News & Events Dr. Kenessa Edwards and Cheryl Johnson, CRNA, Volunteer at the Young Women’s College Prep Charter School Career Day January 29th, 2015 Dr. Kenessa Edwards, CA-3 resident, and Cheryl Johnson, CRNA, recently volunteered at the Young Women’s College Prep Charter School Career Day, Rochester’s first all-girl’s public school. The purpose of the career day was to feature women from diverse personal and professional backgrounds to excite 7th-9th grade girls about future career opportunities. Dr. Edwards and Cheryl spoke to small groups of students about a career in Anesthesiology and the steps they took to get there, including education, skills needed to be successful, daily responsibilities, and challenges. The teens enjoyed hearing about Anesthesiology and many were interested in going into medicine. Dr. Edwards and Cheryl were unanimous in saying this was a wonderful volunteer experience. Dr. Wojtczak Named Distinguished Fellow of the Kosciuszko Foundation Collegium of Eminent Scientists January 28th, 2015 Dr. Jacek Wojtczak has received recognition as a Distinguished Fellow of the Kosciuszko Foundation Collegium of Eminent Scientists for outstanding achievements and contributions to the Polish scientific community. Founded in 1925, The Kosciuszko Foundation promotes closer ties between Poland and the United States through educational, scientific and cultural exchanges. The list of scholars includes four Nobel Prize winners, 22 members (foreign) of the Polish Academy of Sciences, several members of the U.S. Academy of Sciences, and other renowned scientists. Dr. Dworkin Recipient of the Mitchell B. Max Award for Neuropathic Pain January 27th, 2015 Dr. Robert Dworkin is the 2015 recipient of the Mitchell B. Max Award for Neuropathic Pain, given in recognition of his outstanding achievements and work in the field of neuropathic pain. Dr. Dworkin is the first non-neurologist to receive the award, which is sponsored by the American Academy of Neurology, and will be presented at their annual meeting in April. Congratulations, Dr. Dworkin! Dr. Papadakos Quoted in OR Manager January 23rd, 2015 In the February 2015 issue of OR Manager, Dr. Peter Papadakos is quoted in the Human resources article, “Wise use of social media can enhance your professional career”. The quotes came from an article Dr. Papadakos published in the Journal of Anesthesiology Clinical Research. Dr. Papadakos In Periop Insider and to Speak at AORN January 22nd, 2015 Dr. Peter Papadakos was quoted extensively in an article in the Periop Insider, the weekly newsletter of the Association of periOperative Registered Nurses, titled “Mobile Tech in the OR: Are Your Policies Strong Enough?”. Dr. PJ will also be speaking this March at AORN’s Surgical Conference & Expo (March 7-11 in Denver) to share strategies for preventing mobile device distraction in the perioperative setting. Dr. Glance Visiting Professor at Vanderbilt January 21st, 2015 Dr. Laurent Glance will be the visiting professor at Vanderbilt University on Thursday and Friday, Jan. 22-23, 2015. He will be giving two talks: Health care reform and the Anesthesiologist and Blood Transfusion: Evidence-based or Faith-based. Dr. Glance to Deliver FAER-Helrich Research Lecture at ASA January 21st, 2015 Dr. Laurent Glance will deliver the FAER-Helrich Research Lecture at the 2015 annual meeting of the ASA in San Diego on Monday, Oct. 26, 2015, one of the keynote lectures for the meeting. The FAER-Helrich Research Lecture recognizes outstanding scholarship by a scientist in an effort to encourage young anesthesiologists to consider careers in research and teaching, which are crucial if Anesthesiology is to maintain its reputation as a medical specialty continuously striving for excellence in patient care. Dr. Papadakos Visiting Professor at Mount Sinai January 15th, 2015 Dr. PJ Papadakos served as the Thomas Iberti Memorial Visiting Professor of Surgery at the Mount Sinai School of Medicine January 14-15. Dr. Papadakos presented Grand Rounds in Surgery entitled, "Surfactant Dysfunction in Mechanical Ventilation", and also participated in teaching rounds in the surgical ICU and interacted with medical students, residents in surgery and anesthesiology, fellows and faculty. The annual lectureship honors Dr. Thomas Iberti the Director of Critical Care medicine at Mount Sinai from 1983-1993 who was one of the pioneers of the field of Critical Care. Previous honorees have been internationally known experts in Critical Care, and Dr. PJ was humbled to join their ranks. Dr. Papadakos Commentary in Jan. 2015 Issue of Anesthesiology News January 12th, 2015 Dr. Peter Papadakos, has a commentary featured in the January 2015 issue of Anesthesiology News, titled “EMRs and Smart Technology: Vectors of Infection in a Modern World”, which discusses the spread of infections via the touch screens on personal electronic devices. Dr. Papadakos Publishes in the Journal American Academy of Physician Assistants January 5th, 2015 Dr. Peter Papadakos, along with his physician assistant colleagues, Mr. LaRiccia and Ms. Carpenter, published a paper in the January issue of Journal American Academy of Physician Assistants (JAAPA) dealing with malignant hyperthermia. JAAPA is the major journal of that