|| DukeMedNews || Andrea Lukes

Andrea Lukes
Director of Gynecology, Women’s Hemostasis and Thrombosis Clinic, Gynecologic Specialties

Interests:
Dr. Lukes manages all gynecologic issues in females (adolescents and adults) with bleeding or clotting disorders. She is the principal investigator in a multicenter CDC sponsored treatment trial for women with bleeding disorders.

The most common problem Dr. Lukes manages is excessive menstrual bleeding (menorrhagia) and other menstrual problems or abnormal uterine bleeding. Her clinic focuses on providing comprehensive diagnostic and therapeutic options for women. Unfortunately, only in one-half of the cases do we find a reason for abnormal uterine bleeding. In the last decade we have begun to recognize that women with excessive menstrual bleeding may have underlying bleeding disorder, the most common being von Willebrand Disease. Still, the more common problems for excessive menstrual bleeding include uterine fibroids, endometrial polyps, adenomyosis, and infections.

Dr. Lukes is interested in understanding the causes of menstrual problems and offers comprehensive diagnostic and therapeutic options. Diagnositc options include clinical history and physical examination, pelvic ultrasound including saline infused sonography, endometrial sampling (within office and hysteroscopic guided sampling). Laboratory work includes assessments for anemia, blood disorders, endocrine disorders, etc. Therapeutic options include alternatives to hysterectomy, many medications, the levonorgestrel-intrauterine system, endometrial ablations (5 technologies now available), hysteroscopic surgery, myomectomies, uterine artery embolization (with radiology), as well as hysterectomies.

Office Phone: (919) 684-9699 or (919) 681-5788
Fax: (919) 681-7292 or (919) 681-5929
Email:lukes001@mc.duke.edu

|| DukeMedNews || Email

Suggested lead: Children aren’t the only ones who need to be reminded to eat their vegetables. Tom Britt has more.

Cut 1…:soq…:60 (Preview this in a WAV file in 16-bit mono.)

Nutritional needs change as we get older. Marilyn Sparling is a registered dietician with Duke University Medical Center. She says women entering menopause need to start watching for signs of osteoporosis, heart disease, and if weight is a problem, diabetes and hypertension. One way to fight osteoporosis is to increase calcium intake. The obvious source is milk, but some people either don’t like milk, or are allergic to it. For these people, Sparling recommends more vegetables in the diet, primarily greens, like broccoli, spinach, and turnip greens.

“It’s not really that hard to get it in your diet, although some people just don’t like those foods, and then a calcium supplement is appropriate. I also think for a woman over 50 it’s not a bad idea to take a basic multi-vitamin. One that’s formulated for women over 50.”

Sparling stresses that such specially formulated multi-vitamins have more D, B, and E and less iron. Sparling advises to stay away from highly processed foods and anything that has saturated fat, “trans-fat” or hydrogenated oils. I’m Tom Britt.

Sparling says when it comes to calcium, more can sometimes lead to too much.

Cut 2…some risks…:14 (Preview this in a WAV file in 16-bit mono.)

“Most menopausal women, from age 50 on, need somewhere between one thousand and 15 hundred milligrams. It’s okay to go a little higher, but no one should go over 2 thousand because there can be some risks.”

|| DukeMedNews || Victor Dzau, M.D.

Image Size : 7″ w X 4.56″ h

Description : Victor J. Dzau, M.D., was appointed Chancellor for Health Affairs at Duke University and President and CEO of the Duke University Health System effective July 1, 2004. He is also James B. Duke Professor of Medicine and Director of Molecular and Genomic Vascular Biology at Duke.

Most recently, Dr. Dzau was the Hersey Professor of the Theory and Practice of Physic (Medicine) at Harvard Medical School, Chairman of the Department of Medicine at Brigham and Women’s Hospital, and Physician-in-Chief and Director of Research at Brigham and Women’s Hospital, Boston. Prior to his work at Harvard and Brigham and Women’s, he served as Arthur Bloomfield Professor and Chairman of the Department of Medicine at Stanford.

