VOLUME 17 NO. 7 n inside.dukemedicine.org n July 2008

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w o r k i n g

A smoke-free success

One year ago, Duke Medicine went tobacco-free. About 1,000 people have sought help in quitting smoking — read about the struggle of one of them, Rodd Mangum. Page 13

d u k e d i f f e r e n c e

global Health PLuS

Coordinating with the Chinese government, Duke Medicine is sending a truckload of needed medical equipment into the earthquake zone. Page 4

How genes could change the way we view our health

putting the me in medicine

Read more about the use of genetics and medicine on page 6 and in the Inquiry section.

An integral part of a typical doctor’s visit is filling out paperwork about your health history, including details about the health status of close family members. In traditional medicine, those ‘family

histories’ are the closest most physicians have gotten to considering your genome as a diagnostic aid for common complex diseases such as heart disease and diabetes. Today, advances in the genome sciences are poised to change that practice.

f e e d b A c k

o n T H e w e bi n S i d e S c o o P

Inside Duke Medicine2 July 2008

Highlighting the best health,

science and employee news

from Duke Web sites

I N S I D E V O L U M E 1 7 , I S S U E 7 nCOntACt us Campus mail: DUMC 104030 Deliveries: 2200 W. Main St., Suite 910-B, Durham, NC 27705 Phone: 919.660.1318 E-mail: editorinside@mc.duke.edu

CREDIts Cartoon: Josh Taylor

stAff Editor: Anton Zuiker Managing Editor: Mark Schreiner science Editor: Kelly Malcom Calendar Editor: Erin Pratt Designer: Vanessa DeJongh Intern: La-Tasha Davis Copyright © 2008 Duke University Health System

Inside Duke Medicine, the employee newspaper for the Duke University Health System, is published monthly by Duke Medicine News & Communications.

Your comments, story ideas and photo contributions are always welcome and appreciated. Deadline for submissions is the 15th of each month.

Genetics and Grandpa's 95 years

Earlier this year, Inside Duke Medicine changed its look and re-energized its content. Inquiry, a new section showcasing the best in science and research at Duke Medicine made its debut.

Some fast facts about Inside Duke Medicine:

• Serves employees across Duke Medicine. • Distributes 18,000 copies. • Is produced by the Office of Internal Communications within Duke Medicine News & Communications. • New issues come out on the first business day of every month. • Can be reached by email at editorinside@mc.duke.edu

You’ve heard from us. Now it’s time to hear from you.

Please go to our Web site — http://inside.dukemedicine.org — follow the ‘Share your thoughts’ link, and fill out the short survey.

You’ll be glad that you did. Not only will you help us improve, but survey takers who respond by Aug. 1 and leave an e-mail address or telephone number will be entered into a drawing for a $25 gift certificate to the Medical Center Bookstore. The first 15 entries will also receive a Duke Medicine water bottle.

Now it's your turnWin a chance for prizes by telling us what you think about Inside Duke Medicine fuel for thought

Two Fuqua School of Business profs (shown above) argue that posting a vehicle’s fuel efficiency in “gallons per mile” rather than “miles per gallon” would help consumers make better decisions about car purchases and environmental impact. http://www.duke-news.duke.edu/2008/06/gpmfuqua.html

John Staddon, Ph.D., James B. Duke professor of psychology and brain sciences at Duke University, writes about how U.S. traffic signs challenge driver attention and lead to more accidents, in the July/August issue of The Atlantic. http://www.theatlantic.com/doc/200807/traffic

Recent Nicholas School for the Environment & Earth Studies graduate Michael Stringer created Velocommuter.org to help fight global warming by encouraging people to leave their cars at home and bike to work – if only for a day. http://www.nicholas.duke.edu/news/ns-velocommute.html and http://www.velocommuter.org/

See page 16 for five ways to save gas.

R E A D I N G S n

D U k E b L O G G E R S nOn a recent visit to my hometown of DeKalb, Ill., I spent a delightful

afternoon sitting with my 95-year-old grandfather beside a backyard waterfall. The weather was gorgeous, bunnies were nibbling the grass and the Cubs were winning — paradise!

Grandpa Louis Sisco, right, had built his house 62 years ago, when he moved out from Chicago for easier access to his job as traveling drug salesman for McKesson Corp. (As a kid in the Roaring Twenties, he sold newspapers on a downtown Chicago street corner.)

“What’s your secret to longev-ity?” I asked him.

“A positive attitude and a sense of humor,” he answered right away.

I’m sure his daily walk, taken at 4:30 every morning for more than 50 years, helped, too.

These days, genetic genealogy is a passion of mine – I’m keen to know how the genes I’ve inherited from my grandparents, combined with the environment in which I’ve grown up and pharmaceuticals developed to

fight disease, will help me stay as sensible and spry into my nineties.

I don’t have to look too far.In this issue of Inside Duke

Medicine, we explore how Duke scientists and clinicians are finding ways to personalize medicine to the unique genomes of patients. Kelly Malcom has two articles, about research at the Institute for Genome Sciences and Policy and about treatments tailored to gene variants. And Misha Angrist, aka GenomeBoy, explains why he volunteered to make his genome available to science.

“I’ve lived a long life,” my grandpa said to me, about all the genomics he knows to share. And with that, I left him to don his headphones for the final innings of the ballgame. n

– Anton Zuiker

from the field

More than a dozen Duke students and faculty blog during their global health field experiences, including one student who is studying lemurs in Madagascar, and the impact the destruction of their habitat will have on public health. http://lemurhealth.blogspot.com/ and http://globalhealth.duke.edu/education-fieldwork/fieldwork-blogs

c A L e n d A r

give

July 12 8 a.m.-3 p.m. Duke Multiple Myeloma Bike Ride presented by the Division of Cellular Therapy.Participate in a 50K or 100K bike ride, from the Cameron Stadium through rural Durham and Orange Counties. Multiple myeloma is the second most common cancer of the blood. About 60,000 new patients are diagnosed every year in the U.S. with the disease. Environmental factors and toxin exposure may play a role in the epidemiology of this cancer, but the exact causes are still uncertain. Chemotherapy and stem cell transplants remain the preferred treatment for multiple myeloma, but new treatments and drugs are being developed. Registration fees support families and patients at the Multiple Myeloma Center at Duke, as well support research and treatment against this disease. http://dukemultiplemyelomabikeride.com

July 26 10 a.m.-7 p.m. “Fore the Patients,” Wana Kaye Rhodes Memorial Golf Tournament to benefit the Duke Cancer Patient Support Program. Golfers of all skill levels are invited to attend. National Golf Club in Pinehurst. Details: 684-4497

c A L e n d A r

3July 2008 Inside Duke Medicine

July/August Your insider's guide to what's happening at Duke Medicine

How to submit:Send calendar listings to editorinside@mc.duke.edu

Want more info?Visit us online at http://inside. dukemedicine.org.

The Calendar is a monthly selection of events that feature the best of happenings at Duke and Duke Medicine.

do

July 5 8 a.m.-12 p.m. North Hills Farmer’s Market sponsored by Duke Raleigh Hospital. Enjoy fresh produce at North Hills Commons in Raleigh. The market will open July 5 and is planned to operate 8 a.m.-12 p.m. each Saturday through early October. The market will feature fresh vegetables and produce, as well as flowers and herbs. http://www.northhillsraleigh.com/FarmersMarket.htm

July 21-25 5-day Summer Research Courses on Spirituality, Theology and Health Each course will focus on how to conduct research on these topics and how to develop an academic career. Participants will each have 30 minutes one-on-one with Dr. Harold Koenig and 30 minutes with another mentor of their choice. http://www.dukespiritualityandhealth.org/

July 29 11:30 a.m.-1:30 p.m. Raleigh Chamber of Commerce Executive Women’s Luncheon Jan Hargrave, nonverbal com-munications expert and author of Let Me See Your Body Talk and Strictly Business Body Language, will address personality types, strategies for working with others and body language. Attendees will identify ways to bring out the best in others. Attendees will also learn how to listen to the “full body” to eliminate distractions and improve concentration. The luncheon presented by Duke Raleigh Hospital will be at the Hilton in North Raleigh. Register: http://www.raleighchamber.org

August 5 6:30-8 p.m. “Baby Meets Bowser” Barbara Shumannfang, author of Happy Kids, Happy Dogs will provide helpful tips to prepare your dog for the new baby. Teer House. Register: 416-3853.

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

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

learnJuly 9 10:30-11:30 a.m. Introduction to Infant Massage A four-week series that will introduce mothers to the basics of infant massage. Join Debbie Carter, International Association of Infant Massage, at the Teer House for the class. Register: 416-3853.

