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Duke Heart Week ending 1-17-2021

Chief’s message: Transitions

The country is appropriately fixated on a peaceful transition of power this week as Joe Biden is sworn in as the 46th President of the United States.  Closer to our home in Durham, we are also dealing with several transitions.  The Duke Heart group lost a true leader this week in Amy Kessenich, a senior director of our Heart Network and kind soul who continued to work on our quality in the network up until her passing.  Our thoughts and prayers are with her and her family, and we hope to celebrate her life once the pandemic is better.

We have also had several faculty transitions over the last several years, and this week we announce the retirement of Doug Schocken, a mere 54 years after arriving at Duke as a Freshman in 1966.  He has blessed us with a wonderful walk down his memories at Duke seen below in the Pulse.  We are lucky to continue to have Doug interact with us for some time and look forward to hearing about his next adventures.  In the clinic and on the wards, we will miss his wit, his ability to provide thoughtful and important points at clinical case conferences, grand rounds, and in general practice.  Our fellows will miss his ECG teaching, although we will aim to keep some of that going.  Perhaps most of all, with our some of our faculty retiring, or in the case of some unfortunately passing away, we will miss the ability to have the continuity and direct relationship to the Duke culture of excellence that they have embodied for some many years.  So hopefully like many transitions, we will focus on continuing the legacy research, education, and clinical care while recognizing our privilege of standing on the shoulders of those that have come before us and taught us.

News from the Week:

Passings: Amy Kessenich, Senior Director, Duke Heart Network

We are deeply saddened at the loss of Duke Heart Network’s Senior Director, Amy Kessenich, MHA/MPA, BSN, RN. The news of her death was shared on Thursday with faculty and staff of the Duke University Health System in an announcement made by the senior leadership team of Duke Network Services. Their statement:

“It is with the heaviest of hearts that we share with you the passing of our esteemed colleague, Amy Kessenich, on January 13, 2021. Amy’s positive influence has been an inspiration to Duke and our affiliates for almost 30 years. A consummate nursing professional, Amy brought her energy, enthusiasm and brilliance to a career that spanned a variety of clinical and leadership roles in bedside nursing, quality, performance improvement, Heart Center excellence and affiliations.

Amy truly believed that it was the responsibility of large systems, privileged with a breadth of expertise and resources, to ally with community hospitals and physicians to enhance access to high-quality health care at the local level. Amy embodied this belief when she relocated with her family to Lumberton, NC, in 2006 to serve as the Duke-employed director of the Southeastern Health cardiovascular service line. She subsequently served as senior director of the Duke Heart Network (DHN) from 2012 until her death.

Amy worked tirelessly with her team and colleagues in the Duke Heart Center to assimilate evidence-based care and data-driven approaches to performance improvement to advance health together with our DHN affiliates. As a leader, she bolstered the confidence and skills of those with whom she worked, both formally and informally. Amy was by nature a nurturer of others. Her self-worth was mirrored in the growth of those around her through teaching, influencing, reinforcing and encouraging staff and physicians.

Our hearts are comforted by the knowledge that Amy’s spirit remains in the lives that she enriched through the selfless work and commitment she gave to our organization and our affiliated communities. At Duke, we strive for excellence. Amy defined excellence through her every action, throughout every day. This is the legacy she leaves with us. Let us all aspire to her greatness through the merits of our own actions.

Amy’s family has requested that in lieu of flowers, donations may be made to the American Cancer Society in her memory.

We extend our condolences to her family, friends and colleagues. Her loss is felt deeply by so many, including those who shared the following with us:

“Amy was the guiding light for our Duke Heart Network personally, professionally, and most importantly for our entire North Carolina community.  She was able to improve clinical care across our region by applying data driven evidence based practice with a consistent, humble, and patient centered manner. Personally, Amy encouraged and taught me and generations of our faculty, fellows, to impact and improve the health of our communities.

She will be missed, and our thoughts and prayers are with her family.”

Manesh Patel, MD, Chief of the Division of Cardiology and Co-Director of Duke Heart Center

“My heart is truly broken by the passing of Amy. The world has lost a wonderful person. She was one of the most deeply caring, kind, generous, warm, and compassionate individuals I have known. Her passion was extending Duke’s excellence beyond the local Duke environment – and in the process she transformed many programs for the better. She had an intuitive knack for always knowing what to do, when and how – and imparted that wisdom to all around her. She was quick to praise when other were successful, gaining the greatest satisfaction when she succeeded in helping those around her. She really was the “Best of Duke” – and we will all miss her dearly.”