Dr. Dzau’s academic interests are in cardiovascular translational research and mission-based education. His laboratory has studied the molecular and genetic mechanisms of cardiovascular disease and applied genomic and gene transfer technologies to develop novel therapeutic approaches. His work on the renin angiotensin system (RAS) paved the way for the contemporary understanding of RAS in cardiovascular disease and the development of RAS inhibitors (e.g. ACE inhibitor) as therapeutics. He pioneered gene therapy for vascular disease, being the first to introduce DNA decoy molecules to block transcriptions as gene therapy in vivo. Two of his discoveries E2F decoy and nitric oxide synthase gene therapy are now being evaluated in clinical trials.

The recipient of many awards and honors, Dr. Dzau received the first Hatter Award from the Medical Research Council of South Africa in 2000. He was awarded the prestigious Gustav Nylin Medal by the Swedish Royal College of Medicine and the Swedish Cardiology Society, the Novartis Award for Hypertension Research by the American Heart Association (which also named him one of its Distinguished Scientists for 2004), the 2004 Max Delbruck Medal by the Max Delbruck Center for Molecular Medicine, Berlin, Germany, the 2005 Golden Door Award by the International Institute of Boston, and a 2005 Ellis Island Medal of Honor by the National Ethnic Coalition of Organizations.

Dr. Dzau has served on numerous committees and advisory boards, including, previously, the Executive Committee of The Academy at Harvard Medical School (of which he is a founding member) and the boards of Brigham and Women’s Hospital, Partners Healthcare, and the Harvard Clinical Research Institute. Currently, he serves as a member of the Board of Directors for both Duke University Health System and Genzyme Corporation. He has been elected to the Institute of Medicine of the National Academy of Sciences (USA) and the European Academy of Sciences and Arts. Previous Chairman of the National Institutes of Health (NIH) Cardiovascular Disease Advisory Committee, he served on the Advisory Committee to the Director of the NIH. In 1999, he became Editor-in-Chief for the American Physiological Society’s new journal, Physiological Genomics. A founding member of the Society of Vascular Medicine and Biology and the Council of Arteriosclerosis, Thrombosis, and Vascular Biology of the American Heart Association, Dr. Dzau was Editor-in-Chief of the Journal of Vascular Medicine and Biology.

Dr. Dzau received his MD from McGill University in Montreal and underwent postgraduate training at Harvard Medical School. He was born in Shanghai, China, raised in Hong Kong, and is a citizen of the United States. He and his wife Ruth have been married for 33 years and are the parents of two daughters.

Updated: 11/10/05

PHOTO CREDIT: This photo is the property of Duke University Medical Center. Use of this photo requires credit to Duke University Medical Center. If you have any questions, please contact the Duke University Medical Center News Office at (919) 684-4148.

|| DukeMedNews || Email

Suggested lead: Children aren’t the only ones who need to be reminded to eat their vegetables. Tom Britt has more.

Cut 1…:soq…:60 (Preview this in a WAV file in 16-bit mono.)

Nutritional needs change as we get older. Marilyn Sparling is a registered dietician with Duke University Medical Center. She says women entering menopause need to start watching for signs of osteoporosis, heart disease, and if weight is a problem, diabetes and hypertension. One way to fight osteoporosis is to increase calcium intake. The obvious source is milk, but some people either don’t like milk, or are allergic to it. For these people, Sparling recommends more vegetables in the diet, primarily greens, like broccoli, spinach, and turnip greens.

“It’s not really that hard to get it in your diet, although some people just don’t like those foods, and then a calcium supplement is appropriate. I also think for a woman over 50 it’s not a bad idea to take a basic multi-vitamin. One that’s formulated for women over 50.”

Sparling stresses that such specially formulated multi-vitamins have more D, B, and E and less iron. Sparling advises to stay away from highly processed foods and anything that has saturated fat, “trans-fat” or hydrogenated oils. I’m Tom Britt.

Sparling says when it comes to calcium, more can sometimes lead to too much.

Cut 2…some risks…:14 (Preview this in a WAV file in 16-bit mono.)

“Most menopausal women, from age 50 on, need somewhere between one thousand and 15 hundred milligrams. It’s okay to go a little higher, but no one should go over 2 thousand because there can be some risks.”

|| DukeMedNews || Email

Suggested lead: Children aren’t the only ones who need to be reminded to eat their vegetables. Tom Britt has more.

Cut 1…:soq…:60 (Preview this in a WAV file in 16-bit mono.)