July 10 4-5 p.m.“Health Care Reform and Presidential Politics,” the first annual Duke AHEC Program Lecture, given by health policy expert Jonathan B. Oberlander, Ph.D. Searle Center Lecture Hall Reception immediately following. The lecture is free and open to all Duke Uni-versity Health System faculty, staff, trainees, & students. RSVP to tara.owens@duke.edu or call 684-2648

July 17 6:30-8 p.m. Health Benefits of a Vegetarian or Vegan DietExplore how to meet your nutrient needs with a more plant-based diet with speaker, Leslie Gaillard. Teer House. Register: 416-3853

July 18 8:30 a.m.-5:30 p.m. 8th Annual Highlights from ASCO “The Era of Per-sonalized Cancer Treatment,” a symposium for medi-cal oncologists, hematologists, radiation oncologists, surgical oncologists, pharmacists, nurse practitioners and physician assistants. The Umstead Hotel, Cary. Details and registration: http://cancer.duke.edu/

July 21 6 -8 p.m. Grilling Without the Gas. Food tasting. Discover how to cook with coals and enjoy all your favorite recipes with speaker John D. Howe. Teer House. Register: 416-3853

FEATURED ACT IV I TY

FEATURED ACT IV I TY

Pam Isner with her winning entry from the 2007 Employee Arts Show. Submit your work for this year's show by August 8. PHOTO BY HEALTH ARTS NETWORK AT DUKE (HAND)

Tune up your bike and hit the road for the Duke Multiple Myeloma bike Ride on July 12. Details below. FILE PHOTO

FEATURED ACT IV I TY

b u L L e T i n SAT A g L A n c e

I N S I D E J O k E n I T f I G U R E S n

News briefs, notices, events,

and the IDM book Club

g L o b A L H e A LT H

She's going to go to kindergarten. She's going to do great.

Duke Medicine sends supplies to China quake zone

“ ”– Duke's Louise Markert, M.D., Ph.D., speaking to the News & Observer about the prognosis of 1-year-old Jayla Turner, who underwent a thymus transplant developed by Markert.

8,620,667Hospital lab procedures during 2007 fiscal year.

That’s more than

4 every minuteSource: http://www.dukehealth.org

4 Inside Duke Medicine July 2008

By Bill stagg

Duke University Health System has donated a truckload of medical

supplies to help hospitals and health centers in China in their ongoing efforts to treat earthquake victims.

Hundreds of thousands of people were injured or developed illnesses as a result of the May 12 earthquake in Sichuan province.

The equipment and supplies, gathered through Duke’s Global Health PLUS (Placement of Life-changing Usable Surplus) program, include a portable operating table, anesthesia machines, patient monitors, dialysis machines, ECG monitors, exam tables and thousands of isolation gowns, latex gloves and face masks.

The outreach effort was coordi-nated through the Chinese Embassy in Washington, which provided Duke with a list of the most-needed medical supplies at this stage of the crisis. Armstrong Relocation, Duke’s contracted relocation company, is donating its services to transport the equipment to a central distribution point. The equipment then will be shipped to China through Gifts in Kind

International, which has partnered with UPS to deliver relief donations from many corporations to China.

“The earthquakes in China present a real humanitarian crisis for all of us,” said Michael Merson, M.D., director of the Duke Global Health Institute. “Global Health PLUS allows us to respond to the urgent needs of our col-leagues overseas in a way that will help strengthen the country’s health system

long after another disaster captures the world’s attention.”

The Duke Global Health PLUS program makes surplus medical equipment and supplies from DUHS available to educational, research and service projects overseas sponsored by Duke faculty members.

Individuals can make financial do-nations at http://www.studentaffairs.duke.edu/earthquake/index.html n

A damaged bank in the city of bei Chuan stands amidst rubble in the aftermath of the recent earthquake in China. PHOTO COURTESy Of WIkIMEDIA COMMONS

R A N k I N G S n

Duke Medicine among best places work in It

For the second year, Duke University Health System has been ranked on Computerworld magazine’s annual list of 100 Best Places to Work in IT.

The magazine noted that the health system requires round-the-clock information technology support, “and its IT workers are given the technology they need to make that support happen.”

http://www.computerworld.com

P R O C E S S E S n

1 committee replaces 4

In June, Duke University Health System rolled its four separate product standardization committees — teams that reviewed the products used by nurses at the various hospitals and clinics — into one committee.

The Duke Medicine Product and Equipment Review Team, says Interim Director of Patient Resource Management Mary O’Brien, will optimize product and equipment utilization by evaluating and standardizing existing and new products important to Duke Medicine Nursing Care and Allied Health Services. Requests will be tracked through a centralized database.

The review committee’s oversight will lead to improved patient safety, consistency in clinical practice, and lower total cost, says Jane Pleasants, assistant vice president for procurement and supply chain management.

O’Brien and Steve Finch serve as chair and co-chair. For more information, see http://www.procurement.duke.edu

H O N O R S n

Health system earns AHA’s platinum rating

Duke Medicine has been recognized by the American Heart Association as a Platinum Start! Fit-Friendly Company.

The elite status recognizes the Health System’s ongoing efforts to provide a “culture of corporate wellness.” The culture includes supporting lifestyle improvements, such as increased physical activities.

For example, hundreds of Duke Medicine people participated in the Start! Walking at Work Day in April.

The Platinum Level is the highest level of recognition from the American Heart Association Start! Movement. Duke can now use the Start! logo, pictured above, when promoting AHA events.

5July 2008 Inside Duke Medicine

By Allan H. friedman, M.D.

What makes Duke University a special place to work are

not the achievements of any one individual, but Duke’s culture of collaboration. It is the sum total of the efforts of each of the members of the Duke team that attracts visitors from around the world.

This point was exemplified a few weeks back when U.S. Sen. Edward Kennedy and his family chose to come to the Preston Robert Tisch Brain Tumor Center at Duke for surgical treatment of his brain tumor.

While the national media focused its attention on the care given to Sen. Kennedy, it should be noted that the senator’s care differed very little from the care given any patient that comes to the Preston Robert Tisch Brain Tumor Center at Duke. From the clean, inviting environment to the internationally recognized medical expertise to the friendliness of the staff, Duke distinguishes itself among the medical institutions of this country.

The care given Sen. Kennedy was administered by a Duke team that always plays its “A” game.

While many members of the Duke family contributed to the senator’s care, there are certain individuals who had extensive contact with the senator and his wife. Cecil Borel, M.D., led an outstanding anesthesia team that shepherded the senator through his awake brain operation, as they have done in countless other cases before the senator.

James Harvey Carter, PA-C,

monitored the senator’s neurological functions as the operation proceeded.

The senator’s general medical care was supervised by Christopher O’Connor, M.D., director of the Duke Heart Center. Larry Allen, M.D., and the neurosurgical house staff adminis-tered the senator’s medical care from his admission history and physical examination through his discharge.

The neurosurgical ICU staff and the team of dedicated nurses that cared so well for him and all of our patients provided their trademark high-quality care in their usual friendly manner.

Hospital COO Kevin Sowers, R.N., and his administrative team took care of the senator’s special needs, such as special security and the accommodation for the senator’s staff.

Cathy Ebersohl and Susan Barrella orchestrated the senator’s discharge. Of course, the senator’s oncologic care was overseen by the senior members of the Preston Robert Tisch Brain Center: Henry Friedman, M.D.; Darell Bigner, M.D., Ph.D.; David Reardon, M.D.; John Sampson, M.D., Ph.D.; James Vredenburgh, M.D., and Annick DesJardins, M.D.

The Duke team used this opportunity to show the world the outstanding care given to all patients at Duke University Hospital. n

Friedman is Guy L. Odom professor of neurological surgery, neurosurgeon-in-chief at Duke Hospital and deputy director of the Preston Robert Tisch Brain Tumor Center at Duke.

Teamwork first

On June 2, neurosurgeon Allan Friedman, M.D., and a team of clinicians and staff operated on U.S. Sen. Edward M. Kennedy. Said Friedman, “The surgery was a success.”

D O N A T I O N S n

Aflac presents proceeds to Duke

Aflac presented the Duke Pediatric Blood and Marrow Transplant (PBMT) Family Support Program with a check for $18,458 from the proceeds of the 2007 Aflac Holiday Duck sales. Joanne Kurtzberg, M.D., director of the PBMT, along with Lindsey Kearns, director of the Family Support Program, received the check on May 28 in the Children’s Health Center.

In addition, the Family Support Program collaborated with local representatives of the Columbus, Ga.-based insurer to raise almost $9,000.

idM book c Lu b

Duke gets better

Atul Gawande is a surgeon at Brigham and Women’s Hospital in Boston, and medical writer for The New Yorker — his latest article is a fascinating exploration of why we itch,

and the new theories about how the brain perceives the body.

Gawande’s articles are collected in two books, Complications: A surgeon’s notes on an Imperfect science, and Better: A surgeon’s notes

on Performance (Picador, 2008). A copy of better recently made its way onto the desk of Michael Cuffe, M.D., vice dean for medical affairs and vice president for medical affairs.

“This book is a gripping look at how physicians around the world are finding ways to improve their care,” says Cuffe. “There are some good lessons in here for us at Duke Medicine.”

Cuffe shared the book with his office colleagues, who are helping him to launch a new quarterly newsletter for the Duke Medicine physician community.