James Tcheng, MD, professor of medicine in cardiology

“I was fortunate to begin learning from Amy almost 17 years ago right after I first started at Duke. At the time, Amy was leading the quality improvement efforts of the Heart Center before she expanded her work to the Heart Network affiliates. As we all know, improvement requires change. Not just of processes, but ultimately of how each person shows up each day.  Facilitating the latter is far harder and requires relationships, trust, humility, and perseverance.  It’s not just the data, it’s the art of bringing multiple points of view to the same conclusion.  Amy set the standard for how to encourage people and teams to aspire to more, while not dwelling on past mistakes.  I learned so much from watching her over the years, as I know many others did.  And through Amy’s efforts, thousands of patients received better care, were saved, and have Amy to thank.”

Sean Sondej, Vice President, Duke Heart & Vascular Services

“Amy helped me to reach beyond myself, to strive for what was possible, not just what was easy. I will carry the memory of her constant and patient mentorship with me for the rest of my life.”

Jean Klingenberger, MBA/MHA, BSN, RN, Associate Clinical Director, Duke Heart Network

“I have had the pleasure of working alongside Amy for the last four years and not a day went by that I didn’t learn something from her. She always carried herself as the utmost professional and ambassador for Duke Health, even while fiercely and quietly battling her illness. She maintained optimism even in the most challenging situations and never settled for anything less than the best.  Her dedication to her career and those she served was extraordinary. The imprint she has left on Duke, her colleagues, and our communities will last for decades to come.”

Melanie Watson, MSN, RN, Assistant Vice President of Specialty Affiliations, Network Services

“As Amy is remembered for being a brilliant health care leader who made countless contributions to improving heart care across the country, I also want to recall the exemplary care that Amy provided at the bedside.  I’ll never forget the warmth and confident expertise that Amy provided in the cardiothoracic ICU and especially during a time when she cared for one of my family members many years ago.  I believe that her endless compassion and uncompromising excellence in caring for patients was at the heart of what made her a beloved leader who was successful in advancing quality and program development at community hospitals nationwide to the benefit of thousands of patients.  Some of us had the privilege of having Amy as friend and mentor for nearly 30 years during her career at Duke. We will always miss her, but we are comforted by the fact that her legacy as a true health care hero will continue to inspire us for years to come.”

Harry Phillips, MD, Chief Medical Officer, Duke Network Services

 

Doug Schocken, MD, Retires from Duke Cardiology

Quietly on Friday, January 15, Doug Schocken, MD, hung up his stethoscope and turned in his Duke badge – retiring after more than 30 years as an intellectually driven cardiologist and clinician-investigator. We asked Doug to share his thoughts on his career in medicine and his time at Duke. We also invited several colleagues to share their thoughts on their work with him. Here is what we learned.

“I spent half of my adult life at Duke, wrote Schocken. “I came here at age 18 and have spent 26 years here (in three iterations) and 27 years in Tampa. I have many yarns to spin, but will emphasize my experiences with Duke Cardiology.

I came to Duke as a freshman in 1966. When my dad had his first MI at age 49 in 1968, that was my “a-ha moment.” I figured that if I was destined to get this illness, I’d better learn something about it. I would watch surgery. In the OR’s in Duke South, the 5th floor had windows that looked down into the OR’s on the 4th floor. Great views and you didn’t have to scrub.  I stumbled into one of the first W-P-W cases, with the venerable Will Sealy opening the chest, John Gallagher wielding plunge electrodes and Ray Ideker running the Grass multi-channel recorder.  Dr. Andy Wallace was conducting the whole show. Once I got to medical school, my first heroes were Drs. Bill Floyd and Jess Peter. They were gifted clinically, had real compassion and were master teachers. I also had opportunities to round with Dr. Eugene Stead and Dr. Edward Orgain, the original Duke Cardiologist and a student of Paul Dudley White at MGH.  Dr. Orgain used to make rounds on Sundays, arriving after church in his fine linen suit and equally fine straw hat, called a ‘skimmer’.  He was an ‘old school’ attending.

