DukeMed Magazine - Spring 2012

VOLUME 12, ISSUE 1 SPRING 2012
A new era dawns

in cancer care and research at Duke
14 Introducing the new Duke Cancer Center 22 Then, now & next: Evolving cancer care 29 Finding better cancer therapies
A new home for cancer careas it should be

After years of diligent planning and the efforts of hundreds of members of the Duke and North Carolina communities, I am proud to report that Dukes new cancer center welcomed its first patients on February 27, 2012. The opening of this landmark facility is truly a historic milestone for Duke Medicine, and perhaps the most tangible symbol of a new era in cancer care and research at Duke that began in November 2010 with the launch of the Duke Cancer Institutea strategic reorganization of our cancer care and research programs designed to accelerate progress against the disease. Weve devoted much of this issue of DukeMed Magazine to these exciting developments, because we believe they are a thrilling advance in our teaching, research, and clinical care missionsan essential step toward true transformation in the way that cancer patients are cared for, at Duke and everywhere. We built the Duke Cancer Center facility to meet the growing need for high-quality cancer services in our region, where the number of people diagnosed with cancer is rising by double-digit percentages every five years. We didnt just consider the need in terms of population growth and statistics, though. As anyone who has been touched by cancer knows, its hard to adequately convey the stress that cancer can put on a patient and his or her family. Apart from the physical and mental impact of the disease itself, the rigors of the treatment processfrom chemotherapy to endless appointments and paperworkcan be a gauntlet of its own. Through the Duke Cancer Institute, we are working to change that reality in two ways: first, by redesigning cancer care to improve each patients experience, and second, by facilitating the development and delivery of more effective therapies that will bring new hope for patients everywhere. This new building supports both goals: It is designed to be at once a welcoming, healing environment for patients and a nexus of research and treatment innovation. Victor J. Dzau, MD
Chancellor for Health Affairs, Duke University President and CEO, Duke University Health System James B. Duke Professor of Medicine Chancellor Dzau with philanthropist Jonathan Tisch (left) and North Carolina governor Bev Perdue (right) at the Duke Cancer Center ribbon-cutting ceremony on February 23, 2012. For more coverage of the grand opening celebration, see page 34.
For the first time, we have brought oncology clinicians and support staff from across the medical center together under one roof, and organized them into dedicated, integrated teams focused on specific cancer types. Our patients will benefit from more convenient access to a full spectrum of specialistsand from an array of thoughtful amenities and services designed with their total health, comfort, and well-being in mind. At the same time, this facility will magnify the clinical and research impact of the Duke Cancer Institute (DCI), which is uniting laboratory scientists with physicians and patient-care staff to forge new collaborations that will drive advances in care. As the primary clinical site for DCI, the cancer center is a place where patients can access the latest therapies through clinical trialswhile in turn our clinicianscientists glean insights that inform further advances in research. I consider the establishment of the DCI to be among our most important and transformative initiatives during my time as chancellor. To me, this discoverycare continuum is the promise of Duke Medicine, and what makes us a source of real hope to every patient we serve. To paraphrase Michael B. Kastan, MD, PhDa renowned cancer scientist whom I appointed as the DCIs inaugural director in 2011at Duke we dont simply seek to provide great care, we seek to provide cures. In terms of cancer, the word cure is an ambitious one perhaps even an outrageous one. But it is true that for the first time in the generation since we launched the war on cancer, weve got not only better tools to fight with but also an environment designed to encourage hope and healing. We have great expectations. This is an exciting time for Duke Medicine, and we look forward to sharing it with you.
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VOLUME 12, ISSUE 1, SPRING 2012
29
14 introducing the new
duke Cancer Center Look inside a landmark

22 then, now, next
Transforming cancer care from generation to generation

29 found in translation
Dukes design to deliver better cancer therapies

d e Pa r t m e n t s
2 dukemed now
Campus construction, advancing medical education in Tanzania, taking blood-pressure management into the community, more
8 Clinical update
Myth-busting kidney donation, detecting prostate cancer in the obese, less is more in knee replacement rehab, new option for heart valve replacement, how stress damages DNA, more
34 Cancer Center Grand
opening events
38 dukemed Giving 39 dukemed People 43 new Physicians 52 Cme Calendar
DUKE MEDICINE ADMINISTRATION

Victor J. Dzau, MD Chancellor for Health Affairs, Duke University President and CEO, Duke University Health System (DUHS) William J. Fulkerson Jr., MD Executive Vice President, DUHS Kenneth C. Morris Senior Vice President, Chief Financial Officer, and Treasurer, DUHS Nancy C. Andrews, MD, PhD Dean, School of Medicine Vice Chancellor for Academic Affairs Catherine L. Gilliss, DNSc, RN Dean, School of Nursing Vice Chancellor for Nursing Affairs K. Ranga Krishnan, MB ChB Dean, Duke-NUS Graduate Medical School Singapore Monte D. Brown, MD Vice President for Administration, Duke University Health System Robert M. Califf, MD Vice Chancellor for Clinical Research Karen Frush, MD Chief Patient Safety Officer, DUHS Mary Ann Fuchs, DNP, RN Chief Nursing and Patient Care Services Officer, DUHS Art Glasgow Vice President and Chief Information Officer, Duke Medicine Ellen Medearis Vice President, Development and Alumni Affairs, Duke Medicine Michael Merson, MD Vice Chancellor for Duke-NUS Affairs Paul Newman Executive Director, Private Diagnostic Clinic and Patient Revenue Management Organization Thomas A. Owens, MD Chief Medical Officer, DUHS Carl E. Ravin, MD President, Private Diagnostic Clinic Kevin Sowers, RN President, Duke University Hospital Douglas B. Vinsel President, Duke Raleigh Hospital Kerry Watson President, Durham Regional Hospital
dePartment CHairs
Psychiatry and Behavioral Sciences: Sarah Hollingsworth Lisanby, MD Radiation Oncology: Christopher Willett, MD Radiology: Geoffrey D. Rubin, MD Surgery: Danny O. Jacobs, MD
duKe uniVersitY HealtH sYstem Board of direCtors
NOW
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duke university Hospital
Thomas M. Gorrie, PhD, Chair Peter Van Etten, Vice Chair Nancy C. Andrews, MD, PhD Daniel T. Blue Jr. Jack O. Bovender Jr. Richard H. Brodhead, PhD Victor J. Dzau, MD Frank E. Emory Jr. James F. Goodmon Carolyn E. Henderson Danny O. Jacobs, MD Rebecca Trent Kirkland, MD Richard D. Klausner, MD John H. McArthur, PhD Lloyd B. Morgan Theodore N. Pappas, MD Carl E. Ravin, MD Steven Scott, MD Susan M. Stalnecker Katherine Keith Thomas G. Richard Wagoner Jr.
duKe uniVersitY Board of trustees mediCal Center aCademiC affairs Committee
emergency department
duke university school of nursing
Thomas M. Gorrie, PhD, Chair Anne T. Bass, Vice Chair Julie Barroso, PhD Adrienne Clough Paul E. Farmer, MD, PhD Donald P. Frush, MD Xiqing Gao, JD Felicia Hawthorne (GPSC Student) Elizabeth Kiss, DPhil Cynthia Kuhn, PhD Michael Marsicano, PhD Alan D. Schwartz Laurene Sperling Nancy C. Andrews, MD, PhD* Monte Brown, MD* Victor J. Dzau, MD* Catherine L. Gilliss, DNSc, RN* Peter Lange, PhD* Navid Pourtaheri* William G. Anlyan, MD** Eugene W. Cochrane Jr.** Jean G. Spaulding, MD**
* Ex officio member ** Observer
Construction over the past few years has dramatically reshaped the medical center campus. (above left to right: June 2009 and December 2011)
DukeMed Magazine welcomes comments from our readers. Write to us via e-mail (dukemedmag@mc.duke.edu) or postal mail: DukeMed Magazine DUMC 3687 Durham, NC 27710
Anesthesiology: Mark Newman, MD Biochemistry: Richard Brennan, PhD Biostatistics and Bioinformatics: Elizabeth DeLong, PhD Cell Biology: Brigid Hogan, PhD Community and Family Medicine: J. Lloyd Michener, MD Dermatology: Russell P. Hall III, MD Immunology: Michael S. Krangel, PhD Medicine: Mary E. Klotman, MD Molecular Genetics and Microbiology: Joseph Heitman, MD, PhD Neurobiology: Stephen G. Lisberger, PhD Obstetrics and Gynecology: Haywood Brown, MD Ophthalmology: David L. Epstein, MD Orthopaedics: James A. Nunley II, MD (interim chair) Pathology: Salvatore Pizzo, MD, PhD Pediatrics: Joseph St. Geme III, MD Pharmacology and Cancer Biology: Donald P. McDonnell, PhD
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duKe mediCine Board of Visitors
Leslie E. Bains, Chair William G. Anlyan, MD* Kirk J. Bradley Santo J. Costa Duncan M. Faircloth* Michael Fields Michael T. Gminski Thomas M. Gorrie, PhD* George L. Grody Charles R. Hughes Robert A. Ingram Richard S. Johnson John D. Karcher David L. Katz, MD David P. King Garheng Kong, MD, PhD Donald R. Lacefield Milton Lachman* Roslyn Schwartz Lachman* Nicholas J. Leonardy, MD Brandt C. Louie Christy King Mack Thom A. Mayer, MD* Charles C. McIlvaine Robert B. Mercer Stelios Papadopoulos, PhD Joshua Ruch Ruth C. Scharf Glenn H. Schiffman Charles W. Stiefel Stewart Turley James M. Whitehurst Myles F. Wittenstein Sheppard W. Zinovoy*
*honorary member
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Editor: Minnie Glymph Designer: Jennifer Sweeting Creative Director: Kevin Kearns Production Manager: Margaret Epps Contributing Writers: Sarah Chun Carol Harbers Greg Jenkins Kathleen Yount Contributing Photographers: Duke Photography: Chris Hildreth, Jared Lazarus, Megan Morr, Jon Gardiner, and Les Todd Bill Stagg
Editorial Advisory Board: Martha Adams, MD Kathryn Andolsek, MD Dan Blazer, MD Nelson Chao, MD Sally Kornbluth, PhD Ted Kunstling, MD Ellen Luken Lloyd Michener, MD Harry Phillips, MD Joseph St. Geme III, MD Douglas Stokke Robert Taber, PhD DukeMed Magazine is published twice a year by the Office of Marketing and Creative Services. DukeMed Magazine DUMC 3687 Duke University Medical Center Durham, NC 27710 919-419-3270 dukemedmag@mc.duke.edu Web: dukemedmag.duke.edu
2012 Duke University Health System MCOC-8954
duke university Hospital learning Center duke medicine Pavilion emergency department
duke Cancer Center
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Our changing campus

Checking in on the medical center Google Maps cant keep up with
THE OPENING OF THE NEW DUKE CANCER CENTER in February marked a major milestone in a sweeping plan to transform and integrate the medical center campus. Since leaders announced the plans to add new facilities to meet increasing demand for clinical care, enhance the patient experience, and support innovative education and research, construction crews and cranes have swarmed around the campus to make the vision a reality. First to open, the Duke Cancer Center brings 267,000 square feet of dedicated space for the care of cancer patients (read more, page 14). Space vacated by cancer services in the adjacent Edwin A. Morris Building and Duke Clinic will be used to expand the footprint for other growing services and to bring related services closer together to streamline care deliveryincluding opening a new acute-care sickle cell treatment facility, creating multidisciplinary thoracic and abdominal transplant clinics, and expanding non-chemotherapy infusion services. The cancer center will be followed late this year by the opening of the School of Medicine Learning Center. The first new home for medical student education since the Davison Building opened in 1930, the 104,000-squarefoot Learning Center will provide students with the latest in educational technologies and a team-based learning design. It also houses a 350-seat auditorium to accommodate the medical centers growing needs. Next to open, in mid-2013, will be Duke Medicine Paviliona 580,000-square-foot, eight-story addition to Duke University Hospital. With the buildings exterior nearly complete, construction teams are now working on the interior, which will include 18 operating suites, imaging, and 160 patient- and family-centered critical- and intermediate-care patient rooms to meet growing demand. Altogether, the new buildings will add almost a million square feet to campus. New gardens, revised vehicle and pedestrian traffic patterns, and a campus-wide wayfinding scheme will unite new and existing facilities and complete the transformation. Over time, Duke Medicine plans to recruit nearly 1,000 new staff, while the projects themselves have supported as many as 1,000 construction jobs at a time. The activity wont stop after these projects wrap up: planning is already under way for
transforming another campus: Duke Raleigh Hospital in Wake County is also in the midst of several major projects to enhance services for its growing patient population. This includes expanding imaging and nonsurgical interventional capabilities, expansion of the emergency department, and expanding surgical facilities with the addition of two new operating rooms. Learn more at dukeraleighhospital.org.
other projects to meet needs in the years ahead, including an addition to the School of Nursing building as well as a new Duke Eye Center building that will expand clinical facilities to better serve the 80,000-plus patients Duke Eye Center now sees each year. Duke has received Certificate of Need approval from the State of North Carolina for the new facility, and is more than twothirds of the way towards the fund-raising goal to start construction. Learn more at dukemedicine.org/giving. Keep up with construction progress at dukemedicine.org/construction.
Visit Duke Medicine online at dukemedicine.org
DukeMed Spring 2012
Documenting Duke Medicine

DUKE PEDIATRICIAN John Moses, MD, believes so deeply in the power of documentary work to inspire physicians, he found a way to put cameras and microphones in the hands of residents to let them experience it for themselves. Moses, an accomplished photographer and documentary producer, worked with Liisa Ogburn at the Duke Center for Documentary Studies (CDS) to create the Documenting Medicine project, a collaboration between Dukes medical center and the CDS. Begun last year with a three-year grant from the Graduate Medical Education Innovation Fund, the program is a first of its kind. Moses and Ogburn are convinced that training young physicians in documentary practices can give doctors insights into the factors that affect the health of their patients and their response to medical treatmentand that this kind of insight can improve the efficiency and effectiveness of medical care. Five residents took part in the inaugural program; 12 currently are enrolled, and there is a waiting list. The CDS is also offering a continuing education course, A Day in the Life of a Patient, for people interested in using photography and audio to tell the story of a person with a serious medical condition. This four-day intensive workshop will teach the fundamentals of capturing good quality sound and images, discuss the ethics and constraints of documenting patient stories, and familiarize students with editing software. For more information, visit documentingmedicine.com.
Boone: Emergency medicine resident Andrew Parker, MD, photographed patients admitted repeatedly to the ER for the same nonresolving symptoms. Boone has juvenile rheumatoid arthritis, which causes chronic pain, near blindness, and stiff joints.
stephanie: Former resident Alison Sweeney, MD, photographed babies and mothers as part of her Life in the NICU series. Stephanie was born at 34 weeks six weeks premature.
Physicians call 800-MED-DUKE (800-633-3853), patients and consumers call 888-ASK-DUKE (888-275-3853)
With the extraordinary health needs in sub-Saharan Africa, in particular Tanzania, we are wise to invest in medical training as one way of addressing the challenges. We are excited by the possibilities this grant provides to the future of Tanzania and medical education, and to extend our partnership with KCMC. JOHN BARTLETT, MD
Making MDs in Tanzania

NEARLY 200 MEDICAL STUDENTS at the Kilimanjaro Christian Medical Centre (KCMC) in Tanzania sat for the National Board of Medical Examiners (NBME) examination this past summer. It was the first time the officially sanctioned test had been given on the African continent. KCMC administered the test as part of the $10-million Medical Education Partnership Initiative (MEPI) grant awarded to KCMC and the Duke Global Health Institute in 2010 by the Presidents Emergency Plan for AIDS Relief (PEPFAR), Fogarty International Center, and the Health Resources and Services Administration to strengthen medical education in Tanzania. The grant expands the decades-long partnership between Duke and KCMC to train a new generation of Tanzanian physicians with the knowledge and tools to become their countrys leaders in academics, research, and policy. The NBME exam was administered over the Internet, which was a large feat for a university in a low-resource setting where power failures are common. Thanks to the MEPI award, KCMCs medical education building now has a new technology
donald: Cindy Feltner, MD, an occupational and environmental medicine fellow, photographed her father, Donald (above), and his co-workers at a coal mine in West Virginia as part of her ongoing project on the management of chronic disease in the workplace.
infrastructure to allow for high-speed Internet access, AV-equipped classrooms with videoconference capabilities, a computer lab, and medical education laboratory space. Also through the initiative, the medical curriculum at KCMC will be reviewed and enhanced, particularly training in basic and laboratory sciences and research methodology. With guidance from medical education leaders at Duke University School of Medicine and Duke-NUS Graduate Medical School in Singapore, the curriculum will be revised to utilize team-based, problem-based, and community-based learning methods. With the extraordinary health needs in sub-Saharan Africa, in particular Tanzania, we are wise to invest in medical training as one way of addressing the challenges, says John Bartlett, MD, DGHI associate director for research and co-principal investigator. We are excited by the possibilities this grant provides to the future of Tanzania and medical education, and to extend our partnership with KCMC. The KCMC-Duke collaboration is one of 14 MEPI award recipients. MEPI provides grants to foreign institutions in sub-Saharan African countries to develop or expand and enhance models of medical education.
DukeMed Spring 2012
DUKE GLOBAL HEALTH INSTITUTE 5
Do as I do
A noted Duke cardiologist practices what he teaches
ROB CALIFF WAS SHOCKED when he discovered he had hypertension. It had been a few years since hed paid much attention to his blood pressurethen, in 2010, his doctor told him it was too high. Considering Califfs life and work, his high blood pressure is not surprising. He is an executive at a large corporation, he eats out frequently, he travels all over the world, hes in his late 50s, and he doesnt care for exercise. But heres the twist: Califf is Dukes vice chancellor for clinical research, hes a practicing cardiologist, he directs the Duke Translational Medicine Institute, and hes one of the worlds foremost researchers in cardiovascular medicine. Califf had already begun treatment for hypertension when he decided to enroll in a Duke-led, community-based quality improvement initiative designed to help residents of Durham County control their blood pressure. He was the first person to enroll in Check It, Change It, a grassroots effort that is an offshoot of Durham Health Innovations (DHI), a public-private-academic partnership that Califf helped found.
Dan Morgan of Durham (above), a 67-year-old retired retailstore executive, has enjoyed success in Check It, Change It.
In his first four months in the new community-based hypertension management program, he lost 20 pounds and was close to going off the blood pressure medication he had been on for two years. Morgan believes that the process of creating new, healthy habits has been the most important thing for him. He works out at the Downtown Durham YMCA every day for an hour, and he has improved his eating habits significantly. Honestly, I dont love the treadmill and the stationary bike, says Morgan, whose knees wont allow him to play as much racquetball as he would prefer. But now that its a habit, I miss it when I dont go. Although the program asks participants only to check their blood pressure at least twice a week, part of Morgans new set of good habits includes checking it every day at the YMCA. He even keeps a chart there of his progress. Ultimately, such habits are key to consistent BP management. I went 90 miles an hour in my career for 40 years, and it was stressful, Morgan says. Its a good time to start a new routine.
Check It, Change It is a unique model of integrated care for hypertension. The genesis of the project was when Califf and Duke won an award from the National Institutes of Health to investigate how medical researchers can translate findings more quickly from an academic setting into the community to improve population-based health. With the award in hand and the knowledge that 30 percent of Durham County residents suffer from hypertension, DHI began to formulate an intervention strategy. Meanwhile, the American Heart Association
(AHA) heard about the effort and contributed substantial funding. The program began enrollment in December 2010 after hiring three physician assistants and seven community health coaches to serve as patient liaisons. These Check It, Change It staffers promoted the program heavily in busy community venues such as churches, mosques, barbershops, schools, libraries, and community centers. We wanted to drive blood pressure care outside of traditional health care settings into the community where people work,
NEW MASTERS PROGRAM
YEAR PROGRAM
STUDENTS IN THE FIRST CLASS
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BIOSTATISTICS & BIOINFORMATICS FACULTY AT DUKE
45+
Biostatisticians:
Adding to the count
TODAYS STUDIES OF THE SMALLEST increments of a humanthe genome, the gene, the protein, the metaboliteyield a tremendous amount of complex data. That means that todays biomedical research teams are increasingly reliant on biostatisticianspeople who have not only strong statistics skills but also a foundation in human biology, and the ability to communicate statistical principles to multidisciplinary research teams. The demand for biostatisticians is outstripping the supply. Hence Dukes new Master of Biostatistics Program, which welcomed its first class of 16 students this school year. The two-year degree program provides mentored academic training in biostatistics, including experiential learning opportunities in authentic ongoing research. We wanted this to be different from a traditional masters program, says Greg Samsa, PhD, director of graduate studies for the Department of Biostatistics and Bioinformatics. We wanted active, hands-on learning. Biostatistics is a relatively new and rapidly growing discipline, and these are the skills we know employers are looking for. The program provides a practice-based learning environment, so that graduates will leave the program with a portfolio that demonstrates their mastery of analytical skills, biological knowledge, and communication. Learn more at biostat.duke.edu.
live, and play, says Bimal Shah, MD, a Duke cardiologist who is co-principal investigator for Check It, Change It with fellow Duke cardiologist Kevin Thomas, MD, and Sharon Elliott-Bynum, PhD, executive director of community health nonprofit CAARE Inc. Through eight participating clinics, program staff enrolled 2,045 Durham County residents. With the Check It, Change It team, participants designed a plan to reduce their blood pressure (BP), including diet and exercise modifications, hypertension educational counseling, and/or medication. Physician assistants monitored progress and followed up to make sure participants stayed on track. Patients checked their own BP at least once a week, either at home or at blood pressure monitoring stations located in 17 convenient locations throughout the community. The self-check stations automatically entered blood pressure measurements into the AHAs Heart 360 Web portal, a tool that promotes data sharing with primary care providers and Check It, Change It staff. (Those monitoring at home entered their data on Heart 360 themselves.) The goal was a reduction in BP after six months of program participation.
Califfs results have been good: he has lost 10 pounds, with a goal of losing five to 10 more; his blood pressure is controlled by one medication; and he works out at least 30 minutes a day on an elliptical machine. His regular monitoring has allowed him to adjust the dosage of his medicine right away when he notices spikes in his BP. But it has been the human contact of Check It, Change It that he has found the most helpful. We know that people are busy and lead stressful, complex lives, Califf says, noting that program staff helped him stay diligent. Theyll get on the phone and give you a call if you havent entered your data, or your data doesnt look good. Active follow-up and reminders are the most important thing. The intervention phase of Check It, Change It ended in February, and preliminary results are positive. If final results indicate success, organizers plan to extend the community-based model to other chronic health issues such as obesity, diabetes, and high cholesterol. They also hope that other communities will adopt the model.
DukeMed Spring 2012
UPDATE
Clinical
Talking to patients about live kidney donation

