2016 BluePrint

BluePrint

Volume 7

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2016

BLUEPRINT.DUHS.DUK E.EDU FEATURE

Regional Anesthesiologists Play Crucial Role in Duke’s First Hand Transplant FACULT Y SPOTLIGHT

Preventing an Electrical Storm Dr. Arturo Suarez

The Demystification of Pain Driving the Discovery of Innovative Therapies

Duke Perioperative Medicine Fellowship in collaboration with University College London

Duke University Medical Center

Now accepting applications for this interdisciplinary, transatlantic fellowship in perioperative medicine!

University College London

Interested? Visit our website at TinyURL.com/DukePeriopFellow or email Dr. Tim Miller for details: timothy.miller2@duke.edu Now accepting applications for July 2018

BluePrint Contents

Volume 7

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2016

BLUEPRIN T.DUHS .DUK E.EDU

18 The Demystification of Pain

Driving the Discovery of Innovative Therapies Duke Anesthesiology offers promising solutions to a national health crisis with the openings of a new center for pain research and a new pain practice, all in effort to unravel the mysteries of chronic pain and improve patient care.

FEATURE

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Regional Anesthesiologists Play Crucial Role in Duke’s First Hand Transplant

Dr. Joshua Dooley and his team take us inside the operating room for an in-depth look at a 12-hour surgery where they and 17 surgeons gave a patient a new lease on life and made medical history at Duke.

2 Message From the Chair

Dr. Joseph Mathew

6 Highlights

Divisional News

Perioperative Enhancement Team (POET) • Preoperative Diabetes Management Education • ILE@D Joins SoM Curriculum • New Education Classes Rankings

Duke University School of Medicine • Dean Nancy Andrews Stepping Down

24 Duke DREAM Campaign

2016 DIG Recipients

30 Innovative Research FACULT Y SPOTLIGHT

22 Preventing an Electrical Storm

Dr. Arturo Suarez

A compelling bedside story of how Dr. Suarez helped a critically-ill patient face one of her biggest fears while he prepared for a surgery that has never before been documented.

The Morpheus Consortium

Viagra Drug May Relieve Edema in Swimmers

Polar Profiling

34 Global Health 38 Residency Recap 40 Alumni Notes 42 Departmental Listing 44 Career Corner

Appointments • Nominations • Promotions

46 Honor Society

Awards • Grants • Honors

BluePrint 2016

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BluePrint is published once a year by Duke Anesthesiology. This issue was published on September 19, 2016.

Your comments, ideas and letters are welcome.

View this issue and past issues online: BluePrint.DUHS.Duke.edu Please contact us at : Duke Anesthesiology BluePrint Magazine DUMC 3094 Durham, NC 27710 Tel: (919) 613-0469 E-mail: blueprint@duke.edu Editor in Chief Stacey Hilton Assistant Editor Leighanne Toole Lead Writer Stacey Hilton Contributing Writers Leighanne Toole Duke Anesthesiology Faculty & Staff Duke Health Marketing & Communications Duke University School of Medicine Art Director & Designer Leighanne Toole Contributing Photographers John “Jack” Newman Elizabeth Perez, RN, BSN Duke Anesthesiology Faculty & Staff Website Administrator Christopher Keith BluePrint Taskforce Members Solomon Aronson, MD, MBA, FACC, FCCP, FAHA, FASE Richard L. Boortz-Marx, MD Jennifer E. Dominguez, MD, MHS David B. MacLeod, MB, BS, FRCA Allison Kinder Ross, MD Kerri M. Wahl, MD, FRCP(C) Connect With Duke Anesthesiology: WEBSITE:

Anesthesiology.Duke.edu

FACEBOOK:

@DukeAnes

TWITTER:

@Duke_Anesthesia

LINKEDIN:

Duke-Anesthesiology

YOUTUBE:

Duke Anesthesiology

(Right; Dean’s Suite) Noted for his research in improving perioperative outcomes, particularly neurocognitive dysfunction, alterations in brain connectivity and occurrence of atrial fibrillation after cardiac surgery, and for his leadership in perioperative echocardiography.

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In this occasion of the launch of another BluePrint publication, I look to the days ahead of us with hope, determination and great excitement, for 2016 has been a year of significant expansion for Duke Anesthesiology. In January of this year, we launched the Center for Translational Pain Medicine with world-renowned pain researcher, Dr. Bill Maixner, at its helm. The Center further develops Duke’s existing clinical and research program in innovative pain therapies by bringing together, under one umbrella, leading basic scientists, clinicians and clinical researchers — a comprehensive team made up of about 40 faculty and researchers as well as five basic science labs. A novel component of the Center’s strategy is the multidisciplinary treatment of orofacial pain — the first such program at any anesthesiology department in the country.

In June of this year, we formally launched the Morpheus Consortium, a joint effort between Duke University School of Medicine and University College London. The mixing of talent and leadership from two very innovative institutions will undoubtedly transform patient care, research and education. I am grateful to Professor Monty Mythen (Duke alumnus) and his colleagues for their partnership in this shared vision of “changing the face of anesthesiology.” The first formal venture under this brand is the new Duke Perioperative Medicine Fellowship, which begins July of 2017. In August, Dr. Padma Gulur joined Duke Anesthesiology as the Vice Chair for Performance and Operations and will be focused on developing and implementing a plan to integrate the delivery of pain management services across Duke Health. Finally, Dr. Paul Wischmeyer will be joining the Department in November. Dr. Wischmeyer is the nation’s leading investigator in nutrition for the critically ill and will be developing a clinical nutrition service in partnership with Duke Surgery.

He will also serve as the Director of Perioperative Research at the Duke Clinical Research Institute.

Ongoing efforts to improve the perioperative care of our patients have included the Preoperative Diabetes Management Program as part of the POET initiative and the transformation of the pre-admission testing clinic to a perioperative optimization center.

In this edition of

BluePrint you will read more about the first hand transplant in North Carolina, performed at Duke with a significant contribution from our Regional anesthesiologists. Other highlights in the clinical arena include the expansion of critical care delivery in the SICU and Duke Regional Hospital; institution of the Responsible Drug Use and Cost Effective Strategy that has already produced more than $800,000 in savings; development of two new peripheral block techniques (RAPTIR, SIFI); enhanced service delivery for mechanical thrombectomy in stroke patients; demonstration of cost savings with the first population health-based outpatient pain program at Duke; development of a protocol for the “gentle cesarean;” participation in the national pediatric Wake Up Safe quality improvement initiative; and development of a Point of Care Ultrasound Curriculum. Finally, I am thrilled to welcome Adam Flowe as our new Chief CRNA. He has already proven to be a great leader and partner with us.

From an educational perspective, Ashley Grantham joined us as medical education specialist with the goal of improving educational content and assisting in the redesign of curricula. New rotations this year include a MS4 rotation in the CTICU under the leadership of Dr. Quintin Quinones, and a Regional Anesthesiology fellowship exchange program in Belgium, under the leadership of Dr. Jeff Gadsden. Dr. Ankeet Udani was also awarded a grant to study the effectiveness of classroom-based experiential learning versus electronic-based self-directed learning. Once again, Dr. Nancy Knudsen was recognized for her teaching excellence as this year’s distinguished speaker at the Duke University School of Medicine graduation.

There is no doubt that the landscape of healthcare is rapidly changing, but I note that Helen Keller once said, “Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing. To keep our faces toward change and behave like free spirits in the presence of fate is strength undefeatable.” While change is rampant, I am excited by the many accomplishments and new opportunities that have been created and led by the incredible faculty, staff, trainees, friends and alumni that comprise Duke Anesthesiology. We are successful because you have kept your faces toward change and have had an unceasing commitment to excellence. It is to you that I give thanks and raise my glass in celebration.

Sincerely,

Joseph P. Mathew, MD, MHSc, MBA Jerry Reves, MD, Professor of Anesthesiology and Chairman, Department of Anesthesiology

Photo Courtesy of Duke University Photography

Message From the Chair

A Tradition of Excellence DUK E A NE S T HE SI OLO G Y A LUMNI A S S O CI AT I ON At Duke, we believe that continued engagement with our alumni is the key to our future success. We take great pride in these talented men and women who play an integral role in strengthening our department and making it an ideal environment in which future generations of trainees can learn, work and achieve excellence.