Nutritional needs change as we get older. Marilyn Sparling is a registered dietician with Duke University Medical Center. She says women entering menopause need to start watching for signs of osteoporosis, heart disease, and if weight is a problem, diabetes and hypertension. One way to fight osteoporosis is to increase calcium intake. The obvious source is milk, but some people either don’t like milk, or are allergic to it. For these people, Sparling recommends more vegetables in the diet, primarily greens, like broccoli, spinach, and turnip greens.

“It’s not really that hard to get it in your diet, although some people just don’t like those foods, and then a calcium supplement is appropriate. I also think for a woman over 50 it’s not a bad idea to take a basic multi-vitamin. One that’s formulated for women over 50.”

Sparling stresses that such specially formulated multi-vitamins have more D, B, and E and less iron. Sparling advises to stay away from highly processed foods and anything that has saturated fat, “trans-fat” or hydrogenated oils. I’m Tom Britt.

Sparling says when it comes to calcium, more can sometimes lead to too much.

Cut 2…some risks…:14 (Preview this in a WAV file in 16-bit mono.)

“Most menopausal women, from age 50 on, need somewhere between one thousand and 15 hundred milligrams. It’s okay to go a little higher, but no one should go over 2 thousand because there can be some risks.”

|| DukeMedNews || Email

Suggested lead: Children aren’t the only ones who need to be reminded to eat their vegetables. Tom Britt has more.

Cut 1…:soq…:60 (Preview this in a WAV file in 16-bit mono.)

Nutritional needs change as we get older. Marilyn Sparling is a registered dietician with Duke University Medical Center. She says women entering menopause need to start watching for signs of osteoporosis, heart disease, and if weight is a problem, diabetes and hypertension. One way to fight osteoporosis is to increase calcium intake. The obvious source is milk, but some people either don’t like milk, or are allergic to it. For these people, Sparling recommends more vegetables in the diet, primarily greens, like broccoli, spinach, and turnip greens.

“It’s not really that hard to get it in your diet, although some people just don’t like those foods, and then a calcium supplement is appropriate. I also think for a woman over 50 it’s not a bad idea to take a basic multi-vitamin. One that’s formulated for women over 50.”

Sparling stresses that such specially formulated multi-vitamins have more D, B, and E and less iron. Sparling advises to stay away from highly processed foods and anything that has saturated fat, “trans-fat” or hydrogenated oils. I’m Tom Britt.

Sparling says when it comes to calcium, more can sometimes lead to too much.

Cut 2…some risks…:14 (Preview this in a WAV file in 16-bit mono.)

“Most menopausal women, from age 50 on, need somewhere between one thousand and 15 hundred milligrams. It’s okay to go a little higher, but no one should go over 2 thousand because there can be some risks.”

|| DukeMedNews || Email

Suggested lead: Children aren’t the only ones who need to be reminded to eat their vegetables. Tom Britt has more.

Cut 1…:soq…:60 (Preview this in a WAV file in 16-bit mono.)

Nutritional needs change as we get older. Marilyn Sparling is a registered dietician with Duke University Medical Center. She says women entering menopause need to start watching for signs of osteoporosis, heart disease, and if weight is a problem, diabetes and hypertension. One way to fight osteoporosis is to increase calcium intake. The obvious source is milk, but some people either don’t like milk, or are allergic to it. For these people, Sparling recommends more vegetables in the diet, primarily greens, like broccoli, spinach, and turnip greens.

“It’s not really that hard to get it in your diet, although some people just don’t like those foods, and then a calcium supplement is appropriate. I also think for a woman over 50 it’s not a bad idea to take a basic multi-vitamin. One that’s formulated for women over 50.”

Sparling stresses that such specially formulated multi-vitamins have more D, B, and E and less iron. Sparling advises to stay away from highly processed foods and anything that has saturated fat, “trans-fat” or hydrogenated oils. I’m Tom Britt.

Sparling says when it comes to calcium, more can sometimes lead to too much.

Cut 2…some risks…:14 (Preview this in a WAV file in 16-bit mono.)

“Most menopausal women, from age 50 on, need somewhere between one thousand and 15 hundred milligrams. It’s okay to go a little higher, but no one should go over 2 thousand because there can be some risks.”

Therapy, Medication Combination Superior for Children with Obsessive-Compulsive Disorder

DURHAM, N.C. – Children with obsessive-compulsive disorder (OCD) fare best when treated with a combination of cognitive behavioral therapy (CBT) and sertraline (trade name Zoloft), researchers at Duke University Medical Center and their colleagues at two other research institutions have determined. The team’s research findings appear in the October 27, 2004 issue of the Journal of the American Medical Association.