Because of his writings about performance, Gawande was asked by the World Health Organization to head an international task force that devised a safety checklist with 22 items spread over three stages: before, during and after an operation.

Inside Duke Medicine soon will explore how Duke is using similar checklists and other evaluation measures to improve perfor-mance. Contact us if you have examples or case studies.

P R O C E D U R E S n

new way for vendors to check-in

Effective June 1, vendor representatives are required to comply with a new procedure for checking in prior to entering clinical areas within all Duke University Health System acute and ambulatory care facilities.

Vendors calling on Duke Medicine should:

1. Register with Status Blue, a Web-based service that requires evidence of competence and completion of required training.

2. Check in at a designated computer upon arrival at Duke.

3. Display at all times the Status Blue Identification Badge printed upon registration.

Employees are asked to visually check the representative’s badge to assure alignment between competency level and the services provided by the representative in support of patient care decisions, along with the expiration date. Check this site to validate a vendor’s information: https://www. status-blue.com/statusBlue/static/Content/Default.aspx

S A f E T y n

new warning system being installed

This summer, a new outdoor warning system will be installed at Duke that will feature seven strategically placed, pole-mounted sirens, including on the medical campus.

The units will have speakers that can blast warning tones and recorded or live voice messages to instantly alert students, faculty, staff and visitors during life-threatening emergencies.

“This is part of a multi-layered notification system designed to address one audience — people outdoors — so they can take immediate action,” said Aaron Graves, associate vice president for Campus Safety and Security. “The outdoor warning system will be supplemented with e-mail alerts, text messaging and police runners.”

Designed by Federal Signal Corp. in Illinois, Duke’s outdoor warning system may be tested occasionally in the coming months to help familiarize people with tones that will be used during actual emergencies such as a tornado sighting or an armed and dangerous person on campus.

“We will use the system to give you rapid instruction to go inside, take shelter in a secure location or take some other action for your safety,” Graves said.

o n T H e c o V e r

6 Inside Duke Medicine July 2008

By Kelly Malcom and Kendall Morgan

In 2003, scientists deciphered the 3 billion units of DNA that make up

the human genome for the first time. Researchers continue to uncover new links between DNA and disease every-day and — given advances in genome technologies — the pace of those discoveries will only increase.

“Over the past three years alone, there have been hundreds of new genetic findings related to more than 40 complex diseases that we never knew about before,” says Geoff Ginsburg, M.D., Ph.D., director of the Center for Genomic Medicine at the Institute for Genome Science and Policy (IGSP). “These findings may one day help physicians single out certain individuals as candidates for early health interven-tions or closer monitoring.”

Duke is on the cutting edge of the field of genomic medicine, says Ginsburg. Basic research in the IGSP and other departments is resulting in important advances in genomics with potential direct applications to medical practice.

In one effort to bring those discover-ies to the clinic, he plans to launch a study within the coming months that will integrate genetic testing for diabetes susceptibility with traditional clinical care at two Duke outpatient clinics. The goal is to find out if this information lends patients the motivation they need to adopt healthier lifestyles.

Ginsburg and other members of the IGSP are also working with the Executive Health Program at the Duke Center for Living to explore the use of genetic testing and genomic counseling, in combination with a detailed familial genetic risk assessment, as part of a more comprehensive health assessment and strategic health plan.

For the curious with a cool grand to spend, many direct-to-consumer com-panies are now offering whole genome scans. Send in a tube of your saliva and get back a whole genome profile that can reveal information about your ancestry and risk of developing certain diseases. (In fact, Duke’s Executive Health Program is offering the personal genomics profiles from Navigenics, a direct-to-consumer genome testing

company based in California, in an effort to help individuals learn more and do more with their test results.)

Researchers at the IGSP have also launched a study, called the Duke Personal Variome Project, to find out what is it that early adopters of personal genomics hope to gain by knowing what’s “written” in their DNA. And what, if anything, they will do with the information once they’ve got it.

The effort is the first, as far as the researchers know, specifically aimed to explore participants'

perceptions about their genomes and the impact that their genomic informa-tion will have on them. “It is clear that some among us, whatever the motiva-tion, are ready to test their genomes. But why?” said Huntington Willard, Ph.D., IGSP director and a principal investigator of the project.

The 14 participants in the project’s pilot phase, all from within the Duke genomics community, will each have

their genetic material (in this case extracted from blood) tested for selected genetic markers, called single nucleotide polymorphisms or SNPs, known to increase the risk of certain diseases, including breast cancer, heart disease, diabetes and Alzheimer’s disease. Afterward, participants can choose whether or not they want to receive their various test results.

It’s a decision fraught with a lot of emotion, says study participant Beth Sullivan, Ph.D., assistant professor of molecular genetics and microbiology. “I’ve always been interested in my DNA and I know that certain diseases run in my family. I personally have chosen to see my results. But then I’ll have to decide, will I share them with my family? Will I tell my doctor?”

After this initial phase, Willard hopes to expand the project to include groups in the broader Duke and Durham communities. The challenge will be educating non-geneticists about their genomes and the limitations of genomic testing. “It’s important to understand

that a genomic test result can’t provide a diagnosis. It can really only give you an idea of risk,” explained Sullivan.

now what?

Despite the promise for personalizing medicine and the ever increasing amount of scientific data available, the connec-tion between particular gene variants in the genome and the risk for many of the most common diseases remains rather limited so far. As David Goldstein, direc-tor of the IGSP’s Center for Population Genomics and Pharmacogenetics and co-PI of the new project, has said, “We remain in a situation where we have very little that is clinically actionable.” In other words, Ginsburg added, “based on population information, I may be able to tell you that you have a 20 percent chance of developing diabetes. A genome test, right now, may tell you that you have a 22 percent chance. That’s not much more than I could have told you before.”

Despite these caveats, knowing a patient’s genetic risk for disease gives physicians another tool to make heath care more refined and precise, says Ginsburg. The extent to which this information can lead to changes in a patient’s attitude about his or her health is a question the Personal Variome Project and Ginsburg’s diabetes studies are trying to answer. Willard said, “The Duke Personal Variome Project is as much a social experiment as a scientific one.”

While the full health benefits of genome testing have yet to be realized, Duke researchers are finding ways in which genes may help personalize medicine today. Researchers at the IGSP and Duke Comprehensive Cancer Center are leading clinical trials to test the utility of genomic ‘signatures’ of a patient’s tumor for guiding the treatment of breast, lung, and prostate cancer (see Inquiry, pg. 7).

Ultimately, Ginsburg said, a genome scan may become as standard as measuring blood pressure in a routine check-up with your doctor. n

f U R T H E R C O V E R A G E n

For more on how genetics may change the way physicians prescribe drugs, ongoing clinical trials in genomics, and one blogger's personal experience with genetic testing, see Inquiry (pages 7 -10).

Beth Sullivan, Ph.D., of the IGSP, poses with photographs of her family. She says she has considered the potential impact of her genomic testing on her loved ones. PHOtO By lA-tAsHA DAvIs

The genome gets personal

“I'll have to decide, will I share my results

with my family? Will I tell my doctor?“

the science & Research supplement to Inside Duke Medicine

VOLUME 17 NO. 7 n inside.dukemedicine.org n July 2008

from genes to drugsBy Kelly Malcom

Through a rigorous system of testing and clinical trials, pharmaceuticals

come to market. If a drug works in a test group, it’s then extrapolated that the same treatment will work in the population at large. However, not everyone responds to every drug in the same way, especially when it comes to more complex diseases like cancer.

This trial-and-error approach to prescribing drugs may eventually change in the face of genomic research now underway at Duke.

In 2006, a research team led by Anil Potti, Ph.D. and Joseph Nevins, Ph.D., of the Department of Genetics published a paper in the journal Nature demonstrating that the genetic profiles of cancer patients’ tumors could predict their response to chemotherapy.

The new tests have the potential to save lives and reduce patient’s exposure to the toxic side effects of chemotherapy, Potti said.

Within the past few months, Kelly Marcom, M.D., a medical oncologist, building on his collaboration with Nevins and the Institute for Genome Science and Policy (IGSP), has launched clinical trials that will test

these findings in breast cancer patients. The IGSP is now actively recruiting patients with early stage breast cancer to see whether genetics can be used by a physician to determine if a tumor will respond to a particular treatment and identify tumors more likely to recur. Similar trials will investigate this approach to chemotherapy in patients with lung cancer and prostate cancer.

Phillip Febbo, M.D., a medical oncologist, is leading other trials to test anti-cancer drugs in patients with advanced prostate cancer. In one trial on the horizon, called Metastisis at Duke, or MAD, researchers will collect biopsies from participating patients, perform genomic analysis of the samples and run a panel of chemotherapy predictors, resulting in a report that will be given to the patients’ oncologists.

“The question we’re trying to an-swer is how the information provided by genetics will be used in general oncology practice,” said Febbo. The trial, which will be supported financially by the Health System, will provide a novel approach to the care of cancer patients at Duke, he said.