As a resident in the CCU in Duke South in those days, there were only PGY-2’s, no PGY-1’s or 3’s.  Twenty-four hours on and 24-hours off for six weeks.  Oh, and you had to show up for morning and evening rounds on your days off.  We had two fellows who alternated weeks on. We never saw them except occasionally on rounds.  Mine were George Cooper, later at MUSC, and Wayne Alexander, later chief of cardiology and medicine at Emory. The CCU resident had to carry the defibrillator to codes, up and down the stairs of Duke South. Woe be unto the resident who dropped the 25 pound Life-Pak 1 down a stairwell.

Joe Kisslo arrived from Yale when I was a 2nd year medical student.  Joe got to play with the first Duke 2D echo system in the Western Hemisphere (really the first good 2D system anywhere).  The unit was the brainchild of Olaf Von Ram and filled an entire room in Duke South.  You could hardly fit the bed and the sonographer in the same space, and those vacuum tubes could generate some heat.  It seemed that nearly every echo request led to one manuscript or another.  No one had ever seen anything like this in real time.

I came back from the NIH in 1977 having the swollen head that only a first-author paper in Nature could bring.  After my time in ‘Lefkoland,’ in 1980, as with all the other research fellows in the pre-DCRI era, we had to present at the monthly Cardiology Research Conference.  By that time, Joe Greenfield was the Division Chief. At the end of my presentation of many elegant binding curves and adenylate cyclase assays, Joe (as only he could do), gruffly bellowed, “Schocken, that was mighty fine science…but it sure wasn’t cardiology.”

In 1981, I weighed all my options and selected a young school in a young city and cast my lot with the University of South Florida (USF) in Tampa.  I had a great career there, met my wonderful wife, Dawn, had two terrific kids (both Duke grads), but my “Tampa Tales” are for another time.

I owe a great debt of gratitude to Pam Douglas, Chris O’Connor, Howard Rockman and Tom Bashore for having faith in me and trust in my ability to help the division after the untimely passing of Fred Cobb. They engineered a plan to bring me back here in 2008, and I am most grateful for the opportunity that brings me now to the conclusion of a wonderful career in clinical academic cardiology.

What does the future hold for me?  More time with my wife, who has put up with my 13 year “deployment” from Tampa.  I’m going to continue reading ECG’s for Duke. I am looking forward to tuning up my sailboat, playing golf, working on DIY projects, including my deconditioned body (victim of the pandemic’s closure of Duke’s gyms).  I hope to do some fishing — lots of fishing.  I have an enormous list of books to be read, many of which I already own.  I also have lots of movies and TV series to watch.  I’ve heard that “Seinfeld” is good.  My wife got me a new camera several years ago, and I’m itching to use that, too.

Last, to all my colleagues who have supported me with great referrals and thoughtful consults, thank you very much.  To all the many, many staff members, administrators, PA’s, nurses, technicians, and medical assistants, especially those from my clinical home at Southpoint, thank you.  You have contributed in so many ways to make my career much more than it would have been otherwise.  It’s been a great ride.”

Schocken served as president of the Duke University Collaborative Cardiovascular Society (DUCCS) from 1997 to 1999, and has served as Medical Director of the Southpoint Clinic since 2011. A small retirement celebration was held on Friday.

“The folks at Southpoint gave me a beautiful send-off, suitably masked and (mostly) distanced with take-away cookies sealed in cellophane and bottled water to consume elsewhere,” added Schocken. “I got lots of very thoughtful gifts and mementos. It was wonderful.”

Our colleagues shared the following:

“I was delighted when we were able to recruit Doug to return to Duke in 2008 after his years leading the USF cardiology program and fellowship. Among other strengths, he brought rich expertise and national leadership in cardiac rehab and prevention, helping to fill the gap left by Fred Cobb’s untimely death in 2006; in electrocardiography, taking over from Galen Wagner; and heart-mind interactions, stepping in after Chris O’Connor’s departure. It is emblematic of Doug’s quiet competence that he has contributed so much to the Division’s clinical and educational programs, yet asks for little recognition. It is a real personal pleasure on his retirement now, to fully acknowledge, and celebrate, his impact on the Division, the Heart Center and Duke Health.”

