Consultation Service

We maintain an active inpatient consultation service at Strong Memorial Hospital. Our patients encompass a broad spectrum of clinical problems. Trainees are responsible for evaluation and providing management recommendations for these patients. We make daily teaching and service rounds. Additionally, the consultation service follows up all positive tuberculosis cultures and assists in the management of patients with tuberculosis or suspected tuberculosis. Generally, first-year fellows will spend 6 months on this service.

Ambulatory Chest Medicine Clinic

Throughout their training, fellows participate in a weekly outpatient clinic which accepts referrals from physicians throughout the upstate New York area. The clinic is held at Strong Memorial Hospital in an area adjacent to the Pulmonary Function Laboratory, so that necessary tests such as spirometry and blood gases can be done at the time of the patient's visit. Emphasis in this clinic is placed on teaching rather than providing primary care for a large number of patients. Fellows also use this clinic to follow selected inpatients after discharge from the hospital. This design lets the fellows have the opportunity to see unusual cases, as well as gain experience in the long-term management of selected patients with chronic respiratory diseases. Fellows manage their clinic patients under the direct supervision of a faculty member.

At least one-half day per week, each of the faculty members see patients who are referred to them. Additionally, faculty see patients with obstructive lung diseases at the new Mary Parkes Asthma Center, and an Occupational and Environmental Lung Diseases Clinic meets once a month. After the first year of training, fellows may elect to participate in these clinics, as well.

Intensive Care Units: Strong Memorial Hospital

The Strong Memorial Hospital Adult Intensive Care Units are major resources for teaching critical care medicine and pulmonary disease in critically ill patients. They offer Pulmonary and Critical Care fellows exposure to a wide range of critical illness, patient care challenges, and high technology medicine in an environment with an educational emphasis. One of our faculty members, Dr. Michael J. Apostolakos, is Director of Adult Critical Care at Strong Memorial Hospital.

The Adult and Pediatric ICUs described below have undergone or will shortly be undergoing major renovation.  A new 15-bed Burn/Trauma ICU and 22-bed Pediatric ICU were recently opened (12/04), and boast state of the art equipment and monitoring facilities, with each patient room providing approximately 300 square feet of floor space.  The SICU renovation (to be completed 2006) and MICU renovation (to be completed 2007) will have the same state of the art specifications.

A 17-bed Medical and Respiratory Intensive Care Unit at Strong Memorial Hospital is under the direction of Dr. Apostolakos. Other members of the Pulmonary and Critical Care Unit participating in this Unit include Drs. Smita Desai, Michael Larj, Joseph Modrak, Carol-Lynn Petronaci, David Trawick, Irene Perillo, Anthony Pietropaoli, and Jim White. Drs. Caroline Jones and Thomas Watson provide thoracic surgery consultation. This Unit has state-of-the-art monitoring facilities, ventilators, and a nurse-to-patient ratio of 1-2:1. The staff of the Pulmonary and Critical Care Unit is a major contributor to the general teaching and management of this facility. First-year fellows function as consultants for the house staff assigned to this Unit. Fellows also participate in resident teaching and have direct involvement with pulmonary artery catheter placement and interpretation of data, pleural biopsies, endotracheal intubations, chest tube insertion, and therapeutic and diagnostic bronchoscopies. In the initial year of training, fellows spend 3-6 months in this Unit; they may elect further training on this Unit in subsequent years.

A 14-bed Surgical Intensive Care Unit combined with a 15-bed Trauma-Burn Unit at Strong Memorial Hospital are the major teaching facilities for the Critical Care Fellowship Programs in the Departments of Anesthesiology and Surgery. These Units are directed by Drs. David Kaufman and Dr. Julius Cheng of General Surgery, and Drs. Peter Papadakos and Joseph Dooley from the Department of Anesthesiology. The Units serve patients who have had extensive subspecialty or general surgery, burns, or trauma. During the initial year of fellowship, trainees may elect time in these Units. Those fellows interested in Critical Care certification will also spend time in these Units during subsequent years.

A 14-bed combined Cardiology and Cardiothoracic Intensive Care Unit is under the direction of Dr. Joseph Delehanty from the Department of Medicine. This Unit serves open heart surgery patients as well as patients with complicated myocardial infarction and heart failure requiring mechanical ventilation. The heart transplantation program and heart failure center bring many patients to this unit. Fellows may choose an elective in this Unit during their second and third years of fellowship.

A Respiratory Step-down Unit, under the leadership of one of the Pulmonary and Critical Care Faculty, Dr. David Trawick, opened in the fall of 1997. This 14-bed unit has the capability of caring for 8 ventilator-dependent patients. This Unit emphasizes approaches for weaning patients from mechanical ventilation and encompasses a multidisciplinary approach to patient care. A separate 20-bed unit for chronically ventilator-dependent patients is located a few miles from Strong Memorial Hospital.