Despite knowing that OCD is illogical, children and adolescents with OCD dwell or “obsess” on unwanted thoughts and perform repetitious actions or rituals in a compulsive manner as a way of dealing with those thoughts. Compulsive hand washing or cleaning, counting to certain numbers or the repetitious checking of household items or belongings are examples of symptoms that might manifest in children and adults with this disorder.

Until now, the researchers said, little was known about the relative efficacy of CBT and medication, either alone or in combination, to treat pediatric OCD. The CBT used in this study is an OCD-specific psychotherapeutic treatment designed to create and reinforce new thought patterns and behaviors in children and adolescents with the disorder, said the researchers. The drug sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression and OCD.

“The results are so robust decision makers at all levels of the health care system simply have no reason not to recommend CBT as the starting place for treatment of OCD in children and adolescents,” said John March, M.D., chief of child and adolescent psychiatry at Duke and co-principal investigator on the study. “Starting with medication has no clear benefit for the patient. Our research team feels very strongly that we now have conclusive evidence that CBT — alone or in combination with medication — works exceptionally well for this patient population.”

The research team enrolled 112 patients between the ages of 7 and 17 with a primary diagnosis of OCD into a randomized, controlled clinical trial conducted at three centers in the U.S. Patients were randomly assigned to receive either CBT plus sertraline, CBT alone, sertraline alone or pill placebo for a period of 12 weeks.

Those in the active medication and placebo groups received standard care from a child and adolescent psychiatrist who monitored the effects of the medication (or placebo) and who offered general support and encouragement in resisting OCD. The participants in both groups and their care providers did not know if they were receiving or administering the active pill or placebo. They were seen once a week for medication adjustments during the first six weeks of the study, and then were seen every other week for the next six weeks. The dosage ranged from 25 to 200 milligrams over the first six weeks, depending on the response of the individual. Over the following six weeks, dosage was adjusted for side-effects only.

Those in the CBT groups had 14 visits with a therapist over 12 weeks – twice a week for the first two weeks and then once weekly for the remainder of the study period. Each visit lasted approximately one hour. Participants in the CBT-only group were aware they were not receiving medication. Participants in the CBT combination group were aware they were receiving active medication, as opposed to placebo.

The team found that 53.6 percent of the participants in the combination group (CBT plus sertraline) showed no signs of the disorder by the end of their treatment. For the CBT-only group, 39.3 percent of participants became nearly asymptomatic for OCD; with sertraline alone, 21.4 percent of the group became asymptomatic, and of those receiving the placebo, only 3.6 percent responded with greatly reduced symptoms of OCD.

“The take home message from this study is that kids with OCD should receive cognitive behavioral therapy – either alone or in combination with an SSRI – because that is what gives patients the best chance to overcome OCD,” said March. “OCD can be thought of as a ‘brain hiccup’ where an obsessive thought gets stuck and, as a result, the child feels compelled to perform certain actions to eliminate the thought and its accompanying bad feelings. Patients with OCD know that their thoughts and subsequent behaviors are irrational but they feel powerless to do anything about it. The great thing about CBT is it teaches a strategy called ‘exposure and ritual prevention’ that has been shown to give kids and adults control over the disease.”

The team points out that all treatments were generally well-tolerated among the study participants and there was no evidence of harm-related events due to SSRI treatment.

OCD occurs in approximately one in 200 children, with onset typically occurring either between the ages of 6 and 9 years old or during the teen years. The lifetime prevalence of OCD for the entire population is between 2 and 3 percent, according to the researchers.

“Our study is consistent with several other studies in showing that SSRI treatment alone is helpful for many children and adolescents, but the vast majority remains with significant OCD symptoms,” said Edna B. Foa, Ph.D., director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania and co-principal investigator on the study. “This study converges with other studies in demonstrating that many children and adolescents with OCD really get on board with the CBT treatment and realize that the treatment is freeing them from a very difficult and distressing disorder. We must train more mental health professionals in becoming proficient in delivering CBT for pediatric OCD.”

Currently, there are few providers who are well-trained in providing CBT, said Foa. The researchers believe insurance companies play a role in the problem by continuing to pay only for treatment with medication and other forms of talk therapy that are ineffective despite OCD treatment guidelines that state medication plus CBT should be a first course of treatment.