• Register or update your profile in our Alumni Database to receive special offers, our annual BluePrint publication by mail, and invitations to exclusive department events

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• Consider continuing your legacy with a donation to the Duke DREAM Campaign and have your name featured on our website’s Donor Honor Roll

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As a graduate of Duke Anesthesiology, you are automatically enrolled as a member of the Duke Anesthesiology Alumni Association! Help us grow our department’s alumni outreach by staying connected to your peers, fellow alumni and faculty.

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I AT

Regional Anesthesiologists Play Crucial Role in Duke’s First Hand Transplant

By Stacey Hilton

Nearly 50 years after a meat-grinding accident, a Texas man received a new left hand during a 12-hour surgery at Duke University Hospital that made medical history.

On May 27, a team of five anesthesiologists and 17 surgeons performed the first hand transplant in North Carolina.

“It was a good day,” says Dr. Joshua Dooley, the lead anesthesiologist on the case who spent nearly six months working with the surgeons to develop an optimal anesthesia protocol for the patient. “Our team of anesthesiologists played a critical role in this transplant. It was our job to keep the patient asleep under general anesthesia, keep him alive during the surgery, give him the proper blood products, and ensure that he had optimal pain control when he woke up.”

The anesthetic team also controlled the patient’s vital signs for those 12 hours, giving surgeons the best possible opera­tive field during the microsurgery, an intri­cate process of connecting bones, blood vessels, muscles, nerves, tendons and skin.

A crucial component of this transplant was Dr. Dooley’s ability to perform a regional nerve block on the patient using a peripheral nerve catheter, a specialized procedure used by Duke Anesthesiology’s Orthopaedics, Plastics and Regional Anesthesiology Division that is only available at a small percentage of hospitals across the country. He used ultrasound to place a nerve catheter near the nerves that are responsible for pain and movement of the arm.

Local anesthetic was then deposited around those nerves which increased blood flow and provided proper pain control that would last for days after the surgery to avoid heavy reliance on narcotics.

Dr. Linda Cendales changing dressings on Rene Chavez’s new hand after his “It was extremely important to highly complex, 12-hour surgery was performed on May 27. He is one of less get the placement of that nerve than 90 people worldwide to undergo a hand transplant.

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catheter in ex­actly the right spot without injuring any large blood vessels or his lung, which could have possibly canceled the case,” says Dr. Dooley. Given the high complexity of this surgery that’s only offered at nine other hospitals in the nation, Dr. Dooley knew it was crucial to choose anesthesiologists who possessed the skill set necessary for this life-altering procedure to care for the patient. Two of those anesthesiologists are Dr. Michael Bullock and Dr. Michael Shaughnessy, both of whom received their fellowship training in regional/ ambulatory anesthesiology at Duke.

“Even though the public may see it as ‘just a hand,’ it’s actually a pretty vital structure that has the potential for catastrophe if not handled correctly,” says Dr. Bullock. “From our perspective, we knew everything had to go perfectly to ensure success,” adds Dr. Shaughnessy who took the handover report from Dr. Dooley early that Friday morning and managed the patient’s anesthetic for the next eight hours during retrieval of the donor limb and the early phase of connecting the blood vessels and the tissues.

“That was when we saw the most significant amount of bleeding,” says Dr. Shaughnessy. “The biggest challenge was managing the blood loss. We had to be careful not to over transfuse or under transfuse.”

“We know with patients like this, there will be a fair amount of blood loss that

Photos Courtesy of Duke Health

Feature

REGIONAL ANESTHESIOLOGISTS PL AY CRUCIAL ROLE IN DUKE’S FIRST HAND TR ANSPL ANT

Feature

(Opposite page, left to right) Drs. Michael Bullock, Michael Shaughnessy, and Joshua Dooley

Critical Anesthesia Management: à Multidisciplinary team rehearsals à Expertly performed ultrasound guided

nerve catheter

à Large bore vascular access, including Photos Courtesy of Duke Health

arterial and central venous catheters

à Manage large volume blood loss and

multiple exchange transfusion

à Prevention of complications related to

prolonged surgery

(Left) Dr. Joshua Dooley performs a regional nerve block on the patient, Rene Chavez, before his hand transplant at Duke University Hospital.

can catch people off guard if they’re not ready for it,” adds Dr. Dooley. Tackling that challenge, they inserted a large central line and utilized a rapid infusion device which allowed his team to quickly transfuse large amounts of blood products to the patient.

“Once we had the arm and connected the arteries, we didn’t attach the veins right away, so you can imagine the blood went into the hand and out onto the operating field, but not into his body. We were prepared for the patient to lose blood quite rapidly for a period of time.”

According to Dr. Bullock, heart and lung transplant patients can actually lose less blood than patients undergoing a hand transplant. “It’s surprising how much blood these patients can lose and how much we needed to be involved in the management of this type of a transplant.” The patient lost nearly two blood volumes, which the anesthesia team replaced by using some of the latest transfusion protocols and had additional support from the blood bank, anesthesia technicians and nurses. “It was a very rewarding process to be part of.

We had a plan in place to make sure there were always fresh eyes on the patient,” adds Dr. Shaughnessy.

Another obstacle in the operating room that the team of anesthesiologists had to overcome was the fact that their patient was lying down in a fixed position for a long period of time. “When we took on this case, we were prepared for the possibility that it could go on for longer than 12 hours,” says Dr. Shaughnessy. “We took extra steps to prevent position-related injuries. These complications during a short operation could be minor, but this case was differ-

ent.” Those steps included positioning the tracheal tube so it was not pressing on the patient’s lips and padding the patient, all to avoid pressure injuries.

Dr. Bullock relieved Dr. Shaughnessy for the final four hours of the surgery in which he ensured that the patient was stable, adequately fluid resuscitated, and that his blood levels returned to normal so they could profuse the limb and transport him to the Inten­sive Care Unit. “A hand transplant is known to be quite a painful procedure. Without our specialized techniques in regional anesthesia, the patient probably would have had a worse postoperative outcome and he definitely would have had more pain,” notes Dr. Bullock.

“As big of a case as this appears from an outside point of view, for us, it wasn’t that much different than what we do every day in this division,” adds Dr. Dooley. “Nearly every one of our joint replacements gets an ultrasound-guided nerve block. Duke is at the forefront of clinical application of current research. We’re also well in tune with our surgeons, how they work, and what is going to happen in the operating room. This is why we’re one of the few hospitals the Department of Defense has chosen to care for these types of cases.”

“The pressure that might be felt in working on a landmark case like this didn’t consume us,” says Dr. Shaughnessy, “because once we’re in that setting, we go into a mode of providing the patient with optimal, evidence-based care.”

According to Duke Surgery, only 150 people throughout the world have had a hand transplant. Dr. Bullock says this procedure is so rare because it’s difficult to

find a patient that is appropriate for a hand transplant due to a variety of issues, such as tissue cross-matching and even psychological factors. “Having Dr. Linda Cendales and her surgical team, along with a great group of regional anesthesiologists, finally put the framework into place for us to be able to do this transplant. I think logistically it just wasn’t possible before now because all of the pieces weren’t readily available.”

“This transplant was a huge milestone for us. You have to have your first, and with this patient, we have climbed over that mountain,” says Dr. Dooley, who is already looking ahead to the future, fine-tuning the anesthesia protocol for future hand transplantations at Duke. According to Duke Surgery, this transplant marks the inauguration of a clinical trial that will determine the safety and efficacy of hand transplantation, as well as the efficacy of a new anti-rejection drug, belatacept. “Our first hand transplant exemplifies how key components of academic science are codependent and how success in one, augments opportunity for success in another,” says Dr. Linda Cendales, the hand transplant surgeon who led the procedure. “We came together across departments and disciplines to accomplish something few have done before, and we opened new possibilities to our population in need. We can all be proud of that.” n

This case is helping to launch Duke’s hand transplantation program, funded by the U.S. Dept. of Defense, in hopes of providing functional limbs to injured servicemen/women and civilians.