Pamela Douglas, MD, Ursula Geller Distinguished Professor for Research in Cardiovascular Disease

“Having been a resident and cardiology fellow at Duke, both Tom Bashore and Chris O’Connor were keen on trying to recruit Doug back to Duke to lead our outpatient clinical Cardiology practice at Southpoint.  For me, however, it was his love of the beta-adrenergic receptor that was the key driver of getting Doug back to Duke. In the late 1970’s, using newly developed radioligand binding methods, Doug published a seminal paper describing changes in beta adrenergic receptor density in humans with ageing.  His work led to the eventual discovery of the deficit of adrenergic receptors in heart failure and ultimately to the conceptual basis for why we use beta-blockers in the current management of patients with heart failure.

Doug’s inquisitive nature and sharp intellect has been instrumental in our ability to transform Cardiology at Southpoint into a vibrant academic clinical cardiology practice that is second to none.  Whether it was a discussion about the interpretation of a difficult ECG, a complex patient medical problem or just being able to schmooze about “receptors,” Doug had this ability to always bring the joy of medicine and discovery into one’s life.”

Howard Rockman, MD, Edward S. Orgain Distinguished Professor of Cardiology and Director, Duke Cardiovascular Research Center

“Doug is one of the most vibrant and compassionate people I know. He is always insightful and respectful; and is a walking encyclopedia of Duke Cardiology history. He embodies the Duke Cardiology Training Program experience and why we all love it so much.  He bleeds Blue and I will always cherish his words of wisdom, his sage advice, and his thoughtful mentorship!”

Rich Krasuski, MD, Director of Duke University Collaborative Cardiovascular Society (DUCCS)

“It has been an honor to share a workroom with Doug at Southpoint for the past two years. Doug is a masterful clinician who taught me a great deal about what it means to connect to patients on a personal level while providing world class care. Every Monday and Tuesday morning I looked forward to seeing where our casual conversations would lead. Invariably they led to non-medical topics – our childhoods, travels, hobbies, books, and, most often, our families. I have come to appreciate that, despite all of his academic and clinical accomplishments, Doug is most proud of who he is as a father and husband. Thank you, Doug, for showing me what true success looks like. I am looking forward to our continued friendship.”

Robert Harrison, MD, assistant professor of medicine in cardiology

“I remember during his first week back at Duke, we needed help on the inpatient heart failure service and we asked Doug to round. Bright and chipper at 7:30 in the morning, he began to care for over 30 patients. His intellectually thoughtful and careful attention to detail provided excellent care one by one, but at 5 p.m., when I went to check on him, he was only halfway through rounds with several hours to go. I reminded Doug that sometimes we cannot address every single medical problem of every patient as an inpatient (the Stead way) and some of these could be left for work-up in the outpatient clinic. He smiled, kept rounding in his way, and happily finished at midnight. Over the years, Doug built an important and complex practice seeing up to 60 patients a week emphasizing his passion for prevention of heart failure and ischemic heart disease.

I know everyone in Duke Cardiology will miss Doug. His quite intellectual approach, thoughtful commentary, and his commitment to the long-lasting principles of the Division, including the fellowship and the DUCCS organization will be remembered.

While Doug may not be seen at Duke South on a day-to-day basis, he will continue the Duke legacy by remaining editor of the Marriot EKG book that Galen Wagner had led, participating in educational programs, and continuing to advocate for Duke Cardiology.

Thank you Doug for your service to Duke, your patients and colleagues will be forever grateful.”

Christopher O’Connor, MD, President of Inova Heart & Vascular Institute and former division chief of Duke Cardiology

 

ACLS/BLS Update

A group of faculty members who attended the July and October, 2020 ACLS/BLS classes sponsored by Duke Heart received an email entitled “Extremely Urgent.”  This was sent out in error.  (Apologies!) As long as you have a current card, there is no further action needed on your part.  The modules/test/hands-on check offs you completed are sufficient for renewal.  Please check your spam email if you are still in need of your card. Hat tip to Laura Dickerson for letting us know about this!