Beyond cancer, researchers within the IGSP’s Center for Genomic

Medicine are looking for connections between genetics, predisposition to diseases like diabetes, and drug response in HIV and hepatitis C, just to name a few.

“By overlaying genetics and genomics with the current practice of medicine, we’ll be able to make medical decisions that are more right for the given patient,” said Geoff Ginsburg, M.D., the center’s director.

Elsewhere at Duke, researchers are looking at the connection between our genes, our behavior, and disease.

Redford Williams, M.D., of the Department of Psychiatry, is looking at the association between genes, environ-ment, and the stress response. Williams found that people with a genetic variant responsible for the control of serotonin levels, when combined with a poor household environment, were at greater risk for high blood pressure and elevated heart rate during stressful periods. In the future, the added information provided by these individual’s genetic profiles could lead to combination therapies for high blood pressure and serotonin control.

Genes can even predict who can quit

Duke researchers are leading the way to tailoring treatments based on a patient's DnA. fIlE PHOtOs

see GEnEs, p.9

By Mary Jane Gore

A new study by Duke University researchers provides more

evidence that the nitric oxide system in the life of a cell plays a key role in disease, and the findings point to ways to improve treatment of illnesses such as heart disease and cancer.

The nitric oxide system in cells is “a major biological signaling pathway that has been missed with regard to the way it controls proteins,” and it is linked to cancer and other dis-eases when the system goes awry, said Jonathan Stamler, M.D., of the depart-ments of medicine and biochemistry.

In the body, nitric oxide (pictured above) plays a role in the transport of oxygen to tissues and physiological activities such as the transmission of nerve impulses, and the beating of the heart. When things go wrong with the nitric oxide system, bad things can happen in bodies, according to recent studies. For instance, there may be too little nitric oxide in atherosclerosis and there may be too much in Parkinson's disease; there may not be enough nitric oxide in sickle cell disease and there may be too much in some types of diabetes, Stamler said.

The new findings, which Stamler said change understanding of how the nitric oxide system is controlled, appear in the May 23 issue of the journal Science.

“What we see now for the first time is that there are enzymes that are removing nitric oxide from proteins to control protein activity,” Stamler said. “This action has a broad-based effect, frankly, and probably happens in virtually all cells and across all protein

‘Missed’ biochemical pathway important in virtually all cells

f e AT u r e

see nItRIC OXIDE, p.9

A nitrogen molecule bonded with an oxygen molecule.

n e w S

8 Inquiry July 2008

scientists discover how cells move a critical proteinBy Mary Jane Gore

Nearly every cell in the body has a primary cilium, a crucial

antenna-like protrusion that pro-cesses signals and cellular responses. Defects in the cilium are linked with a wide variety of illnesses and disorders including cancer, blindness, polycystic kidney disease and others.

Scientists at Duke University Medical Center have found the pathway through which a signaling protein called Smoothened (Smo) can move into the primary cilium, a discov-ery that could eventually translate into therapeutic treatments for cancer.

“This is the first time that anyone has shown how cell surface receptors like Smo get into the cilium where they must reside to signal properly,” said first author Jeffrey Kovacs, Ph.D., a post-doctoral fellow in the Duke Departments of Medicine and Immunology.

Improper Smo signaling is known to result in formation of tumors, yet no treatments directed at Smo activity are currently available. Smo is a member of a large family of cell surface receptors termed G-protein coupled receptors, or GPCRs, first described by co-author Robert J. Lefkowitz and his group. Members of the GPCR family are the targets of about 60 percent of drugs that are on the market to treat clinical conditions, Kovacs said. Figuring out exactly which mecha-nisms govern Smo signaling could lead to treatments, he said.

In this latest study, the team

found that beta arrestin proteins are responsible for moving Smo to the primary cilium.

“The beta arrestin molecules mediate the interaction of the protein Smo with a motor protein that liter-ally grabs the Smo and moves it to the primary cilium,” said Lefkowitz, M.D., James B. Duke Professor of Medicine and investigator of the Howard Hughes Medical Institute. “We knew that the beta arrestins interacted with Smo, but we didn't fully appreciate the complexity of this interaction until now.”

“The next step in our research is to look for ways that other GPCRs

are put into position, not just Smoothened,” Kovacs said. “We want to know how these receptors signal in a movement-dependent way. This may give us an idea about how different molecules work to turn on or turn off the signaling pathways” that cause these abnormal clinical conditions.

Lefkowitz theorized and discovered GPCRs years ago. His laboratory later discovered beta arrestins, named for their ability to turn off or “arrest” the receptors' activity. Recently, the lab has been discovering ways in which beta arrestins turn on signaling pathways as well as turning them off. n

The antenna-like primary cilium (orange) processes signals from the body's cells. IMAGE PROvIDED By J. KOvACs

Tannithsha Reya, Ph.D. of the Department of Pharmacology

and Cancer Biology and Michael Ehlers, Ph.D. of the Department of Neurobiology have been selected for Duke University’s Thomas Langford Lectureship Award.

This program was initiated eight years ago as a tribute to the memory of Thomas Langford, former Divinity School faculty member, dean, and provost, who embodied the highest university values of scholarship, teaching, collegiality, and the

promotion of faculty excellence and community. The annual Langford Lectureship series is designed to

provide Duke’s faculty with an op-portunity to hear about the ongoing scholarly activities of their recently promoted colleagues.

As recipients, Reya and Ehlers will deliver lectures about their research to an interdisciplinary audi-ence and receive a $1,000 research stipend. Reya’s research focuses on understanding the mechanisms that regulate hematopoietic stem cell fate and self-renewal. Ehlers focuses on the interface of cell biology and neural circuit plasticity. n

Reya and Ehlers Earn Thomas Langford Award

TANNITHSHA REYA, PH.D. MICHAEL EHLERS, PH.D.

science Editor: Kelly Malcom

Inquiry features science and research- related news items from Duke Medicine News and Communications and other Duke departments. To submit content, contact us at editorinside@mc.duke.edu

nARsAD names four Duke young investigators

Four Duke University scientists have been given Young Investigator Awards by NARSAD, the world's leading charity dedicated to mental health research. They are among 220 early-career scientists in the United States and 11 other countries who will receive $60,000 from NARSAD over the next two years to advance their research on psychiatric disorders. The Duke investigators are William E. Copeland, Ph.D., assistant professor of medical psychology; shih-Chieh lin, M.D., Ph.D., a postdoctoral fellow in neurobiology; Peter J. nicholls, M.D., a research associate in biological psychiatry, and Xiaodong Zhang, Ph.D., an assistant professor of biological psychiatry at Duke and the NUS Graduate Medical School in Singapore.

HHMI awards Duke Researchers

The Howard Hughes Medical Institute (HHMI) has recognized several members of the Duke community in its recent batch of awards. Congratulations are extended to:

Mark Onaitis, M.D., assistant professor of thoracic surgery, for receiving an Early Career Physician-Scientist award. Onaitis is part of Department of Cell Biology Chair Brigid Hogan’s lab, and he’ll use his five-year grant to study how mutations in adult stem cells might lead to lung cancer.

Duke medical students Jessica Chang and Caroline yeager for receiving HHMI-NIH Research Scholars Program awards that will send them to the NIH campus in Bethesda, MD, for hands-on biomedical research.

Several Duke medical students for receiving Research Training Fellowships to support their individual research plans and lab work: Rex Cheng, Mackenzie Cook, Divakar Gupta, Mohamad Halawi, Michael Hodavance, John lewis, tina tailor and sima yazdani.

Awards from singapore

Faculty at the Duke-NUS Graduate Medical School have recently been honored by the Singapore Ministry of Health and The Agency for Science, Technology and Research in an effort to boost the pool of clinician scientists and translational researchers in Singapore. Michael Chee Wei liang, M.B.B.s., a cognitive neuroscientist and David M. virshup, M.D., program director for cancer and stem cell biology, received the Singapore Translational Research Investigator Award. Ong sin tiong, MBBch, a hematologist and oncologist, received the Clinical Scientist Award.

9July 2008 Inquiry

smoking and those who can’t. Jed Rose, Ph.D., of the department of biological psychiatry and the Center for Nicotine and Smoking Cessation Research was part of a team of re-searchers that compared the genes of smokers who had successfully kicked the habit to those who failed to quit. They found clusters of positive results in gene variants present more frequently in the successful quitters. In a subsequent study, Rose and others found genetic markers that correlated with successful quitting with the use of nicotine replacement therapy or a drug called bupropion. Their work now revolves around confirming these initial findings.

Whether for cancer, high blood pressure, or smoking cessation, doctors are looking toward genet-ics to help tailor their treatment options and make the practice of medicine more personalized.

How to Get Involved

If you are a cancer patient, learn how

to get involved in clinical trials at Duke

investigating genomics and cancer by

visiting http://genomestohealth.org. n

GEnEs, continued

By Mary Jane Gore

A new microscope system that can take 3-D pictures of an embryonic

mouse organ over 24 to 48 hours has shown Duke Medical Center research-ers the first glimpse of the formation of blood vessels during development.