BluePrint 2016

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Highlights

DIVISIONAL NEWS

AMBUL ATORY ANESTHESIA

Duke Fellows Visit Belgium for Observership In early May, three Duke Ambulatory and Regional Anesthesia fellows visited Belgium for a week-long observership as part of the newly established fellowship exchange program with the New York School of Regional Anesthesia-Center for Research Education and Enhanced Recovery (NYSORA-CREER). Drs. Evan Sutton, Irfan Samee, and Siddharth Sata had the opportunity to visit three different sites during the trip, where they engaged in an exchange of ideas with other anesthesiologists, residents and fellows. They also observed a variety of peripheral, neuraxial and ultrasound-guided regional

nerve blocks and discussed challenging cases and ongoing research. The institutions they visited included: Ziekenhuis Oost-Limburg (ZOL) Hospital During a research protocol “writing bootcamp,” the fel(Left to Right) Drs. Evan Sutton, Irfan Samee, Admir Hadzic, and Siddharth Sata. lows brainstormed ideas for a regional technique for analgesia after an- KU Leuven University Hospital terior total hip arthroplasty surgery. They One of Europe’s largest and oldest hospidrafted a protocol to study the efficacy of tals, the fellows were given a full tour by a suprainguinal fascia iliaca block for antetheir host, Dr. Steven Coppens. rior total hip arthroplasty, in collaboration with Dr. Admir Hadzic (NYSORA-CREER UZ Leuven Pellenberg fellowship director), Dr. Catherine VandeThis off-site, fast-paced orthopaedic surpitte and the ZOL fellows. The ZOL team is gery center is located about six miles east planning to implement this study at their of KU Leuven University Hospital in the institution with the potential of creating a scenic Belgian countryside. n multicenter study involving Duke.

BASIC SCIENCES

Dr. Jordt’s Research Featured at NIEHS Science Days Sven-Eric Jordt, PhD, director of the Chemical Sensing, Pain and Inflammation Research Laboratory, gave an invited presentation at the National Institute of Sven-Eric Jordt, PhD Environmental Health Sciences’ (NIEHS) annual event showcasing outstanding extra and intramural research funded by the National Institutes of Health (NIH) located in Research Triangle Park. Dr. Jordt’s research on mechanisms of chemical sensing and pain, mediated by transient receptor potential ion channels, has received generous support and awards by NIEHS, including the Outstanding New Environmental Scientist Award and the Presidential Early Career Award for Scientists and Engineers. Dr. Jordt’s research is also featured in NIEHS’ newsletter, the Environmental Factor: tinyurl.com/JordtNIEHS. Attendees of the 2015 NIEHS Science Days 6

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DUKE ANESTHESIOLOGY

A Perfect Score!

Led by program director, Dr. David Warner, the Integrated Training in Anesthesiology Research Program (NIH T32 GM08600) is designed to provide junior investigators with research training devoted to improving care of the anesthetized or critically ill patient, ultimately advancing scientific knowledge in the field. This past year, Duke Anesthesiology scored a perfect 10 out of 10 rating by the National Institutes of Health! The program is the cornerstone of our departmental research training endeavor setting high standards for investigative training offered to medical students, residents, junior faculty, and visiting scholars who participate in the research training process. n

discussed connections between inflammation and disease, sharing insights suggesting that inflammation could be a crucial component in the development of human diseas-

DIG Winner Published in Anesthesiology One of our 2016 Dream Innovation Grant winners, Dr. Niccolò Terrando, was published in the official journal of the American Niccolò Terrando, PhD Society of Anesthesiologists for his abstract, “Neural Control of Inflammation: Implications for Perioperative and Critical Care.” Learn how these new insights might spawn novel therapeutic strategies for the treatment of inflammatory diseases in the context of perioperative and critical care medicine. n Read More: TinyURL.com/Terrando

es. NIEHS is the only NIH institute located outside of the Bethesda, Maryland campus and has established many collaborations with local institutions, including Duke. n

CARDIOTHORACIC ANESTHESIA

Giving Blood a Boost

patients receive blood transfusions on a monthly basis. But, says Dr. Ian Welsby, Duke/UNC team uses pilot funding to a cardiac anesthesiologist and intensivist at Duke, and Dr. Jay Raval, a patholoexplore whether ‘rejuvenated’ blood gist and transfusion medicine expert at can reduce transfusion frequency UNC, the red blood cells in stored blood for people with sickle cell disease become exhausted over time in ways that might limit their lifespan. Now, with DUKE TR ANSL ATIONAL MEDICINE INS TITUTE funding support from the Clinical and Duke’s Dr. Ian Welsby (left) talking over coffee with UNC’s Dr. Jay Raval (right).

Translational Science Awards (CTSAs) In healthy people, donut-shaped red cells in at Duke and UNC, Welsby and Raval are repurpose this FDA-approved process, but the bloodstream carry oxygen and deliver teaming up to explore whether an FDA-ap- nobody is using it for this.” it to all of the body’s tissues. But in people proved method for rejuvenating the red Pretreating blood prior to transfusion with the inherited condition known as sick- blood cells in banked blood might help to adds an additional layer of complexity, but, le cell disease, red cells stiffen and take on extend the time between transfusions for he says, “if patients benefit, it’s worth the a sickled appearance. Those inflexible cells patients with sickle cell disease. extra step. Rejuvenated blood may be a can stick to each other and to blood vessel “I’m not sure why nobody’s thought better product.” n walls, causing blockages that interfere with about this before,” Welsby says. “Perhaps oxygen delivery and lead to sudden crises. we have a unique perspective as an ICU Read the Full DTMI Article Online: To improve blood flow and prevent doctor and a blood banker who also mandtmi.duke.edu/news/giving-blood-boost dangerous complications, many sickle cell ages sickle cell disease. It makes sense to

GENER AL, VASCUL AR, AND TR ANSPL ANT ANESTHESIA

You Can’t Achieve What You Don’t Start

BY ANKEET D. UDANI, MD, MSED

“You can’t achieve what you don’t start” — I often utter this phrase to myself and students I teach.

I consider myself fortunate to have found my academic, educaAnkeet D. Udani, MD, MSEd tional, and clinical interests in anesthesiology. But fortune is only part of the story. Mentorship, motivation, and mobilization continue to be primarily responsible for my career development.

Mentorship My mentors have certain things in common. First, they were all mentored well themselves. Each has rich past experiences, and they share similar personalities with me. My mentors keep me in mind when projects come around that match my interests. They try to get me to experiment with new projects as well—outside my comfort zone. This is how I first made the

jump from simulation-based education in operating room anesthesiology to regional anesthesiology training. It was my mentors who saw my contributions to regional anesthesia training and nominated me for ASRA Resident of the Year in 2013. And, finally, my mentors always make time to meet with me, formally and informally. For all of these reasons, I am very grateful.

Motivation Staying motivated means mastering certain skills and always looking for the next. My motivation first came from imitating my mentors and learning from them. Now it comes from an urge to best understand how we learn in medicine. It really is an urge — I have a strong desire to discover ways to effectively train anesthesiologists to be better than we ever have. Although there are a lot of us working on this goal, there is plenty of completed work to build upon. New discoveries add to our understanding and create even more opportunities for implementation and research.

“Staying motivated allows me to persevere through the steps in my career that are difficult and keeps me moving forward.”

Mobilizing Resources I have gravitated toward departments, institutions and organizations that have resources to support my goals. I was able to mobilize many of these resources with guidance from my mentors and persistence.

The work I put into mobilizing was always rewarded 10-fold. For example, both Stanford and Duke had programs to support me pursuing a master’s degree in education.

The degree strengthened my fund of knowledge and allowed me to design and complete a funded study of deliberate practice in regional anesthesia training.

Mentorship, motivation, and mobilization — 3 Ms that are responsible for my career development. ASRA has played a large part in supporting my educational endeavors, including research, which started by winning the Resident of the Year Award. I stayed motivated and now serve as faculty at ASRA’s annual meeting. I am thankful for the award and trajectory it helped set for me. I have no doubt the award and supportive nature of ASRA will continue to develop bright minds in the future. n

Originally Featured on the ASRA Blog BluePrint 2016

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Photo Courtesy of the Duke Translational Medicine Institute

Highlights

DIVISIONAL NEWS

Highlights

DIVISIONAL NEWS

PAIN MEDICINE

NEUROANESTHESIOLOGY

Pre-surgical Spine Optimization Program Gains Momentum

psychologic preparation and telehealth for surgery in higher-risk patients.