profession. Carpenter V, LaRiccia B, Papadakos PJ. Malignant Hyperthermia in a Trauma Patient. JAAPA 2015; 28(1):45-47, PMID 25522026 Drs. Gewandter and Smith Co-first Author a Paper in The Journal of the American Dental Assoc. (JADA) December 31st, 2014 Drs. Jennifer Gewandter and Shannon Smith, along with Drs. Robert Dworkin, Kenessa Edwards (not shown), Joseph Pawlowski, and Daniel Rothstein (respectively) evaluated reporting practices in peer-reviewed publications of pain related to temporomandibular disorders. Specification of primary outcome analyses, methods to accommodate missing data, and adverse event collection methods and rates were generally poor. This review alerts authors, reviewers, and editors involved in the publication of TMD trials to these reporting issues with the goal of improving reporting quality in the future. Gewandter JS, Smith SM, McKeown A, Edwards K, Narula A, Pawlowski J, Rothstein D, Desjardins PJ, Dworkin SF, Gross RA, Ohrbach R, Rappaport BA, Sessie BJ, Turk DC, Dworkin RH. Reporting of adverse events and statistical details of efficacy estimates in randomized clinical trials of pain in temporomandibular disorders: ACTTION systematic review. Dr. Jacek Wojtczak Publishes 2 Articles in Journal of Ultrasonography December 29th, 2014 Dr. Jacek Wojtczak has published two articles in the Journal of Ultrasonography, both in Issue 14, pp 362-366 and 367-370, respectively. The first is titled “Laryngo-tracheal ultrasonography to confirm correct endotracheal tube and laryngeal mask airway placement”. Waveform capnography was recommended as the most reliable method to confirm correct endotracheal tube or laryngeal mask airway placements. However, capnography may be unreliable during cardiopulmonary resuscitation and during low flow states. It may lead to an unnecessary removal of a well-placed endotracheal tube, re-intubation and interruption of chest compressions. Real-time upper airway (laryngo-tracheal) ultrasonography to confirm correct endotracheal tube placement was shown to be very useful in cadaveric models and during emergency intubation. Tracheal ultrasonography does not interrupt chest compressions and is not affected by low pulmonary flow or airway obstruction, but is limited by ultrasonography scattering and acoustic artifacts generated in air – mucosa interfaces. Sonographic upper airway assessment emerges as a rapid and easily available method to predict difficult intubation, to assess the laryngeal and hypopharyngeal size and visualize the position of the laryngeal mask airway in situ. This study demonstrates that the replacement of air with saline in endotracheal tube or laryngeal mask airway cuffs and the use of the contrast agents enables detection of cuffs in the airway. It also allows visualization of the surrounding structures or tissues as the ultrasound beam can be transmitted through the fluid-filled cuffs without being reflected from air–mucosal interfaces. The second article is titled, “Models to teach lung sonopathology and ultrasound-guided thoracentesis”. Lung sonography allows rapid diagnosis of lung emergencies such as pulmonary edema, hemothorax or pneumothorax. The ability to timely diagnose an intraoperative pneumothorax is an important skill for the anesthesiologist. However, lung ultrasound exams require an interpretation of not only real images but also complex acoustic artifacts such as A-lines and B-lines. Therefore, appropriate training to gain proficiency is important. Simulated environment using ultrasound phantom models allows controlled, supervised learning, have developed hybrid models that combine dry or wet polyurethane foams, porcine rib cages and human hand simulating a rib cage. These models simulate fairly accurately pulmonary sonopathology and allow supervised teaching of lung sonography with the immediate feedback. In-vitro models can also facilitate learning of procedural skills, improving transducer and needle positioning and movement, rapid recognition of thoracic anatomy and hard-eye coordination skills. We described a new model to teach an ultrasound guided thoracentesis. This model consists of the experimenter’s hand placed on top of the water-filled container with wet foam. Metacarpal bones of the human hand simulate a rib cage and a wet foam simulates a diseased lung immersed in the pleural fluid. Positive fluid flow offers users feedback when a simulated pleural effusion is accurately assessed. Drs. Sisk and Shapiro Win First Prize at the Scientific Panel 16th Annual Bragging Contest December 17th, 2014 Congratulations to Cardiothoracic Anesthesia Fellow Dr. Tracy Sisk (left) and Dr. Janine Shapiro (right) for winning first prize at the Scientific Panel 16th Annual Bragging Contest: Any Case You have Done, I have Done a Better One, Representing University of Rochester School of Medicine and Dentistry at the 68th Annual PostGraduate Assembly in Anesthesiology. Dr. Papadakos Honored at American Assoc. of Respiratory Care Annual Mtg. December 17th, 2014 Dr. Peter Papadakos participated at the 60th International Respiratory Convention, the annual meeting of the American Association of Respiratory Care, December 9-12, where he was honored as the outgoing Chair of the Board of Medical Advisors and for his contributions to the