Among other things, a team lead by cell biologist Blanche Capel, Ph.D., has found a previously unknown mechanism in the formation of blood vessels that may help scientists better understand how a tumor rallies a blood supply to its aid.

Using mice that have blood vessel cells marked by green fluorescence, the cell biologists studied vessels that supply mouse gonads. These are the embryonic organs that give rise to ovaries or testes later in development.

The scientists’ novel system for studying development using time-lapse microscopy and tiny samples of tissue shed new light on the dynamic process of organ formation. This system answered key questions about how the vasculature gets fitted into the organ as it forms, Capel said. Before this, scientists could only image one point in development at a time.

The striking new images became

the cover story of the Proceedings of the National Academy of Sciences and were assembled into a time-lapse movie.

The Duke team was surprised by the vigorous cell movements involved in the development of male gonads. “In the male gonad, the major blood vessel in the adjacent tissue comes apart and the individual blood vessel cells move to a new location, and reassemble into new vessels inside the testis,” Capel said. “This breakdown

process represents a possible way for growing tumors to access a blood supply, by commandeering a mecha-nism similar to the ones organs use to recruit vessels into the tumor.”

She pointed out that a blood supply is critical to a growing tumor, and this may be an important mechanism in the formation of blood vessels in tumors that scientists have not appreciated before. “That is an exciting finding,” Capel said. n

first-ever recording of blood vessel development

Cross section of a developing male testis shows characteristic structures including testis cords (red clumps of germ cells), a large coelomic blood vessel (pink), and other branching blood vessels with the gonad (blue). PHOTO COPYRIGHT 2008 NATIONAL ACADEMY OF SCIENCES, U.S.A.

Aziz wins sarnoff fellowship

Hamza Aziz, a graduate medical student, has received the

Sarnoff Fellowship from the Sarnoff Cardiovascular Research Foundation.

He did his third year research project with Aimee Zaas, M.D., Geoffrey Ginsburg M.D., Ph.D., and John Perfect, M.D., as mentors. He has worked on a project developing

gene expression signatures of a fungal infection (invasive candidiasis) in a mouse model and is currently validating the findings. He’s received an

IDSA (Infectious Diseases Society of America) Student Travel Award to present his research at the 48th Annual ICAAC/IDSA meeting in Washington DC in October 2008.

With the fellowship, Aziz will take an additional year to pursue more laboratory research. n

HAMZA AZIZ

classes. Nitric oxide is implicated in many disease processes. Sepsis, asthma, cystic fibrosis, Parkinson’s disease, heart failure — all of these diseases are linked to aberrant nitric-oxide-based signaling.”

An important factor that previously wasn't appreciated, he said, is that the target of nitric oxide in disease is different in every case. The finding of how nitric oxide binding to proteins is regu-lated opens the field for new refinement in biochemical research, said Stamler.

“Now we will need to study whether the aberrant cell signals are a matter of too much nitric oxide being produced and added to proteins or not enough being removed from proteins,” he said. “It is not simply a matter of too much or too little nitric oxide being in cells, but rather how much is being added or taken away from specific proteins, which is quite a different thing.” n

nItRIC OXIDE, continued

The Pilot International Foundation Club of Charlotte has given $50,000 to the Joseph and Kathleen Bryan Alzheimer's Disease Research Center. The foundation was established in 1975 to support the community-based work of Pilot Clubs by promoting the awareness and prevention of brain-related disorders, and improving the lives of those affected by such disorders, through education, volunteerism, financial support and research. Pictured: Judy Breaud, 2007-2008 Pilot International President, Kathleen Welsh-Bohmer, Ph.D., Director and Principal Investigator, Joseph and Kathleen Bryan Alzheimer's Disease Research Center, and Margaret Gilbert and Peggy Jessup, of the Pilot Club of Charlotte.

Pilot International gives gift to Bryan Alzheimer's Disease Research Center

10 Inquiry July 2008

e S S Ay

By Misha Angrist, Ph.D.

I was the guinea pig, the objet d’art. At the end of May I was at

the World Science Festival in New York, the lone civilian on a panel with a handful of famous scientists to talk about, among other things, my genome.

Partly by design, partly by accident, I have become something of a poster child for personal genomics (albeit sometimes a reluctant one). It began when I decided to write a book on personal genomics after reading about Harvard geneticist George Church, DNA sequencing pioneer and founder of The Personal Genome Project. The PGP seeks to recruit a group of people willing to share their genomic data as well as information about their health. The idea is that by studying a cohort that is not concerned about privacy, PGP researchers are not put in the awk-ward position of having to guarantee the confidentiality of those they’re studying. Not only that, by having access to subjects’ medical records, scientists wouldn’t have to study genomes in a vacuum. Strings of A’s, G’s, T’s and C’s (the DNA alphabet) are not of much use to human health or understanding human biology if you can’t link them to human traits.

The PGP began by recruiting ten subjects willing to make their genomic and health data public. I am one of those 10.

As a first step, Church’s team genotyped the 10 of us for 500,000 markers that tend to vary among people — these markers are called “single-nucleotide polymorphisms,” or SNPs (“snips”). They are the same types of markers that new

personal genomics companies — deCODEme, 23andMe and Navigenics among them — are charging people $1000 or more to type in order to learn their genomic risks for various conditions such as heart disease and diabetes. I was also typed (for free) for the Navigenics panel of 900,000 markers.

Of the 17 conditions Navigenics considers “vetted” for reporting back to customers, my own genomic risk estimates were not terribly surprising. Most notably I am at increased risk for type 2 diabetes, obesity and heart attack. My father had a quadruple bypass at age 60 and his father died of a heart attack at age 50. There is heart disease on my mother’s side as well. In other words, Navigenics confirmed what I already knew: that I ought to go back to the gym and lay off the Ben & Jerry’s. (Alas, I had hoped to take up smoking, too —

damn you, Navigenics!) And herein lies one of the

chief complaints about these services. Because they measure risk for complex, common conditions like heart disease, the advice one gets — eat right, exercise, don’t smoke — tends to be of the generic variety, no matter one’s genotype. At the World Science Festival, fellow panelist and UNC geneticist Jim Evans said as much (indeed, a large fraction of the clinical genetics community shares this view). Why, they ask, does someone need to drop a thousand bucks just to learn this sort of commonsensical stuff?

Of course, no one does and, understandably, many will choose not to. But it’s possible that incorporating these risk estimates into a portrait of one’s overall health can serve as a motivator and perhaps offer a clearer view of the path toward prevention.

And isn’t this what physicians have been agitating for over the last several decades?

The other mitigating factor is time. I look at my genomic data as a savings bond. It may not be worth much today, but barring the scientific equivalent of a sub-prime meltdown, I have little doubt it will play a substantive part in my health and perhaps my children’s health in the next few years. I don’t think it’s outlandish to predict that a genome scan will soon be a routine part of our checkups. As the price for genotyping and sequencing falls and as we learn what these variants mean, I don’t see how it cannot.

People often assume that be-cause of what I’m doing and because I write a blog called GenomeBoy, that I must be a starry-eyed genome worshipper. But if anything, getting genotyped has reminded me how much more we are than our DNA. All of those common-sense behavior changes actually matter. We are the products, finally, of our genes and our environments. And there is nothing mystical about either.

Recently I took my kids to see Kung Fu Panda (spoiler alert) and had an epiphany. When the pudgy panda finally opens the sacred scroll that will tell him how to defeat the bad guy, he sees only his own reflection. “There is no secret ingredient,” he realizes.

And for most of us, so it is with our genomes. n

Misha Angrist is assistant professor of the practice at the Duke Institute for Genome Sciences & Policy. Read his blog at http://www.genomeboy.com.

Genomics and the secret ingredient

r e S e A r c H @ d u k e

Picture this

Green fluorescent dye reveals the presence of cells deep within the brain of a mutant mouse that represent a growing tumor. see other riveting research images at http://www.research.duke.edu

c L i n i c A L T r i A L S

Join up

Duke has a wide range of ongoing clinical trials that you may qualify to take part in. to see a list of trials, visit http://www.dukehealth.org/clinicaltrials

T H e A b S T r A c T

your voice

the new school of Medicine faculty newsletter, The Abstract, has launched. to submit faculty news and information, contact abstract@mc.duke.edu

the author and his daughter, lena, who has half his DnA. PHOTO PROVIDED BY THE AUTHOR

f i r S T P e r S o n

11July 2008 Inside Duke Medicine

PAT i e n T c A r e

Consider this: A patient by the name of Joe Smith comes to the hospital.He gets his patient ID band placed properly,

is admitted to Room 12 on one of the floors, and completes the admission process with the nursing, medical and support staff. He has an antibiotic ordered, and his nurse brings it to his room to administer it. She asks the patient his name, and he tells her he’s Joseph Smith. She administers the medication as ordered. A while later, the nurse realizes that the antibiotic was actually supposed to go to another Joe Smith, who is in Room 22.