“People in the community often just get a prescription because it’s the easiest and cheapest course of action; yet it’s not the optimal treatment for the patient,” said Henrietta Leonard, M.D., a member of the study team, professor of psychiatry at Brown University and director of training for child and adolescent psychiatry at the Bradley/Hasbro Children’s Research Center. “This study argues against medication alone as initial treatment for OCD in kids.”

Research funding for “The Pediatric OCD Treatment Study” was provided by the
National Institute for Mental Health. Sertraline and matching placebo were provided to the study under an independent educational grant from Pfizer, Inc. Neither the NIMH program staff nor Pfizer participated in the design and implementation of the study, analysis of the data, or in writing the study findings.

March has received speaker and consultant fees, as well as research support, from Pfizer and has served as a scientific advisor to the company. Foa has received research support from Pfizer and has served as a scientific advisor to the company. Leonard has not received fees or funding from Pfizer.

Other authors on the study include Patricia Gammon, Ph.D., Allan Chrisman, M.D., John Curry, M.D., David Fitzgerald, Ph.D. and Kevin Sullivan, from Duke; and, Martin Franklin, Ph.D., Jonathan Huppert, Ph.D., Moira Rynn, M.D., Xin Tu, Ph.D., Ning Zhao, Ph.D., and Lori Zoellner, Ph.D., at the University of Pennsylvania; and, Abbe Garcia, Ph.D., and Jennifer Freeman, Ph.D., at Bradley/Hasbro Children’s Research Center (Brown University) in Providence, RI.

Therapy, Medication Combination Superior for Children with Obsessive-Compulsive Disorder

DURHAM, N.C. – Children with obsessive-compulsive disorder (OCD) fare best when treated with a combination of cognitive behavioral therapy (CBT) and sertraline (trade name Zoloft), researchers at Duke University Medical Center and their colleagues at two other research institutions have determined. The team’s research findings appear in the October 27, 2004 issue of the Journal of the American Medical Association.

Despite knowing that OCD is illogical, children and adolescents with OCD dwell or “obsess” on unwanted thoughts and perform repetitious actions or rituals in a compulsive manner as a way of dealing with those thoughts. Compulsive hand washing or cleaning, counting to certain numbers or the repetitious checking of household items or belongings are examples of symptoms that might manifest in children and adults with this disorder.

Until now, the researchers said, little was known about the relative efficacy of CBT and medication, either alone or in combination, to treat pediatric OCD. The CBT used in this study is an OCD-specific psychotherapeutic treatment designed to create and reinforce new thought patterns and behaviors in children and adolescents with the disorder, said the researchers. The drug sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression and OCD.

“The results are so robust decision makers at all levels of the health care system simply have no reason not to recommend CBT as the starting place for treatment of OCD in children and adolescents,” said John March, M.D., chief of child and adolescent psychiatry at Duke and co-principal investigator on the study. “Starting with medication has no clear benefit for the patient. Our research team feels very strongly that we now have conclusive evidence that CBT — alone or in combination with medication — works exceptionally well for this patient population.”

The research team enrolled 112 patients between the ages of 7 and 17 with a primary diagnosis of OCD into a randomized, controlled clinical trial conducted at three centers in the U.S. Patients were randomly assigned to receive either CBT plus sertraline, CBT alone, sertraline alone or pill placebo for a period of 12 weeks.

Those in the active medication and placebo groups received standard care from a child and adolescent psychiatrist who monitored the effects of the medication (or placebo) and who offered general support and encouragement in resisting OCD. The participants in both groups and their care providers did not know if they were receiving or administering the active pill or placebo. They were seen once a week for medication adjustments during the first six weeks of the study, and then were seen every other week for the next six weeks. The dosage ranged from 25 to 200 milligrams over the first six weeks, depending on the response of the individual. Over the following six weeks, dosage was adjusted for side-effects only.

Those in the CBT groups had 14 visits with a therapist over 12 weeks – twice a week for the first two weeks and then once weekly for the remainder of the study period. Each visit lasted approximately one hour. Participants in the CBT-only group were aware they were not receiving medication. Participants in the CBT combination group were aware they were receiving active medication, as opposed to placebo.

