more of our clinical and basic science researchers are jumping in and forming strong partnerships that mirror the Duke and NUS collabo-ration,” said Williams.

Krishnan praised the efficiency of the country, from the airport luggage system to the way the nation’s scientific establishment is helping to support Duke-NUS.

“We are building a vibrant school in Singapore, and it is important that we share our success stories in order to keep strengthening the connections between our two campuses,” said Krishnan.

Presentations covered seven programmatic areas and the

growing opportunities for Durham-based faculty to collaborate with colleagues in Singapore.

Duane Gubler, Sc.D., is one of them. An expert in dengue hemor-rhagic fever and other vector-borne infectious diseases, Gubler joined Duke-NUS last year to lead the Program for Emerging Infectious Diseases.

“Emerging infectious disease epidemics are the greatest threat to Singapore’s economy,” said Gubler, explaining that Singapore’s role as a regional financial center and transportation hub exposes it to many tropical illnesses. He showed a slide of the tangled web of air routes that connect the earth’s cities, depicting the ease with which infectious diseases can now travel the world – a point underscored by the A:H1N1 influenza outbreak in the news last month. (See page 8.)

“All fevers are local, but some are more global than others,” said Christopher Woods, M.D., MPH, associate professor of medicine and a member of the Hubert-Yeargan

Center for Global Health. Woods studies the etiology of febrile illness, and has found that fevers often associated with expected diagnoses are instead caused by unexpected illnesses – for example, patients with fever in Malawi were presumed to be infected with malaria, but instead were suffering from disseminated tuberculosis.

Woods is collaborating with Gubler and others at Duke-NUS to develop and test diagnostic algorithms for a genomic approach to pathogen discovery.

Similarly, Bart Haynes, M.D., director of the Duke Human Vaccine Institute, is collaborating with Duke-NUS to explore the development of therapeutic anti-bodies and preventive vaccines to combat diseases for which the body does not produce broadly neutral-izing antibodies.

In a presentation on health services research, Eric Peterson, M.D., MPH, praised Singapore for its advanced level of electronic health information. He’s collaborat-

ing with David Matchar, M.D., director of health services research at Duke-NUS, to explore how Singapore’s clinical registries can be a platform for scientific discovery.

Exploring the collaboration op-portunities in cancer research, Patrick Casey, Ph.D., senior vice dean of research at Duke-NUS, explained the work of Patrick Tan, M.D., Ph.D., on the Gastrome Project, which is mapping gene expression signatures in gastric cancer. Tan has produced a graphical network showing 15,000 interactions of some 3,500 genes implicated in that cancer.

Tan’s research, said Casey, is an example of how Duke investigators might connect to Duke-NUS.

“Your favorite gene is important in cancer X, but you don’t know the signaling networks most important to its mechanisms of action. You can ask Patrick about your gene’s best friends in the gastrome, which will generate testable hypotheses about pathways in your system,” he said.

Other presentations explored the cardiovascular and metabolic disorders, clinical research on a global basis, brain sciences, and translating the Duke medical curriculum to Singapore.

Williams moderated a panel dis-cussion at the end of the symposium, asking six Duke leaders to share their perspectives on the Duke-NUS partnership and where it’s heading.

“This is going to change Duke,” said Victor J. Dzau, M.D., chancellor for health affairs, noting that together Duke and Duke-NUS are creating a vision for a 21st century global medical school.

For a list of Duke faculty currently collaborating with Duke-NUS colleagues, go to http://inside.dukemedicine.org and search “Singapore faculty.” n

R. Sanders Williams, Michael Merson and Ranga Krishnan discuss global health and medical education at the May 7 East Meets West Symposium. Photo by duke Photo

r e c o G n i t i o n


last chance

Have you taken the Work culture Survey yet? June 5 is the final day.

online any time

You can download a PDF of this issue, suitable for emailing or printing, at http://inside.dukemedicine.org

next issue

The next print edition will appear in late June. The deadline for submis-sions for that issue is June 10.

The Master Clinician/Teacher awards

this award recognizes those individuals with superla-tive accomplishment and service in the areas of clinical care and teaching.

this year’s awardees were Howard Rockman, M.D., edward S. orgain Professor of Medicine and chief of the division of Cardiology, Joseph Govert, M.D., Associate Professor of Medicine, and Richard McCann, M.D., Professor of Surgery.

The Leonard B. Tow Humanism in Medicine Award, provided by the Arnold P. Gold foundation, was awarded to Malcolm Stanley Branch, M.D., Associate Professor of Medicine.

The Leonard Palumbo Jr., M.D. Faculty Achieve-ment Award – Art Palumbo was on hand to witness the bestowing of a prestigious award named for his brother, a noted duke researcher and clinician. It was given to Thomas D’Amico, M.D., Professor of Surgery in the division of Cardiovascular and thoracic Surgery.

other awards included:

Gordon G. Hammes Faculty Teaching Award to David C. Richardson, Ph.D., Professor of biochemistry

Ruth and A. Morris Williams, Jr. Faculty Research Prize to Erich D. Jarvis, Ph.D., Associate Professor of Neurobiology and hhMI investigator.

Research Mentoring Awards:

Clinical: Harvey J. Cohen, M.D., Professor of Medicine and Chair of the department of Medicine

Laboratory-based: Howard A. Rockman, M.D.

Translational: John R. Perfect, M.D., Professor of Medicine and acting chief of the division of Infectious diseases, and Bruce A. Sullenger, Ph.D., Professor of Surgery and director of duke translational research Institute.

The 2009 Spring Faculty meeting was held on May 7 in the Doris

Duke Center to honor faculty from the School of Medicine and the School of Nursing for the 2008-2009 academic year. Several awards and recognitions were presented, including:

A season of awards

Brandon Cheng, ninth-grader at Enloe High School in Raleigh, performed a musical interlude to begin the En Memoriam section of the program. The Spring Faculty Meeting annually remembers departed colleagues. All PhotoS by duke Photo

The Duke School of nursing also recently presented several awards, including:

The Distinguished Alumna Award, which went to Margarete Lieb Zalon, BSn ’69, Ph.D., Rn.

The Distinguished Contributions to Nursing Science Award, awarded to Linda Lindsey Davis, Ph.D., Rn

The Outstanding Faculty Award went to Susan Denman, Ph.D.

The Distinguished Teaching Award was given to Midge Bowers, nP.

Mary Champagne, Rn, Ph.D., was named the Laurel Chadwick Professor of Nursing at Duke University.

Catherine Gilliss, D.n.SC., Rn, dean of the School of Nursing and vice chancellor for nursing affairs, was named the Helene Fuld Health Trust Professor of Nursing.

ABoVE: Dean Andrews presents the faculty research prize to Erich Jarvis, Ph.D. BELoW: Duke-nUS professor Shirish Shenolikar chats with Sally Kornbluth and Ed Buckley.

Inside Duke Medicine - June 2009 (Vol. 18 No. 6)

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