Duke performs about 120 kidney transplants every year, and a third are from living donors. Matthew Ellis, MD, medical director of Dukes kidney transplant program, says many people dont realize that they can give this gift of life without endangering their own. He says being ready to address common misconceptions about live donations can help pave the way for more kidney transplants and more lives saved. Here are five concerns that a physician can ease when a patient is considering the donation.
Matthew Ellis, MD
I have to be related to someone to donate a kidney to him or her. New antirejection medications make it possible to donate to distant relatives, even friends. But wanting to donate doesnt mean youre automatically qualified to do so. Dukes transplant team takes prospective donors through a careful physical and psychological screening processmuch of which can be done remotely for donors who live far awayto make sure the donor can undergo the surgery with no ill effects, physical or otherwise. The surgery is difficult, expensive, and Ill need to take a lot of time off. Todays kidney-donation surgery usually takes only a few hours, and it requires only a few small incisions and two or three days in the hospital. We say it usually takes three weeks to get back to almost all of your normal activities, and about six to eight weeks to feel completely back to normal, says Leslie Hicks, RN, Dukes kidney transplant coordinator. All hospital expenses are paid for by the recipients medical coverageonly costs of travel, time off work, and a few post-surgery medications arent covered, and there are several organizations that may help cover those costs for donors who cannot.
If my intended recipient and I arent a match, the process ends there. Thanks to the new paired kidney donation program, if you and your loved one are not a compatible match, you can be put into a database that multiple hospitals use to search for other incompatible donor/recipient pairs who might fit your criteriameaning the other donor gives your loved one a kidney, and you give yours to their loved one. In December 2011, Dukes transplant team successfully performed the first such double transplant in the Trianglemaking possible two live-donor transplantations that otherwise might not have happened.
After the surgery, my life will be different, and it might limit what I can do. Careful screening of donors means that only people who are in very good health will be selectedand for those people, the risks of future complications are very low. Women of childbearing age can still have healthy pregnancies after donating, and the risk for future kidney disease is not affected by the donation of a single kidney. Your health care needs after the surgery are essentially the same as before the surgery, says Ellis. Kidney donors will need regular blood and urine tests to monitor kidney function, and they need to watch their blood pressure, so they must visit their regular physician every yearbut, Hicks points out, thats something all of us should do anyway. Duke doesnt accept Good Samaritan kidney donations. Duke is now accepting altruistic donors those who are willing to donate a kidney to a recipient in need, even if that person is a stranger.
Learn more at dukehealth.org/transplant.
Obesity and prostate cancer detection

THE DIGITAL rectal exam may have heightened importance for those who are obese. Researchers at the Duke Cancer Institute and elsewhere have found that obese men were less likely to have abnormal digital rectal exams than non-obese patients. This isnt good newswhen the doctors office exam was abnormal, it was likely to be an advanced prostate tumor. The reason may be that earlier, smaller tumors are not discernable through excessive girtha shortcoming made worse by the tendency for PSA (prostate-specific antigen) screenings to also miss early signals of prostate cancer among obese men. The findings help explain why prostate cancer is often more lethal among overweight men versus those of healthy weight. Simply put, in obese men, its not getting
caught early, says David Chu, MD, urology resident and lead author of the study published in the July 2011 Prostate Cancer and Prostatic Diseases. Chu and researchers at Duke, the Durham VA Medical Center, and Sapienza University of Rome, analyzed data from 2,794 men undergoing prostate biopsies for this study. The findings also reconfirmed earlier research at Duke that PSA tests often fail to indicate a potential problem in obese men. In such instances, the PSA protein detected in the test reads normal, but may actually be at an elevated level that is diluted by a bigger mans additional volume of blood. The current study suggests that while an abnormal digital rectal exam may be an important predictor for prostate cancer in normal-weight men, it confers extra significance for obese men. Physicians should not neglect to do the digital rectal exam, especially in obese men, specifically because they are at high risk for unfavorable cancer outcomes, says Lionel Baez, MD, senior author of the study. In fact, the study showed that the digital rectal exam among obese men actually detected some tumors that were not flagged by PSA screening alone.
A path to better chemo delivery

AN EMERGING ASPECT of cancer research is attacking tumors on a cellular level by learning exactly how certain molecules move through cell membranes. To fully understand the mechanism by which the so-called transporter molecule carries substances such as cancer drugs into cells, scientists had to determine how this molecule is constructed. With this knowledge, they can create chemotherapies that are delivered more efficiently by the transporter molecule. A team of researchers at Dukes Ion Channel Research Unit recently mapped the structure of this key molecule, paving the way for more effective cancer drugs with fewer effects to healthy tissue. The research was published in Nature online on March 11. Graduate student Zachary Johnson was the lead author. The transporter molecule, properly called a concentrative nucleoside transporter, works by moving nucleosides, the building blocks of DNA and RNA, from the outside to the inside of cells. It can also transport nucleoside-like chemo drugs through cell membranes. Once inside the cells, the nucleoside-like drugs are modified into nucleotides that are incorporated into DNA in ways that prevent tumor cells from dividing and functioning. We believe it is possible to improve nucleoside drugs to be better recognized by a particular form of the transporter molecule that resides in certain types of tissue, says research team leader Seok-Yong Lee, PhD, assistant professor of biochemistry. For his work, Lee won the National Institute of General Medical Sciences Award from the Biophysical Society. Lees team determined the chemical and physical principles a transporter molecule uses to recognize the nucleosides, so if you can improve the interactions between the transporter and the drug, you wont need as much of the drug to get it into the tumor cells efficiently, Lee says.
David Chu, MD, and Lionel Baez, MD (left to right)
Concentrative nucleoside transporter molecule embedded in cell membrane

DukeMed Spring 2012 9
Why stress is bad

FOR YEARS, RESEARCHERS have published papers that associate chronic stress with chromosomal damage. Now researchers at Duke have discovered a mechanism that helps to explain the long-speculated stress response in terms of DNA damage. In the study, conducted by postdoctoral fellow Makoto Hara, PhD, mice were infused with an adrenaline-like compound that works through a receptor called the betaadrenergic receptor. The scientists found that this model of chronic stress triggered certain biological pathways that ultimately resulted in accumulation of DNA damage. This could give us a plausible explanation of how chronic stress may lead to a variety of human conditions and disorders, which range from merely cosmetic, like graying hair, to lifethreatening disorders like malignancies, says senior author Robert J. Lefkowitz, MD, James B. Duke Professor of Medicine and Howard Hughes Medical Institute investigator, who has studied the beta-adrenergic receptor for many years. The paper, published in August in Nature, showed that the infusion of an adrenaline-like compound for four weeks in the mice caused degradation of p53, a tumor suppressor protein that is considered a guardian of the genomeone that prevents genomic abnormalities. In these mice, p53 was present in lower levels over time. We believe this paper is the first to propose a specific mechanism through which a hallmark of chronic stress, elevated adrenaline, could eventually cause DNA damage that is detectable, Lefkowitz says.
David Attarian, MD
Banishing the myth of passive knee rehab

MEDICINE IS NOT IMMUNE to the seductions of traditionthere are studies to prove it. A lot of things that we do in medicine, we do because weve always done it, not because there are good data to support that practice, says orthopaedic surgeon David Attarian, MD, who knows firsthand how difficult it can be to break bad habits in practice. Knee replacement surgery has, for the past 30 years, made use of continuous passive motion (CPM) to aid recovery in patients. The CPM machinea device that requires a fair amount of effort on the part of the nurse, therapist, or family member to put it on the patient without hurting the patientcame into popularity after some data showed that it might help reduce drainage and increase a patients range of motion at discharge (which was, at that time, seven to 10 days after surgery). Attarian estimates that CPM machines are still in use in as many as half of hospitals that perform total joint replacement. Some hospitals use it as a way to control costs, because it reduces their need for therapists to be on hand, he says. Moreover, patients have come to expect the CPMthey hear
previous patients talking about how it helped them recover, and they think they need it. But heres the thing: current data dont support it. Over the past 10 years, hospitals that specialize in total joint replacement have studied the use of CPM versus moving a patient rapidly into active therapy, says Attarian, and theyve found that it is no better for a patient than introducing physical therapy shortly after the surgery. Dukes Total Joint Coordination of Care Committee has developed a new protocol regarding knee replacement surgery: instead of CPM, the patient receives his or her first physical therapy visit on the day of the surgery (or the following morning), and his rehabilitation focuses on active motion instead of passive. Attarian led a Duke study of the protocol, and the results mirrored the data gathered at other institutions: leaving out CPM reduces patient pain and resource drain by cutting out the burden of applying and removing the device, which requires two people and four to six hours worth of labor over the course of a day. And the patients have the same outcomes at discharge and three months out, compared to results from CPM patients. While it took some time to convince patients and doctors alike, Attarian says, the protocol is now used 100 percent of the time at Duke.
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G. Chad Hughes, MD
J. Kevin Harrison, MD
CoreValve TAVI trial showing impressive early results

Will Neighbors, already a survivor of quadruple coronary artery bypass grafting and a lower right lobectomy to remove a lung tumor, had a heart attack in May 2011. The event required no immediate surgery, but it did exacerbate his aortic valve stenosis. Neighbors first came to Duke from his home in southern Arkansas in 2008, when he was diagnosed with valve disease. When he returned three years later, his doctors saw a once-active man laid low by his aortic valve stenosis. Neighbors was so short of breath, he would get dizzy and fall if he attempted to walk or to bend over to pick up an object. He was ruled ineligible for open surgery because of the position of bypass grafts under his sternum. CoreValvean experimental, stentbased valve-replacement procedurewas his only option for treatment. It was this, he says, or nothing at all.
Neighbors was among the early Duke participants in the Medtronic CoreValve transcatheter aortic valve implantation (TAVI) clinical trial. Almost a year after the first CoreValve implant at Duke, its still too early to draw conclusions, but trial leaders say initial results are encouraging. Thats a positive sign in a study in which all patients are high-risk for valve treatment, and all patients have additional concomitant health problems, such as lung disease or kidney disease. Because other stent-based valves have shown an increased risk of stroke compared to standard valve surgery, choosing patients cautiously is critical. Cardiologist J. Kevin Harrison, MD, who along with cardiothoracic surgeon G. Chad Hughes, MD, leads the study at Duke, says that prospective study participants frequently tell him that their ability to remain somewhat independent is key to their quality of life. They are interested in survival and having their symptoms improve, but if the cure is worse than the disease, they arent interested. If they have a stroke and theyre left so that they cant walk or they cant function, says Harrison, you havent really helped them. Harrison and Hughes lead a large team performing the procedure. Despite the extensive preparation by the two physicians, Harrison jokes, Its like running a football team. They rely on a crew of about 15, including highly trained surgical and cath lab nurses and technicians, cardiothoracic anesthesiologists, and cardiac CT and echocardiography specialists. Electrophysiology staff implant and run
temporary pacemakers to allow accurate valve positioning and to treat episodes of slow heart rates. Two people are assigned only to load the valve in the delivery catheter properly. The doctors implanted Neighborss valve on July 23, 2011, a few days after his 79th birthday. Hours following the procedure, he walked the hospital hallway with assistance. Neighbors now feels so good, he walks twice a day and is signing up for a 12-week physical rehab class. Hes also looking forward to driving again, which along with his reinstated vigor will give him freedom that was missing for three months. Im going to get loose, he laughs, and nobodys going to catch me. To inquire about enrolling a patient in the CoreValve TAVI trial, call 919-681-3763.
There are two cohorts to the CoreValve trial: The first includes only patients with severe aortic valve stenosis for whom open surgery is not an option. All of these patients receive the CoreValve. The second cohort is patients who are high-risk for standard valve surgery. These participants are randomized one-to-one to receive either CoreValve or standard valve surgery. Although Duke delayed its enrollment in the trial by four months to be sure the device had been thoroughly bench-tested for durability, its in the top five of 41 enrolling sites in the United States.
Visit Duke University Health System online at dukehealth.org
DukeMed Spring 2012
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Cholesterol: Bad to the bone

HIGH CHOLESTEROL has another charge on its rap sheet. According to Duke researchers, the condition contributes to a loss of bone density by throwing off the bodys careful cellular balance of bone formation and bone loss. The finding may change the way people look at both cholesterol and the statin drugs that treat it. Statin drugs have been associated with positive effects on bone density, but scientists have thought this effect was separate from the drugs ability to lower circulating cholesterol, says Donald McDonnell, PhD, chair of the Duke Department of Pharmacology & Cancer Biology. His teams studies, conducted on mice, show otherwise: they found that a byproduct of cholesterol, 27-hydroxycholesterol, promotes the activity of a class of proteins known as liver X receptors, resulting in increased breakdown of bone. At the same time, this cholesterol derivative blocks the protective effects of estrogen in bone cells. This means that lowering the levels of circulating cholesterol may be whats behind a statins effect on bone density and bone loss. The findings also help explain estrogens long-documented but poorly understood role in maintaining bone health. Although estrogens have been used for years for the treatment and prevention of postmenopausal osteoporosis, the mechanisms by which it accomplished its positive actions were unclear, McDonnell says. These data not only begin to explain this positive activity of estrogen but also suggest potential new approaches for treating bone loss.
Cesarean birth? Put boots on the mom

A WOMANS RISK of deep vein thrombosis (DVT) jumps during pregnancy and the six weeks afterwardin fact, about one in every thousand pregnant women will develop the condition, in which a blood clot forms in an internal vein, typically in the legs. Its one of the leading causes of pregnancy-related death, in part because few patients are aware of the warning signs. Dukes Andra James, MD, coauthored new guidelines from the American College of Obstetricians and Gynecologists intended to encourage obstetricians to identify patients at high risk for DVT and to closely monitor all patients for DVT. Women with a history (or even family history) of DVT, or who have certain inherited clotting disorders, may need anti-clotting medicines throughout the pregnancy, say the recommendations, published in the September issue of Obstetrics & Gynecology. For women who are slated for a cesarean delivery, which increases the risk of DVT, the guidelines recommend using compression boots. These devices, which slip over each leg and regularly inflate and deflate to help blood flow more briskly, are already commonly used for procedures such as hip replacements. While there havent been large studies with cesarean deliveries to prove how much difference the gadgets could make, James says the group decided to recommend them because in other types of surgery, the devices can cut the clot risk by two-thirds.
Andra James, MD
Donald McDonnell, PhD
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ECMOwalking?
IN JANUARY 2010, 16-year-old Jessica, suffering from end-stage cystic fibrosis, was transferred to the Pediatric Intensive Care Unit (PICU) at Duke Childrens Hospital with hopes of receiving a double lung transplant. Her lung failure was severe enough that she needed to be placed on extracorporeal membrane oxygenation (ECMO). Even with this machine acting as Jessicas lungs, she was too sick and too weak to handle the transplant surgery. Jessica was going to die unless she got much stronger, and fast. The Duke team decided that Jessicas only chance for survival would be to actively participate in a physical therapy program that could increase her strength while on ECMO life support. Walking a pediatric patient on ECMO, the most extreme form of life support available, had never been done before, and would require careful planning and significant staff and technological resources. But this unique ambulatory ECMO approach, developed by a multidisciplinary team led by director of lung transplantation David Zaas, MD, ECMO medical director Ira Cheifetz, MD, cardiothoracic surgeon R. Duane Davis, MD, and pediatric intensivist David Turner, MD, has allowed Jessica and two other extremely ill patients to receive healthy lungsand to thrive after transplantation. Its a new way to deliver life support as a bridge to transplant, says Zaas, and weve shown that you can markedly decrease length of stay, improve outcomes, and lower hospital costs. In this protocol, the ECMO cannula is implanted through the neck (as opposed to the groin) and sedation is completely turned off, so that the patient can undergo active physical therapy. Its quite a sight to see. Shes attached to a tower of pumps and medicine lines, says pediatric respiratory coordinator Lee Williford, describing the
Jessica (left) and Gina (right) were among the first patients ever to receive physical therapy while on ECMO, an extreme form of life support. The innovative protocol developed at Duke enabled both girls to gain enough strength to undergo lung transplants.
first application of the protocol on Jessica. Whats more, she has a hole in her throat from the tracheotomy and her surgical interventions are fresh and cause pain. It was scary enough just to sit her upright, let alone have her walk. The only thing keeping her alive, the cannula coming out of her neck, could come out with one wrong step. There is no chance that these patients would have survived without this innovative process, so we had to try it, says Cheifetz. Jessica was indeed able to become strong enough to walk while on ECMO, and she received her new lungs just weeks after starting the program. Jessica died unexpectedly a year after her transplant, but the lungs she received gave her a year of better quality of life than her cystic fibrosis had ever allowed. Another of the first patients to receive ambulatory ECMO, Gina Kosla, was airlifted to Duke on February 24, 2011, in acute respiratory failure. Kosla has cystic fibrosis, and when she developed influenza the virus shut down her already clogged lungs. She was immediately put on a high-frequency oscillating ventilator, but she continued to worsen and was put on ECMO. When she woke up, she was told that in order to receive a lung transplant, she needed to start
walking. I was nervous at first, she says, but I did what they told me. In fact, she walked 700 feet while attached to the ECMO machine. It didnt seem like a big deal to me. I love marine science and everyone kept talking about this fish tank down the hall, so I decided I was going to go see this fish tank. Kosla got three to four hours of exercise a day in anticipation of her lung transplant. She was put on the transplant list on her 20th birthday, and got her lungs six days later. Shes currently enjoying life and lungs back home in Maryland. Zaas explains that these patients do well because the physical therapy helps them maintain muscle mass and avoid weakness associated with critical care, which means they are less likely to suffer the common transplant complicationsmost of which dont come from the transplanted lungs, but from the sickness of the patient prior to transplant. We are now trying to determine which other populations can benefit from this unique program, says Cheifetz, so that more children and young adults can receive this lifesaving measure. The team published an article on these cases in Critical Care Medicine in December 2011.
Visit Duke University Health System online at dukehealth.org
DukeMed Spring 2012
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Introducing the new Duke Cancer Center

by
MINNIE GLYMPH
photography by
JARED LAZARUS
On February 27, 2012, a new landmark opened its doors on Dukes medical center campusthe seven-story, 267,000-square-foot Duke Cancer Center. More than just state-of-the-art space, its an environment designed to transform the experience of every patient welcomed inside.
One of the first patients ever to step inside the new Duke Cancer Center was there long before opening day. Back in October 2011, 80-year-old Laurence DeCarolis donned hard hat, orange vest, and safety glasses to be escorted across a muddy courtyard bustling with heavy equipment to the building-in-progress. DeCarolis, a leukemia survivor, and his wife, Elizabethboth longtime volunteers with Dukes Cancer Patient Support Programhad been invited to take part in a walk-through test of the facilitys wayfinding signage. Along with other volunteers, they navigated their way to five sample appointment locations following temporary paper signs, and then offered feedback to help make sure the permanent signage would clearly direct patients to their destinations. The navigation test was one of many times during the multiyear planning and construction process that patients, faculty, staff, and volunteers pitched in to make this new building the best possible environment for delivering and receiving cancer care. And the team effort toward that shared goal has produced a place thats truly remarkable, says DeCarolis. You walk in and just say, Oh boy. The initial reaction is one of awe, with that fantastic atrium. And then as you come in you see all the special touches, like the host stations with complimentary beverages and snacks and the wonderful resource room and the lounge areas where you can look out into natural light. You can tell that so much thought has gone in to making patients comfortable. facilities didnt always support thatthey were more sterile environments designed primarily for clinical efficiency. The new cancer center is designed from the ground up with the patient in mind. In fact, patientsincluding DeCarolis and many othershelped inform the design, providing input in early focus groups that was complemented with extensive research and additional suggestions from caregiver teams. We really wanted to listen to what people found challenging and what we could do to make the whole experience better for them, says DCI administrator Carolyn Carpenter. For example, in the old space, family members often overflowed from crowded waiting rooms into the hallway. Research showed that patients brought an average of 3.5 friends or family members with them, so the new building was designed with ample, living-room-like waiting areas. For the 120 patients who receive chemotherapy each day, the new facility offers options of cubicles for privacy, a bright communal space for chatting, or even receiving treatment on the rooftop terrace on pleasant days. And healing spaces such as a quiet room for meditation are complemented by practical amenities like a boutique, a pharmacy, an educational resource center, and a caf serving healthy foodsreflecting the focus on whole-person care.
CritiCal needs and Creature Comforts