“The ultimate goal is to improve patient outcomes,” notes Dr. Thomas Buchheit, Duke Anesthesiology’s chief of the Division of Pain Medicine. He completed an initial In effort to establish Duke as an internapilot program last year and determined tional leader for defining and measuring that there was a clear, clinical need for an the steps for optimal care of pain and spine expanded and comprehensive program. patients, Duke Anesthesiology is collaborat- Anesthesiologist, Dr. Neil Ray, and orthoing with Duke Orthopaedic Surgery on an paedic spine surgeon, Dr. Sergio Mendoza innovative program for pre-surgical spine Lattes, have also been at the helm since optimization. The Spine Program Optimizaits inception. tion for Risk Cohorts combines medical inCurrently finalizing processes, the protervention, physical therapy prehabilitation, gram will start its phase two intervention in November of 2016 as a Perioperative Enhancement Team (POET) initiative. Additionally, there will be close measurements of outcomes, a critical step in the delivery of outcomes-based, cost conscious care within Duke Thomas E. Buchheit, MD Neil D. Ray, MD Sergio Mendoza Lattes, MD Anesthesiology. n

PEDIATRIC ANESTHESIA

Pediatric Medical Mission in the Philippines With a population of nearly 102 million and a birth rate of 24 per 1,000, congenital heart disease (CHD) is a significant health concern in the Philippines. Annually, 20,000 children with CHD are born in the Philippines and one out of four of those patients dies due to lack of medical treatment. According to the World Health Organization, CHD is currently the fourth leading cause of death in Filipino children under the age of five.

A multidisciplinary team from Duke University Health System (DUHS), led by Dr. Andrew Lodge, returned to the Philippine Children’s Medical Center (PCMC) on April 18 for their fifth cardiac surgery mission.

During their trip, the team successfully completed ten open heart operations on children with a variety of congenital heart defects. Duke Anesthesiology’s Dr. Kelly Machovec and Emily Funk, CRNA, partici8

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Dr. Kelly Machovec (left) and CRNA Emily Funk (right) assisted with ten successful open heart surgeries for Filipino children.

pated in the provision of anesthetic care for the children. Diagnoses treated on this surgical mission included total anomalous pulmonary venous connection, ventricular septal defects, atrial septal defects, patent ductus arteriosus, tetralogy of fallot, and A-V septal defect. n

Tackling Intracerebral Haemorrhage With Gender Hormones Clinician-researcher, Dr. Michael “Luke” James, has been studying two specific factors that may impact recovery Michael L. “Luke” James, after patients suffer MD, FAHA an intracerebral hemorrhage (ICH): sex and gonadal hormones. His groundbreaking research was featured in the August 2015 issue of International Innovation, a magazine that covers innovative research projects worldwide in new and exciting ways.

In the interview, Dr. James reveals that by unveiling the sex differences in ICH outcomes, this may contribute to a wider clinical and research area.

According to the magazine, ICH is the only stroke subtype with no effective treatment. Stroke is currently the fifth leading cause of death in the U.S. and ICH accounts for 50 percent of all stroke mortalities. With hardly any research on the effects of sex differences on ICH outcome and the extent to which demographic factors interact with each other, Dr. James’ findings may one day guide the development of novel, patient-tailored therapies for ICH. n View the Full Magazine Article: TinyURL.com/JamesInnovation

Wake Up Safe National Quality Improvement Initiative

Duke Anesthesiology is now part of a national collaboration among more than 30 children’s hospitals to make pediatric anesthesia safer than ever before by sharing and analyzing adverse events in the pediatric population. As members of the Society for Pediatric Anesthesia, and with the leadership of Dr. Nathaniel Greene, our department has access to additional resources to improve the care of children.

Highlights

DIVISIONAL NEWS

REGIONAL ANESTHESIOLOGY

Regional Anesthesia Division Takes ASRA 2016 by Storm Duke Anesthesiology’s Orthopaedics, Plastics and Regional Anesthesiology Division was well-represented at the 41st Annual American Society of Regional Anesthesia and Pain Medicine Meeting (ASRA) in New Orleans as 14 members of its team presented 11 abstracts, hosted two lectures and led four hands-on workshops.

“We’re systematically looking at a variety of outcomes with a view to how we can improve patient postoperative recovery and their experiences at hospitals,” says Dr. Jeff Gadsden. “This division at Duke continues to be a leader in the specialty through innovative technology and our approach to expanding the field, and I hope that conference delegates came away with an impression of ‘Duke Regional’ as a trail-blazer.”

Dr. Gadsden and six of his colleagues co-presented an abstract, titled “Anesthetic Technique and Hypotension During Hip Fracture Repair: A Retrospective Study of 2,916 Patients,” which studied different

CRITICAL CARE MEDICINE

types of anesthetics used for hip fracture surgery, a very common operation. Their findings revealed an association between general anesthesia and the incidence of hypotension during surgery.

Overall, the introduction of regional anesthesia is one of the most impactful advancements for the entire specialty. Duke Anesthesiology was among the first anesthesiology departments in the nation to adopt regional anesthesia techniques such as continuous perineural catheters and ambulatory pain pumps. A new focus within this division is America’s opioid epidemic and how regional anesthesia physicians are making a difference in the lives of patients.

“Tens of thousands of surgical patients at high risk for opioid-related adverse events receive prescriptions for opioids both in hospitals and at home, many of which are

completely unnecessary given our ability to eliminate postoperative pain with targeted, long-lasting nerve blocks. If I can get a patient through their entire perioperative stay with an advanced regional technique as their primary pain modality, that has potential for huge improvements in outcomes,” says Dr. Gadsden. “We are proving here at Duke to be one of the leaders in perioperative and acute pain medicine by demonstrating these benefits. If I were looking ahead in the next five years for what would be the next best thing, I wouldn’t be surprised if it came from Duke.” n

VETER ANS AFFAIRS ANESTHESIOLOGY SERVICE

Chief Appointed to Newly Created Division On September 1, 2015, the department launched the Division of Critical Care Medicine with Dr. Raquel R. Bartz at its helm.

Since stepping into her new role as chief, Raquel R. Bartz, MD, MMCi Dr. Bartz has continued to recruit academically and clinically gifted trainees and faculty, furthering the department’s legacy of providing excellent care to patients and producing critical care leaders of the future. By engaging with Duke Health leadership, she’s helping to identify opportunities to improve patient care and hopes that this new division will become a leader in the discovery of knowledge in perioperative critical illness. n

(Left to Right) Drs. Stephen Parrillo, Jeff Gadsden, Stuart Grant, Alicia Warlick, Brian Ohlendorf, Gavin Martin (division chief), Michael Shaughnessy, Ellen Flanagan, Joshua Dooley, Jennifer Fortney, Erin Manning, and Andrea Udani. Not Pictured: David MacLeod.

Cardiac Care in Cuba Not many people can say they’ve been to Cuba, let alone been on a mission trip to the foreign nation, except for Duke Anesthesiology’s Dr. Atilio Barbeito. He accompanied an incredibly talented and resilient health care team to Havana, Cuba, and helped to establish the first-ever sustainable program between American and Cuban cardiovascular specialists, according to Dr. Robert M. Jarrett, president of Hearts Around the World, Inc. In January of 2016, the travel restrictions to Cuba for U.S. non-profit humanitarian

organizations were lifted, which allowed this organization to move forward with establishing a cardiovascular exchange program with the Institute of Cardiology and Cardiovascular Surgery in Havana.

Cuban citizens are in desperate need of cardiovascular care. In a joint effort with Cuban physicians, perfusionists and nurses at the institute, Dr. Barbeito took part in several complex cardiac surgical procedures, rounded in the ICU, evaluated dozens of patients with cardiovascular disease, and performed several procedures for cardiac arrhythmias. “More importantly,” Dr. Barbeito noted, “we began a relationship of trust and mutual respect among the Cuban-American teams.”

When asked whether the trip was a success, “I think so,” Dr. Barbeito responded. “We completed the first mission trip to Cuba, and all cases had good outcomes. We forged a great relationship with the local team and have ambitious plans for the future.” n BluePrint 2016

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9

Highlights WOMEN’S ANESTHESIA

“Gentle C” Enhances Birthing Experience In effort to provide a more intimate birthing experience for women having a cesarean section, Duke Anesthesiology’s Women’s Anesthesia Division Jennifer E. Dominguez, launched a new initiaMD, MHS tive at Duke University Hospital at the beginning of this year called the “Gentle C.” Dr. Jennifer Dominguez says they wanted their patients undergoing C-sections to feel the same sense of intimacy during their delivery, and closeness with their birth partner and newborn baby, as women having vaginal deliveries. “The goal in developing this initiative was to provide both a sterile, surgical environment in which we can properly monitor the hemodynamics of the mother (such as heart rate, blood pressure and oxygenation) and maintain her safety while facilitating a warm, personalized birthing experience for mothers and their families.”