profession. He also served on the Board of Directors of the Society for 2013-14. Beginning next year, the annual award for the best student paper at the annual meeting will be named the Papadakos Award. Dr. PJ is honored to aid in the development of future academic leaders of the profession. The American Association of Respiratory Care has approximately 50,000 members worldwide. Dr. Jennifer Macpherson to Speak at PGA Inaugural Conference December 3rd, 2014 Dr. Jennifer Macpherson will be one of the speakers at the inaugural PGA Thoracic Anesthesia Symposium to be held Dec. 11-12, 2014. The one and-a-half day program will feature leading national and international experts in thoracic anesthesia, and will feature topics such as Prevention of Lung Injury During Thoracic Surgery, Lung Separation and the Difficult Airway, Surgical and Anesthetic Management of Esophagectomy, Discussions of Challenging Cases, PBLDs, Pro/Con Debate, and Thoracic Anesthesia Hands-on Workshop. Dr. Papadakos Publishes in European Respiratory Review December 3rd, 2014 Dr. Peter Papadakos and colleagues have published the article, “Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review” in the journal, European Respiratory Review. The aim of the article was to review the role of noninvasive ventilation (NIV) in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS), H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers. Antonio M. Esquinas, S. Egbert Pravinkumar, Raffaele Scala, Peter Gay, Arie Soroksky, Christophe Girault, Fang Han, David S. Hui, Peter J. Papadakos, and Nicolino Ambrosino on behalf of the International NIV Network. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review. Eur Respir Rev 2014; 23:427-438 | DOI:10.1183/09059180.00009413 Dr. Papadakos On Cover of Anesthesiology News December 2nd, 2014 Dr. Peter Papadakos' article, “The Day Medicine Stood Still” was featured on the cover of the November 2014 issue of “Anesthesiology News”. Drs. Kaminski, Eaton, and Stern Publish in Anesthesia & Analgesia November 21st, 2014 Drs. Anna Kaminski (Left), Michael Eaton (Center), Peter Knight, David Stern (Right), and Andrew Sifain have published in the Echo Rounds section of the December issue of Anesthesia & Analgesia. The article is titled, “Mitral Valve Repair Failure Diagnosed with a Sudden Change in Jet Direction from Posterior to Anterior: Inconsistent with Systolic Anterior Motion”. Anesthesia & Analgesia, Dec 2014;119(6), pp 1271-1274 Drs. Gewandter, Pawlowski, Poli, Rothstein, Dworkin & Smith Publish in Journal of Pain November 21st, 2014 Drs. Jennifer Gewandter, Joseph Pawlowski, Joseph Poli (not shown), Daniel Rothstein, Robert Dworkin, and Shannon Smith (Respectively) have published an article that reviews the completeness of sample size calculation reporting in recent analgesic clinical trials. This article discusses the importance of reporting all elements of sample size calculations, given the ethical implications of underpowered or overpowered clinical trials. McKeown A, Gewandter JS, McDermott MP, Pawlowski JR, Poli JJ, Rothstein D, Farrar JT, Gilron I, Katz NP, Lin AH, Rappaport BA, Rowbotham MC, Turk DC, Dworkin RH, Smith SM. Reporting of sample size calculations in analgesic clinical trials: ACTTION systematic review. Journal of Pain, in press. Drs. Gewandter, Smith, Williams & Dworkin Publish in Pain November 19th, 2014 Drs. Jennifer Gewandter, Shannon Smith, Mark Williams, and Robert Dworkin (Respectively) have published an article describing “spin” or misrepresentation of statistically non-significant results in analgesic clinical trials in the Journal of Pain. Jennifer S. Gewandter, Michael P. McDermott, Andrew McKeown, Shannon M. Smith, Robert A. Gross, Matthew Hunsinger, Allison H. Lin, Bob A. Rappaport, Andrew S.C. Rice, Michael C. Rowbotham, Mark R. Williams, Dennis C. Turk, Robert H. Dworkin. Data interpretation in analgesic clinical trials with statistically non-significant primary analyses: An ACTTION systematic review. Journal of Pain. In press. Mary Therese Biltucci Publishes in Clinical Implant Dentistry and Related Research November 19th, 2014 Mary Therese Biltucci, MA and co-authors have published the article, “Bacterial Composition at the Implant-Abutment Connection under Loading in vivo”, in the journal, Clinical Implant Dentistry and Related Research. Purpose: Platform-switched implants have been demonstrated to prevent bone loss after loading. The present study evaluated bacterial composition of sites from implant-abutment connections of immediately loaded implants, which were placed in the anterior mandible. Ten patients participated in this study. Conclusions: Chlorhexidine irrigation does not seem to have any effect on decontamination of connections. As shown previously, there is significantly more bone loss around B implants compared with A implants. Although there was no statistical difference in the microbial profiles, thee was indeed a trend for the presence of typical periodontal pathogens associated with the internal polygonal butt-joint connection. A possible scenario is that this connection tends to harbor the pathogens that may be involved in subsequent bone loss. Georgios E. Romanos, DDS, PhD, Prof. Dr. med. Dent.; Mary Therese Biltucci, MA; Alexis Kokaras, PhD; Bruce