The Duke Cancer Center has in fact required years of thoughtful planning and concerted effort. The idea of creating a dedicated cancer center at Duke began taking shape in the mid-2000s, when it became clear that existing facilities were neither designed for the way cancer care was evolving nor sufficient to meet the growing demand for services. Not only is the Duke Cancer Institute (DCI) currently serving more than 50,000 patients a year, forecasts project a 15.3 percent increase in new cancer cases in North Carolina between 2010 and 2015and a 22.4 percent increase in the greater Triangle region that is Dukes home base. Far beyond simply adding space to accommodate more patients, though, We saw a real opportunity to create an environment that would dramatically improve the patient experience, says Kevin Sowers, MSN, RN, president of Duke University Hospital. Our providers have always put the patients first, but older
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DUKE CANCER CENTER AT A GLANCE Number of floors: 7 Size: 267,000 sq. ft. Original project budget: $235 million Construction initiated: Late 2009 Completion: February 2012 Key components: 123 clinical exam rooms 73 infusion stations Radiation oncology Radiology services Mammography suite 3 new linear accelerators Patient and family amenities: Boutique with specialty items for cancer survivors Outdoor garden terrace with infusion area for patients Retail pharmacy Patient resource center Caf Quiet room Sustainability features: Green roof space Use of sustainable building materials Energy-efficient mechanical systems LEED Silver status targeted
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The new cancer center is a wonderful, beautiful environment in which to deliver the very best cancer care, says William J. Fulkerson Jr., MD, executive vice president of Duke University Health System. Caring for our patients, their loved ones, and each otherthats what its all about.
Were also building survivorship services around that multidisciplinary care activities like social work, nutritional counseling, all the things we do to help the patient thrive during and after their treatment will be much easier to deliver with this kind of geography. The expanded space provides an opportunity to enhance these kinds of services, adds Carpenter. With space organized around disease groups, we can accommodate additional staff to enhance the depth of specialized care we offer. We havent historically had a dietician especially for breast and ovarian cancer, for example, but now there will be one embedded on the floor where those services are located. Well have genetic counselors, new-patient coordinators, family and marriage therapists, and pharmacists dedicated to focusing on specific patient populations, whether its prostate cancer or head and neck cancer. We want to give patients easy access to a total range of expertise.
else, it wasnt always easy in the past for trial coordinators to find private space to discuss enrollment opportunities with patients. The new facility not only includes dedicated private rooms for these consultations, but will actually make clinical investigation itself easier, says Kastan. Many clinical protocols are multidisciplinary in nature, with surgery, imaging, and chemotherapy components. Having those specialists together in one setting, along with dedicated nurses who are in tune with every aspect of the treatment protocols, will make it easier to conduct complex trials. In such ways, he adds, the building supports the overarching vision for the DCI, which was created in 2010 under the leadership of Duke chancellor for health affairs Victor J. Dzau, MD, to accelerate the translation of research discoveries into improved patient care (see related article, Found in translation, page 29). This is going to be a sea change in patients experience, Kastan says. The opening of this new facility, combined with the creation of the DCI, will enable multidisciplinary teamwork, facilitate the clinical research enterprise, and make care more effective, efficient, and patient-friendly. Its really making cancer care what it should bean endeavor where everything starts and ends with the patient in mind.
an enVironment for oPtimal Care

Beyond providing a comfortable and welcoming environment, the Duke Cancer Center will also enhance the leading-edge care Duke Cancer Institute is known for, says DCI executive director Michael B. Kastan, MD, PhD. One important change is that the facility brings together almost all cancer clinical services on the main medical campus, meaning that patients no longer have to travel to far-flung locations to see multiple specialists. Instead, most of the DCIs 100-plus board-certified physicians and 500 clinical staff will come together in multidisciplinary teams organized by disease typeso that patients will have access to a full range of expertise in one convenient setting. Its one-stop care delivery, says Kastan. The providers visits are all coordinated and everyone comes to the patient, which not only makes for a better patient experience but better medical care, because communication and efficiency are enhanced by the subspecialists being in close proximity.
desiGned for ProGress

The new facility is also designed to bolster clinical researcha key differentiator for the Duke Cancer Institute, which currently conducts around 700 clinical trials of investigational new cancer therapies and treatment approaches at any given time. While these trials can provide patients with treatment options they will find nowhere
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At your service: New-patient coordinators like Kristi Wuellner, Stephanie Pinnell, and manager Deborah Jackson (center) are among the first folks patients meet at the Duke Cancer Institute. The coordinators serve as a sort of concierge to help patients organize their appointments, gather needed records from their community physicians, and get answers to their questionsbasically, Pinnell says, Its our job to make things easy. The coordinators, pictured here in the Joan and Bob Tisch & Family Atrium and Reception Area, each specialize in a certain cancer type such as prostate or sarcoma. They also serve as a primary contact for referring physicians. The Oncology Scheduling Hub directs calls to new-patient coordinators: 919-668-6688.
One of the things Im excited about is that because this new space streamlines patient visits, I have more time to talk to patients, explain the clinical trials, and answer all their questions, says Beatrice Nelson, RN, research nurse clinician, who is working with gynecologic oncologist Angeles Secord, MD, to enroll patients in studies of vaccines, antiangiogenesis drugs, and other trials. So that makes it very research-friendly and easier for the patient. The environment is so relaxing, with private spaces for clinical trial education that are nice and big so the whole family can come in.
Angeles Secord, MD, with Beatrice Nelson, RN (right)
A warm welcome: The cancer center lobby features a working fireplace surrounded with the names of donors who have given gifts of $1 million or more toward progress fighting cancer at Duke.
Laurence and Elizabeth DeCarolis, volunteers with the Duke Cancer Patient Support Program
Team huddles are easy in the new Duke Cancer Center. With the whole spectrum of cancer specialists together in one building, co-located by disease type, and given ample space for both formal and impromptu conferences, providing truly multidisciplinary care is possible on an unprecedented scale. Pictured here are several members of Dukes thoracic oncology group, one of the first to formalize the team approach, which offers patients treatment plans based on the collaborative input of experts in medical oncology, thoracic surgery, radiation oncology, pulmonary medicine, and genetics.
Susan Blackwell, PA, Christopher Kelsey, MD, Gordana Vlahovic, MD, Mark Onaitis, MD, and David White, MD
Encouraging words: Designed to promote quiet contemplation, the Healing Path on the ground floor of the Duke Cancer Center atrium features inspiring quotes suggested by patients, families, faculty, and staff. Among them are words from Nancy Emerson, Pam Leight, Susan Moonan, and Terri Schinazi, who authored Finding the CAN in Cancer a book provided by the Duke Cancer Patient Support Program to patients and families coping with cancer.
This new building will make patients more comfortable, Im sure of that, says John Emerson, partly because they wont have to go hither and yon to see their doctors. The people at Duke have always been so friendly and compassionate, so that hasnt changed, but this new facility is fantastic. One of more than 200 volunteers with the Duke Cancer Patient Support Program, Emerson was married to the late Nancy Weaver Emerson, a well-known Duke cancer development officer who died in 2003 after surviving 20 years with breast cancer. Nancy Emerson sparked the idea for the programs beloved Tree of Hope, which has been lit each holiday season since 1991 in memory and honor of the many cancer patients Duke has served over the years. The Tree is a centerpiece of the Seese-Thornton Garden of Tranquility, which will be relocated to the grounds of the new cancer center in the coming months for the enjoyment of patients and families in the years to come. The start of something new: Volunteer John Emerson on the Bernstein Family Garden rooftop terrace, where patients can opt to receive chemotherapy treatments on pleasant days.
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The Belk Boutique, named for a $1-million gift from Belk Inc. and operated by the Duke Cancer Patient Support Program (DCPSP), carries a range of specialty items for men and women undergoing cancer treatmentfrom wigs and turbans for those who have experienced hair loss after treatment, to prostheses and postsurgical garments, to gentle makeup and deodorant for sensitive skin. A self-image specialist offers private consultations to help patients feel confident about their appearance. There hasnt really been one place people could go for these specialty products in the past, says Cheyenne Corbett, PhD, director of the DCPSP, which provides services to help patients cope with emotional, relational, and spiritual issues related to cancer. The space in this facility really helps us take our services to the next level to better support those facing cancer.
The Quiet Room offers a calming atmosphere for personal reflection as well as group programs, such as journaling, chair yoga, and mind-body classes. Mindfulness can be an effective way for patients to deal with all the stresses in their livescancer and everything else, says Tracy Berger (left), a marriage and family therapist who facilitates the Mind-Body Approaches to Coping with Cancer support group along with social worker Greg Bankoski (right). We try to teach patients that what they think about really has an impact on their physical selves.
Three state-of-the-art linear accelerators not only deliver precise beams of radiation to tumors with minimal effect on surrounding tissues but also feature miniature planetariums that take patients minds off their treatment with soothing, shifting scenes of day- and nighttime skies including the occasional shooting star. Its one of many ways nature has been brought into the Duke Cancer Center, says Tracy Gosselin, MSN, RN, associate chief nursing officer for oncology services. While patients are receiving radiation treatment, five days a week for three, five, or six weeks, I can imagine they would prefer to be elsewhere. Weve tried as much as we can to bring in elements that speak to the quality of life people encounter outside of cancer treatment, so that while youre here, maybe for a little bit of the time you can take your mind away from it all.
The machines in our new facility are designed to be userfriendlynot only for patients, but for the therapists who administer the treatment, which means we can give treatments more efficiently and with enhanced safety.
Christopher Willett, MD, chair, Department of Radiation Oncology
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The new Duke Cancer Center includes two floors of new imaging equipment, including PET, MRI, CT, and SPECT CT scanners as well as a patientcentered breast imaging facility. Cancer is a disease that frequently requires imagingto detect the disease, define its extent, determine treatment response, and monitor for recurrence, says Geoffrey Rubin, MD, chair of the Department of Radiology. To minimize any potential risk to patients, we want to expose them to as low a dose of radiation as is reasonably achievable, while still gleaning the knowledge we need to best treat their disease. The equipment in our new platform is absolutely state-of-the-artit will offer not only the highest image clarity but five to 10 times less radiation per image than the older generation of equipment. Its perhaps the most advanced imaging suite in the state of North Carolina. Tracy Jaffe, MD, chief of abdominal imaging, and CT technologist Cindy Davis
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Duke Raleigh Cancer Center: In addition to the new cancer center in Durham, Duke Cancer Institute brings patient-centered, multidisciplinary care to patients in Wake County at the recently expanded Duke Raleigh Cancer Center (DRCC). Today, patients have the luxury of having many options, many choicesincluding where they receive their care, says Joseph Moore, MD, a longtime Duke professor of hematology-oncology and medical director at DRCC. Our presence in Raleigh provides more options to the people of Wake County, who can receive world-class Duke cancer care in the comfort of their own community. In addition, at Dukeaffiliated hospitals throughout North Carolina, we are helping to provide the citizens of this state with high-quality care from prevention, screening, and diagnosis through treatment and survivorship.
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DukeMed Spring 2012
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NOW
by Carol Harbers photography by Jared Lazarus
01
02
transforminG CanCer Care at duKe
AS THE DUKE CANCER INSTITUTE
ERA BEGINS, FACULTY AND STAFF LOOK BACK ON HOW DUKE HAS CHANGED CANCER CARE FOR THE BETTERAND WHERE WERE HEADED NEXT.
decades that followed, Duke scientists

03
NEXT
new Duke Cancer Center, where those treatment advances will be delivered to patients in a far more focused and patient-friendly manner than ever before. Weve come so far in the generation since the war on cancer was declared, says Michael B. Kastan, MD, PhD, executive director of the Duke Cancer Institute. But today truly is the beginning of a new era for cancer patients at Duke. We are determined to transform care from diagnosis through treatment and survivorship, making our clinical approach more patientcentered, delivering treatments that are more effective and less toxic, and helping each patient not only survivebut thrive.
01 Barnes Woodhall, MD 02 The Edwin A. Morris Clinical Cancer Research
and clinicians contributed, discovery by discovery, to a growing arsenal of tactics to prevent and treat the once-unstoppable diseaseoffering new hope to patients in North Carolina and all over the world. Yet while many have benefited from those advances, the dream of curing people too often remains elusive. With a vision for accelerating progress, Victor J. Dzau, MD, chancellor for health affairs at Duke, led the conceptualization and creation of the Duke Cancer Institute, which was ultimately launched in 2010. The Duke Cancer Institute represents a total restructuring of clinical care and research designed to generate innovative ideas and speed the translation of scientific discoveries into advances in care. This new approach to cancer care and research was catapulted forward in February 2012 with the opening of the
hen Evelyn Morgan was hired
as Dukes first oncology clinical nurse
specialist in 1967, she embraced her role. I was drawn to the field because it seemed romantic and challenging. We were going to cure people! she says. But often what we gave patients could prove to be no good. In those early days, when patients often died from the side effects of new treatments rather than the cancer itself, researchers and doctors all over the country were desperate for a better way. Just a few years after Morgan started work on the wards, in the early 1970s, the government would declare war on the cancer menace and create the nations first eight comprehensive cancer centersone of which was at Duke. In the
Building, opened in 1978 and named for a $1-million gift from Edwin and Mary Morris, provided the rst dedicated facility for cancer treatment and clinical cancer research at Duke. 03 Evelyn Morgan
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We look forward to going to Duke, actually. We walk out with a smile on our faces. I feel very blessed.
Sabrina Lewandowski, 10-year brain tumor survivor, with Gregory and Layla Lewandowski Duke Cancer Center waiting area
First comes love

THE CASE OF THE BRAIN TUMOR CENTER
The upward trajectory of cancer care at Duke can be clearly traced in the rise of one of its shining stars, the Preston Robert Tisch Brain Tumor Center. In 1937, Barnes Woodhall, MD, came to Duke as its first chief of neurosurgery (and the only neurosurgeon in North Carolina). He established at Duke one of the first brain tumor programs in the nationa highly focused program, offering just one treatment: surgical tumor excision. For decades, surgery remained essentially the only treatment for brain tumor patients, even when Darell Bigner, MD, PhD, now director of the brain tumor center, arrived at Duke in 1963. Patients would die within months, he says.
One morning in 2002, Sabrina Lewandowski awoke with a headache that wouldnt let up. The then 30-year-old teacher eventually was diagnosed with glioblastoma multiforme, the deadliest form of brain cancer. Dukes Peter Bronec, MD, performed surgery, and Lewandowski was referred to neuro-oncologist Henry Friedman, MD, deputy director of the Preston Robert Tisch Brain Tumor Center at Duke, where she was immediately started on chemotherapy and radiation. In the meantime, her boyfriend, Gregory, proposedhe had purchased a ring while she was in surgery. Later I begged him not to marry me, she says, because I couldnt even promise him a year. But the team at Duke had a plan. Dr. Friedman told me the plan, and he said that if it didnt work, we had another plan, she says. She battled neutropenia and lost her hair. But the cancer never returned. Rather than settle for the standard of care, we used a rotation of chemotherapeutic agents following surgery and radiotherapy, says Friedman. We believe she did well because we used multiple agents, which is not the norm in this field, but she also may have had a tumor with a unique predisposition to respond to therapy. I choose to believe that our foundation of hopewhich embraces more than the standard of care made the difference. Ten years on, Lewandowski remains cancer-free. In February 2012 she became the first patient seen in the Preston Robert Tisch Brain Tumor Centers new Duke Cancer Center clinicand a first-time mom, welcoming daughter Layla on February 9.
I was just an ordinary person who experienced an extraordinary event with a happy ending.
Gayle Serls, Dukes first adult cord-blood transplant patient Duke Cancer Center caf
Extraordinary
Gayle Serls of Durham says her life is ordinaryand thats just fine with her. For a time, it was about as far from ordinary as a life can get. In 1995, at 45 years old, Serls was diagnosed with a rare form of acute lymphocytic leukemia, which could not be treated with conventional chemotherapy. Her best hope was an autologous bone marrow transplant, for which she was referred to Johns Hopkins. The night before she was to leave, though, she learned that her cancer had returned, and the procedure could not be performed. Now I had no hope, she says. But a new option was taking shape at Duke. Joanne Kurtzberg, MD, had pioneered the use of cord blood transplants to treat children with cancer in 1993and in 1996, Serls became the first adult to receive the groundbreaking procedure at Duke. Today, Serls is one of the longest-surviving adult cord blood transplant patients in the world, and helps make the lifesaving procedure possible for others through her job at the Carolinas Cord Blood Bank at Duke. Duke physician-scientists continue to pioneer advances in the field, through both the pediatric program and an adult program founded by Nelson Chao, MD, in 1996 (see related story on page 29).
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The brain tumor group was determined to find a better wayas evidenced by a history of major breakthroughs, which helped establish Dukes reputation as a leader in care and research for all cancers. In the 1950s, Woodhall became one of the first physicians to use chemotherapy nitrogen mustardfor brain tumors, albeit with limited success. He also pioneered the use of animal models to test chemotherapy for the treatment of brain tumors. In the 1980s, Duke researchers worked with the National Cancer Institute to establish the Brain Tumor Study Group, which introduced radiation therapy as a treatment option. In the 1990s, Dukes Henry Friedman, MD, worked with pharmaceutical companies and participated in national trials that led to the approval of temozolomide (Temodar), which significantly prolonged survival. In 2007, a Duke pilot study led by Friedman and James Vredenburgh, MD, found that bevacizumab (Avastin)one of a new category of drugs which Duke studies had shown to cut off tumors blood supplycould slow the growth of glioblastoma multiforme (GBM), the most common and deadly form of brain tumor. In 2008, John Sampson, MD, PhD, presented evidence that a vaccine aimed at inducing immunity to GBMs may stave off recurrence and more than double survival times. And in 2011, Lee Jones, PhD, added a new treatment to the mix by showing that brisk, regular exercise may also extend survival.
As the advances came from every angle, patients came from all over to Dukes by-now world-famous brain tumor team. And it truly had become a team, offering not just surgery but medical and radiation treatments, plus extensive support services. Today, specialists of all stripes work closely together to formulate the best treatment plan, increase the effectiveness of treatment, give the patient a better experience, and improve outcomes. Hope has become the mantra of the Duke brain tumor group. And there is hope, theres just no question about it, says chief neurosurgeon Allan Friedman, MD. Not only does Duke bring brilliant science to bear in treating patients with cancer, but we treat the whole person and constantly strive to improve quality of life.
oncologist, surgeon, and othersin one day, in the same place, and leave with a team-built plan for comprehensive care. In practice, thats not easy to achieve. In fact, many cancer patients today still start their treatment based on advice from a single specialist. The true multidisciplinary clinic is rare, says Kastan. Only a handful of centers work this waynot even most freestanding cancer centers do it. It is very complicated to have all the different disciplines together, to get physicians from across the departments and across clinical boundaries together for every patient. Its challenging in most settings, and requires a concerted effort. Yet it is an absolute requisite for optimal care. Thats why leaders structured the new Duke Cancer Institute to make multi-D care a realityfor every patient, in every clinic. To foster collaboration, DCI clinicians are organized by disease site (such as breast cancer or lung cancer), not by their discipline (i.e., surgery or medical oncology). They also meet regularly with clinical and basic researchers interested in the same disease sites to generate new ideas for study. The new cancer center is physically designed to support the multidisciplinary approach, as well (see page 14). It is very resource-intensive in terms of physicians time, says Joseph Moore, MD, a medical oncologist at Duke since 1975. But for a patient, its very efficient. It is a very focused way of diagnosing and planning treatment.
GETTING TO MULTI-D
The history of the brain tumor program illustrates the major trends that are driving care at the Duke Cancer Institute today: Unprecedented advances in technology and in drug development. A focus on the whole person and quality of life. And a commitment to bring all of those resources together for the patient. Key to achieving that is the multidisciplinary clinicin which experts from every specialty come together to deliver integrated care that is completely focused on the needs of the patient. Ideally, a multidisciplinary clinic means patients meet with all their specialistsmedical oncologist, radiation
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01 Darell Bigner, MD, PhD 02 Allan Friedman, MD 03 Henry Friedman, MD 04 Cancer researchers in the 1970s
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01 03 04 03 Duke University Hospital, 1980 04 A nuclear magnetic resonance
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The benefits are already clear to those teams at Duke that practice multi-D care on a smaller scale. We understood the value of this type of care early on, says Jeffrey Crawford, MD, medical oncologist and associate director of the thoracic oncology group, who came to Duke as a resident in 1974. It is critical for the patient to get that combined expertise. They come here for expertise, but they are often surprised to see just how much they have access to. Multidisciplinary care may have flourished earlier at Duke than other centers because of the structure of tumor boards at Duke, adds Crawford. The tumor board is a standing meeting in which surgeons, medical oncologists, and radiation oncologist get together to review cases and discuss joint treatment plans. We never had a generic tumor board herethey have always been disease-specific, says Crawford. The multidisciplinary clinic is an extension of that. Instead of waiting for the tumor board to meet, were able to bring together expertise for individual cases immediately. Its like a live tumor board for the patient. For breast cancer, multidisciplinary care also works extraordinarily well, says Gary Lyman, MD. In Dukes breast oncology group, he and other medical oncologists work closely together with specialists in not only surgery and radiation oncology but also imaging, pathology, and others in making the diagnosis, and with social workers, dieticians, physical therapists, and others in supportive care.
The effects are clear: Over the past two decades, we have made tremendous progress in the treatment of breast cancer, he says. Today, depending on what numbers you look at, 80 to 90 percent of patients who present with early-stage breast cancer go on to cure. That kind of success has been made possible in part by the multidisciplinary approach, as we are making more informed and coordinated decisions earlier in the management of patients with breast cancer.
Antiemetics changed the playing field, agrees Crawford. Once we could manage the nausea caused by platinum-based chemotherapy, we were able to further develop those drugs. A few years later, he and others at Duke introduced another advance in symptom management by leading multicenter trials of GCSF (Neupogen), a drug approved by the FDA in 1991 to treat chemotherapy-related neutropenia by stimulating the growth of white blood cells. Advances in technology have also contributed to making radiation treatment gentlerand more precise, says Christopher Willett, MD, chair of radiation oncology. Intensity-modulated radiation therapy and 3D radiation therapy have refined the delivery of radiation to treat tumors while minimizing effects on healthy tissue. The introduction of imaging technology such as MRI and PET improved visualization and detection of cancers and the accuracy of treatment. And linear accelerators allow therapy to be delivered with extraordinary precision. Today, Were working to define which patients would benefit from radiation therapy through imaging and, importantly, the unique biology of each cancer, says Willett. Our ultimate goal is to tailor treatment to the individual patient. That is really where all of cancer care is going. The new class of drugs known as targeted therapies is a key step toward that aim. Duke researchers have played key roles in developing and testing many of these new therapies, including
MERCIFUL MEDICINES, PRECISION CARE