Three highlights of this new patient-centered approach include: Bringing birth partners into the operating room as soon as possible during the C-section, well before the birth of the baby; Allowing patients to listen to the music of their choice during delivery to de-sterilize the operating environment; and Implementing the use of both an opaque drape to maintain a barrier during the surgical procedure and a new, clear drape that remains in place during delivery which allows women to actually watch their baby come out of their uterus before being placed directly onto their abdomen for immediate skin-to-skin bonding time.

This division helps deliver more than 3,000 babies each year at Duke University Hospital. n 10

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DUKE ANESTHESIOLOGY

DIVISIONAL NEWS

COMMUNIT Y DIVISION

By the Numbers 10,341

9,094

Duke Regional Hospital

North Carolina Specialty Hospital

Davis Ambulatory Surgical Center

Mebane Surgery Center

4,967

2,874

34,579 TOTAL CASES Performed by Community Division Physician Anesthesiologists & CRNAs

4,500

Triangle Implant Center Triangle Orthopaedics Surgery Center 2,256 Duke Fertility Center 280 Michael Law MD Aesthetic Plastic Surgery 267

Annual Conference Positions Duke Anesthesiology as Premiere Education Destination For the first time in 18 years, Duke Anesthesiology brought its annual conference back home. The three-day conference, “Controversies in Madhav Swaminathan, Perioperative MediMD, FASE, FAHA cine,” kicked-off on September 9 at the prestigious Washington Duke Inn & Golf Club in Durham. In a one-on-one interview with one of the program directors, Dr. Madhav Swaminathan, he highlighted the four new changes at this year’s conference.

care professionals (HCPs), need to be more engaged in order to offer more meaningful care.

Anesthesia providers are very well equipped to lead POM. Why is it important to discuss issues surrounding the management of patients undergoing surgery?

We’ve been practicing in silos for years.

When we start thinking of ourselves as leaders in POM, I think it’s important that we bring practitioners of various disciplines together to discuss all of these issues, which ultimately helps everyone understand their role in the context of the field.

How did the conference first come about and how has it evolved?

Dr. Mark Newman, former department Why is perioperative medicine chairman and current president of Duke’s significant in today’s health care?

Private Diagnostic Clinic, had a vision to Perioperative medicine (POM) encompass- establish Duke Anesthesiology as a prees the whole continuum of the surgical exmiere education destination, featuring perience, taking care of a patient’s disease providers of quality education in the field process from start to finish. We, as health of anesthesiology. In 1998, the focus was on cardiothoracic anesthesia and transesophageal echocardiography (TEE), a niche field at the time. The conference focus evolved over the years into a perioperative brand, consistent with the changing pattern of perioperative health care in today’s medicine. The conference is more inclusive of other subspecialties, but still This year’s three-day conference drew in more than 120 attendees from all over retains the essential principle the United States as well as 20 industry sponsors. 39 faculty presenters from of being recognized as a high Duke, University College London and The Ohio State University took part in 33 highly-engaging lectures and debates, six panel discussions, and two workshops. quality educational experience.

PERIOPER ATIVE ENHANCEMENT TEAM (POET )

Highlights

What set this year apart from past Duke Anesthesiology conferences?

First, this year was multidisciplinary and appealed to a variety of HCPs, including anyone involved in the perioperative care of patients. Second, it took place in the fall and in Durham, NC – back “home” for the first time in 18 years. The timing changed, the content changed, the focus changed, and the location changed, but Dr. Newman’s underlying vision remained the same.

How is this conference different than other CME conferences focused on POM? Over the course of three days, we brought together experts in their field to discuss important controversies in a more entertaining fashion via lectures, panel discussions, lively debates and hands-on practical workshops. As opposed to simply discussing topics, these debates emphasized the fact that POM is not as cut and dry or black and white as it may seem.

What are the main take-aways this year?

First, HCPs heard expert opinions on a variety of controversial topics, such as safe opioid prescribing practices, a hot topic given the current opioid epidemic in America. Second, they were exposed to a breadth of issues ranging from transfusion medicine as well as pain, hemodynamic and critical care management. Third, for a more hands-on experience, this meeting featured a simulation session on emergency management. It also featured social events that allow valuable face time with other attendees, faculty and vendors in a relaxed atmosphere. Finally, the conference is now taking place in the “City of Medicine” (Durham, NC), a health care leader in the United States.

How do you hope participants will use the information they learned?

After listening to all of the excellent topics and debates from this year’s conference, I’m hoping that participants will be able to incorporate some of the newfound knowledge into their own practices and will use some guidelines to improve the management of patients in the perioperative period. They’ll also hopefully better understand the roles played by other providers in associated fields. The awareness of these different perioperative practitioners is invaluable and I hope it will lead to improved communication as well. n

The new Preoperative Diabetes Management Program is a collaborative effort between anesthesiologists, surgeons, endocrinologists and internal medicine with one common goal – improving glucose control before surgery to enhance the outcomes of Duke spine patients.

Duke’s POET Targets Spine Patients with a Unique Launch Diabetes is the seventh leading cause of death in this nation and often predicts poor postsurgical outcomes. On April 7, Duke Anesthesiology’s Perioperative Enhancement Team (POET) launched the Preoperative Diabetes Management Program and expanded the Preoperative Anemia Clinic for patients seen in the Duke Spine Center. It’s a collaborative effort between anesthesiologists, surgeons, endocrinologists and internal medicine with one common goal – improving glucose control before surgery to enhance the outcomes of Duke spine patients.

“This group of patients is of particular interest because when glucose is not controlled there is an increased risk for postoperative infection,” says anesthesiologist, Dr. Erin Manning. “These patients typically have substantial incisions and hardware placed inside their bodies which put them at higher risk of infections to begin with; combine that with poor glucose control and they don’t always heal well.”

There are multiple steps in the new program to identify patients who are at risk of poor glycemic control: once a patient is determined to be a surgical candidate, a nurse will review their chart to check for diabetes and A1C levels. If their most recent A1C test is over 7.5, they are referred to a preoperative diabetes clinic with the expectation that they would go

into surgery with a less likely chance of having an adverse outcome, including infection and poor wound healing.

Endocrinologist, Dr. Tracy Setji, helped develop protocol for both the screening criteria (A1C levels – the marker for glycemic control) and the identification of highrisk patients, and worked with POET to develop both the inpatient and outpatient protocols. She says the protocol within this new program is also designed to capture the large number of patients with undiagnosed diabetes, which is just over eight million people, according to the Centers for Disease Control and Prevention.

“We’re often called in after surgery, when patients’ blood sugars are high and they want to be discharged, or when they come back with an infection,” adds endocrinologist, Dr. Susan Spratt, who built the order set that providers and the health system’s nursing staff use to tee-up orders to access glucose control and refer patients to Duke’s endocrinology clinic.

“We are thrilled that we can be proactive in this endeavor instead of reactive.”

This program extends beyond spine patients with diabetes to the Duke Preoperative Anemia Clinic. Because there can be significant blood loss in the larger spine surgeries, the goal of the “anemia arm” is to have patients optimized regarding hemoglobin levels with the expected outcome of giving them fewer blood transfusions in the OR and after surgery. n

Read the Full Article Online: TinyURL.com/DukeSpine BluePrint 2016

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Highlights

DEPARTMENT STATISTICS

Duke Anesthesiology by the Numbers CA SES

122,518 TOTAL CASES

Billed July 1, 2015 – June 30, 2016 (FY 2016)

34,579

22,804

Community Division

11,569

Pain Medicine (Clinic Visits and Cases)

General, Vascular & Transplant Anesthesia

VA Anesthesiology Women’s Anesthesia Service 6,083

11,125

8,138

9,558

Orthopaedics, Plastics, and Regional Anesthesiology

7,194

Pediatric Anesthesia

Cardiothoracic Ambulatory Anesthesia Anesthesia 5,828 Neuro-anesthesiology 5,640

PUBLICATIONS

315

Published July 1, 2015 – June 30, 2016 (FY 2016)

164

Other

PUBLICATIONS 48

23

20

14

Cardiothoracic Anesthesia

Basic Sciences

General, Vascular, Transplant Anesthesia

13

Pain Medicine

VA Anes.