Lefkowitz Memoir Coming Soon

Robert Lefkowitz has a soon-to-be published memoir hitting shelves on Feb. 2. A Funny Thing Happened on the Way to Stockholm: The Adrenaline-Fueled Adventures of an Accidental Scientist is available for pre-order; it’s being published by Simon & Schuster. An article about it appeared last week in Duke Today, accessible here.

Congratulations, Bob!

 

Fellows Recognized by Duke Emergency Services

We are pleased to share some recognition of our Fellows courtesy of Duke’s Emergency Department. In a note shared with us today by Anna Lisa Crowley, we found recognition of Matt Carlisle, Jessica Duran, Sipa Yankey and Michelle Kelsey. “In an effort to recognize our hard-working consultants down in the Emergency Department, we initiated a Consultant Kudos program as a way to give a friendly shout-out to our colleagues. Attached are the comments we have received over the last several months for your service. Special thanks to these amazing residents!”

Carlisle: Matt was extremely pleasant over the phone. He also spent awhile helping me better understand an EKG! (10/31); Thank you for being thorough and kind and spending a lot of time with the family! You came up with a reasonable plan for a somewhat difficult patient with real comorbidities complicated by anxiety and dementia. Thanks! (9/5)

Yankey: Expeditious, very helpful. Came immediately to speak to the team in person rather than over the phone. Provided helpful information regarding work-up and management of similar patients in the future. (12/28); Did an amazing job helping me in the waiting room to see patients. It was a day in the ED that was exceptionally busy with no beds to evaluate patients in. He’s very gracious and kind and seeing patients through their waiting rooms and giving them exceptional care. He was even able to help expedite the admission process for two of the patients who are in heart failure exacerbation. I appreciate his kindness and care for these patients and his clear communication about the plan. He is a great role model for his colleagues of what an exceptional consultant looks like. (10/16); He is always so friendly and happy to discuss the patient with you. Even if it’s a consult for abnormal troponin, and the issue is not cardiac, he is extremely helpful (12/14)

Duran: Excellent bedside manner, efficient and kind. Such a positive interaction with every consult and always willing to teach and discuss the patient even at 3 a.m. (9/28)

Kelsey: Michelle was incredibly patient and helpful with two cardiology consults in the middle of the night. She was enthusiastic about teaching and talked through her thought process, which was a great learning opportunity for me (EM intern). Thank you! (10/6)

Great job, Fellows! Thanks for always being incredible representatives for Duke Heart!!

ICYMI:

Just in time for MLK day! Congratulations to Jennifer Rymer and co-authors, Camille Frazier-Mills, Larry Jackson, Kevin Thomas, Pamela Douglas, Andrew Wang, Manesh Patel and Anna Lisa Crowley for their article, Evaluation of Women and Underrepresented Racial and Ethnic Group Representation in a General Cardiology Fellowship After a Systematic Recruitment Initiative, published online in JAMA Network on Jan. 11. (Check out news coverage below!)

It’s a great recognition of important work by our program leaders and a shout out to our fellows. Nicely done!

 

Karsch Vaccination Site Needs Volunteers:

Manesh Patel shared a note with faculty earlier this week regarding the Karsch Vaccination Site’s need for staffing assistance. There is a need for volunteers who can administer the COVID Vaccine to patients.  In order to volunteer you have to go to the NCID website and register (it only takes about 5 minutes). Once you register, you also have to email Rebecca Cray so that they can associate your registration with Duke (at the NC website this may take a few days/week).  Once done – if interested — you are ready to volunteer. We thank you for considering.

The Karsch Vaccination Site is in need of physicians, APPs and RNs to support the site from 4-8 p.m. on weeknights and weekends, particularly over the next two weeks. If you are willing and able to help out, please follow the instructions below to register with the state and then send Rebecca (cc’d here) your NCID User name so she can work with the state to expedite your registration and put you on the schedule for the times you are able to work.

PART 1

Complete this process:

  1. Go to https://ncid.nc.gov/
  2. Click register (bottom right corner, blue box)
  3. Click Business user type option
  4. Complete the required fields to create an NCID
  5. Follow the steps to access your NCID account and create your security question.

 

PART 2

When complete – please forward your NCID USERNAME to Rebecca Cray Concha (rebecca.cray@duke.edu) so that we can link it to DUHS.  Please also provide the email that you used to register.

Many thanks to all who have already volunteered!