Another sea change in cancer care comes as a blessed relief. Patients suffered so many side effects from chemotherapy, Evelyn Morgan recalls of her early days as a clinical research nurse. The nausea was what they feared most. In fact, many antiemetics were originally developed as treatments for the side effects of chemotherapy. The introduction of effective antinausea medication in the late 1980s revolutionized care, says Kevin Sowers, MSN, RN, president of Duke University Hospital, who began his career as a nurse on the hospitals oncology ward. When I got started in this field in 1985, we treated cancer patients with chemotherapy in the hospital because of the nausea and vomiting. The advances in symptom management drugs changed everything, including moving much of cancer care to the outpatient setting.
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The way I feel, the way I recuperated, its hard to believe exercise couldnt be significant. It enhanced my quality of life. I have no doubt that exercise therapy in the future will become more important in cancer prevention and treatment.
Marc Liles, prostate cancer survivor Patient and Family Resource Center, Duke Cancer Center
The health club

When Marc Liless doctor recommended surgery for his locally advanced prostate cancer, he wanted a second opinion. Not because I didnt have faith in my doctor, but I wanted to do everything I possibly could, he says. At Duke, Liles met with what he calls the dream team, including surgeon Cary Robertson, MD, radiation oncologist W. Robert Lee, MD, and urologist Craig Donatucci, MD. They spent a couple of hours with me and explained all my options, says Liles. In the end, Liles did choose radical prostatectomy. A year later, his PSA level is very low, and there is no cancer outside the prostate. In fact, hes in his best health ever, thanks to his participation in a groundbreaking Duke study of exercise in prostate cancer survivors. This trial is examining, for the first time, the effects of exercise on erectile function and other cardiovascular risk factors in men undergoing a radical prostatectomy for localized prostate cancer, says principal investigator Lee Jones, PhD, scientific director for the Duke Center for Cancer Survivorship. Liles says the exercise was great for his overall health and well-being. And Jones believes other patients can reap big benefits, too. My dream is that when a person walks in with a cancer diagnosis, they are told, This is your therapy, and by the way, here is your referral to an exercise specialist, he says.
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bevacizumab (Avastin)first approved by the FDA for colorectal cancer in 2004 and lapatinib (Tykerb), approved in 2007 for treatment of HER2-positive breast cancer. Unlike chemotherapy drugs, which kill all rapidly dividing cells, targeted therapies inhibit molecular pathways specific to certain cancer cells. More focused than chemotherapies, they are less toxicand they also extend survival. When the war on cancer began in 1971, we didnt have the tools we needed to fight cancer, says Kastan. Today, thanks to four decades of laboratory and clinical discoveries that are leading to earlier diagnoses and better therapeutic drugs, we see differences in many arenas, from acute leukemia to breast cancer to brain tumors. Where little hope could be offered to patients back then, we have many success stories now. Even in tumors that are very resistant to treatmentpancreatic cancers, some lung tumorswe now have nontoxic drugs that can increase survival by two or three months. That may not seem like much, but its promising since it tells us were heading in a good direction, he adds. Were learning that to really improve the cure rates, we need to refine our understanding of cancer and tumor biology, and have scientists and clinicians work hand-in-hand to apply that understanding to each persons care. Our goal with the DCI is to create those opportunities that will continue to move us forward.
SURVIVORSHIP: A MEASURE OF SUCCESS

More effective treatments have given rise to more cancer survivorsonce an anomaly, now a fast-growing group. Lee Jones, PhD, scientific director of the Duke Center for Cancer Survivorship, believes it was about a decade ago that widespread attention began to be given to the particular needs of survivors. There are about 13 million cancer survivors in the United States today. Its a direct result of our progress in detecting and fighting cancer, he says. In fact, he notes, the percentage of people surviving cancer long-term has risen from 50 percent in 1975 to 67 percent by 2009. Duke launched its survivorship center in 2005 to support cancer patients both during and after their treatment. We believe that individuals become cancer survivors at the moment of diagnosis and are survivors for the balance of life, says director Tina Piccirilli. That holistic view informs the centers services, which include a wide range of educational and support programs from pharmaceutical and genetic counseling, to physical therapy and nutrition counseling, to support groups and social work. The center also leads research aimed at defining the role lifestyle interventions play in patients overall quality of life. For example, research by Jones and his colleagues has shown that not only does exercise improve how cancer
patients feel during and after treatments, but it may also extend their lives. Cancer is out of their control, but exercise is not, and therefore is very empowering, Jones says. My goal is that one day exercise therapy will be considered part of standard of care for the treatment of many cancers, just like it is following a diagnosis of cardiac disease. In the new Duke Cancer Center, this increased emphasis on patients quality of life is evident at every turnfrom the caf serving healthy foods to the educational resource center to the organization of clinical care. In this new facility, support services the dietician, social worker, counselors, and othersare integrated into the clinical space along with the multidisciplinary care teams, says Tracy Gosselin, MSN, RN, associate chief nursing officer for oncology services. This really is patient-centered care, where everything is focused on their comfort and efficiency. The whole building, and the whole experience we offer, says that we are there to promote their healing. Thats what its all about, agrees Kastan. The more we can support the patient physically, socially, and medically, the more likely they are to successfully complete their therapyand the more likely we are to cure them, says Kastan. That remains our ultimate goal.
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SALLY KORNBLUTH, PHD, IS A BIOLOGIST WHO SPENDS A LOT OF TIME THINKING ABOUT FROG EGGS. She studies them to
understand apoptosis, the cellular death programming thats present in all normal frog (and human) cells, but becomes disrupted in cancer cells so that they proliferate unchecked. By totally pure chance, she says, she happened to hear about the work of oncologist Neil Spector, MD, a Duke colleague who led the development of the breakthrough breast cancer drug lapatinib (Tykerb) and was looking for new ways to help women who become resistant to the drug. Kornbluths work on apoptosis led the two researchers to a new approach they used an existing drug to suppress a protein that regulates tumor resistance, thereby resensitizing the tumors to lapatinib. They hope that someday soon this new treatment method will make its way towards a clinical trial. This process of aligning bits and pieces of knowledge and ferrying them from a cell culture discovery to a human therapy is called translational research. Currently the process takes about 15 yearswhen its successful, that is. Thats not a terribly long time in the realm of science, but time is precious for patients. Speeding up that processand making it less a matter of chance than Kornbluth and Spectors happenstance meetingis one of the driving ideas behind Dukes massive reorganization of its cancer enterprise into the Duke Cancer Institute (DCI).
Found in translation
by Kathleen Yount
How can we find better cancer therapiesfaster? With a bold strategy to spark innovative ideas and bring them into practice, Duke Cancer Institute is designing the answers.
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We often hear in the media about great scientific discoveries, like finding a new gene in fruit flies, and the researchers say, At some point, we hope this will help people. Since most of us will be touched by disease at some point in our lives, we all want to see those great discoveries applied to advancing treatment and outcomes. And thats what translational research is all about.
NEIL SPECTOR, MD CO-DIRECTOR OF EXPERIMENTAL THERAPEUTICS DUKE CANCER INSTITUTE
Great strides have been made against cancer over the past few decades, but there are still too many people whose cancer cannot be effectively treated, says Victor J. Dzau, MD, Dukes chancellor for health affairs, who led the establishment of the DCI in 2010. Its clear that we need to accelerate progress against this devastating disease, which is why we created the DCI. The unique structure of the DCI represents a more focused, integrated approach to the cancer problem that brings researchers and clinicians together to spark innovation across the spectrum of cancer types, Dzau says. Our vision is to transform cancer care by accelerating the translation of research discoveries into breakthrough treatments that improve patients experience and outcomes.
excellent physicians working in the clinic, says Spector, who is co-director of the DCIs Experimental Therapeutics research program. Bridging the divides between bench and bedsideor even among various benchesis a significant challenge. Yet most cancer experts agree that its somewhere between these two worlds where the big advances in oncology will be made. The Duke Cancer Institute was built to be the bridge. It all starts with the framework, says Michael B. Kastan, MD, PhD, executive director of the DCI. The institute is designed not around various specialties and disciplines, but around the diseases it seeks to cure. Like a grid of intersecting interests and skills, there are 10 disease groups for different tumor siteseach one drawing together clinicians, clinical researchers, and basic scientistsas well as nine National Cancer Institute-designated research programs focused on crosscutting interests such as radiation oncology, prevention, and cancer genomics.
Since the DCI was created, the disease groups have been meeting on a regular basisand creating new connections. The DCI is juxtaposing people who have common interests, helping people know who their relevant partners are and sparking enthusiasm for new ideas, says Kornbluth, who is vice dean for basic science in Dukes medical school. For example, [breast oncologist] Kim Blackwell runs clinical trials on lapatinib. Shes a busy clinician; Im living in a different world. But through interactions with Kim and other clinicians in the breast cancer working group, now Im thinking, Could we work together? There is much more communication among faculty, much more thought being given to clinical-trial protocol development in all areas, Kastan says. We believe thats step one toward our goal, which is essentially to do all phases of drug development under one roof, with fewer costs (both human and capital) and better results. New target identification, drug discovery, development, testing, and taking that into clinical trialswe want to do the whole spectrum within the DCI.
maKinG tHe riGHt ConneCtions

Traditionally in universities, and in the biomedical industries, there have been excellent basic scientists working in the laboratory, and then there have been
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sParKinG neW ideas

Paradigm shifts take time. But the DCIs new way of attacking old challenges makes so much sense, Duke faculty members are embracing the change. Take Donald McDonnell, PhD. Professor and chair of the Department of Pharmacology & Cancer Biology and a specialist in the development of drugs that target prostate and breast cancers, McDonnell has been at Duke more than 15 yearsbut until recently he had minimal interaction with clinicians looking at the other side of what he was looking at. Now, thanks to the DCI, hes leading a research project that involves colleagues from his own lab, his department, the university, and the medical center. We have come together to produce something thats made me phenomenally reinvigorated, he says.
Dan George, MD, directs genitourinary medical oncology at Duke. Ive been here eight years, and though Donald and I have always had shared interests, weve never had the impetus to come together. It was really the DCI umbrella that gave us the priority to do that work. For patients with prostate cancer, lowering androgen levels is one of the best available therapies, but a certain percentage of men die from recurring cancer that persists even after inhibiting the production of androgens to nearly undetectable levels. McDonnell and George explored new ways to explain how these tumor cells survive even when androgen is blocked, and have discovered a potential antitumor molecule that shows promise against these recurring cancers. Theyre now in the process of translating their findings into human trials, relying
on collaborations with even more groups across the universityfrom chemists to imaging specialists. Its been very rejuvenating to feel connected across the institution, says George. One great thing about academics is that this environment allows you to do things that you cant do anywhere else.
tiGHteninG tHe CYCle of innoVation

The notion that a closer connection between scientists and clinicians could reap big rewards didnt fall from the sky, of course. Some Duke teams are living proof. Nelson Chao, MD, works in stem cell transplantation, an area that he says is, by definition, translational. This is a fairly new field, so a lot of what were doing is cutting-edge, he says. Our patients are terribly ill, and were always running trials to try to make things better. Toward that end, the Adult Blood and Marrow Program he leads formed a cohesive system of constantly going back to the lab to try to find new ways to treat the disease and reduce complications from the treatment. For us, he says, the distance between the laboratory work in mice to humans is relatively short. Judging by the leaps made since Duke pioneered the use of cord blood in adult patients in 1996, the system works. Chaos group conducted the first large study demonstrating success in transplanting stem cells from donors who are not fully matched. They introduced chemotherapy that is less aggressive than standard practicethereby making transplant an option for patients who would otherwise be deemed too sick or too old. New research into hematopoiesisunderstanding what regulates the stem cells that give rise to bloodis testing new ways to trigger stem-cell renewal. And multiple projects are under way to manipulate transplanted bone marrow to reduce or prevent graftversus-host disease.
We are in a time of great progress. To continue, we must have a coordinated flow of basic research into translational research. This means many disciplines working together, and thats where Duke excels. Its not a place of great egos, but of great collaboration.
SALLY KORNBLUTH, PhD VICE DEAN FOR BASIC SCIENCE DUKE UNIVERSITY SCHOOL OF MEDICINE
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Really, its a remarkable thing that were doing, says Chao. Nearly all patients can have a stem cell donor. He credits the success in part to the fact that, in his group, the physicians are also scientists. It works for what we do. It means the people in the labs understand what the problems really are, so it gives their work more of a focus. Chao says he believes the new DCI structure will encourage more groups to strengthen connections to laboratorybased faculty who can help spin off discoveries to the clinic. And, he adds, the DCIs investment in clinical and research resources will lift all boats. The work we do is very resourceintensive, he says. I think the DCI will bring shared resources that will give us all more security. Having the right people is essential, but so is having the infrastructure.
more on practical experience than on intimate understanding of cancer biology, says Spector. Take maximum tolerated dose, which is how most chemotherapies were developed years ago. To kill as many rapidly dividing cells as possible knowing that will unavoidably include some normal cellsyou had to set the dose to the limit of what people can stand, and then back down a bit. This has changed dramatically, says Kastan, thanks to molecular and cellular biology breakthroughs that have opened windows into the inner workings of malignant cells. From these new discoveries the drug arsenal has changed from one of shock-and-awe to more targeted missiles aimed at different cell processes. Over the last 40 years, the problem in cancer was that weve had only a handful of drugs we could use, and they were not very specific and they had a lot of toxicities, Kastan says. The problem in the next 20 years is going to be the opposite: were going to have too many drugs and not know how to use them. Indeed, many potentially effective drugs are at our fingertips. But our technologies and tools are outpacing our ability to interpret the information they
provide. If theres anything the era of genomics is teaching us, its that theres no such thing as a single tumor type, Kastan says. Instead of lung cancer being a disease thats treated by the typical three or four drugs, were going to have 20 subsets of lung cancer, each one treated with different drug combinations depending on its biochemistry and genetics. Figuring out those tumor subtypes, and then matching them with the right therapies, is the challenge of the future, he says. The less you know about the mechanism that a drug acts upon, the less you know about how the treatment works and how it will behave in the clinic. Then you risk spending five years in clinical trials, coming up with a ho-hum result in patients, and having no information to figure out how to make it better or why it didnt work, says Spector. The drug goes on a shelf, collecting dust, when it could quite possibly be effective in a different tumor. This nearly happened in the case of the new kinase inhibitors for lung cancer, Kastan notes. These drugs are highly effective, but only in a small percentage of patients. And they almost missed it.
tHe trouBle WitH tarGets

The timing of Dukes investments in cancer research is criticalit is a necessary adjustment to stay effective in the face of mushrooming numbers of cancer therapies. Historically, the war on cancer has been a somewhat empiric one, based
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I do believe well develop much more effective drugs over the next 10 yearsones that really hit the Achilles heel of cancer. You can see the science thats being generated lead in that direction. And I want us to be in the position to make and translate those discoveries.
MICHAEL B. KASTAN, MD, PhD EXECUTIVE DIRECTOR, DUKE CANCER INSTITUTE
The researchers just barely noticed that a small subset of people in the trials were responding, and they eventually figured out that those patients had a specific mutation targeted by the drug. It may only work in 10 percent of lung cancer patientsbut you know, thats 10 percent. To find those needles in the haystack, to actually deliver on the ideas generated by its new collaborative model, the DCI plans to strengthen the pipeline from preclinical testing to clinical research. Were going to have to know much more about the exact setting in which a drug may be useful before we take it into trials in humans, says Kastan. Toward that end, We plan to develop better animal model systems of cancer so that we can improve our understanding of the biology of tumors and test these new therapies more efficiently. That way we have lots of information at the outset to tell us how to test the drugs in people and in which people. Complementing that resource, the DCI is building an enormous data warehouse of tissue samples from tumors biopsied at Duke, so researchers can learn more about the molecular pathology of every type of cancer. We need these samples
to conduct experiments that will help us understand the potential application of each discovery, and information on patient outcomes to understand how it might be relevant, says Spector. Duke is one of only a handful of places in the world with the capability to build a database of this magnitude. The more patients we care for, the larger the database will be, and the greater the impact it will have on the future of cancer research and care. DCI leaders have also been working over the past year to strengthen the infrastructure for cancer clinical trials, increasing the involvement of biostatisticians to improve data collection and analysis. That way, says Kastan, we know when were finished, well get an answer that will be interpretablethat we can learn from.
multidisciplinarywith surgical, imaging, chemotherapy, and other components having all of those providers on the same site makes participation much easier. The new building includes dedicated space for clinical trial consultation and coordination, making standard what was previously a rare luxury for clinical trial coordinatorsprivacy and quiet space near patient exam rooms to discuss clinical trials, informed consent, and any questions a patient has about clinical research. To do great research, we have to bring everyone togetheroncologists, surgeons, biologists, pharmacologists, chemists, radiologists, and the support staff of nurses and coordinators, says Kastan. It takes a village to do this right. And by following this paradigm, when we do clinical trials in patients we will already have learned so much from preclinical testing that we can design trials more effectively. That means it takes fewer patients to have a bigger impact, it costs a lot less money, and we make advances faster. At Duke, our goal is not just to take great care of patients. Its to take great care of them and to cure them, says Kastan. You can do that only through research.
GatHerinG tHe trooPs

Clinical trials are what drive discoveries into practice, and the studies are fundamentally intertwined with patient care. The new Duke Cancer Center is designed to encourage patient participation in clinical research by simplifying a complicated process and placing it in a central location. Because many clinical protocols are
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Grand Opening Celebration