The team found that 53.6 percent of the participants in the combination group (CBT plus sertraline) showed no signs of the disorder by the end of their treatment. For the CBT-only group, 39.3 percent of participants became nearly asymptomatic for OCD; with sertraline alone, 21.4 percent of the group became asymptomatic, and of those receiving the placebo, only 3.6 percent responded with greatly reduced symptoms of OCD.

“The take home message from this study is that kids with OCD should receive cognitive behavioral therapy – either alone or in combination with an SSRI – because that is what gives patients the best chance to overcome OCD,” said March. “OCD can be thought of as a ‘brain hiccup’ where an obsessive thought gets stuck and, as a result, the child feels compelled to perform certain actions to eliminate the thought and its accompanying bad feelings. Patients with OCD know that their thoughts and subsequent behaviors are irrational but they feel powerless to do anything about it. The great thing about CBT is it teaches a strategy called ‘exposure and ritual prevention’ that has been shown to give kids and adults control over the disease.”

The team points out that all treatments were generally well-tolerated among the study participants and there was no evidence of harm-related events due to SSRI treatment.

OCD occurs in approximately one in 200 children, with onset typically occurring either between the ages of 6 and 9 years old or during the teen years. The lifetime prevalence of OCD for the entire population is between 2 and 3 percent, according to the researchers.

“Our study is consistent with several other studies in showing that SSRI treatment alone is helpful for many children and adolescents, but the vast majority remains with significant OCD symptoms,” said Edna B. Foa, Ph.D., director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania and co-principal investigator on the study. “This study converges with other studies in demonstrating that many children and adolescents with OCD really get on board with the CBT treatment and realize that the treatment is freeing them from a very difficult and distressing disorder. We must train more mental health professionals in becoming proficient in delivering CBT for pediatric OCD.”

Currently, there are few providers who are well-trained in providing CBT, said Foa. The researchers believe insurance companies play a role in the problem by continuing to pay only for treatment with medication and other forms of talk therapy that are ineffective despite OCD treatment guidelines that state medication plus CBT should be a first course of treatment.

“People in the community often just get a prescription because it’s the easiest and cheapest course of action; yet it’s not the optimal treatment for the patient,” said Henrietta Leonard, M.D., a member of the study team, professor of psychiatry at Brown University and director of training for child and adolescent psychiatry at the Bradley/Hasbro Children’s Research Center. “This study argues against medication alone as initial treatment for OCD in kids.”

Research funding for “The Pediatric OCD Treatment Study” was provided by the
National Institute for Mental Health. Sertraline and matching placebo were provided to the study under an independent educational grant from Pfizer, Inc. Neither the NIMH program staff nor Pfizer participated in the design and implementation of the study, analysis of the data, or in writing the study findings.

March has received speaker and consultant fees, as well as research support, from Pfizer and has served as a scientific advisor to the company. Foa has received research support from Pfizer and has served as a scientific advisor to the company. Leonard has not received fees or funding from Pfizer.

Other authors on the study include Patricia Gammon, Ph.D., Allan Chrisman, M.D., John Curry, M.D., David Fitzgerald, Ph.D. and Kevin Sullivan, from Duke; and, Martin Franklin, Ph.D., Jonathan Huppert, Ph.D., Moira Rynn, M.D., Xin Tu, Ph.D., Ning Zhao, Ph.D., and Lori Zoellner, Ph.D., at the University of Pennsylvania; and, Abbe Garcia, Ph.D., and Jennifer Freeman, Ph.D., at Bradley/Hasbro Children’s Research Center (Brown University) in Providence, RI.

|| DukeMedNews || Contact Us

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Duke University Medical Center News Office is a full-service news office available 24 hours a day, every day, to respond to inquiries from the media. We are dedicated to quickly respond to media requests and encourage you to call our office if you have questions about Duke University Health System or Duke University Medical Center. The News Office also can assist journalists in contacting Duke Med experts in a wide variety of medical specialties. During weekdays from 8:30 a.m. to 5:30 p.m., Eastern Time, call us at (919) 684-4148. After hours, please call (919) 970-3671 to reach the on-call staff member.

Consumers also can obtain information about physicians and services at the Duke University Health System by contacting the Duke Consultation and Referral Center at 1-888-ASK-DUKE (888-275-3853). Information about programs at Duke and other consumer health information can be found at http://dukehealth.org.

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