J. Paster, PhD. Bacterial Composition at the Implant-Abutment Connection under Loading in vivo. Clin Implant Dentistry and Related Res, 2014. PACE – Dec 4th, 2014 November 7th, 2014 Please join us for this informative session on Physicians & Attorneys Cooperative Education on December 4th, 2014 Dept. of Anesthesiology University of Rochester Medical Ctr. For more information please go to the PACE Event Page. Dr. Jacek Wojtczak Publishes in Journal of Anesthesiology & Clinical Science October 30th, 2014 Dr. Jacek Wojtczak, together with Dr. Davide Cattano and his group, have published the article, “External neck landmark identification and measurement correlation in a normal weight cohort” in Volume 3, Article 7 of the Journal of Anesthesiology & Clinical Science. Abstract: Background: Airway management, including proper airway devices sizing, is dependent on airway features, which ultimately should correlate with body features: unfortunately such correlation has been inconsistent. The aim of this study was to determine the correlation of normal values of several external neck landmark (airway features) measurements with age, gender, height and weight (body features) for normal weight adult subjects to establish a consistent correlation. Methods: After IRB approval, 200 subjects (100 male and 100 female) were enrolled. External neck landmarks were measured using a measuring tape. Measurements were also assessed by digital caliper to compare marginal errors. Only non-obese (BMI <30 kg/m2) adults presenting for preoperative anesthesia assessment were screened. Results: A total of 200 subjects completed the study. The difference between female and male hyocricoid distance (6.0+1.3 cm and 6.5+1.4 cm; P<0.01) and thyroid width (4.9+0.8 cm and 5.3+ 0.7 cm; P<0.001) was statistically significant. Univariate regression analysis demonstrated ENLs measurements were correlated with different physical characteristics except the occipital distance which did not provide any correlation with the airway anatomical variables. Conclusion: There was a significant correlation between: thyromental, hyoidcricoid and thyroid width distances with height and weight (P<0.0001); thyroid height and throcricoid distances with height (P=0.027 and P=0.008, respectively); hyoidmental with age (P=0.037), and sternomental distance with height and age (P<0.0001). Results from multivariate regression provided interesting insight into the association between each ENL, airway features and physical characteristics. These findings may be useful to determine prediction models of important neck landmarks measurements when actual measurements are not feasible. Dr. Zana Borovcanin Recipient of 2014 MCIC “Risk Reduction Awards Program” Grant October 23rd, 2014 Dr. Zana Borovcanin has been awarded a $50,000 grant from the MCIC Risk Reduction Awards Program. MCIC Vermont, Inc. is the medical malpractice carrier for the University of Rochester Medical Center. Part of the MCIC mission is to prevent harm that leads to litigation. As a part of the MCIC 2014 strategic plan, funding is available for projects that propose innovative ways in reducing risk. Dr. Borovcanin’s project, “Implementation and Evaluation of URMC Difficult Airway Response Team (DART)”, will help establish a DART team at URMC, which will be capable of delivering the highest-quality and safest care during difficult airway management at our institution. Congratulations to Dr. Borovcanin and co-investigators: Janine Shapiro, MD, Sarah Peyre, EdD, Oren Harary, MBA, MPH, and Changyong Feng, PhD Residency Program 1st Place in Lifebox Challenge! October 16th, 2014 Announced in October, 2013, the first Annual Resident Lifebox Challenge is an initiative of the ASA Resident Component to engage U.S. anesthesiology residents in support of the global safe surgery program of the Lifebox Foundation. ASA's Charitable Foundation serves as the platform for the resident fundraising activities. At the 2014 ASA annual meeting in New Orleans, it was announced that the University of Rochester Residency Program swept the competition (11 other academic programs participated) in both total contributions and per resident giving! In addition, by raising the largest absolute dollar contribution, our program is eligible for a matching gift to increase our gift to Lifebox. Congratulations and thanks to all who donated! Drs. Gewandter, Smith, Pawlowski, Poli, Rothstein, Williams & Dworkin Publish Article in Pain October 2nd, 2014 Dr. Jennifer Gewandter (right), and co-authors, including Anesthesiology residents, Drs. Joseph Pawlowski, Daniel Rothstein, and Mark Williams, former resident, Dr. Joseph Poli, Dr. Shannon Smith, and Dr. Robert Dworkin published an article describing the reporting of intention-to-treat analyses in analgesic clinical trials. The study found that the phrase “intention-to-treat” is frequently used to describe analyses that exclude randomized participants. Recommendations to use the term “intention-to-treat” consistently to facilitate interpretation of RCTs are provided. Jennifer S. Gewandter, Michael P. McDermott, Andrew McKeown, Shannon M. Smith, Joseph R. Pawlowski, Joseph J. Poli, Daniel Rothstein, Mark R. Williams, Shay Bujanover, John T. Farrar, Ian Gilron, Nathaniel