Duke Medicine celebrated the opening of the new Duke Cancer Center in February with a weeklong series of events for faculty and staff, patients and families, volunteers, donors, and friends. The week began with a dedication and blessing of the hands ceremony for Duke Cancer Institute faculty and staff, and continued with open houses for Duke faculty, staff, and students, and for patients and community members. See more coverage of the events at dukemedicine.org/ construction.
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01 Hundreds of Duke community members and friends visited the Duke Cancer Center during the grand opening celebrations. 02 02 Blessing of hands ceremony for Duke Cancer Institute (DCI) faculty and staff 03 DCI administrator Carolyn Carpenter and Dr. Joe Moore 04 Duke University Hospital president Kevin Sowers and Evelyn Morgan (see story on page 22) 05 Angie Heilman, Kathy Farrell, Steve Shipes, and Kevin Sowers at the faculty and staff open house 06 David Johnson II and Brittney Tata welcomed guests to the cancer center
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07 NASCAR legend Richard Petty and his wife, Lynda, a patient at the Preston Robert Tisch Brain Tumor Center at Duke, shared their story in a video that premiered during the Grand Opening. (Online at dukecancerinstitute.org) 08 Durham community members Juanita and Kevin Montgomery with Chancellor Victor Dzau 13 09 A tour of the Quiet Room during the open house for cancer patients, survivors, and community members 10 Bob Harris, Voice of the Blue Devils, and Phyllis Harris
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11 Faculty physicians Dr. David Witsell, Dr. David Brizel, and Dr. John Kirkpatrick 12 Chief Nursing and Patient Care Services Officer Mary Ann Fuchs (center) with guests 13 Carolyn Carpenter, DCI executive director Michael Kastan, guest speaker Jamie Valvano Howard, and Kevin Sowers 14 Faculty, staff, and administrators gathered for the Duke Cancer Institute Scientific Symposium 15 Dr. Charles L. Sawyers of Memorial SloanKettering Cancer Center delivered the Chancellors Lecture, Overcoming Cancer Drug Resistance.
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Grand Opening Celebration
Duke Cancer Centers grand opening celebration culminated with an official ribbon-cutting ceremony, tours, and dinner celebration for donors and friends of the Duke Cancer Institute. To see three special videos produced for the event, please visit dukemedicine.org/giving.
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01 Earl Tye, Mark Toland, Karen Enloe, Joe Morris, Frank Courtney, and Tracy Gosselin in the fifth floor waiting area of the Duke Cancer Center 02 Dr. Michael Kastan, Bill Caler, and Chancellor Victor Dzau 03 Jonathan Tisch and Claire Weinberg 04 Dr. Michael Kastan, Karen Armstrong, Mark Armstrong, Cheri Armstrong, Chancellor Victor Dzau 05 (Foreground) Reverend Michael Page, President Richard Brodhead; (background) NC state senator Floyd McKissick, Dr. Thomas Gorrie 06 Dr. Michael Kastan, Ruth Georgiade, Janet Kean, Tom Kean, and Chancellor Victor Dzau 07 Duke Medicine Orchestra and ribbon-cutting ceremony guests
08 Dr. Monte Brown, Dr. William Fulkerson, Reverend Michael Page, Dean Nancy Andrews, Dr. Thomas Gorrie, Jonathan Tisch, Chancellor Victor Dzau, Governor Bev Perdue, Dr. Michael Kastan, President Richard Brodhead, Kevin Sowers, Claire Weinberg, and Michael Fields 09 Chancellor Victor Dzau, Kevin Sowers, and Bill Robertson of Belk Inc. toast the opening of the cancer centers Belk Boutique. 10 Sebastian, Rosie, Juan, and Diego Vega 11 Jim Powell, Dr. Elizabeth Bullitt, Dr. Allan Friedman, and Ann Powell 12 Jonathan Tisch, Lizzie Tisch, and Dr. Henry Friedman 13 Mimi Sebates, Jenna Siskey, and Diane Siskey 14 Chancellor Victor Dzau and Jonathan Tisch
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DUKEMED GIVING
Gifts from individuals and organizations are the largest source of non-government support for Duke Medicines research, education, patient care, and service missionsand we are grateful to all who help us make a difference. To learn more about how you can help, please call 919-385-3100 or visit dukemedicine.org/giving.
Saying Thank You
Nursing to Benefit from Bovender Bequest

From left: Wayne Michaels, producer, MIX 101.5 WRAL-FM; Joseph St. Geme, MD, chair of the Duke Department of Pediatrics and chief medical officer, Duke Childrens Hospital; Bill Jordan and Lynda Loveland, co-hosts, MIX 101.5; Vanna Fox, on-air personality, MIX 101.5; Ardie Gregory, vice president and general manager, MIX 101.5; and Susan Glenn, executive director of development, Duke Childrens Hospital.
Duke Endowment Gift Fuels Radiothon Raises Neurosciences Growth Record $1.2 Million for Duke Childrens The field of neuroscience is widely regarded
as being ripe for discovery over the next two decades, and now, thanks to a $9-million gift from The Duke Endowment, Duke Medicine is poised for rapid and substantial growth. As it has so often in the past, The Duke Endowment has recognized great potential and has made it possible for Duke to lead both in basic discovery and in the translation of discovery into new treatments in this critical field, says Nancy C. Andrews, MD, PhD, dean of the Duke University School of Medicine. The Duke Endowment gift, announced in June, has already enabled the recruitment of two new department chairs: Sarah H. Holly Lisanby, T87, MD91, HS91-95, in psychiatry, and Stephen G. Lisberger, PhD, in neurobiology. As many as 15 additional faculty members in these departments, and also in neurology, will be recruited in the next five years, according to Andrews. We support Dukes decision to unify the disciplines of neurobiology, neurology, and psychiatry and hope this grant will lead to ways to prevent or cure neurological and psychiatric disorders that are devastating to patients and families in the Carolinas, says Mary Piepenbring, vice president of The Duke Endowment. This years MIX 101.5 WRAL-FM Radiothon for Duke Childrens Hospital & Health Center raised a record-breaking $1,256,037 to support valuable programs, research, and services for the patients at Duke Childrens. Bill Jordan and Lynda Loveland, MIX 101.5 morning show talent, were hosts for the two-day live broadcast in February from the McGovern-Davison Childrens Health Center. The MIX 101.5 Radiothon is Duke Childrens largest annual single fund-raising event and raises more money per capita than any other Childrens Miracle Network Hospitals Radiothon in the United States or Canada. Over the past 18 years, MIX 101.5 has raised more than $14 million for Duke Childrens. In addition to patients, friends of Duke Childrens spoke on air, including Food Lion president Cathy Green Burns, comedian Jeff Foxworthy, radio show host John Tesh, and Duke Athletics coaches Mike Krzyzewski, Joanne P. McCallie, and David Cutcliffe. Coach John Danowski and players from the Duke mens lacrosse and football teams volunteered in the phone bank.
Duke University trustee Jack Bovender Jr., T67, G69, and his wife, Barbara, of Nashville, North Carolina, will give $5 million to Duke University School of Nursing as part of a $25-million bequest announced in December. The bequest also provides $10 million for the Health Sector Management Program at Dukes Fuqua School of Business and $10 million for Trinity College of Arts & Sciences. The gift to the School of Nursing honors Barbara Bovender, who was a head nurse at Duke University Hospital when she and Jack married. It also honors Jacks mother, brother, and daughter-in-law, who are all registered nurses. Nurses are playing an increasingly important role in the delivery of health care, and our school has a strong tradition of preparing both outstanding clinicians and nurse-scientists who can lead health innovations for the future, says Catherine L. Gilliss, BSN71, DNSc, RN, FAAN, dean of the Duke University School of Nursing. The Bovenders support recognizes the contributions of nursing and will help us continue to lead. Jack Bovender earned an undergraduate degree in psychology and a masters degree in hospital administration at Duke. He worked in the health care industry for 40 years before retiring in 2009 as chair and chief executive officer of Hospital Corporation of America. He is a member the Duke University Board of Trustees and the Duke University Health System Board of Directors. Duke has played an important role in my life, says Jack Bovender. Its rare for a single university to be able to offer a worldclass education in the liberal arts, in business, and in the delivery of quality health care.... Through this gift, Barbara and I want to help pave the way for future students to take advantage of all that Duke has to offer.
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DUKEMED PEOPLE
Remembering Mary Duke Biddle Trent Semans
ary Duke Biddle Trent Semans, the scion of the family that founded Duke University, died on January 25.
My feeling is that we are all here for each other, Semans told Duke Magazine in 1987. I take very seriously this business of treating your neighbor as yourself, trying to be your brothers keeper. Theyre solid maxims for life. Youve got to be interested in what besets other people, what their needs are. Semans also supported the university and Duke Medicine through the Mary Duke Biddle Foundation (begun by and named after her mother), the Josiah Charles Trent Memorial Foundation, the Josiah Charles Trent Collection of the History of Medicine, and the Mary Duke Biddle Scholarship, among other efforts, according to the Duke Medical Center Archives. Victor J. Dzau, MD, chancellor for health affairs and CEO for Duke University Health System, says Semans has truly been the heart and soul of Duke Medicine. Her passion and personal involvement in the everyday life of Duke Medicine has been a source of inspiration to everyone, says Dzau. She spoke often of the importance of humanity in the practice of medicine and effectively modeled her conviction through personal actions and by sharing her unwavering support and encouragement to Duke physicians and health care providers. She was a very special friend to me, the faculty, and employees across Duke Medicine. She will be greatly missed. Semans is survived by seven children: Mary Trent Jones, WC63, of Abingdon, Virginia; Sarah Trent Harris, WC63, of Charlotte; Rebecca Trent Kirkland, WC64, MD68, of Houston; Barbara Trent Kimbrell of Sullivans Island, South Carolina; Jenny Semans Koortbojian, G06, of Durham; James Duke Biddle Trent Semans of Chapel Hill; and Beth Semans Hubbard, T85, of Los Angeles; 16 grandchildren; and 29 great-grandchildren.
She was 91. Although small in physical stature, Semans was a
towering figure in progressive causes throughout her life, championing education, human rights, and the arts. Mary Semans occupied a unique place in the life of this university, says Duke University president Richard H. Brodhead. She was our principal link to Dukes founding generation and continued her familys tradition of benevolence throughout her life. She supported every good thing at this university, and she was a powerful force for good in Durham and the Carolinas. Above all, she had a generosity toward others and belief in human possibility that made every encounter an inspiring event. Duke mourns the passing of one of its greatest friends. Semanss connections to Duke University were deep and varied, ranging from art history student in the 1930s to serving on the Board of Trustees from 19611981. She also spent decades as a trustee, vice chair, and chair of The Duke Endowment, a private foundation founded by her great-uncle James B. Duke when he gave the monies that transformed Trinity College into Duke University. The foundation supports higher education, health care, childrens welfare, and spiritual life in North and South Carolina. Semanss love for Duke University was matched by her commitment to her adopted hometown of Durham. The greatgranddaughter of industrialist-philanthropist Washington Duke, for whom Duke University is named, Semans served as mayor pro tem of Durham from 19531955. She was a trustee of Lincoln Community Hospital from 19481976, a facility the Duke family started in 1901 to serve the needs of black patients in Durham.
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APPOINTMENTS
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Carolyn Carpenter, formerly interim administrator for the Duke Cancer Institute (DCI), was announced as the new administrator for the DCI and associate dean for the Duke University School of Medicine in January. Carpenter will continue to have responsibility for all administrative functions within the DCI and will continue to serve as the lead academic and clinical service line administrator. Her collaborations will include the medical school as it relates to academic priorities and activities within the DCI. She holds a master of health administration degree from the University of Virginia and is a fellow in the American College of Healthcare Executives. michel landry, Phd, previously an assistant professor in the Department of Physical Therapy at the University of Toronto, has been named chief of the Doctor of Physical Therapy Program at Duke. He will begin his appointment on July 1. Landry is an active health policy and health services researcher with particular interest in the balance of supply and demand in health and rehabilitation, creating forecasting models to develop a sustainable workforce of health care professionals, and communitybased rehabilitation on a global-health level for people with disabilities. He will hold concurrent positions as adjunct associate professor at the University of Toronto and adjunct assistant professor at the University of North Carolina at Chapel Hill. stephen G. lisberger, Phd, a nationally renowned investigator who studies how brain mechanisms transform visual motion into accurate eye movements, has been named chair of the Department of Neurobiology. Lisberger, a Howard Hughes Medical Institute investigator and former professor of physiology at the University of California, San Francisco, assumed his role at Duke on January 1. Lisberger is the founding director of the W.M. Keck Foundation Center for Theoretical Neurobiology and a co-director
of the Sloan-Swartz Center for Theoretical Neurobiology at UCSF. He is a fellow of the American Academy of Arts and Sciences and received the Young Investigator Award from the Society for Neuroscience, as well as the McKnight Investigator and McKnight Scholar awards. He spent 11 years as a section editor and senior editor for the Journal of Neuroscience, and has been the chief editor of Neuroscience since 2010. Lisberger succeeds James McNamara, MD, Carl Deane Professor of Neuroscience, who served as department chair since 2002.
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thomas a. owens, md, previously the chief medical officer for Duke University Hospital and chief of the Hospital Medicine Program, began his new role as chief medical officer for Duke University Health System on February 1. In overseeing medical affairs throughout the health system, Owenss responsibilities will include working with Karen Frush, MD, chief safety officer, to set the health system quality agenda, and ensure alignment of physicians and physician services with health system strategic plans and clinical program priorities. He will oversee an integrated primary care service that brings together Duke Primary Care, the Department of Community & Family Medicine, and the Division of General Internal Medicine clinics, while also working to develop approaches to a patient-centered medical home. Owens will also be charged with playing an important role as the physician leader for health system-wide health care reform planning and innovation. theodore Pappas, md, Duke Minimally Invasive Surgery Professor of Surgery, was appointed as vice dean for medical affairs for the Duke University School of Medicine and began his role in July. He will serve as a liaison between the Deans Office and clinical faculty, working with clinical department chairs as well as providing strategic direction for Dukes medical and nursing schools and Duke University Health System.
adam Perlman, md, began his appointment as executive director of Duke Integrative Medicine in September. Perlman was formerly the executive director of the Institute for Complementary and Alternative Medicine, chair of the Department of Primary Care, and associate professor of medicine at the University of Medicine & Dentistry of New Jersey. Perlman serves as chair of the Consortium of Academic Health Centers for Integrative Medicine, comprising 51 leading academic medical centers across the country with integrative medicine programs. His diverse research interests include the effects of multivitamin supplementation on school performance in underserved children, the efficacy of massage for osteoarthritis of the knee, and the use of complementary and alternative medicine in patients with cancer. michael Platt, Phd, professor of neurobiology, has been appointed the new director of the Duke Institute for Brain Sciences. Platts interests include utilizing economics and evolutionary biology to study how organisms confront information-processing problems and how the organisms neural circuit mechanisms that guide decisionmaking are shaped as a result. His priorities include engaging interdisciplinary collaborations within the medical school and the university and promoting high standards of educational development for undergraduate, graduate, and postdoctoral students. mark stacy, md, professor of medicine, has been appointed as vice dean for clinical research in the Duke University School of Medicine. He has been a key driver in improving Dukes clinical research practice and in developing the site-based research director community. In his new role, Stacy will continue to work in partnership with Sally Kornbluth, PhD, who recently transitioned into her new role as vice dean for basic science.
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HONORS & AWARDS

amy abernethy, md, associate professor of medicine in medical oncology and associate professor in the School of Nursing, was named president-elect for the American Academy of Hospice and Palliative Medicine. nancy andrews, md, Phd, dean of the School of Medicine, was honored with the 2011 American Society of Hematology Mentor Award in Basic Science during the societys annual meeting in December. adrian angold, mBBs, associate professor of psychiatry and behavioral sciences, was named president-elect of the International Society for Research in Child and Adolescent Psychopathology (ISRCAP), an organization dedicated to furthering the research and treatment of childhood mental disorders. Bruce Capehart, md, assistant professor of psychiatry and behavioral sciences, was selected as a co-chair of the Service Members, Veterans, and Military Families Task Group within the National Network of Depression Centers (NNDC) in August. Capehart, a leader in the fields of PTSD and traumatic brain injury, will support NNDCs efforts to make diagnosis of mood disorders affordable, accessible, and acceptable. nelson Chao, md, Donald D. and Elizabeth G. Cooke Cancer Research Professor, has been named to the National Biodefense Science Board of the US Department of Health & Human Services. His three-year term began in February. Victor J. dzau, md, chancellor for health affairs at Duke University and president and CEO of Duke University Health System, was presented with the 2011 Henry G. Friesen International Prize in Health Research in September. His selection cited his international stature that best exemplifies Henry Friesens prescience, organizational creativity, and broad impact on health research and health research policy. Christopher edwards, Phd, associate professor in psychiatry and behavioral sciences, was named the recipient of the 2012 Dr. Martin Luther King Jr. Community Caregiver Award in January. The annual award is given by Duke University Hospital in recognition of an employee who demonstrates a commitment to supporting the community. Edwards received a $5,000 award toward his volunteer organization.
Edwards Frank Haynes Montefiori
The Bill & Melinda Gates Foundation awarded three grants to Duke for HIV projects in the Collaboration for AIDS Vaccine Discovery (CAVD) program. The total amount is approximately $37.2 million: Michael Frank, MD, Samuel Katz Professor of Pediatrics, received a three-year, $892,000 grant to study HIVs interaction with the human immune system, particularly the complement proteins that coat invading viral envelope antigens to facilitate the bodys natural immune response. Barton Haynes, MD, Frederic Hanes Professor of Medicine, director of the Center for HIV-AIDS Vaccine Immunology, and director of the Duke Human Vaccine Institute, received a three-year, $11.7-million award to study the best way to create effective vaccine immunogens that mimic the proteins on the HIV outer envelope that will help to stimulate the right antibodies to neutralize the virus at the time of transmission. David Montefiori, PhD, professor of surgery and director of the Laboratory for AIDS Vaccine Research and Development in the Department of Surgery, received a five-year, $24.6-million grant to continue his teams efforts in the Comprehensive Antibody Vaccine Immune Monitoring Consortium. Much of the research from these grants will help further the study of the potential new vaccine RV144, whose early trials in Thailand showed promise and generated optimism that a broadly effective HIV vaccine is finally within reach. Barton Haynes, md, Frederic Hanes Professor of Medicine and director of the Duke Human Vaccine Institute, received the Alexander Fleming Award for Lifetime Achievement from the Infectious Diseases Society of America in October. Joseph Heitman, md, Phd, James B. Duke Professor and chair of the Department of Molecular Genetics & Microbiology, received an NIH MERIT Award from the National Institute of Allergy and Infectious Diseases.
The award recognized the transformative insights of Heitmans work in fungi and the evolutionary origins of sexual reproduction. michael Hershfield, md, and david Pisetsky, md, Phd, professors of medicine, were designated as masters of the American College of Rheumatology. The highest honor bestowed by the college, the title is conferred on individuals who have made outstanding contributions to the field of rheumatology through scholarly achievement and/or service. Joanne Kurtzberg, md, professor of pediatrics, received the Lifetime Achievement Award from the Pediatric Blood and Marrow Transplant Consortium. She is the fourth recipient of this award and was recognized for a career that exemplifies the mission of the consortium, to support research and education to improve the availability, safety, and efficacy of hematopoietic cell transplantation and other cellular therapeutics for children and adolescents. Kurtzberg was honored during the 2012 Tandem BMT Meetings of the American Society for Blood and Marrow Transplantation and the Center for International Blood and Marrow Transplant Research in San Diego in February. nico Katsanis, Phd, Jean and George Brumley Jr. Professor of Cell Biology and Pediatrics and director of the Duke Center for Human Disease Modeling, is slated to receive the E. Mead Johnson Award for Research in Pediatrics at the 2012 Pediatric Academic Societies Annual Meeting in Boston in April. The award honors clinical and laboratory research achievements in pediatrics and is considered the most prestigious award in pediatric research. Katsanis is receiving the award for his research focusing on BardetBiedl syndrome, a rare genetic disorder with symptoms that affect the kidneys and a variety of other organs, such as the eyes and the developing nervous system.
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HONORS & AWARDS