Service

11

9

7

10

Neuroanesthesiology

7

Regional Pediatric Anesthesiology Anesthesia

Ambulatory Anesthesia 2

AUTHORS GR ANTS

Grants Within July 1, 2015 – June 30, 2016 (FY 2016)

NEW GRANTS TOTALING MORE THAN

105

48

CURRENT OPEN GRANTS

18

Women’s Anesthesia

$6.3MILLION

Center for Translational Pain Medicine $134,043 Pain Medicine $25,000 VA Anes.

Service $567,480

12

7

6

6

6

Basic Sciences $1,579,882

Cardiothoracic Anesthesia $1,104,205

Neuroanesthesiology $450,347

Pediatric Anesthesia $525,306

Regional General, Vascular, Women’s Anesthesiology Transplant Anes. Anesthesia $969,278 $396,584 $618,732

4

3

2

1 1

NON-COMPETING CONTINUING GRANTS TOTALING MORE THAN

$2.9MILLION

RESEARCH L ABOR ATORIES

9 RESEARCH L ABOR ATORIES 12

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Chemical Sensing, Pain and Inflammation Research Laboratory Sven-Eric Jordt, PhD

Molecular Pharmacology Laboratory Madan Kwatra, PhD

Multidisciplinary Neuroprotection Laboratories Human Pharmacology and Physiology Lab (HPPL) David S. Warner, MD David B. MacLeod, MB BS Neuroinflammation and Cognitive Molecular Neurobiology Laboratory Outcomes Laboratory Wulf Paschen, PhD Niccolo Terrando, PhD

DUKE ANESTHESIOLOGY

Pain Signaling and Plasticity Laboratory Ru-Rong Ji, PhD Systems Modeling of Perioperative Cardiovascular Injury & Adaptation Laboratory Mihai V. Podgoreanu, MD, FASE Nerve Injury and Pain Mechanism Laboratory Thomas Van de Ven, MD, PhD

2

Highlights

EDUCATION

Twitter Journal Club Reaches New Heights The numbers are in and we’re excited to announce that this year’s Twitter Journal Club (TJC) had the highest level of engagement to-date with more than 1.4 million impressions!

This recurring week-long journal club has been gaining popularity since its inception in January of 2015 and owes its success to its trailblazer and the assistant director of residency, Dr. Ankeet Udani. “We were really excited to team up with the largest journal in anesthesiology,” said Dr. Udani.

“The future holds more collaborations with various journals, including the Journal of Neurosurgical Anesthesiology.”

New this year, Duke co-hosted the TJC discussions with anesthesia societies. Starting the week of February 21 and co-hosted with The American Society of Regional Anesthesia and Pain Medicine, the fourth

1,410,688 850 87 7 10

Impressions

Tweets

Participants

Avg Tweets/Hour

Avg Tweets/Participant

Duke Anesthesiology residents gather in the Mary Duke Biddle Trent Semans Center for Health Education for another lively Twitter Journal Club discussion.

installment of TJC examined a clinically relevant and engaging pain medicine article, “Pain Phenotypes and Associated Clinical Risk Factors Following Traumatic Amputation.” It was co-written by Duke Anesthesiology faculty, including Drs. Thomas Buchheit, Thomas Van de Ven, John Hsia, David MacLeod, Francis Keefe, and alumnus Dr. Chester “Trip” Buckenmaier. Drs. Buchheit and Hsia were able to join the in-person discussion with anesthesia residents, which added perspective into the research they conducted for the article.

Live tweeters from around the world tuned in the week of May 8 as TJC co-hosted its fifth installment with Anesthesiology, the official journal of the American Society of Anesthesiologists. Leading up to the May journal club, Anesthesiology highlighted the TJC’s success and what participants could expect in an article in their April newsletter of the ASA Monitor. The publicity worked tremendously. The discussion, titled “Self-Reported Mobility in Older Patients Predicts Early Postoperative Outcomes After Elective Noncardiac Surgery,” received live tweets from international participants in Nepal, Canada, and other countries. n

Interactive Learning Initiative Joins SoM Curriculum Medical education has traditionally been passive, mainly using a lecture format. In 2009, Dr. Jeffrey Taekman and former project manager, Michael Steele, spearheaded an initiative called Immersive Learning Environments at Duke (ILE@D). Their grand vision was to become a hub of virtual health care education. Seven years after its launch, they reflect upon the creation of ILE@D as the department has advanced it to the next level by implementing it into the Duke School of Medicine’s curriculum and in a massive open online course on Coursera.

What is ILE@D? It leverages commercial video game platforms to build educational modules for health care, effectively engaging students in virtual training environments that can be applied to real-world scenarios. It’s a three-dimensional, collaborative world, essentially acting as an umbrella that encompasses five virtual learning experiences: 1) Stroke – a neurological exam that trains users how to identify the signs and symp-

toms of a stroke 2) Handover – aims to improve communication and decrease preventable adverse events related to operating room to Neuro-ICU handovers 3) Medic – trains Army medics and other medical personnel to manage the top causes of death in Two Duke medical students engaged in virtual training environments. the modern battlefield, including hemorrhage, airway obstruction and tension pneumothorax What are the long-term goals for ILE@D? 4) Hemorrhage – trains clinicians on Using health system data to develop intereffective teamwork and communication active cases to identify and address gaps behaviors in the context of a postpartum in patient care. We’d also like to implement hemorrhage case new training devices that can sense your 5) Sedation – teaches and refreshes the body and actually place you into a true vircognitive skills of rapid sequence intutual environment, such as a mock operating bation and moderate/deep sedation to room. Microsoft HoloLens, which we’re very non-anesthesia providers excited about, will project virtual patients into the actual environment. Though you Who is the target audience of ILE@D? won’t be able to feel or touch, the technoloPrimarily medical and nursing students, gy will know where you are and allow you to but the greatest unmet need is in the interact with a holographic patient. n health system, training physicians and nurses. We believe virtual environments Interested in learning more about ILE@D and screen-based simulation will have or exploring a funding opportunity? a huge impact on the certification and Visit simcenter.duke.edu recertification processes.

BluePrint 2016

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Highlights

EDUCATION

(Left to Right) Drs. Alicia Warlick, Quintin Quinones and Eleanor Vega have helped create new education courses that will ultimately allow fourth-year medical students here and abroad the opportunity to take part in premier anesthesia rotations at Duke Anesthesiology.

Duke Anesthesiology Introduces New Education Classes Duke Anesthesiology has taken another step forward in achieving its mission of “providing extraordinary care through a unique culture of innovation, education, research and professional growth” with the launch of new education initiatives focusing on medical students.

For the first time ever, this department has created courses that venture into a new environment and accept fourth-year medical students outside of Duke, all in effort to increase diversity and allow medical students here and abroad the opportunity to take part in premier anesthesia rotations in the Department of Anesthesiology.

The Creation of “Anesth401C” and “Anesth402C” Dr. Quintin Quinones believes the Cardiothoracic Intensive Care Unit (CTICU) is one of the premiere learning environments at Duke University Hospital (DUH), but nationwide, he says it’s not typically a place where med students are part of the team or where education is offered due to the high acuity of the patients and lack of educational focus. It wasn’t until he became faculty with the Department of Anesthesiology that Dr. Quinones realized the vital need for a course in the CTICU where students could receive critical care training like never before.

Determined to make that happen, he spent about one year, from start to finish, on his “passion project” - writing two cardio intensive care courses (a four-year elective and a sub-internship), formally proposing them to the Duke University School of Medicine’s curriculum committee and getting them approved.

“When I saw the opportunity to write a course, I was really excited about it,” says Dr. Quinones. “The next generation of physicians needs to be well-equipped with the knowledge provided in these new courses and medical school is where we lay that foundation.”

The courses were rolled out to medical students this past February – courses that Duke Anesthesiology has never offered before until this year. Dr. Quinones’ courses are unique because the sub-internship is 14

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DUKE ANESTHESIOLOGY

also offered to visiting medical students and because of what students will be exposed to in the CTICU at DUH. According to Dr. Quinones, medical students rarely see patients who are on veno-arterial extracorporeal membrane oxygenation (ECMO), and they almost never see patients who are on ECMO for cardiogenic shock or patients who have mechanical assisted devices such as left ventricular assist devices (LVADs) and right ventricular assist devices (RVADs). Now, they have that opportunity; students can interact with cardiac intensivists and play an active role in how those patients are cared for.