P. Katz, Michael C. Rowbotham, Dennis C. Turk, Robert H. Dworkin. Reporting of intention-to-treat analyses in recent analgesic clinical trials: ACTTION systematic review and recommendations. Pain. In press. Dr. Daryl Smith Publishes in Case Reports in Emergency Medicine September 29th, 2014 Dr. Daryl Smith has published an article in Vol. 2014 of Case Reports in Emergency Medicine, titled “Treatment of Acute Flares of Chronic Pancreatitis Pain with Ultrasound Guided Transversus Abdominis Plane Block: A Novel Application of a Pain Management Technique in the Acute Care Setting”. Doi:10.1155/2014/759508 Drs. Daryl Smith, Sarah Kralovic, and Garret Morris Article Accepted to ASAIO Journal September 19th, 2014 Drs. Daryl Smith, Sarah Kralovic, Garret Morris (left) and colleagues have had their paper accepted for publication in the ASAIO Journal. Their article is titled, “Trial Ultrasound Guided Continuous Left Stellate Ganglion Blockade Prior to Surgical Gangliolysis in a Patient with a Left Ventricular Assist Device and Intractable Ventricular Tachycardia: A Pain Control Application to a Complex Hemodynamic Condition”. Drs. Glance and Wissler's Article Featured in Several News Outlets, Including an Interview with NPR September 11, 2014 Drs. Laurent Glance and Richard Wissler's article in Health Affairs on obstetrical outcomes has been featured in several media outlets. Titled, “Study: Wide hospital quality gap on maternity care”, it was featured with the Associated Press, ABC News, FoxNews, HealthDay, Intelihealth, KWTX, Medbroadcast, Medscape, North Dallas Gazette, San Francisco Chronicle, US News & World Report, Washington Post, Health Affairs blog, WBUR Boston, and Fosters Daily Democrat. Dr. Glance was also interviewed by NPR. Link to the interview Residents, Drs. Pereira and Williams Publish in Pain September 2, 14 Dr. Anthony Pereira first-authored a literature review on the implications for chronic pain treatment of antidepressant-associated suicidal ideation and behavior that has just been accepted for publication by Pain. Dr. Mark Williams served as co-author of a literature review on acute and chronic pain associated with Lyme borreliosis that was just published in Pain. References to both of these articles appear below: Zimering JH, Williams MR, Eiras ME, Fallon BA, Logigian EL, Dworkin RH. Acute and chronic pain associated with Lyme borreliosis: clinical characteristics and pathophysiologic mechanisms. Pain, 2014;155:1435-1438. Pereira A, Conwell Y, Gitlin MJ, Dworkin RH. Suicidal ideation and behavior associated with antidepressant medications: implications for the treatment of chronic pain. Pain, in press. Dr. Papadakos Grand Rounds Speaker at Drexel School of Medicine August 14, 2014 Dr. Peter Papadakos was the Visiting Professor at the Drexel School of Medicine’s Hahnemann University Hospital in Philadelphia on July 29th. His Perioperative Medicine Grand Rounds presentation for the Departments of Anesthesiology, Surgery and Nursing was titled, “Distracted Doctoring a Major Health Care Safety Concern”. Dr. Papadakos Letter to Editor in Chest August 11, 2014 Dr. Peter Papadakos published a commentary in the August issue of Chest, the journal of the American College of Chest Physicians. In his role as Chairman of the Board of Medical Advisors which provides oversight to the American Association of Respiratory Therapists, Dr. Papadakos’ letter is in support of legislation HR 2619 before Congress to allow respiratory therapists to practice independently under the supervision of a physician to aid in the care of patients with complex respiratory diseases. This collaboration would greatly aid in the predicted shortage of pulmonary physicians and hopefully impact on the rate of readmissions to hospitals and thus impact on health care costs. Papadakos PJ. Board of Medical Advisors Supports HR 2619. Chest. 2014;146(2):e61-e62. Link to Article Drs. Glance, Wissler, and Marroquin Publish Paper in Health Affairs August 7, 2014 Drs. Laurent Glance, Richard Wissler, Bridget Marroquin, and colleagues Drs. Dick, Glantz, Qian, Mukamel and Kellermann have published the paper, “Rates of Major Obstetrical Complications Vary Almost Fivefold Among US Hospitals”, in Health Affairs (Health Aff [Millwood]. 2014 Aug 1;33(8):1330-6. doi: 10.1377/hlthaff.2013.1359.) Author information Laurent G. Glance is vice chair for research and a professor of anesthesiology and public health sciences at the School of Medicine and Dentistry, University of Rochester, in New York. Andrew W. Dick is a senior economist at the RAND Corporation in Boston, Massachusetts. J. Christopher Glantz is a professor of obstetrics and gynecology at the School of Medicine and Dentistry, University of Rochester. Richard N. Wissler is a professor of anesthesiology at the School of Medicine and Dentistry, University of Rochester. Feng Qian is an assistant professor of health policy and management, School of Public Health, University at Albany, in New York. Bridget M. Marroquin is an assistant professor of anesthesiology at the School of Medicine and Dentistry, University of Rochester. Dana B. Mukamel is a professor in the Department of Medicine, University of California, Irvine. Arthur L. Kellermann is a professor in and dean of