Jeffrey swanson, Phd, and marvin swartz, md, professors in psychiatry and behavioral sciences, received the 2011 Carl Taube Award, an honor given by the Mental Health Section of the American Public Health Association, in November. The award is presented to scholars who have made significant contributions in the field of mental health research and treatment. Georgia tomaras, Phd, associate professor of surgery, has been appointed to the National Institute of Allergy and Infectious Diseases Advisory Council for the term of November 2011October 2015. She will participate in performing second-level reviews, providing policy advisement, reviewing programs, and developing and clearing concepts for funding opportunities. Hai Yan, Phd, associate professor of pathology, received a $1-million research grant from Accelerate Brain Cancer Cure and the V Foundation in October. Five scientists from Duke University Medical Center were announced in December as the newest fellows in the American Association for the Advancement of Science (AAAS): Richard Brennan, PhD, professor and chair of the Duke Department of Biochemistry Bryan Cullen, PhD, James B. Duke Professor of Molecular Genetics & Microbiology Mariano Garcia-Blanco, MD, PhD, professor of molecular genetics & microbiology Sue Jinks-Robertson, PhD, professor of molecular genetics & microbiology Donald McDonnell, PhD, Glaxo-Wellcome Professor of Molecular Cancer Biology and chair of the Duke Department of Pharmacology & Cancer Biology All of these individuals are world-class scientists who have made discoveries that drive their fields forward, says Nancy Andrews, MD, PhD, dean of the Duke University School of Medicine. With this honor, they join a very distinguished group of scientific leaders. We are very fortunate to have so many people of this caliber on our faculty.
Lyman
Rivelli
Rubin
Tomaras
seok-Yong lee, Phd, assistant professor of biochemistry, and david tobin, Phd, assistant professor in molecular genetics & microbiology, received the 2011 NIH Directors New Innovator Award for challenging the status quo with innovative ideas that have the potential to propel fields forward and speed the translation of research into improved health for Americans and others. stephen G. lisberger, Phd, professor and chair of the Department of Neurobiology, has been awarded the Bernice Grafstein Award from the Society for Neuroscience. The award recognizes individuals for dedication to promoting womens advancement in neuroscience, specifically by mentoring women to facilitate their entry and retention in the field. John looney, md, professor of psychiatry and behavioral sciences, was elected to the board of regents of the Southern Psychiatric Association in September. Gary H. lyman, md, professor of medicine, was elected to the board of directors of the American Society of Clinical Oncology, a leading professional organization representing more than 30,000 oncologists and others who care for people with cancer. Lyman will begin his four-year appointment in June. As a member of the board, he will help set policies, oversee finances, and influence the direction of the organization. J. lloyd michener, md, professor and chair of the Department of Community and Family Medicine, was named as a member of the National Advisory Council for Complementary and Alternative Medicine by the NIH National Center for Complementary and Alternative Medicine.
John olson Jr., md, Phd, associate professor of surgery, was appointed to the NIH Center for Scientific Reviews Cancer Biomarkers Study Section for the term of July 2011June 2017. Members are selected on the basis of their demonstrated competence and achievement in their scientific discipline as evidenced by the quality of research accomplishments and publications in scientific journals. sarah rivelli, md, assistant professor of psychiatry and behavioral sciences and director of the Combined MedicinePsychiatry Training Program, was recognized with an Association of Medicine and Psychiatry Service Award during the organizations annual meeting in September. In addition, Rivelli has been named president-elect, with a two-year term starting in fall 2013. Geoffrey rubin, md, George Barth Geller Professor for Research in Cardiovascular Diseases and chair of the Department of Radiology, has been named president of three medical societies. In June he became president of the Fleischner Society for Thoracic Imaging and Diagnosis, in September he became president of the North American Society for Cardiovascular Imaging, and he most recently was named president of the Society of Computed Body Tomography & Magnetic Resonance. david steffens, md, professor of psychiatry and behavioral sciences and division head of geriatric psychiatry, was named president-elect of the American Association for Geriatric Psychiatry. His term began in March. richard surwit, Phd, professor of psychiatry and behavioral sciences, was selected as the recipient of the 2012 Society of Behavioral Medicine Distinguished Scientist Award. His award will be announced in April during the societys 33rd Annual Meeting & Scientific Sessions.
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DUKE WELCOMES NEW PHYSICIANS