What went wrong here? Why, anyone can make a mistake like that, right? Although it may seem that giving a medication to the Right Patient should be a simple process, it isn’t always. Situations like the one noted here can be avoided by following basic guidelines and principles — the 6 Rights of the Medication Use Process:

1. Right Patient2. Right Drug3. Right Dose4. Right Route5. Right Time6. Right OutcomeAt Duke, we have also identified a set of

nonnegotiable critical behaviors that reinforce these 6 rights: Using two identifiers when order-ing, preparing or dispensing a medication and transcribing orders for medications; using name alerts for patients with similar sounding names; and minimizing interruptions when involved in any part of the medication administration process.

As part of the ongoing efforts to promote medi-cation safety at Duke University Hospital,

the Medication Safety Education Committee, in conjunction with the Medication Safety Leaders of the system, has developed the “6 Rights in 6 Months” campaign to help raise awareness about safe medication administration practices. The campaign was developed to highlight best prac-tices for all people who take part in the medication administration process, not just the frontline med giver. This month the focus is on the Right Patient.

The term Right Patient takes on various, different meanings for the diverse groups involved throughout the entire medication administration process. For a physician or prescriber, it means using “double identifiers”— two of either the medical record number (MRN), patient name, or patient date of birth (DOB) — instead of just one

of these identifiers when ordering medications and being aware of having the correct patient on the order screen when entering orders into CPOE.

For the pharmacy technician processing and filling orders, it means not using a room number to identify a patient, but, instead, using a complete name and MRN. For the nurse at the bedside giving medications, it means using “double identifiers” properly and making sure to use the “name alerts” when there is more than one patient with the same or similar names on the floor. And for the patient, it means not being uncomfortable with asking the nurse about the medications they are receiving.

Everyone has an active role in helping assure we have the safest delivery of medications.

“The effectiveness and beauty of the 6 Rights lies in how it takes something so complex — a 200-plus-step process from first order to patient administration — and shows us the simple root behaviors that, when done each and every time, help minimize the possibilities of committing errors.

Basic, simple, and effective — “A winning combination!” said John Howe, RN, co-chair of the Mediation Safety Education Committee.

Continue to look for other installments of “6 Rights in 6 Months” information. Share the information with co-workers and patients. Ask colleagues how they help ensure that they have the Right Patient. Because to ensure the safest processes are followed consistently, we must all work together. n

This is the first of six articles examining the medication use process.

6 rights in 6 monthsfocus on: 1. the Right Patient

6 Rights of the Medication Use Process :

1 ) Right patient

2) Right drug

3) Right dose

4) Right route

5) Right time

6) Right outcome

Q&A with Kenneth Morris

The economy is in the news. At Duke Medicine, it is Ken Morris’ job as chief financial officer to help chart the health system’s fiscal course. In that role, he directs accounting, financial planning and budgeting, as well as overseeing patient accounting, billing and registration, insurance, and managed care contracting.

How is the health system doing financially?

So far over this fiscal year, health system financial results have been strong. We expect to finish the year slightly ahead of budget. Volumes, however, in some business

lines have grown more slowly than expected.

What does this mean for the next year?

Targets for the new fiscal year have been set higher, so that we have money to fund our work and, importantly, our capital

construction projects. That higher target, some $100 million, is based on realizing more income through growth in the volume of the work that we do.

We are pleased that the Congress has approved continuation of the state disproportionate share payments to North Carolina hospitals - which had been at risk. Though not approved in time to be put into the budget, we now expect to receive this revenue through April 2009. Since the program will again be set to expire before the end of the next fiscal year, we can’t count on them every year going forward. Achieving our targets, therefore, depends on meeting growth commitments.

How will the tough economy affect Duke Medicine?

The environment is expected to be more difficult. We expect after the election in November that Congress will turn to the federal budget and the federal deficit and that there will be pressure to reduce payments to hospitals. When there is an economic downturn, and people are out of jobs and insurance, there is a higher impact on us. There will have to be a concerted effort on our part to bring increasing efficiency to care delivery and the management of resources. We also have an obligation to minimize costs to our patients while providing top quality care.

What does this mean for the health system’s expansion efforts?

With government approval of the Major Hospital Addition, we will be spending significant resources on construction. It is likely that the health system will incur debt in support of the project. This expansion is a strategic decision to help ensure the future growth of the enterprise.

Interview by Mark Schreiner

KENNETH MORRIS

w o r k i n g

12 Inside Duke Medicine July 2008

$5,000 referral bonus nets nurses for Duke hospitalsBy Elizabeth Michalka

When Carolyn Juettner and her husband bought a 96-year-old

farmhouse in 2005, it required renova-tion, but progress was slow with a tight budget and birth of their first child. Then, Juettner received the first half of a $5,000 bonus from Duke, and construction picked up.

The money was enough to refin-ish hardwood floors and construct a toy box that doubles as a window seat. Now Juettner enjoys curling up on the cozy seat in her Chapel Hill home to read about animals to her 2-year-old son, Jack.

The remodeling was possible because Juettner, a clinical nurse in the Intensive Care Nursery at Duke Hospital, simply referred a fellow nurse and friend, Simone Christiano, to work at the hospital.

“I wanted to bring good, expe-rienced staff here,” said Juettner, 39, who has worked as a nurse for 18 years. “If you’re in nursing, and you’re working next to someone, you want them to be reliable.”

Eight years ago, Duke University Health System created the Nurse Referral Program. It encourages nurses like Juettner to recruit other nurses — who are in critically short supply across the country — to work at Duke Hospital. The program has expanded, and today, any Duke employee can cash-in on $5,000 by referring a qualified nurse who joins one of Duke’s three hospitals, includ-ing Durham Regional Hospital and Duke Raleigh Hospital.

“We knew word-of-mouth was the best recruitment mechanism, and Duke nurses can sell the organiza-tion,” said Mary Ann Fuchs, R.N., chief nursing and patient care officer for the Health System.

The program is an important recruitment tool that also improves retention by paying the bonus in two installments — half when the new nurse completes a 90-day orientation period and half after completing the first year. Recruitment and retention are increasingly important in light of a national nursing shortage, Fuchs said. Hospitals are short about 116,000 registered nurses nationally, resulting

in a national vacancy rate of 8.1 percent, according to a report released by the American Hospital Association in July 2007.

Duke University Health System often uses higher cost temporary staff to fill nursing vacancies, which are slightly higher at Duke than the national average. Fuchs said she hopes the referral program will help reduce the need for temporary staff by increasing the number of permanent Duke nurses.

“We’re actually very lucky because due to our reputation, we receive a lot of applicants,” Fuchs said. “We hire about 500 nurses a year, some of whom are returning to Duke after taking time to pursue advanced nursing degrees. We’re also

growing as an institution and need more nurses for that expansion.”

Return on investment

Although the $5,000 is an enticing benefit, Duke nurses like Juettner said making a referral is about more than just money.

“Simone and I worked together in New Jersey years ago, and I knew she was a good nurse,” Juettner said.

That personal accountability makes the Nurse Referral Program work, said Sylvia Alston, associate chief nursing officer for Recruitment and Hospital Administrative Systems.

“The nurse who is referred also feels some accountability because they don’t want to disappoint the person who referred them,” Alston

said. “Both people’s reputations are tied to it.”

Alston said it’s become tougher to find experienced nurses, like Simone Christiano, for many reasons, includ-ing increased demand nationally, an aging workforce, and because nurses are moving on to second careers. But, recruitment numbers are up at Duke, and Alston attributes that success, in part, to the Nurse Referral Program, which was expanded to make all faculty and staff eligible. Also, the bonus rose from $2,500 to $5,000 in 2007. Last year, 175 faculty and staff used the program to refer nurses, and 649 total nurses were hired.

With about 370 open nursing positions across all organizations in Duke University Health System, it’s important to attract qualified entry-level nurses.

Duke Medicine will host the next Nursing Expo on Aug. 3 and 4 at the Durham Marriott at the Civic Center. Alston is hoping at least 200 people attend. As a result of last year’s expo, 59 nurses were hired.

This article first appeared in Working@Duke. n

Born to rn

Simone Christiano was one of 649 nurses hired at Duke Medicine in 2007. She was referred by friend and Duke nurse Carolyn Juettner. PHOtO COuRtEsy Of WORKInG @ DuKE

Duke Medicine Hosts nursing Expo

Duke Medicine hosts its second annual national Nursing Expo, Aug. 3-4.

Details: http://www.dukenursing.org

How the $5,000 Bonus Works

Faculty and staff of Duke University and Health System are eligible to receive $5,000 for successfully referring a nurse to work at Duke Medicine. The referral program applies only to nurses hired at Duke University, Durham Regional and Duke Raleigh hospitals. The $5,000 incentive is contingent upon the referred nurse’s acceptance of a job offer. It is paid in installments — $2,500 after referred nurses complete their 90-day trial period, and $2,500 after a year of continuous service. Other limitations and exceptions apply.