the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, in Bethesda, Maryland. Abstract Of the approximately four million women who give birth each year in the United States, nearly 13 percent experience one or more major complications. But the extent to which the rates of major obstetrical complications vary across hospitals in the United States is unknown. We used multivariable logistic regression models to examine the variation in obstetrical complication outcomes across US hospitals among a large, nationally representative sample of more than 750,000 obstetrical deliveries in 2010. We found that 22.55 percent of patients delivering vaginally at low-performing hospitals experienced major complications, compared to 10.42 percent of similar patients delivering vaginally at high-performing hospitals. Hospitals were classified as having low, average, or high performance based on a calculation of the relative risk that a patient would experience a major complication. Patients undergoing a cesarean delivery at low-performing hospitals had nearly five times the rate of major complications that patients undergoing a cesarean delivery at high-performing hospitals had (20.93 percent compared to 4.37 percent). Our finding that the rate of major obstetrical complications varies markedly across US hospitals should prompt clinicians and policy makers to develop comprehensive quality metrics for obstetrical care and focus on improving obstetrical outcomes. Project HOPE—The People-to-People Health Foundation, Inc. URMC Newsroom Article Dr. Papadakos Publishes in Respiratory Care July 30, 2014 Dr. Peter Papadakos’ article titled, “Electronic Distractions of the Respiratory Therapist and Their Impact on Patient Safety”, was published in the August 2014 issue of Respiratory Care. [Respir Care 2014;59(8):1306-1309] Dr. Papadakos’ Article on URMC Select Major News Coverage July 10, 2014 Dr. Peter Papadakos, who was quoted in the NY Times article Google Glass Enters the Operating Room, has also been featured in URMC Select Major News Coverage. "The display can also be used to see email and surf the web, potentially allowing doctors to take multitasking to dangerous new levels, said Peter J. Papadakos at the University of Rochester Medical Center, who has published articles on electronic distractions in medicine." URMC Select Major News Coverage Dr. Lerman honored at "Sixth Salute to UB Authors" July 2, 2014 Jerrold Lerman, MD, Chief of Clinical Research & Professor of Anesthesiology, University at Buffalo and Women & Children’s Hospital of Buffalo, was recognized by the University at Buffalo on May 5, 2014 at “An Anthology of Recognition: The Sixth Salute to UB Authors.” The event, which honors UB authors who have published full-length scholarly books over the course of the past two years — from January 2012 through December 2013, paid tribute to more than 105 authors, contributing authors and editors. Dr. Lerman was honored for the 5th Edition of his new textbook, “A Practice of Anesthesia for Infants and Children,” which provides complete coverage of the safe, effective administration of general and regional anesthesia to infants and children - covering standard techniques as well as the very latest advances. Dr. Lerman has authored three textbooks with the third coming out later this year. Congratulations, Dr. Lerman! Click to read this article on kaleidahealth. Dr. David Stern Mentioned in The Wall Street Journal July 2, 2014 Excerpt: 'He points to David Stern, who is 63. Dr. Stern, an associate professor of anesthesiology at the University of Rochester Medical Center, took up the violin at age 55 when he began playing with the Rochester New Horizons orchestra. When he started, Dr. Stern recalls, he produced a sound "that the cat hated worse than the vacuum cleaner." But the same nimble fingers that allowed him to insert catheters into patients served him well on the violin.' Read the full article from The Wall Street Journal Dr. Jennifer Gewandter First Author on Article Pubished in PAIN June 25, 2014 Dr. Jennifer Gewandter and co-authors published a systematic review that identified deficiencies in reporting of missing data and methods to accommodate them in analgesic clinical trials. The article provides a review of methods to accommodate missing data that are recommended by statisticians and regulators, and provides recommendations for authors, reviewers, and editors pertaining to reporting of these important statistical details. Jennifer S. Gewandter, Michael P. McDermott, Andrew McKeown, Shannon M. Smith, Mark R. Williams, Matthew Hunsinger, John T. Farrar, Dennis C. Turk, Robert H. Dworkin Dr. Peter Papadakos Quoted in New York Times Article and Featured on Reporte Indigo June 4, 2014 Dr. Peter Papadakos was quoted in the Sunday, June 1st, edition of the NY Times. In an article titled, "Google Glass Enters the Operating Room", Dr. Papadakos comments, "Being able to see your laparoscopic images when you're operating face to face instead of looking across the room at a projection screen is just mind-bogglingly fantastic," he said. "But the downside is you don't want that same surgeon interacting with social media while he's operating." To read the entire article, visit the New York Times. Dr. Papadakos was also featured on Reporte