ANESTHESIOLOGY Residency: Anesthesiology, Weill Cornell Medical Center (New York), 1988-1992 Fellowship: Cardiovascular Anesthesiology, Weill Cornell Medical Center (New York), 1992; Postdoctoral Research, University of California, San Francisco, 1992-1994 Fellowship: Pain Management, Tri-Institute Fellowship, Weill Cornell Medical Center/ Memorial Sloan-Kettering Cancer Center/Hospital for Special Surgery (New York), 2011 Other Degree: PhD, Pharmacology, Duke University, 2005 COMMUNITY AND FAMILY MEDICINE
Brandi a. Bottiger, md Particular Clinical Interests and Skills: Adult cardiac and thoracic surgery, transesophageal echocardiography, swallowing dysfunction after cardiopulmonary bypass and transesophageal echocardiography, crystalloid and colloid in postoperative outcomes and renal function MD Degree: Pennsylvania State University College of Medicine, 2006 Residency: Anesthesiology, Pennsylvania State University Medical Center, 2010 Fellowship: Adult Cardiothoracic Anesthesia, Duke University Medical Center, 2011
edmund H. Jooste, mB ChB Particular Clinical Interests and Skills: Pediatric anesthesiology, pediatric cardiac anesthesiology MB ChB Degree: University of Pretoria (South Africa), 1995 Residency: Anesthesiology, Columbia University Medical Center (New York), 2004 Fellowship: Pediatric Anesthesiology, Childrens Hospital of New York, Columbia University, 2005
Brad m. taicher, do Particular Clinical Interests and Skills: Pediatric anesthesia, pediatric ultrasound-guided regional anesthesia DO Degree: Philadelphia College of Osteopathic Medicine (Pennsylvania), 2006 Residency: Anesthesiology, Thomas Jefferson University Hospital (Pennsylvania), 2010 Fellowship: Pediatric Anesthesiology, Childrens Hospital of Philadelphia (Pennsylvania), 2011 Other Degree: MS, Physiology, Georgetown University (Washington, DC), 2000 MBA, Health and Medical Services Administration, St. Josephs University (Pennsylvania), 2004
tania r. Peters, md Particular Clinical Interests and Skills: General medical dermatology with a focus on acute care and dermatologic surgery MD Degree: University of Maryland School of Medicine, 2007 Residency: Internal Medicine, Washington Hospital Center (Washington, DC), 2008 Dermatology, Duke University Medical Center, 2011
megan m. adamson, md Particular Clinical Interests and Skills: Care for the entire family, womens health MD Degree: Boston University School of Medicine (Massachusetts), 2008 Residency: Family Medicine, Duke University Medical Center, 2008-2011 DERMATOLOGY
Hiep t. dao, md Particular Clinical Interests and Skills: Regional anesthesiology, peripheral nerve blocks for postoperative pain control MD Degree: Georgetown University School of Medicine (Washington, DC), 2007 Residency: Internal Medicine, St. Joseph Mercy Hospital (Michigan), 2008 Anesthesiology, Georgetown University (Washington, DC), 2008-2011 (Chief Resident, 2010-2011)
Grace C. mcCarthy, md Particular Clinical Interests and Skills: Cardiothoracic anesthesia MD Degree: University of Virginia School of Medicine, 2006 Residency: Anesthesiology, Duke University Medical Center, 2006-2010 Fellowship: Cardiothoracic Anesthesia, Duke University Medical Center, 2010-2011
lenny talbot, md Particular Clinical Interests and Skills: Surgical anesthesiology and acute postoperative pain management MD Degree: Duke University School of Medicine, 2007 Residency: Anesthesiology, Duke University Medical Center, 2007-2012
sarah Wolfe, md Particular Clinical Interests and Skills: HIV-related dermatoses, infectious disease dermatology, general dermatology MD Degree: University of Oklahoma College of Medicine, 2007 Residency: Internal Medicine, University of Texas Medical Branch, 2007-2008 Dermatology, Duke University Medical Center, 2008-2011 DUKE PRIMARY CARE
manuel l. fontes, md Particular Clinical Interests and Skills: Perioperative care for patients undergoing cardiothoracic surgical procedures, clinical outcomes research, transesophageal echocardiogram, ICU, teaching MD Degree: University of Massachusetts Medical School, 1988
atif Y. raja, md Particular Clinical Interests and Skills: Compassionate care for patients receiving cardiothoracic procedures MD Degree: University of North Carolina at Chapel Hill School of Medicine, 2006 Residency: Anesthesiology, UNC Hospitals, 2010 Fellowship: Cardiothoracic Anesthesiology, Duke University Medical Center, 2011
thomas J. Van de Ven, md, Phd Particular Clinical Interests and Skills: Management of neuropathic and oncologic chronic pain syndromes MD Degree: Duke University School of Medicine, 2006 Residency: Internship, UPMC Shadyside (Pennsylvania), 2007 Anesthesiology, Duke University Medical Center, 2010
Heather P. lampel, md Particular Clinical Interests and Skills: Extensive patch testing for contact dermatitis investigation; skin cancer surveillance and surgical and nonsurgical treatments; facial rejuvenation including Botox and volumizing procedures MD Degree: Ohio State University College of Medicine, 2002 Residency: Family Medicine, Mayo Clinic Scottsdale (Arizona), 2002-2003 Occupational and Environmental Medicine, University of Pittsburgh (Pennsylvania), 2003-2005 Dermatology, University of California, Irvine, 2008-2011 Other Degree: MPH, University of Pittsburgh (Pennsylvania), 2005
andre e. Bell, md duke Primary Care Brier Creek Particular Clinical Interests and Skills: Family medicine, preventive care, patient education MD Degree: Ohio State University College of Medicine, 1998 Residency: Family Medicine, St. Marys Family Practice (Wisconsin), 2002
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usha r. donthireddi, md duke Primary Care Creedmoor road Particular Clinical Interests and Skills: General internal medicine, including prevention and treatment MD Degree: Osmania Medical College (India), 2000 Residency: Internal Medicine, Forest Hills Hospital, North ShoreLong Island Jewish (New York), 2002-2005
John r. Guzek, md duke Primary Care Harps mill Particular Clinical Interests and Skills: Diagnosis and treatment of simple and complex adult problems, including mood disorders, diabetes, high blood pressure, and heart, kidney, and liver problems MD Degree: University of Pittsburgh School of Medicine (Pennsylvania), 1978 Residency: Internal Medicine, Mercy Hospital (Pennsylvania), 1981-1983 Other Degree: MPH, University of North Carolina at Chapel Hill
sanjay Patel, md Wake forest family Physicians Particular Clinical Interests and Skills: Chronic disease management, evidence-based medicine MD Degree: Temple University School of Medicine (Pennsylvania), 1982 Residency: Family Practice, Montgomery Hospital (Pennsylvania), 1982-1985
adrienne C. tounsel, md duke urgent Care Particular Clinical Interests and Skills: Urgent care, family medicine, minor wound care, mentoring MD Degree: Wayne State University School of Medicine (Michigan), 2008 Residency: Family Medicine, The Toledo Hospital (Ohio), 2008-2011 HOSPITAL MEDICINE
timothy r. Heacock, md duke university Hospital Particular Clinical Interests and Skills: Hospital medicine, ultrasound-guided bedside procedures, pulmonary medicine MD Degree: Case Western Reserve University School of Medicine (Ohio), 2008 Residency: Internal Medicine, Duke University Medical Center, 2011
Christine m. drower, md duke urgent Care Particular Clinical Interests and Skills: Urgent care, pediatric population, family medicine, outpatient procedures MD Degree: Drexel University College of Medicine (Pennsylvania), 2008 Residency: Family Medicine, Duke University Medical Center, 2008-2011
Pearl d. Johnson, md duke urgent Care Particular Clinical Interests and Skills: Urgent care MD Degree: Loyola University Chicago Stritch School of Medicine (Illinois), 1979 Residency: Family Medicine, University of Tennessee College of Medicine, St. Francis Hospital, 1979-1982
sabana s. Pathan, md duke Primary Care Henderson Particular Clinical Interests and Skills: Continuity of care, patient advocacy, preventive medicine for all ages, womens health, colposcopy, pediatric services, sports physicals, office-based surgical and dermatologic procedures, chronic illness management, urgent care MD Degree: Medical University of Silesia (Poland), 2006 Residency: Family Medicine, Hennepin County Medical Center (Minnesota), 2011
Cody a. Chastain, md durham regional Hospital Particular Clinical Interests and Skills: Health care epidemiology, patient safety and quality MD Degree: Loma Linda University School of Medicine (California), 2008 Residency: General Internal Medicine, Duke University Medical Center, 2008-2011
Christopher a. Jones, md duke university Hospital Particular Clinical Interests and Skills: Symptom-based care for all patients with advanced illness, with special emphasis on the elderly, those with cancer, and those at the end of life MD Degree: Jefferson Medical College of Thomas Jefferson University (Pennsylvania), 2006 Residency: Internal Medicine, Alpert Medical School, Brown University (Rhode Island), 2009 Fellowship: Geriatric Medicine, Duke University Medical Center, 2010 Hospice and Palliative Medicine, Duke University Medical Center, 2011
tierney Grandis, md duke Primary Care mebane Particular Clinical Interests and Skills: General family practice including well-child checks and well-woman care, management of chronic disease MD Degree: University of North Carolina at Chapel Hill School of Medicine, 2006 Residency: Family Medicine, Moses Cone Family Practice (North Carolina), 2006-2009 Other Degree: MS, Neuroscience, Duke University, 2001
michele d. nacouzi, md duke Primary Care Brier Creek Particular Clinical Interests and Skills: Womens health care, general medical care MD Degree: New York Medical College, 1991 Residency: Family Practice, Whittier Presbyterian Hospital (California), 1992-1994
Caleb e. Pineo, md duke Primary Care Brier Creek Particular Clinical Interests and Skills: Compassionate and quality primary care, care for families, disease prevention, chronic disease management MD Degree: University of North Carolina at Chapel Hill School of Medicine, 2008 Residency: Family Medicine, UNC Hospitals, 2011 Other Degree: MPH, UNC School of Public Health, 2007
ellen f. eaton, md durham regional Hospital Particular Clinical Interests and Skills: Medical education, quality improvement MD Degree: University of Alabama School of Medicine, 2007 Residency: Internal Medicine, Stanford University Hospital (California), 2007-2010 (Chief Resident, 2010-2011)
muhammad Haroon Khan, mBBs duke university Hospital Particular Clinical Interests and Skills: Inpatient care of internal medicine and cardiology patients MBBS Degree: Khyber Medical College, University of Peshwar (Pakistan), 1997 Residency: Internal Medicine, Robert Packer Hospital (Pennsylvania), 2002-2003 Internal Medicine, Robert Packer Hospital (Pennsylvania), 2003-2005
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Kristin e. meade, md durham regional Hospital Particular Clinical Interests and Skills: Palliative care for patients of all ages across diverse clinical settings, medical ethics with special focus on the ethics of providing ICU-level care to children and young adults with complex chronic medical conditions MD Degree: Stanford University School of Medicine (California), 2006 Residency: Internal Medicine and Pediatrics, Duke University Medical Center, 2006-2010 Fellowship: Pediatric Palliative Care, Akron Childrens Hospital (Ohio), 2010-2011
snehal i. Patel, md durham regional Hospital Particular Clinical Interests and Skills: Hospital medicine, consultative general internal medicine for hospitalized patients, health systems design and improvement, innovative care models, clinical information technology MD Degree: University of Texas Southwestern Medical School, 2008 Residency: Internal Medicine, University of Texas Southwestern Medical Center, 2008-2011
michael e. Blocker, md General internal medicine Particular Clinical Interests and Skills: General infectious diseases, HIV care, travel medicine MD Degree: University of Massachusetts Medical School, 1994 Residency: Internal Medicine, UNC Hospitals, 1994-1997 Fellowship: Infectious Diseases, UNC Hospitals, 1997-2000
david Y. ming, md duke university Hospital and emergency medicine Particular Clinical Interests and Skills: General internal medicine and general pediatrics, care of hospitalized adults and children, resident and medical student education MD Degree: University of Texas Medical Branch School of Medicine, 2006 Residency: Internal Medicine and Pediatrics, Duke University Medical Center, 2010 Jacqueline u. okere, md duke university Hospital Particular Clinical Interests and Skills: Hospital medicine MD Degree: Northeastern Ohio Universities Colleges of Medicine and Pharmacy, 2008 Residency: General Internal Medicine, University of South Florida, 2008-2011
Julius m. Wilder, md, Phd durham regional Hospital Particular Clinical Interests and Skills: Hospital medicine MD Degree: Duke University School of Medicine, 2008 Residency: Internal Medicine, Duke University Medical Center, 2011 Other Degree: PhD, Medical Social and Health Policy, Duke University, 2007 MEDICINE dana P. albon, md Pulmonary, allergy, and Critical Care Particular Clinical Interests and Skills: Lung transplantation MD Degree: University of Medicine and Pharmacy Iuliu Hatieganu (Romania), 2001 Residency: Internal Medicine, Moses Cone Hospital (North Carolina), 2005-2008 Fellowship: Pulmonary and Critical Care, Wake Forest University Baptist Medical Center, 2011 maureen P. andreassi, md General internal medicine Particular Clinical Interests and Skills: General internal medicine MD Degree: SUNY-Stony Brook University School of Medicine (New York), 1994 Residency: Internal Medicine, UNC Hospitals, 1994-1997
J. matthew Brennan, md Cardiology Particular Clinical Interests and Skills: Acute and chronic care of patients with valvular heart disease and advanced coronary artery disease MD Degree: University of Mississippi School of Medicine, 2003 Residency: Internal Medicine, University of Chicago Hospital (Illinois), 2006 Fellowship: Cardiology, Duke University Medical Center, 2010 Interventional Cardiology, Duke University Medical Center, 2011 rebecca a. Burbridge, md Gastroenterology Particular Clinical Interests and Skills: Advanced endoscopy, including endoscopic ultrasound (EUS) and endoscopic retrograde pancreatography (ERCP) MD Degree: West Virginia University School of Medicine, 2003 Residency: Internal Medicine, West Virginia University, 2003-2006 (Chief Resident, 2006-2007) Fellowship: Gastroenterology, Duke University Medical Center, 2007-2010 Advanced Endoscopy, Duke University Medical Center, 2010-2011
melissa a. daubert, md Cardiology Particular Clinical Interests and Skills: Womens cardiovascular health, cardiac computed tomography in acute chest pain and adult congenital heart disease, echocardiography (TTE/TEE in 2D and 3D, stress testing), nuclear cardiology MD Degree: Albert Einstein College of Medicine, Yeshiva University (New York), 2005 Residency: Internal Medicine, Columbia University Medical Center (New York), 2005-2008 Fellowship: Cardiology, Stony Brook University Medical Center (New York), 2008-2011
Jennifer l. Garst, md medical oncology Particular Clinical Interests and Skills: Lung cancer (non-small cell and small cell), lung cancer as a womens health issue, lung cancer clinical trials and clinical research, general hematology and medical oncology, supportive care for lung cancer patients, multimodality treatment approaches for lung cancer, lung cancer vaccine clinical trials, customized and personalized approaches to managing lung cancer, lung cancer screening and high-risk evaluations, thoracic oncology including mesothelioma, carcinoid, and other rare malignancies involving the chest and lungs MD Degree: Medical College of Georgia, 1990 Residency: Internal Medicine, University of Texas Southwestern, Parkland Memorial Hospital, 1990-1993 HematologyOncology, Duke University Medical Center, 1993-1996
Heather r. Gutekunst, md Pulmonary, allergy, and Critical Care Particular Clinical Interests and Skills: Allergic and immunologic disorders, including general allergy and immunology, food and drug allergies, asthma, eosinophilic esophagitis, hives, angioedema, bee/ insect stings, venom allergies, allergen immunotherapy, atopic dermatitis, contact dermatitis, urticaria, anaphylaxis, and common variable immune deficiency; assessment of immunologic function and immunologic mechanism of IVIG, mast cell disorders, allergic rhinitis, conjunctivitis, and chronic sinusitis MD Degree: Brody School of Medicine at East Carolina University (North Carolina), 2004 Residency: Internal Medicine and Pediatrics, Maine Medical Center, 2004-2006 Internal Medicine and Pediatrics, Georgetown University Hospital (Washington, DC), 2006-2008 Fellowship: Allergy and Clinical Immunology, University of Virginia, 2008-2010
michael r. Harrison, md medical oncology Particular Clinical Interests and Skills: Drug development and investigation of novel therapies for bladder, kidney, and prostate cancers; targeted therapy; antiangiogenic therapy; molecular imaging in drug development; biomarkers; clinical care of bladder, kidney, prostate, and testicular cancers MD Degree: Tulane University School of Medicine (Louisiana), 2004 Residency: Internal Medicine, Tulane University, 2007 Fellowship: Medical Oncology, University of Wisconsin, 2009
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MEDICINE continued
MD Degree: University of Toledo College of Medicine (Ohio), 1984 Residency: Medicine, Summa Akron City Hospital (Ohio), 1984-1987
Patrick t. Hickey, do neurology Particular Clinical Interests and Skills: Movement disorders, Parkinson disease, progressive supranuclear palsy, corticobasal ganglionic degeneration, multiple system atrophy, tremor, restless leg syndrome, tics, Tourette syndrome, myoclonus, dystonia, ataxia, Huntington disease, chorea, tardive dyskinesia, Wilson disease, treatment with botulinum toxin, deep brain stimulation DO Degree: Michigan State University College of Osteopathic Medicine, 2006 Residency: Neurology, Michigan State University, Garden City Hospital, 2007-2010 Fellowship: Movement Disorders, Duke University Medical Center, 2010-2012
Kamran mahmood, md Pulmonary, allergy, and Critical Care Particular Clinical Interests and Skills: Thoracic oncology, airway disorders, pleural disease, interventional pulmonology, advanced diagnostic bronchoscopy, endobronchial ultrasound, rigid bronchoscopy, airway laser and thermal therapy, stent placement, pleural procedures including pleuroscopy, general pulmonology, critical care MD Degree: King Edward Medical College (Pakistan), 1995 Residency: Internal Medicine, Nassau University Medical Center (New York), 1998-2001 (Chief Resident, 2001-2002) Fellowship: Pulmonary, Critical Care, and Sleep Medicine, University of Illinois at Chicago, 2002 Interventional Pulmonology, Duke University Medical Center, 2010-2011 Other Degree: MPH, University of Illinois at Chicago, 2005
Justin t. mhoon, md neurology Particular Clinical Interests and Skills: Diagnosis and treatment of neuromuscular disorders, including peripheral neuropathies, myopathies, ALS, and myasthenia gravis; chemodenervation for cervical dystonia, spasticity, and migraine headache; peripheral nerve ultrasound; clinical EMG/NCS MD Degree: University of South Florida College of Medicine, 2006 Residency: Internal Medicine, Medical College of Georgia, 2006-2007 Neurology, Duke University Medical Center, 2007-2010 Fellowship: Neuromuscular Medicine and Electromyography, Duke University Medical Center, 2010-2011
mahesh J. Patel, md Cardiology Particular Clinical Interests and Skills: Preventive and rehabilitative cardiology, exercise physiology, heart failure MD Degree: Tulane University School of Medicine (Louisiana), 2003 Residency: Internal Medicine, University of Texas Southwestern Medical Center, 2006 Fellowship: Preventive Cardiology, University of Texas Southwestern Medical Center, 2007 General Cardiology, Duke University Medical Center, 2011
Jonathan P. Piccini sr., md Cardiology Particular Clinical Interests and Skills: Evaluation, management, and catheter ablation of atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia; pacemaker and defibrillator implantation and laser lead extraction; cardiac resynchronization therapy MD Degree: Northwestern University Feinberg School of Medicine (Illinois), 2002 Residency: Internal Medicine, Johns Hopkins Hospital (Maryland), 2002-2005 Fellowship: General Cardiology, Duke University Medical Center, 2005-2009 Electrophysiology, Duke University Medical Center, 2009-2011 Other Degree: MHS, Clinical Research, Duke University, 2009
Jason i. Koontz, md, Phd Cardiology Particular Clinical Interests and Skills: All aspects of cardiac electrophysiology, including pacemaker and defibrillator implantation; cardiac resynchronization therapy; evaluation, management, and catheter ablation of atrial fibrillation and flutter, supraventricular tachycardia, and ventricular arrhythmias MD Degree: Harvard Medical School (Massachusetts), 2002 Residency: Internal Medicine, Duke University Medical Center, 2002-2004 Fellowship: Cardiovascular Disease, Duke University Medical Center, 2004-2009 Cardiac Electrophysiology, Duke University Medical Center, 2009-2011 Other Degree: PhD, Harvard Medical School (Massachusetts), 2002
robin mathews, md Cardiology Particular Clinical Interests and Skills: General and noninvasive cardiology, inpatient and outpatient consultative services, advanced coronary disease and ischemic heart disease, heart failure management, secondary prevention of cardiovascular disease MD Degree: New York Medical College, 2002 Residency: Internal Medicine, Stony Brook University Medical Center (New York), 2002-2005 (Chief Resident, 2005-2006) Fellowship: Cardiology, Stony Brook University Medical Center (New York), 2006-2009 Advanced Training in Cardiology, Duke University Medical Center, 2009-2011
stephanie G. norfolk, md Pulmonary, allergy, and Critical Care Particular Clinical Interests and Skills: Lung transplant, ICU MD Degree: Case Western Reserve University School of Medicine (Ohio), 2005 Residency: Internal Medicine, University Hospitals of Cleveland/Case Medical Center (Ohio), 2005-2008 Fellowship: Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, 2008-2011
John J. Paat, md General internal medicine Particular Clinical Interests and Skills: Evaluation of wellness and the prevention and management of chronic disease; symptoms and concerns in context of overall function; comprehensive continuity of care
adam i. Perlman, md General internal medicine Particular Clinical Interests and Skills: Comprehensive integrative medicine consultation, integrative approaches to pain management, cancer, and lifestyle-related issues MD Degree: Boston University School of Medicine (Massachusetts), 1994 Residency: Medicine, Boston Medical Center (Massachusetts), 1994-1996 Preventive Medicine, Boston Medical Center (Massachusetts), 1996-1998 Fellowship: General Internal Medicine, Boston Medical Center (Massachusetts), 1996-1998 Other Degree: MPH, Boston University (Massachusetts), 1996-1998
fatima a. rangwala, md, Phd medical oncology Particular Clinical Interests and Skills: Gastrointestinal oncology, including pancreatic, hepatobiliary, esophageal, gastric, colorectal, and anal cancers MD Degree: University of Cincinnati College of Medicine (Ohio), 2005 Residency: Internal Medicine, Duke University Medical Center, 2005-2008 Fellowship: Hematology Oncology, Duke University Medical Center, 2008-2011 Other Degree: PhD, University of Cincinnati (Ohio), 2005
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Fellowship: General Medicine Faculty Development, University of North Carolina at Chapel Hill, 2005-2007 Other Degree: MM, University of Georgia, 1987 Jennifer a. Walker, md General internal medicine Particular Clinical Interests and Skills: General internal medicine, preventive medicine, management of chronic diseases such as diabetes and hypertension MD Degree: Medical College of Georgia School of Medicine, 2003 Residency: Internal Medicine, Duke University Medical Center, 2007 OBSTETRICS AND GYNECOLOGY
michael l. reynolds, md neurology Particular Clinical Interests and Skills: General neurology, neuromuscular disease, EMG/ NCV, EMG-guided botulinum toxin injections for spasticity and other neurologic disorders MD Degree: University of Texas Medical Branch School of Medicine, 1996 Residency: Neurology, University of Texas Medical Branch School of Medicine, Texas Medical Center, 2000 Fellowship: EMG/ Neuromuscular Disease, Duke University Medical Center, 2001
John W. schmitt, md Gynecologic specialties Particular Clinical Interests and Skills: Well-women care, general office and surgical gynecology MD Degree: University of Texas School of Medicine at San Antonio, 1983 Residency: OBGYN, Duke University Medical Center, 1983-1987 OPHTHALMOLOGY
derek W. delmonte, md Cornea and external disease Particular Clinical Interests and Skills: Corneal transplantation; cataract surgery using astigmatism- and presbyopiacorrecting intraocular lenses; laser refractive vision correction; new therapies for corneal ectasia (thinning) and infectious keratitis MD Degree: University of Michigan Medical School, 2006 Residency: Internship, Evanston Northwestern Healthcare (Illinois), 2006-2007 Ophthalmology, Duke Eye Center, 2007-2010 Fellowship: Cornea, External Disease, and Refractive Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Florida), 2011
John H. strickler, md medical oncology Particular Clinical Interests and Skills: Treatment and management of gastrointestinal malignancies, including esophageal, gastric, pancreatic, and colorectal cancers; development of novel therapies through phase 1 and phase 2 clinical trials MD Degree: University of Chicago Pritzker School of Medicine (Illinois), 2005 Residency: Internal Medicine, University of Washington and Affiliated Hospitals, 2005-2008 Fellowship: Hematology Oncology, Duke University Medical Center, 2008-2011 teresa l. tullo, md General internal medicine Particular Clinical Interests and Skills: Treatment and prevention of osteoporosis; nonpharmacologic management of overweight, metabolic syndrome, and fatty liver; diabetes; hypertension MD Degree: University of North Carolina at Chapel Hill School of Medicine, 2001 Residency: General Internal Medicine, Moses Cone Memorial Hospital (North Carolina), 2001-2004
Beverly a. Gray, md General oBGYn Particular Clinical Interests and Skills: General OBGYN, including pediatric and adolescent gynecology; family planning; caring for patients with pregnancy loss, anxiety, and depression MD Degree: University of North Carolina at Chapel Hill School of Medicine, 2007 Residency: OBGYN, Duke University Medical Center, 2011 Henry n. Pleasant Jr., md General oBGYn Particular Clinical Interests and Skills: All areas of general OBGYN, including routine pregnancy care, medical and surgical management of benign gynecologic conditions, family planning, management of menopause, and abnormal bleeding MD Degree: Brody School of Medicine at East Carolina University (North Carolina), 1992 Residency: General OBGYN, Carolinas Medical Center (North Carolina), 1996
anna H. Bordelon, md Comprehensive ophthalmology Particular Clinical Interests and Skills: Cataract surgery, corneal transplant surgery, intraocular lenses, ocular surface disorders, allergic eye disease, refractive surgery, general ocular disease and corneal disease MD Degree: University of Virginia School of Medicine, 2003 Residency: Ophthalmology, Duke Eye Center, 2006-2009 Fellowship: Cornea, External Diseases, and Refractive Surgery, Wilmer Eye Institute at Johns Hopkins (Maryland), 2009-2010
tamer H. mahmoud, md, Phd Vitreoretinal diseases and surgery service Particular Clinical Interests and Skills: Diagnosis and treatment of retinal diseases, with special interest in macular degeneration, diabetic retinopathy, retinal vascular diseases, complex retinal detachment, small gauge vitrectomy, and long-acting intraocular implants MD Degree: Ain-Shams University (Egypt), 1992 Residency: Ophthalmology, Duke Eye Center, 2003 Fellowship: Medical and Surgical Diseases of Retina and Vitreous, Duke Eye Center, 2005 Other Degree: PhD, Ophthalmology, Supreme Council of Universities (Egypt), 2005
Preeya K. Gupta, md Cornea and external disease Particular Clinical Interests and Skills: Corneal transplantation (PK, DSEK); refractive surgery (PRK, PTK, custom LASIK, femtosecond laser, phakic intraocular lens [implantable Collamer lens, Visian ICL]); cataract surgery (presbyopiacorrecting intraocular lenses, astigmatism-correcting intraocular lenses) MD Degree: Northwestern University Feinberg School of Medicine (Illinois), 2006 Residency: Ophthalmology, Duke Eye Center, 2010 Fellowship: Cornea and Refractive Surgery, Minnesota Eye Consultants, Phillips Eye Institute, 2011
s. Grace Prakalapakorn, md Pediatric ophthalmology and strabismus service Particular Clinical Interests and Skills: Medical and surgical management of pediatric eye disorders and adult/childhood strabismus; congenital/pediatric cataracts; intraocular lens implants; amblyopia; diplopia; ocular motility disorders; nasolacrimal duct obstruction; screening and treatment of retinopathy of prematurity MD Degree: Emory University School of Medicine (Georgia), 2005 Residency: Transitional Internship, Scripps Mercy Hospital (California), 2005-2006 Ophthalmology, Emory University Hospital (Georgia), 2006-2009 Fellowship: Pediatric Ophthalmology and Strabismus, Duke Eye Center, 2010-2011 Other Degree: MPH, Emory University School of Public Health, 2005
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ORTHOPAEDICS
usha P. reddy, md oculoplastics and reconstructive surgery Particular Clinical Interests and Skills: Oculoplastics and reconstructive surgery, conditions of the eyelids, lacrimal system, orbit in children and adults MD Degree: Alpert Medical School, Brown University (Rhode Island), 2005 Residency: Ophthalmology, Bascom Palmer Eye Institute, University of Miami, 2009 Fellowship: Oculoplastics and Reconstructive Surgery, Duke Eye Center, 2011
samuel B. adams Jr., md foot and ankle surgery Particular Clinical Interests and Skills: Management of all disorders of the foot and ankle; treatment of osteochondral lesions of the talus; total ankle replacement; orthobiologic applications to foot and ankle surgery, including stem-cell therapies and platelet-rich plasma MD Degree: Jefferson Medical College of Thomas Jefferson University (Pennsylvania), 2004 Residency: Orthopaedic Surgery, Duke University Medical Center, 2010 Fellowship: Foot and Ankle Surgery, Union Memorial Hospital (Maryland), 2011
rhett K. Hallows, md adult reconstruction Particular Clinical Interests and Skills: Complex hip and knee replacement/reconstruction and revision surgery, hip and knee revision arthroplasty (for failed total knee and hip replacements), computernavigated joint replacement MD Degree: University of Utah School of Medicine, 2003 Residency: Orthopaedic Surgery, University of Utah, 2008 Fellowship: Total Joint Arthroplasty, Duke University Medical Center, 2009
rachel m. reilly, md trauma Particular Clinical Interests and Skills: Acute orthopaedic trauma surgery, including fractures of the pelvis, acetabulum, and periarticular fractures; patients with nonunions and malunions MD Degree: University of Cincinnati College of Medicine (Ohio), 2005 Residency: Orthopaedic Surgery, UNC Hospitals, 20052010 Fellowship: Orthopaedic Trauma, R. Adams Cowley Shock Trauma Center (Maryland), 2010-2011 PATHOLOGY elizabeth n. Pavlisko, md Particular Clinical Interests and Skills: Pulmonary pathology, cardiovascular pathology, transplant pathology (heart and lung), autopsy pathology, interstitial and occupational lung disease, pleural and pulmonary malignancy, asbestos-related lung disease, lung tissue fiber burden analysis via electron microscopy MD Degree: Medical University of South Carolina College of Medicine, 2006 Residency: Anatomical and Clinical Pathology, Duke University Medical Center, 2010 Fellowship: Pulmonary Pathology, Duke University Medical Center, 2011 PEDIATRICS alaina m. Brown, md neonatology Particular Clinical Interests and Skills: Neonatal resuscitation MD Degree: University of Virginia School of Medicine, 2008 Residency: Pediatrics, Duke University Medical Center, 2011
ann m. Buchanan, md infectious diseases Particular Clinical Interests and Skills: HIV, tropical medicine, infectious diseases MD Degree: Brody School of Medicine at East Carolina University (North Carolina), 2002 Residency: Pediatrics, University of Rochester (New York), 20022006 Fellowship: Pediatric Infectious Diseases, Duke University Medical Center, 2008-2011 Other Degree: MPH, Maternal and Child Health, University of North Carolina at Chapel Hill, 2007 Diploma, Tropical Medicine and Hygiene, Gorgas Course in Clinical Tropical Medicine (Peru), 2004
Jullia rosdahl, md, Phd Glaucoma service Particular Clinical Interests and Skills: Diagnosis and treatment of glaucoma, cataracts, and general diseases; glaucoma laser; incisional surgical therapies; cataract surgery MD Degree: Case Western Reserve University School of Medicine (Ohio), 2004 Residency: Internal Medicine, Caritas Carney Hospital, Tufts University (Massachusetts), 2004-2005 Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard University, 2007-2010 Fellowship: Glaucoma, Duke Eye Center, 2010-2011 Other Degree: PhD, Case Western Reserve University School of Medicine (Ohio), 2002
Grant Garrigues, md sports medicine Particular Clinical Interests and Skills: Arthroscopic, joint replacement, and reconstructive surgery of the shoulder and elbow; treatment of rotator cuff tears, labral/Bankart/SLAP tears, impingement syndrome, cartilage defects, arthritis, instability, stiffness, nerve compression, throwing athletes, and traumatic injuries MD Degree: Harvard Medical School (Massachusetts), 2005 Residency: Orthopaedic Surgery, Duke University Medical Center, 2010 Fellowship: Shoulder and Elbow Surgery, The Rothman Institute/ Thomas Jefferson University (Pennsylvania), 2011
richard C. mather iii, md sports medicine Particular Clinical Interests and Skills: Hip arthroscopy, sports injuries of the hip, femoroacetabular impingement, cartilage and meniscus injuries, cartilage restoration and transplantation, shoulder replacement and reconstruction, reverse shoulder arthroplasty, shoulder instability, rotator cuff injuries, ACL reconstruction MD Degree: Duke University School of Medicine, 2005 Residency: Orthopaedic Surgery, Duke University Medical Center, 2010 Fellowship: Sports Medicine, Rush University Medical Center (Illinois), 2011
rebecca J. Chancey, md Blood and marrow transplantation Particular Clinical Interests and Skills: Pediatric blood and marrow transplantation MD Degree: Washington University in St. Louis School of Medicine (Missouri), 2008 Residency: Pediatrics, Duke University Medical Center, 2011
richard J. Chung, md Primary Care Particular Clinical Interests and Skills: Primary and consultative care for adolescents and young adults with a particular focus on routine and preventive care, acute care, and chronic issues, including obesity, eating disorders, and concerns related to growth and development MD Degree: Yale University School of Medicine (Connecticut), 2005
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Residency: Internal Medicine Pediatrics, Duke University Medical Center, 2005-2009 Fellowship: Adolescent Medicine, Childrens Hospital Boston (Massachusetts), 2009-2011 rebecca l. smith, md Critical Care medicine Particular Clinical Interests and Skills: Pediatric critical care for children from birth through adolescence MD Degree: Drexel University College of Medicine (Pennsylvania), 2003 Residency: General Pediatrics, North Carolina Childrens Hospital, 2003-2006 (Chief Resident, 2006-2007) Fellowship: Pediatric Critical Care, Childrens Hospital of Pittsburgh (Pennsylvania), 20072010 Julie K. Wood, do Blood and marrow transplantation Particular Clinical Interests and Skills: Pediatric blood and marrow transplantation DO Degree: Philadelphia College of Osteopathic Medicine (Pennsylvania), 2008 Residency: Pediatrics, Duke University Medical Center, 2008-2011 PSYCHIATRY
Residency: General Psychiatry, Duke University Medical Center, 2011 Fellowship: Child and Adolescent Psychiatry, Duke University Medical Center, 2011 Other Degree: MPH, University of North Carolina at Chapel Hill, 2004
RADIOLOGY
deanna m. Green, md Pulmonary and sleep medicine Particular Clinical Interests and Skills: Management of cystic fibrosis and CF-related complications, chronic lung disease of infancy, asthma, general pulmonary diseases such as recurrent pneumonia MD Degree: University of Florida College of Medicine, 2004 Residency: Pediatrics, Johns Hopkins University, 2004-2007 Fellowship: Pediatric Pulmonary, Johns Hopkins University, 2007-2011 Other Degree: MHS, Clinical Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2008-2010
Heather r. romero, Phd medical Psychology PhD Degree: Clinical Psychology, Seattle Pacific University (Washington), 2009 Residency: Clinical Neuropsychology, Duke University Medical Center, 2008-2009 Fellowship: Neuropsychology, Duke University Medical Center, 2009-2011 RADIATION ONCOLOGY
adam C. Braithwaite, md Community radiology Particular Clinical Interests and Skills: Advanced breast imaging and the early detection of breast cancer, trauma imaging MD Degree: New York Medical College, 2002 Residency: Internal Medicine, Carolinas Medical Center (North Carolina), 2002-2003 Diagnostic Radiology, Duke University Medical Center, 2003-2007 Fellowship: Breast and Abdominal Imaging, Duke University Medical Center, 2007-2008 lauren J. ehrlich, md Pediatric radiology Particular Clinical Interests and Skills: Pediatric radiology MD Degree: University of Pennsylvania School of Medicine, 2005 Residency: Transitional Internship, Albert Einstein Medical Center (Pennsylvania), 2005-2006 Diagnostic Radiology, Hospital of the University of Pennsylvania, 2006-2010 Fellowship: Pediatric Radiology, Duke University Medical Center, 2010-2011
dorothee K.d. newbern, md endocrinology Particular Clinical Interests and Skills: Type 1 diabetes, hypoglycemia, hypothyroidism, Graves disease MD Degree: Wake Forest University School of Medicine (North Carolina), 2005 Residency: Pediatrics, Duke University Medical Center, 2005-2008 Fellowship: Pediatric Endocrinology, Duke University Medical Center, 2008-2011
Priti tewari, md Blood and marrow transplantation Particular Clinical Interests and Skills: Stem-cell and bone-marrow transplantation for malignant and nonmalignant pediatric disorders, including pediatric cancers, inherited metabolic disorders, immunodeficiencies, and hemoglobinopathies; long-term follow-up; supportive care; quality of life MD Degree: Ross University School of Medicine (Dominica, West Indies), 2003 Residency: Pediatrics, State University of New York at Downstate, 2003-2006 Fellowship: Pediatric HematologyOncology, Childrens Hospital at Montefiore, Albert Einstein College of Medicine, 20062009 Pediatric Bone Marrow Transplantation, Duke University Medical Center, 2009-2011
naomi o. davis, Phd Child and adolescent Psychiatry medical Psychology Particular Clinical Interests and Skills: Evaluation and treatment services for ADHD (child, adolescent, and adult), parent training (individual and group services), academic skills support PhD Degree: Clinical Psychology, University of Massachusetts, 2007 Residency: Clinical Psychology, UNC Hospitals, 2006-2007 Fellowship: Pediatric Psychology, UNC Hospitals, 2011 Other Degree: MA, Child Development, Tufts University (Massachusetts), 2000
Casey tudor Chollet, md Particular Clinical Interests and Skills: General radiation oncology MD Degree: University of Tennessee College of Medicine, 2006 Residency: General Internal Medicine, University of Tennessee, 2006-2007 Radiation Oncology, Loyola University Medical Center (Illinois), 2007-2011
erikka d. dzirasa, md Child and adolescent Psychiatry Particular Clinical Interests and Skills: Advanced psychopharmacology, cognitive behavioral therapy, mood and anxiety disorders, ADHD, eating disorders MD Degree: Duke University School of Medicine, 2006
danielle m. seaman, md Cardiothoracic imaging Particular Clinical Interests and Skills: Cardiothoracic imaging MD Degree: Case Western Reserve University School of Medicine (Ohio), 2005 Residency: Diagnostic Radiology, University of Cincinnati (Ohio), 2010 Fellowship: Cardiothoracic Imaging, Duke University Medical Center, 2011
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SURGERY
obinna o. adibe, md Pediatric General surgery Particular Clinical Interests and Skills: Advanced pediatric minimally invasive surgery, neonatal surgery, anorectal malformations, inflammatory bowel disease, prenatal counseling, fetal therapy, pediatric outcomes research MD Degree: University of Medicine and Dentistry of New JerseyNew Jersey Medical School, 2001 Residency: General Surgery, University of Connecticut Health Center, 2001-2004, 2006-2008 Fellowship: Fetal Surgery Research, Childrens Hospital of Philadelphia (Pennsylvania), 2004-2006 Pediatric Endosurgery, Childrens Hospital of Alabama, 2008-2009 Pediatric Surgery, Childrens Mercy Hospital and Clinics (Missouri), 2010-2012 richard e. Cooper, md General surgery Particular Clinical Interests and Skills: Thyroid and parathyroid surgery, breast surgery, hernia surgery MD Degree: Keck School of Medicine of the University of Southern California, 1988 Residency: General Surgery, Phoenix Integrated Surgical Program, Banner Good Samaritan Medical Center (Arizona), 1993
nancy J. Crowley, md surgical oncology Particular Clinical Interests and Skills: Breast disease, breast cancer MD Degree: Duke University School of Medicine, 1985 Residency: General Surgery, Vanderbilt University, 19851988 Fellowship: General Surgery, Duke University Medical Center, 1988-1990 Research, General Surgery, Duke University Medical Center, 1990-1993
Gayle a. dilalla, md surgical oncology Particular Clinical Interests and Skills: Breast disease, breast cancer MD Degree: University of MissouriKansas City School of Medicine, 1987 Residency: General Surgery, University of Florida Jacksonville, 1992
Calhoun d. Cunningham iii, md otolaryngologyHead and neck surgery Particular Clinical Interests and Skills: Disorders of the ear in adults and children, including skull-base tumors, acoustic neuromas, glomus tumors; chronic ear infections, cholesteatoma, and eardrum perforations; sensorineural and conductive hearing loss; cochlear implantation, BAHA implants, and implantable hearing aids; otosclerosis MD Degree: Medical University of South Carolina College of Medicine, 1996 Residency: Otolaryngology, Medical University of South Carolina, 2002 Fellowship: Otology Neurotology, House Ear Clinic (California), 2004
matthew G. Hartwig, md Cardiovascular and thoracic surgery Particular Clinical Interests and Skills: Thoracic oncology with an emphasis on minimally invasive approaches to lung and esophageal cancer; videoassisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS); benign and malignant diseases of the lung, esophagus, mediastinum, and chest wall; surgical treatment of endstage lung disease, including lung volume reduction and lung transplantation; ex vivo lung perfusion; donation after cardiac death; extracorporeal life support for respiratory failure MD Degree: Duke University School of Medicine, 2001 Residency: Surgery, Duke University Medical Center, 2001-2007 (Chief Resident, 2007-2008) Thoracic Surgery, Duke University Medical Center, 2008-2010 (Chief Resident, 2010-2011) Fellowship: Research, Thoracic Surgery, Duke University Medical Center, 2003-2005
shelley Hwang, md surgical oncology Particular Clinical Interests and Skills: Diagnosis and treatment of early-stage breast cancer, management of patients at high risk for breast cancer, surgical treatment of patients with breast disease MD Degree: University of California, Los Angeles, David Geffen School of Medicine, 1991 Residency: General Surgery, Kaiser Permanente Los Angeles (California), 1991-1992 General Surgery, Weill Cornell Medical Center (New York), 1992-1996 Fellowship: Breast Surgery, Memorial Sloan-Kettering Cancer Center (New York), 1996-1997 Surgical Oncology, Singapore General Hospital, 1997-1998 Other Degree: MPH, University of California, Berkeley, 2006
aaron C. lentz, md urology Particular Clinical Interests and Skills: Reconstructive urology with a specific focus on minimally invasive approaches to urethral stricture disease, urinary incontinence, ureteral obstruction, fistula repair, genitourinary trauma, sexual dysfunction, prostate enlargement, and videourodynamic evaluation MD Degree: University of North Carolina at Chapel Hill School of Medicine, 2005 Residency: Surgery, UNC Hospitals, 2005-2006 Urologic Surgery, UNC Hospitals, 2006-2010 Fellowship: Reconstructive Urology, Female Urology, and Urodynamics, Duke University Medical Center, 2010-2011
nandan lad, md, Phd neurosurgery Particular Clinical Interests and Skills: Movement disorders, deep brain stimulation, medically refractory pain, spinal neurosurgery, peripheral nerve surgery, general adult neurosurgery MD Degree: Chicago Medical School at Rosalind Franklin University of Medicine and Science (Illinois), 2004 Residency: General Surgery, Stanford University Medical Center (California), 2004-2005 Neurosurgery, Stanford University Medical Center (California), 2005-2011 Fellowship: Stereotactic and Functional Neurosurgery, Stanford University Medical Center (California), 2008-2009 Other Degree: PhD, Rosalind Franklin University of Medicine and Science (Illinois), 2004
michael e. lipkin, md urology Particular Clinical Interests and Skills: Medical and surgical management of kidney stone disease, minimally invasive urologic surgery, endoscopic management of urinary tract obstruction, robotic and laparoscopic urologic surgery MD Degree: University of Medicine and Dentistry of New JerseyNew Jersey Medical School, 2003 Residency: Urology, New York University Medical Center, 2009 Fellowship: Endourology, Laparoscopy, and Robotics, Duke University Medical Center, 2011
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Residency: Surgery, West Virginia University Hospitals, 1997-1998 Neurosurgery, West Virginia University Hospitals, 1998-2003
Catherine a. lynch, md emergency medicine Particular Clinical Interests and Skills: Clinical and research focus in trauma and injury care; health disparities research in injury and emergency care in the United States and in lowand middle-income countries MD Degree: University of Medicine and Dentistry of New JerseyNew Jersey Medical School, 2005 Residency: Emergency Medicine, Yale-New Haven Hospital (Connecticut), 2009 Fellowship: Emergency Medicine/International Health, Emory University (Georgia), 2011
P. Joshua oBrien, md General surgery Particular Clinical Interests and Skills: Abdominal aortic aneurysms, peripheral vascular disease, dialysis access, endovascular therapies MD Degree: Joan C. Edwards School of Medicine at Marshall University (West Virginia), 2004 Residency: General Surgery, Marshall University School of Medicine (West Virginia), 2009 Fellowship: Vascular Surgery, Duke University Medical Center, 2011
Carrie r. muh, md neurosurgery Particular Clinical Interests and Skills: Pediatric brain tumors, pediatric spine tumors, posterior fossa tumors, genetic tumor syndromes, Chiari malformations, craniosynostosis and craniofacial surgery, tethered cord and spina bifida, hydrocephalus, spasticity, vagal nerve stimulators for epilepsy and the evaluation and treatment of other neurosurgical disorders of childhood MD Degree: Columbia University College of Physicians and Surgeons (New York), 2003 Residency: General Surgery, Neurology, Emory University School of Medicine (Georgia), 2003-2004 Neurological Surgery, Emory University School of Medicine (Georgia), 2004-2010 (Chief Resident, 2009-2010) Fellowship: Pediatric Neurosurgery, Childrens Healthcare of Atlanta and Emory School of Medicine, 2010-2011 Other Degree: MS, Political Science/Health Policy, Massachusetts Institute of Technology, 1997
Philip a. omotosho, md metabolic and Weight loss surgery Particular Clinical Interests and Skills: Minimally invasive and bariatric surgery, gastroesophageal reflux, esophageal motility disorders, hiatal hernia, abdominal wall hernias MD Degree: Pennsylvania State University College of Medicine, 2004 Residency: General Surgery, Baystate Medical Center/Tufts University School of Medicine (Massachusetts), 2009 Fellowship: Minimally Invasive Surgery, Duke University Medical Center, 2011
Jonathan C. routh, md urology Particular Clinical Interests and Skills: Reconstructive surgery of congenital anomalies of the genitourinary tract (hypospadias, cryptorchidism, intersex, obstructive uropathies [hydronephrosis], vesicoureteral reflux, exstrophy); management of urinary-tract infections, incontinence, and enuresis in children; management of neurogenic bladders in children; general pediatric urology; consultation for fetal uropathies; urologic neoplasms in children MD Degree: University of North Carolina at Chapel Hill School of Medicine, 2002 Residency: Urology, Mayo Clinic (Minnesota), 2008 Fellowship: Pediatric Urology, Childrens Hospital Boston (Massachusetts), 2011 Pediatric Health Services Research, Harvard Medical School (Massachusetts), 2010 Other Degree: MPH, Harvard School of Public Health (Massachusetts), 2010
Residency: General Surgery, Baylor College of Medicine (Texas), 1977-1981 General Surgery, Creighton University (Nebraska), 1981-1982 General Surgery, Henry Ford Hospital (Michigan), 1982-1983 Thoracic/Cardiovascular Surgery, Wayne State University (Michigan), 1984-1986 Fellowship: Thoracic/ Cardiovascular Surgery, Wayne State University (Michigan), 1983-1984 Endovascular Surgery, Columbia University Medical Center (New York), 2007
Jonathan C. Wendell, md emergency medicine Particular Clinical Interests and Skills: All aspects of out-ofhospital emergency care and disaster medicine with focus on mass-gathering/event medicine MD Degree: University of Arizona College of Medicine, 2007 Residency: Emergency Medicine, University of Maryland, 2010 Fellowship: Pre-Hospital and Global Disaster Medicine, Duke University Medical Center, 2011
lisa a. tolnitch, md surgical oncology Particular Clinical Interests and Skills: Breast disease, breast cancer MD Degree: University of Louisville School of Medicine (Kentucky), 1983 Residency: General Surgery, UNC Hospitals, 1983-1988
Kenneth o. Price, md neurosurgery Particular Clinical Interests and Skills: General adult neurosurgery, cervical and lumbar spine surgery, peripheral nerve entrapment, carotid artery surgery MD Degree: Wake Forest University School of Medicine (North Carolina), 1997
William P. sweezer Jr., md Cardiovascular and thoracic surgery Particular Clinical Interests and Skills: Adult cardiac surgery, thoracic surgery, peripheral vascular surgery, endovascular surgery, mediastinal tumors, thoracoscopic surgery, thoracic surgical oncology MD Degree: Meharry Medical College (Tennessee), 1977
Charles J. Viviano, md, Phd urology Particular Clinical Interests and Skills: General adult urology, including kidney stones, BPH, hypogonadism, erectile dysfunction, hematuria, and vasectomy MD Degree: University of Connecticut School of Medicine, 2000 Residency: Urology, University of Connecticut Health Center, 2000-2006 Other Degree: PhD, Toxicology, University of North Carolina at Chapel Hill, 1994
Charles r. Woodard, md otolaryngologyHead and neck surgery Particular Clinical Interests and Skills: Facial plastic and reconstructive surgery, including rhinoplasty, nasal surgery for breathing obstruction, surgical treatment of the aging face (browlift, blepharoplasty, face-lift, neck lift), cosmetic facial implants, cosmetic injectables and fillers (Botox, Dysport, Restylane, Juvederm, Radiesse), surgical reconstruction following Mohs surgery for facial cancers, management of facial paralysis, maxillofacial trauma MD Degree: Eastern Virginia Medical School, 2005 Residency: General Surgery, University of Virginia Health System, 2005-2006 OtolaryngologyHead and Neck Surgery, University of Virginia Health System, 2006-2010 Fellowship: Facial Plastic and Reconstructive Surgery, Stanford University Medical Center (California), 2010-2011
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2012 duke Cme Calendar