“When I was a medical student at Duke, I never saw a patient on ECMO or saw an LVAD,” says Dr. Quinones. “These are parts of 21st century medicine that are becoming more and more common; it’s not unheard of to take care of a patient that has one of these devices as a non-cardiac anesthesiologist. Med students should understand how these novel techniques work and the basics of how to care for patients that require this high level of support.”

Not only are these courses a milestone for the Department of Anesthesiology, they’re a milestone for Dr. Quinones’ career as a first-time medical course creator.

“I really like education and I love teaching.

I discovered that during my residency and fellowship here at Duke.”

But in true Duke fashion, Dr. Quinones gives credit to his mentor, Dr. Mihai Podgoreanu, and Dr. Nancy Knudsen for guiding him through the process of implementing these courses.

“I have found that training others is the highest level of education you can achieve. When you can teach others that means you really know your craft well and that’s very satisfying to me. And, it’s rewarding to see medical students pick-

ing up that knowledge,” says Dr. Quinones. “I hope this advanced level of learning will continue to be a cornerstone of education at Duke.”

Newly Designed Course Rolls Out When Duke Anesthesiology’s chairman asked for an existing course to be opened, for the first time, to visiting medical students, Drs. Alicia Warlick and Eleanor Vega were excited to take on the role as course directors.

With leadership from Duke University’s School of Medicine, Drs. Warlick and Vega spent a few months creating the new course, titled “Clinical Anesthesiology for Visiting Medical Students,” which officially rolled out this past August and is offered to four visiting medical students – one for each of the elective periods for the fall 2016 term.

Throughout the four-week course, visiting students spend their days in different operating rooms interacting with a variety of anesthesiology attendings. Dr. Warlick hopes to lead these students through a diverse curriculum, including every subspecialty in anesthesia, along with offering them the opportunity to do airways, lines and clinical procedures.

“This course aims to provide visiting medical students with the whole perioperative picture which I hope will ultimately peak these students’ interests in something they’ve never experienced before – something new that they see during this rotation that solidifies their interest in a subspecialty,” says Dr. Warlick.

“We certainly attract the best of the best to apply for the Duke Anesthesiology Residency Program and we want to ensure that we’re attracting excellent students from a wide variety of backgrounds and institutions,” adds Dr. Vega. “This rotation gives visiting medical students in-depth exposure to our curriculum, residents and faculty which we hope will encourage them to apply for our residency program.” n

EDUCATION

Highlights

Anesthesiologist Honored as “Voice of the Class”

Duke Anesthesiologist Addresses New Certification Process

When an email came in from Duke’s associate dean for medical education asking Duke Anesthesiology’s Dr. Nancy Knudsen to be the distinguished speaker at this year’s Hippocratic Oath Ceremony at the Duke University School of Medicine graduation, she had to catch her breath.

“I was sitting next to my mom when I received the email and I couldn’t believe that I had been asked to speak at such an occasion. I immediately thought, I’ll never have this feeling again,” says Dr. Knudsen. “I was honored but wondered why they chose me,” she jokes.

According to Dr. Caroline Haynes’ email, the advisory deans extended the invitation to Dr. Knudsen because she is so well-regarded by the administration and the medical students, along with being known for her “wonderful approach to teaching and the care of patients.” Together, they thought Dr. Knudsen would deliver an inspirational speech, leaving the graduates with “a message to hold onto.”

And that she did. On May 13, Dr. Knudsen delivered an emotional yet humorous speech (inside the newly renovated Duke University Chapel) with no shortage of celebrity spoofs. And she left the graduating class with an inspirational mnemonic, CHARGE, which stands for curiosity, humility, adaptability, respect, gratitude and empathy.

“I was honored but intimidated to think that at the end of their careers, before they start their internships, I was the one who was going to give them some of the last words of advice. It was a privilege,” says Dr. Knudsen. “Before I delivered my speech, I realized in that moment that how I was feeling, is how all those students must feel before they begin their internships – scared and excited, yet hopeful.”

For Dr. Knudsen, the speech was certainly a high point in her career as she joins a list of high-profile leaders at Duke who have delivered the Hippocratic Oath Ceremony speech, including Dean Nancy Andrews and Nobel Prize winner, Dr. Robert Lefkowitz. Dr. Knudsen teaches four courses for medical students. She is the course director for the fourth-year acute care curriculum, faculty member for the PRACTICE course, faculty member for the Clinical Skills course and Capstone. It’s easy to see that teaching is a passion of Dr. Knudsen’s; a passion that she says allows her to learn just as much from her students, if not more, than they learn from her.

“I love to think that I will have some ability to shape the way they care for their patients in the future,” adds Dr. Knudsen. “I think back to the role models I have, how much they mean to me, and how they have influenced the type of doctor I’ve become. If I have any ability to impact the type of doctor these students will become, I feel I will have Dr. Knudsen gave this year’s Hippocratic Oath accomplished more in my career Ceremony speech at the Duke University than I have ever hoped for.” n School of Medicine graduation.

The American Board of Anesthesiology announced this year an overhaul of the way it recertifies members, affecting 1,116 physician anesthesiologists in the state of North Carolina. For years, anesthesiologists would take one major exam every decade. “For many, including myself, this meant cramming for a test with a final reCathleen L. Peterson-Layne, port of pass/fail and no way to know which MD, PhD, MS questions were missed,” says Dr. Cathleen Peterson-Layne. The redesigned Maintenance of Certification in Anesthesiology Program requires members to answer 30 questions each quarter. “The best part is that I receive feedback on my answers immediately along with explanations and resources as to why the one answer is correct while the others are not. Answering 30 questions each quarter of the year encourages the intended ongoing, lifelong learning.”

Anesthesiology Takes Center Stage at Health Innovation Jam At Duke’s inaugural Health Innovation Jam held on September 15, 2015, researchers pitched their clinical products and business ideas to some of the most important leaders at Duke.

Drs. Ru-Rong Ji and Jeff Gadsden were two of just The inaugural Duke Health Innovation Jam featured ten researchers selected Dr. Ru-Rong Ji (left) and Dr. Jeff Gadsden (right). to pitch their innovative and conceptualized ideas to the esteemed panel of investors, including Drs. Joseph Mathew, Sol Aronson and Mark Newman.

Dr. Ji’s pitch, titled “Treating Chronic Pain with Stem Cells,” earnd a potential joint investment between Anesthesiology and Neurosurgery. Dr. Gadsden’s pitch, titled “Contextual Individualized Medical Learning Platform,” caught the attention of Ben Alman, chairman of Orthopaedic Surgery, who is interested in working more with the team. But they weren’t the only doctors who walked away winners – the audience selected Dr. Aronson as runner-up for “Which investor should be a shark on the show ‘Shark Tank!’”

The event was hosted by the Duke Institute for Health Innovation. It was sponsored by Duke Anesthesiology, Duke Department of Medicine, Duke University Hospital, Duke Heart Center, Duke Neurosurgery, Duke Orthopaedic Surgery, Duke Surgery, and Duke’s Private Diagnostic Clinic, PLLC. n BluePrint 2016

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Highlights

Photo Courtesy of Duke Today

DUKE UNIVERSIT Y SCHOOL OF MEDICINE

Senate Confirms Califf as Next FDA Head FEBRUA RY 2 4 , 2 016

Paul Modrich, PhD, in his laboratory at Duke University School of Medicine.

Paul Modrich Receives Nobel Prize in Chemistry DECEMBER 10, 2 015

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DUK E UNI V ER SIT Y MED SCHOOL BLOG

On Wednesday, October 7, 2015, the Royal Swedish Academy of Sciences announced that Paul Modrich, PhD, a Howard Hughes Medical Institute (HHMI) investigator at Duke University; Tomas Lindahl of the Francis Crick Institute and Clare Hall Laboratory in the UK; and Aziz Sancar of University of North Carolina, Chapel Hill, are the recipients of the 2015 Nobel Prize in Chemistry for mechanistic studies of DNA repair. Dr. Modrich, a professor in the Department of Biochemistry, joined Duke in 1976. He is a James B. Duke Professor of Biochemistry and a member of the Duke Cancer Institute. The 2015 Nobel Prize Award Ceremony took place at Stockholm Concert Hall on Thursday, December 10, 2015. n

Duke Medicine Becomes Duke Health J A NUA RY 15, 2 016

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DUK E HE A LTH NE W S & COMMUNIC ATIONS

On January 13, Duke Medicine began a transition to a new name: Duke Health.