Indigo titled "Tweezers, scalpel, Smartphone?" discussing electronic distration in the operating room: (Translated from Spanish) A survey of perfusionists revealed 55 percent used their cell phone during cardiac surgery. Currently, some of the medical negligence is due to “distracted doctoring”, a phenomenon in which doctors do not release their mobile devices, even in the operating room. Campaigns exist that talk about the risks of driving and texting at the same time . There is also talk of distraction between parents and children who are absorbed in the screens of their mobile devices. But not enough attention is paid to another scenario where the use of mobile devices can compromise the health and endanger the lives of others: the operating room. To read the entire article, visit Reporte Indigo. Dr. Jennifer Gewandter Pubishes Article in PAIN May 27,2014 Dr. Jennifer Gewandter and co-authors published an article describing research design considerations for proof-of-concept (POC) chronic pain clinical trials, addressing both exploratory and preliminary efficacy objectives. General considerations regarding POC trials, as well as major POC trial designs and their advantages and limitations are discussed. Designs that maximize statistical power by decreasing variability in outcomes, maximizing effect size, or minimizing participant withdrawal are reviewed. This article communicates consensus recommendations from an IMMPACT (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) meeting of pain research experts from around the world. Jennifer S. Gewandter, Robert H. Dworkin, Dennis C. Turk, Michael P. McDermott, Ralf Baron, Marc R. Gastonguay, Ian Gilron, Nathaniel P. Katz, Cyrus Mehta, Srinivasa N. Raja, Stephen Senn, Charles Taylor, Penney Cowan, Paul Desjardins, Rozalina Dimitrova, Raymond Dionne, John T. Farrar, David J. Hewitt, Smriti Iyengar, Gary W. Jayr, Eija Kalso, Robert D. Kerns, Richard Leff, Michael Leong, Karin L. Petersen, Bernard M. Ravina, Christine Rauschkolb, Andrew S. C. Rice, Michael C. Rowbotham, Cristina Sampaio, Søren H. Sindrup, Joseph W. Stauffer, Ilona Steigerwald, Jonathan Stewart, Jeffrey Tobias, Rolf-Detlef Treede, Mark Wallace, Richard E. White. Research designs for proof-of-concept chronic pain clinical trials: IMMPACT recommendations. Pain, In press. Third Annual Lawrence Educational Symposium: Focus on Sedation May 12, 2014 The third annual Lawrence Educational Symposium took place on May 8th with over 60 participants! This year’s theme was “Focus on Sedation” and 13 abstracts representing sedation cases and challenges were presented. The panel featured Drs. Michael Nead (Medicine), Joel Pasternack (Emergency Medicine), Rajbala Thakur (Anesthesiology) and Elise Van der Jagt (Pediatrics). The discussion was moderated by Dr. Suzanne Karan. Awards were presented at the end of the evening for: Most novel poster presentation: Drs. Bryce Yerman and Henry Tran for “Sedation in a minivan” Poster with most academic value: Drs. Williams, Kothari and Karan for “Challenging sedation in a patient with sickle cell disease on chronic opioid therapy Thank you to Dr. Ruth Lawrence and her family for endowing the funds that allow our department to host this annual event in the memory of her late husband, Dr. Robert Lawrence, who was our department’s first anesthesiology resident. Difficult Airway Workshop conducted on March 6th and May 3rd May 8, 2014 The Difficult Airway Workshop, which is organized by Dr. Zana Borovcanin, is designed to provide residents with state-of-the-art information and hands-on experience with a wide range of established and novel airway techniques. This all-day educational activity is divided in two parts: didactic sessions in the morning followed up with hands-on workshop with eight stations in the afternoon. The last two difficult airway workshops covered multiple skill stations which included adult flexible fiberoptic intubation, airway anesthesia for awake intubation, airway exchange catheters, fiberoptic intubation via supraglottic airway using Aintree catheter, video laryngoscopes and fiberoptic stylets. There was a special station for pediatric difficult airway management covering pediatric flexible fiberoptic intubation and video laryngoscopy. Retrograde wire intubation and surgical airway - cricothyrotomy were performed in simulated airway scenarios. A percutaneous cricothyrotomy was practiced in a pig trachea lab, and conducted by Dr. Lyons. The Workshop also focused on use of endobronchial blockers and fiberoptic lung separation in the difficult airway management. Many aspects of difficult airway management in a variety of clinical settings were highlighted during the Workshop. The goal of the Difficult Airway Workshop is also to learn to appropriately apply the ASA Difficult Airway Algorithm and to develop an understanding of the critical decision points in the course of the difficult airway management. A special thanks to Drs. Dooley, Gloff, Kaminski, Karan, Kolano, Lyons, Tran, Tzimas, Subrahmanian and Sekhar for their participation and teaching in the last two Difficult Airway Workshops. We are grateful to Cook Medical, Karl Storz Endoscopy and Verathon Medical that provided us with their products and demonstrations. For the full slide show of the Difficult Airway Workshop photos (March 6th and May 3rd) go to the URMC Department of Anesthesiology Facebook page. Dr. Gail Johnson Awarded $250,000 Grant May 8, 2014 Dr. Gail Johnson has been awarded a $250K grant from the BrightFocus Foundation for her research titled, “Nrf2 regulates tau clearance: an AD treatment strategy”. It was also featured on the Research@URMC Blog, titled: “Could Cabbage and Broccoli Help in the Fight Against Alzheimer’s?”