For complete guidelines, review the Nurse Referral Program policy, and download the referral form online at http://www.hr.duke.edu/referanurse, or call (800) 232-6877

T e c H n o L o g y

13July 2008 Inside Duke Medicine

voicemail system brings new features

Summer brings warmer weather and, for many Duke Medicine people this year, new voicemail.

Over the next few months, Duke’s Office of Information Technology will install Unity, a new voice mail system, on many telephones throughout Duke Medicine.

Hundreds of users have already switched to the new system. Many more, including those in Duke Hospital and Duke University Medical Center, will be switched over this summer.

While the switch-over may bring some temporary inconvenience, the Unity system will provide new, powerful tools that will make communicating easier and more effective.

Here are some answers to questions about the voicemail conversion:

Why is this happening?

The aging Octel and Audix systems have reached the end of their useful lifecycles. Neither system will allow for upgrades.

How is unity different from my current system?

Unity voice mail offers all the features of your current voice mail. You can retrieve messages from any telephone. New IP phones feature an online Duke telephone directory. What makes Unity different are the upgrades that are coming. Those include links between voicemail messages and e-mail, instant messaging and mobile devices.

How will I know when my voicemail has changed?

Look for an e-mail message well in advance of the changeover. Your manager will also have information about the switch. On the day of the switch, look for OIT professionals in your work area who will be available to answer questions.

Will I need to do anything?

Yes. When your service is switched over, you will need to activate your voicemail system in order to receive messages. After dialing in, you will be directed to create a password and record a greeting.

What about my stored messages?

This is important – stored messages from your current voicemail system will not be trans-ferred to Unity. However, your old voicemail account and password will be active for 30 days after the switch-over should you need to access saved messages.

Where can I find more information?

Read all about the new Unity system at OIT’s voicemail Web page:

http://oit.duke.edu/voicemail

unity is coming

A year without tobaccoBy Erin Pratt

Most people wake up to the buzzing of an alarm clock and

head straight for the shower or a toothbrush, but Rodd Mangum, 47, went straight to his pack of cigarettes and lit up his first one for the day. His first of 60 to be exact.

Mangum, who began smoking at age 21, was smoking three packs of cigarettes a day.

On May 20, Mangum, a courier for the Carolinas Cord Blood Bank at Duke, began his morning routine differently. He omitted his first and other 59 cigarettes of the day. May 20 was the quit date Mangum set during his classes in the QuitSmart program with Duke’s LIVE FOR LIFE.

The QuitSmart program offers a series of three classes that are based on two philosophies. First, the participant must begin to define himself as a non-smoker versus someone who is not smoking currently. “This opens the mind to behavior change, which is the second part of the class — willingness to try new behavior,” said Diane Dunder, health education specialist who teaches the classes.

The biggest step for participants who decide to quite smoking through the program is actually showing up to the first class, Dunder said.

“Arriving to the first class is a bold move,” she said. “The following three weeks will be the hardest.”

Mangum decided enough was enough after a weekend trip with his family to Myrtle Beach, S.C.

“I realized I didn’t smoke that much on the trip, but then as soon as we got back in town I stopped to buy cigarettes,” he said. After talking about it with his wife, Mangum decided it was time to quit smoking.

Mangum learned about QuitSmart through one of his co-workers at Duke who also participated in LIVE FOR LIVE tobacco cessation programs.

Similar trends have developed among employees since Duke Medicine and health systems and hospitals throughout the Triangle made the commitment to be tobacco free starting July 4, 2007.

Since the policy was announced in October 2006, more than 1,000 Duke

employees have participated in a tobacco cessation program through LIVE FOR LIFE.

In January, LIVE FOR LIFE tobacco cessation programs were opened to employees’ dependants on their health insurance polices.

“I have at least one couple in each class now,” Dunder said.

Addiction

Mangum has acid reflux disease which was worsened by his use of tobacco products. He slept sitting up at night to avoid choking. Even though he knew the smoking was affecting his health and quality of life, Mangum like many other smokers was addicted.

Tobacco contains the chemical, nicotine, which is highly addictive and

has complex effects on the body and brain, according to the Duke Center for Nicotine and

Smoking Cessation Research.Dunder said QuitSmart uses a

method called “nicotine fading” to help participants with the initial nicotine withdrawal. This helps the participant adjust to lower levels of the drug.

Mangum smoked Newport King cigarettes which gave him 1.5 mil-ligrams of nicotine per cigarette. Based on the plan developed for his brand he was scheduled to switch to three

different brands over three weeks. “I didn’t even have to buy the last

brand,” he said. “I was at the point that I didn’t have a desire to smoke anymore.”

Mangum said the QuitSmart program gave him the tools he needed and a good foundation to begin the process of quitting.

“I learned how to change my habits,” he said. The process has not been easy and he continues to rely on his “quit team,” a group of family, friends, and co-workers that help him remain committed to being a nonsmoker.

One of Mangum’s co-workers gives him coffee stirrers to chew on when he gets anxious. “When she sees me, she asks how I am doing and if I need anymore,” he said.

Since quitting smoking, Mangum said his health has already improved. “I sleep better at night, smell better, taste better, and I do not use as much cologne.”

Mangum was spending $3,285 a year on cigarettes. “Now I will use that money to buy gas,” he said.

Mangum is not the only one benefiting from the absence of tobacco in his life. His 13-year-old daughter, who complained about having to go to school smelling like cigarette smoke, is happy for her father and glad his vehicle smells better.

“I wanted to extend my life for my family,” Mangum said. n

w o r k i n g

Rodd Mangum believes "by quitting smoking, I'm saving my life." PHOtO By ERIn PRAtt

“I sleep better, smell better, taste better,

and I don't use as much cologne.“

A w A r d SA P P o i n T M e n T S

14 Inside Duke Medicine July 2008

leadership change aligns clinical organizations

On July 1, William fulkerson, M.D., became senior vice president, clinical affairs, for the Duke University Health System. In this new role, Fulkerson is charged with implementing

the health system strategic plan that focuses on growth, alignment and efficiency.

He will be responsible for driving integra-tion and alignment between ambulatory services and hospital-based services across Duke University

Hospital, Durham Regional Hospital and Duke Raleigh Hospital, as well as the physician practice plan. His focus will be improving the effectiveness, efficiency, collaboration and synergy among all components of the clinical enterprise, and positioning Duke Medicine for growth as we undertake the major program-matic and facilities expansion of the Duke University Health System.

This new structure will enable Fulkerson, medical school Dean Nancy Andrews, M.D., Ph.D., and DUHS CEO Victor J. Dzau, M.D., to work together as an effective and efficient team. Kevin Sowers, R.N., chief operating officer for Duke University Hospital, will serve as interim hospital CEO.

Chameides and lyerly get museum appointments

North Carolina Gov. Mike Easley has appointed Bill Chameides, dean of the Nicholas School of the Environment and Earth Sciences at Duke University, and H. Kim lyerly, M.D., director of the Duke Comprehensive Cancer Center in Durham, to the N.C. State Museum of Natural Sciences Advisory Commission. The commission formulates policies for the advancement of the museum and assists in promoting and developing wider and more effective use of the museum as an educa-tional, scientific and historical institution. Commission members serve four-year terms.

Other appointments

Boyd Carlson has been appointed associate chief information officer for application development and Patient Revenue Management Organization-IT. Boyd will provide leadership in the development of mission critical applications across Duke Medicine and will continue directing the PRMO-IT team.

Bruce Kennedy has a new role as assistant vice president for marketing and creative services. He will oversee a merger of Marketing and Creative Services that seamlessly blends a range of marketing communications resources, from planning and strategy to graphic design and Web services.

Mary Holtschneider, assistant clinical professor and director of the Center for Nursing Discovery at the School of Nursing, has been elected to the NC League of Nursing Board of Directors.

Pampering and healing at Duke Cancer patients' spa Day

full celebration for HAfsDuke university Health system CEO victor J. Dzau, M.D., cuts the ribbon to open the Hospital Addition for surgery at Duke university Hospital last month. the addition provides space for new operating rooms and new patient reception and family waiting areas. Dzau, center, was joined by Mark newman, M.D., chairman of the Department of Anesthesiology; Mary Anne fuchs, R.n., chief nursing and patient care services officer for the health system; Kevin sowers, R.n., chief operating officer and interim CEO of Duke Hospital; Chief Medical Officer steve Olson, M.D.; and Greg Georgiade, M.D., vice chairman of the Department of surgery. DUKE UNIVERSITY PHOTO

All-day pampering was part of the Duke Cancer Patient Support Program’s first “Spa Day” on June 11.

Patients enjoyed reflexology, manicures and, massage at the Morris Cancer Clinic (top photos).

Wanda McDevitt, a breast cancer survivor from Durham, selects a wig from The Butterfly Boutique (bottom photo).

“I have been looking for a white wig, and I finally found one,” said McDevitt, who plans to wear it to her 44th high school reunion this summer.