A 17-bed Pediatric Intensive Care Unit at Strong Memorial Hospital has a wide variety of both medical and surgical patients. Trainees may elect to spend time in this Unit during their second and third years.

The Neonatology Division at Strong Memorial Hospital is responsible for a 52-bed Neonatal Intensive Care Unit, a tertiary referral center. This group works closely with us in areas of research that include surfactant replacement for acute lung injury, aerosolization of antiviral agents, and specialized techniques for ventilatory support such as high-frequency ventilation. Fellows acquire experience in handling infant ventilators during this rotation. Opportunities are available for elective time with this Division as well.

The Hematology Division manages a 12-bed Bone Marrow Transplant Unit. The Pulmonary/Critical Care Service frequently helps in the management of these immunocompromised patients with respect to infections, respiratory failure following transplant, and ventilator management.

Other Intensive Care Units

During their initial year, fellows usually spend two to three months at Highland Hospital, in the combined Medical/Surgical/Coronary Intensive Care Unit (14 beds) under the direction of Dr. Irene Perillo. This Unit permits added direct experience in pulmonary and critical care in a community hospital setting. This is an opportunity for gaining experience in the management of patients following thoracic surgery, extensive general surgery, and trauma.

Pulmonary Function Laboratory

Well-equipped pulmonary function laboratories are in operation at Strong Memorial and Highland Hospitals. During the rotation through the Pulmonary Consult Service, trainees learn theory, techniques, and maintenance of equipment including blood gas apparatus, computerized spirometry, diffusion testing, body plethysmography, assessment of control of ventilation, and exercise testing.

Mary Parkes Center for Asthma, Allergy and Pulmonary Care

The Mary M. Parkes Center for Asthma, Allergy and Pulmonary Care was established in 1995 by the Parkes family in honor of their daughter Mary, an intensive care nurse whose long battle with asthma ended with her death in 1991. Since its inception, the mission of the Center has been to promote diagnosis, treatment and research of acute asthma, allergies and other pulmonary diseases. The center has been supported generously by Walter Parkes, father of the Center’s namesake. His most recent donation has made it possible to double the size of the center, relocate it to a brand new facility, and expand the services offered by the Center. Current services include two full PFT labs, a skin testing lab, and facilities for other outpatient pulmonary procedures.

The Center is now affiliated with the University of Rochester Medical Center, combining the Medical Center’s pulmonary division with the services already offered by the Parkes’ program. Twenty adult and pediatric pulmonary and allergy clinicians and researchers will eventually work out of the Mary M. Parkes Center, caring for both adult and pediatric patients. Michael Finigan, M.D., who helped found the Center in 1995, and Mark Utell, M.D., who leads the Medical Center’s pulmonary division, serve as co-medical directors of the Center.

Strong Sleep Disorders Center

All fellows will have exposure to the evaluation of sleep disorders. The Strong Sleep Disorders Center is a 14 bed, state of the art, fully accreditted facility performing over 2500 sleep studies a year.  Dr. Donald Greenblatt is the medical director, and Dr. Joe Modrak is the associate director and the director of post graduate education at the sleep center.  All fellows spend a minimum of 2 weeks (longer if desired by the fellow) rotating at the Strong Sleep Disorders Center in both their 2nd and 3rd years of the fellowship, during which time they are exposed to all facets of sleep medicine.  The Strong Sleep Disorders Center is primarily a clinical facility, but also participates in a number of research projects.  These research projects include a study of a new medicine for treatment of narcolepsy as well as several studies looking at pediatric obstructive sleep apnea.

Procedure Rooms and Facilities

The Pulmonary Division has procedure rooms for performing video-assisted fiberoptic bronchoscopy at both Strong Memorial and Highland Hospitals. Bronchoscopic techniques generally include bronchoalveolar lavage, brush biopsies, transbronchial forceps biopsies, and Wang needle transbronchial biopsies of mediastinal lymph nodes. This equipment can be moved to the bedside or to the Radiology Department where fluoroscopy is available, if necessary, to monitor transbronchial biopsies. Fellows perform bronchoscopy under the direction of the Pulmonary and Critical Care staff physicians. Most fellows perform a minimum of 80 fiberoptic bronchoscopies during their initial year of fellowship training. Fellows also gain experience in other special procedures such as pleural biopsies, lung needle aspiration, Swan-Ganz catheterization, chest tube insertion, tracheal intubation, and brachy- therapy.

Related Subspecialty Services

The flexibility of the program permits fellows to arrange for elective rotations on Cardiology (including the catheterization laboratory), Infectious Diseases, Immunology and Allergy or other medical subspecialties. Also, rotations can be arranged with the Cardiothoracic Surgery Division, the Pediatric Pulmonology Division, the Cystic Fibrosis Service, Pediatric Allergy, and the Neonatology Division.