. Dr. Papadakos Featured in ASA Article May 8, 2014 In a May 2014 article on the American Society of Anesthesiologists’ web site titled, “Situational Awareness, Multitasking, and Distraction in the O.R.”, Dr. Peter Papadakos was featured. The authors state, “Recently, it was suggested by Dr. Papadakos in Anesthesia and Clinical Research that a modified CAGE questionnaire (traditionally used to assess risk factors for alcohol abuse, Table 1) could be used to identify those with a significant addiction to their personal electronic devices (PED). In effect, it would help identify those at risk of being distracted by their own actions before they entered the O.R.” Dr. Marcin Karcz Approved for FAER Grant April 30, 2014 Dr. Marcin Karcz has been approved for a Foundation for Anesthesia Education Research (FAER) Research Fellowship Grant. His application was titled, “The role of antihistamines and nicotine metabolites in cardioprotection.” Congratulations, Marcin! Dr. Jacek Wojtczak To Present At Transthoracic Ultrasound Workshop April 21, 2014 Dr. Jacek Wojtczak will be presenting at transthoracic ultrasound workshops during the Harvard Ultrasound Course for Intensivists and Emergency Medicine Clinicians, being held April 25-27, 2014 at the Carl J. Shapiro Clinical Center at Beth Israel Decsoness Medical Center. Specifically designed for Critical Care and Emergency Medicine Physicians, the course covers all current application of critical care ultrasound. The course covers basic use of Transthoracic Echocardiography (TTE) in the setting of cardiac arrest/peri-resuscitation, and in the management of the patient in shock. In addition, the course will cover emeging topics in critical care ultrasound, such as lung ultrasound for the diagnosis of pneuomothorax, pulmonary edema and pneumonia, it will review in detail the FAST Protocol, the international standard ultrasound protocol for the management of the patient with trauma. For additional information, visit www.cme.hms.harvard.edu/courses/echocardiography. Dr. Papadakos Assists with AORN Policy and Cited in Pacific Standard Magazine April 21, 2014 Dr. Peter Papadakos, a leader in electronic distraction prevention, helped develop the AORN policy, "AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care", to deal with electronic distraction in the perioperative environment. The policy was released 4/15/14 and can be found on the AORN webpage. Dr. Papadakos was also featured in the Pacific Standard: The Science of Society in an article titled, "The Dangerous Rise of Social Media in the Operating Room." Dr. Glance Publishes Editorial in the New England Journal of Medicine April 10, 2014 Dr. Laurent Glance has co-authored an editorial titled, "Redesigning Surgical Decision Making for High-Risk Patients", which was published in the April 10th issue of The New England Journal of Medicine. Glance LG, Osler TM, Neuman MD. Redesigning Surgical Decision Making for High-Risk Patients. N Engl J Med 370:15;1379-1381 Alastair J. Gillies, MD 1924-2014 April 7, 2014 Dr. Alastair J. Gillies, the first Chair of the Department of Anesthesiology, passed away recently at the age of 89. Dr. Gillies was educated at the University of Edinburgh and trained at the Royal Infirmary in Edinburgh. He served on the medical staff in the RAF during the war. As a physician, he followed in the footsteps of his father, an anesthesiologist for the Royal Family in the UK around WWII. He joined the faculty at the University of Rochester in 1959. During his tenure as Chair from 1969 – 1983 he helped to develop and nurture a robust department, focusing on recruitment, education, curriculum development, and research. The Gillies Library is named for him. Members Of Anesthesiology Department Attend Society Of Cardiovascular Anesthesiologists Annual Meeting April 2, 2014 This past week (March 28-April 2), Drs. Ari Balofsky, Paul Nandra, Yaser Rad, and Tarun Subrahmanian represented our department at the Society of Cardiovascular Anesthesiologists annual meeting in New Orleans, LA, and presented cases at the Complex Case Discussion session. Dr. Rad, Dr. Subrahmanian, Dr. Carol Ann Diachun, and Dr. Andy Sifain presented the Anesthetic Management of Pre-Term Delivery in a Patient with Decompensated, Non-Ischemic Cardiomyopathy, Biventricular ICD and Bioprosthetic Tricuspid Valve. Dr. Nandra, Dr. Subrahmanian, and Dr. Sifain presented a case of Iatrogenic Tricuspid Valve Stenosis Following a Bentall Procedure. Dr. Balofsky, Dr. Subrahmanian, Dr. Janine Shapiro, Dr. Michael Schwartz, Dr. Todd Massey, and Dr. Sifain presented a case of Syncardia Total Artificial Heart following a Total Cardiectomy in an Orthotopic Heart Transplantation with Cardiogenic Shock. Drs. Konstantine Tzimas, Laurent Glance, David Stern, and Michael Eaton were also in attendance.