 

COVID-19 Updates:

All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:

Upcoming Opportunities/Save the Date:

MLK Day

On this MLK Day and National Day of Service, we invite you to join Duke in supporting our community through COVID-safe service. The Duke Office of Durham and Community Affairs is hosting a virtual food drive through the Interfaith Food Shuttle. A virtual food drive serves as a wonderful opportunity to support efforts that combat food insecurity and hunger in North Carolina while also remaining safe at home. Contribute to this fundraiser here.

For more information about Interfaith Food Shuttle, visit their website at foodshuttle.org. This event is sponsored by the 2021 Dr. Martin Luther King Jr. Commemoration Committee. For more information about this and other MLK events, visit https://mlk.duke.edu

Cardiology Grand Rounds

Jan. 19: Neha Pagidipati, Dana Portenier & William Yancy presenting A Practical Trans-Disciplinary Approach to Weight Management within the Duke Health System. 5 p.m., Webex.

Jan. 26: Adam DeVore, Ben Bryner & Sharon McCartney presenting DCD Heart Transplantation. 5 p.m., Webex.

Conversations with Colleagues

Talk with your colleagues about recent events in Washington, D.C. The recent violence at the U.S. Capitol has left many of us feeling strong emotions, including sadness, anger, and grief. If you would like to process your emotions together with your fellow team members, Conversations with Colleagues is holding a special series of Zoom meetings – beginning January 20 – dedicated to the topic. The gatherings are guided by a Duke social worker and participants agree to offer one another a supportive environment. Each discussion can include up to 30 people, and seats are available on a first-come, first-served basis. To see the topics and to sign up, please visit: bit.ly/CwCDCEvents.

Global Challenges & the COVID Vaccine

The Duke Global Health Institute (DGHI) is kicking off a “Global Challenges and the COVID Vaccine” Webinar Series on January 19th. The webinar is FREE of charge, but registration is required: https://duke.zoom.us/webinar/register/WN_ZWhQblJdSiSAQuMy292LTw.

The Race for Vaccine Equity, January 19, 2021, 8-9 a.m.

Despite global efforts to ensure all countries have access to COVID vaccines, a large proportion of available vaccines have already been purchased by high-income countries. What can be done to ensure that low- and middle-income countries receive equitable access? Are countries prepared to distribute and administer vaccines? Join experts from DGHI and around the world as they explore the current state of vaccine access and equity.

Overall series description:

The development of safe and effective vaccines to protect against COVID-19 offers the brightest hope of ending a pandemic that has dramatically impacted the world. But many questions remain about how vaccines will be allocated, distributed, administered and accepted in countries of all income levels. This monthly webinar series will share global perspectives on these challenges and offer timely assessment of progress in the campaign to vaccinate people around the world.

 

February is Heart Month!

Feb. 5: Wear Red Day. Share your spirit with colleagues working in the cardiovascular and cardiothoracic space, as well as your support of all those living with and experiencing cardiovascular diseases: wear some red and wear it proudly! (Take pics & share them with Pulse!)

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged.

 

Duke Heart in the News:

 

January 8 — Jennifer Rymer

Medpage Today

Recruitment Strategy Increases Cardiology Fellow Diversity

https://www.medpagetoday.com/publichealthpolicy/medicaleducation/90638

 

January 11 — Jennifer Rymer

Healio/Cardiology

Systematic recruitment initiative diversified cardiology fellowship applicants

http://bit.ly/3qmJ47t

 

January 13 — John Alexander

MDEdge/chest Physician

Calcium-induced autonomic denervation linked to lower post-op AF

https://bit.ly/39MJ3TR

 

January 13 — Renato Lopes

tctMD

REPLACE COVID Bolsters Advice to Continue RAAS Inhibitors in COVID-19 Patients

http://bit.ly/3smWphU

 

January 14 — William Kraus

Thrive Global

Why Our Definition of Exercise Needs a Refresh

https://thriveglobal.com/stories/why-our-definition-of-exercise-needs-a-refresh/

 


1 Comment

  1. Jan. 19: Neha Pagidipati, Dana Portenier & William Yancy presenting A Practical Trans-Disciplinary Approach to Weight Management within the Duke Health System. 5 p.m., Webex.

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