PHOTOS BY ERIN PRATT

Becky Kitzmiller, a Duke School of Nursing Ph.D. student, has been awarded a teaching mini-grant from the Duke Graduate School. She will develop an online orientation/introductory module for graduate nursing students to achieve informatics competencies necessary to use the Gerontological Learning Objects Repository being launched through the work of Center of Excellence in Geriatric Nursing Education.

lincoln Community Health Center Pharmacy was recently identified by the Department of Health and Human Services as one of the leading pharmacies in the nation for excellence in Patient Safety and Clinical Pharmacy Services. LCHC Pharmacy was one of only five community health centers recognized, and the only one in the Southeast.

Mark toles, a Duke School of Nursing Ph.D. student, has been selected as a 2009-2011 John A. Hartford Nursing Pre-doctoral Scholar in Academic Geriatric Nursing. He is one of fifteen scholars who will receive a scholarship covering tuition and fees of up to $50,000 per year for two years.

Carolyn scott, R.n., of Durham Regional Hospital, was named the first Professional Caregiver of the Year for American Cancer Society’s Relay for Life of Durham County.

WILLIAM FULKERSON, M.D.

A w A r d S

DufCu’s Berry named professional of the year

Dan Berry, chief operating officer of Duke University Federal Credit Union was chosen

as Professional of the Year by the National Association of Federal Credit Unions (NAFCU).

Berry and other winners in NAFCU’s 2008 award programs will be honored in conjunction with

NAFCU’s 41st Annual Conference this month in San Diego. He holds an MBA from Duke University and has served as Duke Credit Union’s COO since 2002.

DAN BERRY

15July 2008 Inside Duke Medicine

special to Inside Duke Medicine

As a recreational therapist, Betsy Roy is always looking for creative

ways to provide activities for patients that they may also do at home.

When Rehabilitation patients at Durham Regional Hospital’s Durham Rehabilitation Institute wanted a pingpong or pool table, Roy thought it would provide a fun way for patients to build back some of their functionality.

“We didn’t have the budget to purchase a table, so we decided to make one,” said Roy. “We wanted a table that functions as a pingpong table on one side and a pool table on the other.”

Engineering workers provided the materials and Steve Montel, from Engineering, cut and crafted the wood.

“Making the table was thera-peutic for our patients who sanded and painted the wood,” said Roy. “Not only was it fun, but it required problem-solving and coordination. The patients figured out how we were going to make one side a pool table and one a pingpong table.”

While the team is still working on the pool table construction, patients have had their completed pingpong table for a month.

“Patients play ping pong to improve their balance, hand-eye

coordination and mobility skills. It’s a great activity to incorporate some of those skills. And, it’s fun,” said Roy.

She adds that the table construc-tion was a great collaboration between the patients, Engineering and therapy disciplines.

She sent special thanks to therapists Jeff Forsythe, Steve Montel and Matt Painter, for helping with this project. n

Patients, therapists and operations workers at Durham Regional Hospital worked together to build a game table for patients at the Durham Rehabilitation Institute. PHOTO COURTESY DURHAM

REHABILITATION INSTITUTE

‘We decided to make one’Patients, caregivers work together on special therapeutic project

top Performer Award

the Durham Rehabilitation Institute (DRI) received the National 2008 Top Performer Award from Uniform Data System for Medical Rehabilitation (UDSMR) in recognition of outstanding rehabilitation program performance. This award was based on the Functional Independence Measure (FIM) change from admission to discharge and the percent of patients who are discharged to the community once rehabilitation is complete. These scores are based on the patients’ functional and cognitive abilities. DRI exceeded expectations for 2007 with a score of 96th percentile, the highest score in the southeast region.

L I V E S n

In memoriamThe following employee and retiree deaths have been reported:

May

Dorothy Harris, a former gastroenterol-ogy employee, died May 14. Harris worked at Duke from 1962 to 1987.

Donna Ribet, an assistant vice president for budgeting and cost allocations, died May 23. Ribet began work at Duke in 1973.

valentina neplioueva, M.D., Ph.D., a surgery research scientist , died May 27. Neplioueva began work at Duke in 1995.

April

Pamela Parker, a former employee on surgical unit 6100, died April 22. Parker worked at Duke from 1958 to 1994.

James Carroll, a former medical center engineering and operations employee, died April 23. Carroll worked at Duke from 1973 to 2005.

Mary Jarman, a former medical center employee, died April 9. Jarman worked at Duke from 1955 to 1979.

Hazeline Bowman, a former health system employee, died April 15. Bowman worked in the health system from 1971 to 2002.

Margaret Eidson, a former operating room employee, died April 19. Eidson worked at Duke from 1962 to 1976.

Agnes stephenson, a former billing and collections employee, died April 29. Stephenson worked at Duke from 1982 to 1986.

March

frances norris, a patient resource management worker, died March 2. Norris started work at Duke in 1980.

John Milligan, a cytology employee, died March 8. Milligan began work at Duke in 1990.

Regina lawson, a PRMO employee, died March 11. Lawson started work at Duke in 1977.

Clark Rivinoja, a psychiatry department researcher, died March 13. Rivinoja began work at Duke in 2006.

Judy Carlson, a patient resource management employee, died March 16. Carlson began work at Duke in 1975.

Ardell farrington, a former medical center employee, died March 18. Farrington worked at Duke from 1967 to 1980.

Annie Edwards, a radiology employee, died March 18. Edwards began work at Duke in 1980.

Got news? Bounce it to us. Send photos and news of awards and appointments to editorinside@mc.duke.edu

strength, Hope and Caring: third-quarter awards

The following people from ambulatory clinics were recognized during by the Strength, Hope and Caring program during the third quarter:

Physician/non-Physician Provider Award:

Corbin Peterson, P.A., Dermatology Peterson assists with laser therapy on patients with vascular birthmarks, and has a passion for working with the pediatric population.

non-Clinical Award:

Darphine White, financial Care Counselor, Clinic 1f A patient wrote that White “always treated us with the utmost patience, care and respect.”

Clinical Award:

lisha Johnson, n.A., north Duke street Clinic Johnson was recognized for her expertise, kindness and willingness to help a patient and his family.

team Award:

Janice thorpe, Client service Rep. William Hunt, Phlebotomist sally Guilmart, nurse Manager, Clinic 1J The team pulled together when an out-of-town patient needed labs drawn late in the day.

16 Inside Duke Medicine July 2008

w o r k + L i f e

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Take survey, win prizes

Did you read about our survey and prize drawing? Details are back on Page 2.

next issue

The next print edition will appear August 1. The deadline for sub-missions for that issue is July 15.

1Enhanced Carpool ProgramParking and Transportation Services has

developed new carpool incentives that provide FREE parking in a preferred Duke lot for four or more participants. Each member also receives 12 daily passes for access to the group’s preferred lot and 12 for any remote lot. Three participants pay $4 monthly per person and receive a designated space in a preferred

lot with 12 daily passes for each member in a preferred lot and 12 for any remote lot.

http://parking.duke.edu/carpool

2RideshareTwo people who drive together

can share one permit and divide the cost of the permit. Participants receive up to 24 daily parking passes when they drive alone. Additional daily passes may be purchased for $3 each. The 24 day passes include 12 passes for a preferred lot and 12 for any

remote lot. http://parking.duke.edu/transportation/Rideshare_2008.htm

3VanpoolEmployees or students who live

and work near each other and who share approximately the same work hours can take

advantage of a vanpool through the Triangle Transit (TT), which offers passenger vans for an inexpensive and stress-free commute option. TT vans do not require a parking permit and have

access to any unreserved parking area at Duke. TT pays for gas and insurance, and arranges, oversees, and pays for all maintenance. Riders pay a monthly fare based on the average daily round-trip mileage. TT can assist in finding commuting partners. http://triangletransit.org/vanpool/

4Mileage ReimbursementDuke reimburses employees for business-related

mileage when it is necessary for employees to drive their personal vehicles. The reimbursement rate, which is set by the Internal Revenue Service, is 50.5 cents. Employees wishing to request reimbursement for business-related travel must submit a Miscellaneous Reimbursement Form. Forms should only be submitted after reaching a minimum of $25 in expenses. http://www.finsvc.duke.edu/gap/m200-021.html

5flexible Work OptionsOne way to save on gas is through flexible

work options. Flexible work arrangements are appropriate for some, but not all jobs. Options such as telecommuting or a compressed work week can reduce the need to drive to campus every day. Employees should first discuss with their supervisor whether a flexible work arrangement is a possibility. If it is, the employee should work with the supervisor to develop a plan. A flexible work arrangement must be reviewed and approved by an employee’s supervisors to ensure the arrangement continues to support the department’s goals and that the job is appropriate for a flexible arrangement. More info: http://www.hr.duke.edu/flexwork n

In mid-June, $4 gasoline became a reality in the Triangle.Duke Medicine has programs that employees can use right now to cut fuel costs and help the environment. These are just a beginning. Duke Medicine

leaders, staff and faculty are seeking further ways to address this problem.

5 ways to save gas at Duke:

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