on-site courses
dermatoloGY
ContinuinG mediCal eduCation at duKe For more information on the courses listed below, please contact the Duke Office of Continuing Medical Education at 919-401-1200 or visit cme.mc.duke.edu.
DATE LOCATION CREDITS
Society for Investigative Dermatology 2012 Annual Meeting

radioloGY
May 912
Raleigh, NC
36.5
22nd Annual Duke Review Beach Course

radiation onColoGY
July 2327
Myrtle Beach, SC
21.0
5th Annual IMRT/IGRT North Carolina Symposium
May 5
Durham, NC
DATE
6.75
CREDITS
online courses
duKe CardioloGY e-rounds
Congestive Heart Failure 1950-2010: A 60-Year Perspective Duke Cardiology at the American Heart Association Meetings Late-Breaking Science: Highlights of the ESC Myocardial Mechanics: More than Meets the Eye New Developments in Therapies for Acute Heart Failure Revascularization for Chronic Total Occlusions What's Hot in Cath Lab Research What's Hot in EP Research at Duke What's Hot in Heart Failure Research What's Hot in Prevention Research What's Hot in the Echo Lab at Duke
CHamBer Peer-to-Peer PodCast
Through June 30 Through June 30 Through June 30 Through June 30 Through June 30 Through June 30 Through June 30 Through June 30 Through June 30 Through June 30 Through June 30
1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
Diagnosis of HER2-Overexpressing Breast Cancer Case Presentation: Treating HER2-Overexpressing Breast Cancer
CHamBer on-demand WeBinar
Through May 16 Through June 9
0.5 0.5
Treating HER2-Driven Breast Cancer Coping with Breast Cancer: Emotional Well-Being Assessing Toxicity
duKe CliniCal mediCine series
Through May 12 Through June 16 Through June 16
0.75 0.75 1.0
Endocrinology Conference 2011: Graves Disease Endocrinology Conference 2011: What's New in Diabetes Mellitus Treatment Endocrinology Conference 2011: The Weak and DizziesMedications for Thyroid Disease Pulmonology Conference: ILD in 2010Recognition, Approach, and Treatment Options Cardiology Conference 2011: ACC.11 and the i2 Summit Results Discussion Cardiology Conference 2011: Atrial FibrillationAchieving Safer Anticoagulation Cardiology Conference 2011: A Look into the Future of Antiplatelet Therapy Cardiology Conference 2011: Current Concepts and Future Directions Cardiology Conference 2011: The Evolution of the Coronary StentAddressing Current Limitations Cardiology Conference 2011: Bioresorbable StentsFrom Concept to Clinical Use Nephrology Conference 2011: Management of Diabetes in Patients with Abnormal Renal Function Sedation Management in the Critically Ill and Perioperative Patient Glioblastoma Phase 2 Updates on the Management of Brain Tumors: Clinical Column Series Therapeutic Advances in the Management of Psychoses: Volume 3 Meet the Professors CD-ROM: Clinical Investigators Consult on Challenging Real Cases of Patients with Prostate Cancer Of Ends and Means: Toward Optimized Outcomes in Atrial Fibrillation Emerging Treatment Options for the Prevention of Atrial Fibrillation-Related Stroke CHAMBER Patient Visit Simulator: Management of HER2-Amplified Breast Cancer CHAMBER Standardized Patient Video: Side Effects of Adjuvant TreatmentCardiotoxicity Confronting the Limitations of Dual Antiplatelet Therapy Updates in Neuro-Oncology: 2011 Annual Meeting of the American Society of Clinical Oncology
52
Through May 19 Through May 26 Through June 2 Through June 2 Through June 16 Through June 23 Through June 30 Through July 7 Through July 14 Through July 28 Through July 21 Through May 22 Through May 24 Through June 9 Through June 19 Through June 22 Through June 23 Through July 21 Through July 21 Through July 24 Through July 28
0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 1.0 2.25 1.0 1.25 2.5 1.25 1.0 0.25 2.25 0.75
Weve discovered a powerful weapon in the war on cancer:
You.
Cures for cancer. Its an ambitious goal, but the truth is, its attainablewith your help.
You can help move cancer research forward. Research that could mean promising new drugs and treatments, more precious time for patients, even cures. Your gift to the Duke Cancer Fund provides essential dollars that we can apply quickly and strategically to fund groundbreaking research and innovative treatments. Your donation will foster working partnerships between our patients and our scientists, pushing out the frontiers of cancer research while giving patients the gift of another cherished month, another treasured season, another priceless year. All of us at the Duke Cancer Institute earnestly invite you to lend your strength to our fight against cancer. To learn more about how you can become a partner in the fight, please visit dukecancerfund.org or call 919-385-3129 today.
DUKE CANCER
dukecancerfund.org 919-385-3129
dukemed magazine DUMC 3687 Duke University Medical Center Durham, NC 27710
201013001
Non-profit Org. U.S. Postage PAID PPCO
maga zine
OPENING NEW DOORS

With the launch of the Duke Cancer Institute in November 2010 and the opening of the new Duke Cancer Center in February 2012, This is the beginning of a new era in cancer care and research at Duke, says Michael B. Kastan, MD, PhD, who became the DCIs first executive director last fall. Many challenges remain in battling cancer, but I believe that these groundbreaking initiatives will greatly facilitate our ability to bring advances from the lab into clinical practice and to transform the way that cancer patients are cared for. Learn more in this special issue of DukeMed Magazine.
DukeMed Magazine is printed on Forest Stewardship Council-certified paper, manufactured from wood harvested from well-managed forests certified by Bureau Veritas Certification.

DukeMed Magazine - Spring 2012

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DukeMed Magazine - Spring 2012

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VOLUME 12, ISSUE 1 SPRING 2012

A new era dawns

A new home for cancer careas it should be

14 introducing the new

duke Cancer Center Look inside a landmark

Transforming cancer care from generation to generation

Dukes design to deliver better cancer therapies

DUKE MEDICINE ADMINISTRATION

duke university Hospital

duke university school of nursing

duKe mediCine Board of Visitors

VOLUME 12, ISSUE 1, SPRING 2012

duke Cancer Center

duke university school of nursing

Our changing campus

Visit Duke Medicine online at dukemedicine.org

DukeMed Spring 2012

Documenting Duke Medicine

Making MDs in Tanzania

Visit Duke Medicine online at dukemedicine.org

DukeMed Spring 2012

DUKE GLOBAL HEALTH INSTITUTE 5

NEW MASTERS PROGRAM

STUDENTS IN THE FIRST CLASS

BIOSTATISTICS & BIOINFORMATICS FACULTY AT DUKE

Visit Duke Medicine online at dukemedicine.org

DukeMed Spring 2012

Talking to patients about live kidney donation

Obesity and prostate cancer detection

A path to better chemo delivery

David Chu, MD, and Lionel Baez, MD (left to right)

Concentrative nucleoside transporter molecule embedded in cell membrane

Why stress is bad

Banishing the myth of passive knee rehab

CoreValve TAVI trial showing impressive early results

Visit Duke University Health System online at dukehealth.org

DukeMed Spring 2012

Cholesterol: Bad to the bone

Cesarean birth? Put boots on the mom

Donald McDonnell, PhD

Visit Duke University Health System online at dukehealth.org

DukeMed Spring 2012

Introducing the new Duke Cancer Center

CritiCal needs and Creature Comforts

DukeMed Spring 2012

Duke Hospital Parking

Duke Hospital Duke Medicine Pavilion

Duke E Childrens rwin Ro Hospital ad

Duke Medicine Circle Parking

an enVironment for oPtimal Care

desiGned for ProGress

DukeMed Spring 2012

transforminG CanCer Care at duKe

AS THE DUKE CANCER INSTITUTE

decades that followed, Duke scientists

hen Evelyn Morgan was hired

as Dukes first oncology clinical nurse

First comes love

DukeMed Spring 2012

01 Je rey Crawford, MD 02 Early radiation oncology

tools: state-of-the-art liquid chromatograph

imaging (MRI) scanner, 1983

MERCIFUL MEDICINES, PRECISION CARE