As with Duke Medicine, Duke Health is not a legal entity but will serve as an overarching brand name that conceptually refers to all assets and entities within the Duke University Health System, the Duke University School of Medicine, and the Duke University School of Nursing. The ultimate goals will continue to be improving the health of individuals and communities.

This decision was confirmed as a result of widespread discussions involving faculty, staff, trainees, alumni, board members and others in which a renewed focus on health clearly emerged as a 16

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DUK E UNI V ER SIT Y MED SCHOOL BLOG

Robert Califf, MD, was sworn in as the next commissioner of the U.S. Food and Drug Administration (FDA), previously held by Margaret Hamburg. Prior to joining the FDA, Dr. Califf, a professor of medicine in the Duke University School of Medicine, served as vice chancellor of clinical and translational research at Duke, Robert Califf, MD executive director and founder of the Duke Clinical Research Institute (DCRI), and director of the Duke Translational Medicine Institute. During his time at Duke, Califf led many landmark clinical trials in cardiovascular disease. He is considered an international leader in the fields of health outcomes, quality of care and medical economics. He is one of the nation’s leaders in the growing field of translational research, which is key to adapting scientific advances into clinical care.

“It’s a proud day for the DCRI and Duke,” said DCRI executive director, Dr. Eric Peterson. “Today marks another milestone in his storied career as a champion for improving patient care around the world. Dr. Califf has devoted his life to innovations in clinical research, and we look forward to his contribution to advancing and protecting our nation’s public health.”

President Obama nominated Califf for the position in September of 2015. Califf has served as the FDA’s deputy commissioner for medical devices and tobacco since February 2015. n

core pursuit in a new strategic planning framework that will be introduced to the Duke Health community at the end of January.

“Duke Health signals our intention to explore more comprehensive approaches to health that extend beyond medical care and into other determinants of population health improvement,” said A. Eugene Washington, M.D., Chancellor for Health Affairs, Duke University, and President and CEO, Duke University Health System.

The transition to Duke Health likely will take most, if not all, of 2016. It will involve numerous changes of signage on Duke clinics and Duke Primary Care sites, changes to websites, and many other things. The logo, however, will be virtually identical to that of Duke Medicine except for the word “Health.”

Like Duke Medicine, Duke Health will continue to derive its strength from the internationally renowned health care delivered by our world-class clinicians and care teams, the breakthroughs in knowledge driven by our distinguished community of researchers, and innovative training programs advanced by our exceptional educators around the world.

“Importantly, the leading constant is the value we place on the dedicated, compassionate and high-performing individuals throughout our organization. They are the great strength of Duke Health,” Washington said. n

Dean Nancy Andrews to Step Down in 2017 |

DUK E UNI V ER SIT Y MED SCHOOL BLOG

Nancy C. Andrews, MD, PhD, dean of the Duke University School of Medicine and vice chancellor for academic affairs at Duke University, has announced that she will step down from her role as dean at the end of her tenth year, in June 2017.

In a statement to faculty, students and staff, Dean Andrews wrote, “It has been an honor and a privilege to serve you and Duke, and I could not ask for better colleagues or a more vibrant academic community. From the beginning of my deanship, I’ve been committed to the idea that leadership should be refreshed periodically, and I feel that the end of my second term is the right time. I have finished what I set out to do when I came to Duke, and together we have done much more, in spite of the strong headwinds of a difficult NIH budget and the economic downturn.”

During her tenure as dean, great progress has been made on many critical fronts, including: • Construction of the first new medical education building since 1930, the Mary Duke Biddle Trent Semans Center; • Acquisition of a new facility for the Physician Assistant program; • Construction of the Hudson Building at the Duke Eye Center; • Creation of a satellite campus in the Durham Innovation District; • Two Nobel Prizes in Chemistry awarded for work done by Duke School of Medicine faculty members; • Creation of four new departments: Dermatology, Orthopaedic Surgery, Neurology and Neurosurgery; and creation of the Duke Cancer Institute;

U.S. News Ranks Duke University Hospital Among Nation’s Best AUGUS T 2 , 2 016

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DUK E HE A LTH NE W S & COMMUNIC ATIONS

Duke University Hospital has been named the #16 medical center in the country by U.S. News & World Report. In addition to being included on the national Honor Roll, Duke University Hospital remains #1 in North Carolina and #1 in the Raleigh-Durham area.

Honor Roll designations were awarded to just 20 hospitals out of nearly 5,000 institutions across the country. Rankings consider patient safety, survival rates, technology, and the hospital’s excellence in a number of specialties. Duke has earned a spot in the rankings for more than 20 years.

Duke University Hospital also earned top-20 rankings in seven adult specialties in the 2016-17 report. n Duke University Hospital

Duke University School of Medicine’s Dean Nancy Andrews will be stepping down in June of 2017.

• Development of new educational programs; • Launch of Duke AHEAD, which supports faculty educators; • Creation of the Duke Office for Clinical Research, the Office for Research Development for multi-investigator grants, and the Office for Research Informatics for academic IT innovation; • Establishment of numerous faculty development programs; • Launch of new interdisciplinary research initiatives including the Duke Molecular Physiology Institute, Center for Genomics of Microbial Systems, Center for Human Disease Modeling, Center for RNA Biology, Center for Genomics and Computational Biology, Center for Statistical Genetics and Genomics, Regeneration Next, and the Center for Population Health Sciences; • Creation of MEDx, a School of Medicine partnership with the Pratt School of Engineering; and • Creation of the School’s first inclusion council and implementation of numerous initiatives focused on improving diversity and inclusion in the School.

A committee has been formed immediately to begin a national search for a new dean. n

Duke Medical School Ranked Among the Nation’s Top 10 M A RCH 16, 2 016

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DUK E UNI V ER SIT Y MED SCHOOL BLOG

Duke University School of Medicine ranked eighth in research and eighth in primary care among all medical schools in the nation, according to new U.S. News & World Report rankings. The school conThe Mary Duke Biddle Trent Semans Center sistently ranks among the for Health Education top 10 medical schools.

In addition, the school’s Physician Assistant Program is still ranked number one among all programs in the nation and its Doctor of Physical Therapy Program ranked number 10. Three key specialty areas in the School of Medicine also placed in the top 10 in the nation, including Internal Medicine (ranked fifth), Geriatrics (ranked seventh), and Family Medicine (ranked tenth).

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Photos Courtesy of Duke Health

JULY 2 2 , 2 016

Photo Courtesy of Duke University School of Medicine

Highlights

DUKE UNIVERSIT Y SCHOOL OF MEDICINE

CoverStory

The Demystification of Pain Driving the Discovery of Innovative Therapies

By Stacey Hilton

In the throes of what’s being called “the opioid crisis in America,” Duke Anesthesiology has taken major strides in pain innovation this year, all in effort to unravel the mysteries of chronic pain and improve patient care.

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The Center for Translational Pain Medicine

In January of 2016, an internationally-recognized team of pain clinicians and scientists, led by Dr. William Maixner, formed the Center for Translational Pain Medicine (CTPM) which represents a novel entity meant to transform the way Duke diagnoses and treats painful conditions. The creation of this type of a center has been a goal of Dr. Maixner’s for nearly thirty years – a goal that only Duke could bring to fruition, he says. “Each day, I walk into the world looking for a new discovery, a new hint as how to unravel this complexity of pain, and new ways of treating it.

Meet the CTPM Faculty William Maixner, DDS, PhD Director, Center for Translational Pain Medicine

Jongbae Jay Park, PhD, LAc Director, Acupuncture and Asian Medicine

Aurelio Alonso, DDS, MS, PhD Director, Orofacial Pain

Richard L. Boortz-Marx, MD, MS Medical Director

Andrey Bortsov, MD

Assistant Professor in Anesthesiology

Thomas E. Buchheit, MD Chief, Division of Pain Medicine

Ru-Rong Ji, PhD

Distinguished Professor of Anesthesiology, School of Medicine Chief, Pain Research Director, Pain Signaling and Plasticity Laboratory

Sven-Eric Jordt, PhD

Director, Chemical Sensing, Pain and Inflammation Research Laboratory

Francis J. Keefe, PhD

Professor in Anesthesiology, Psychiatry and Behavioral Sciences, and Medicine

“There are very few places in the world that are dedicated to putting substantial resources toward pain.

Duke has provided that home.”

William Maixner, DDS, PhD

Wolfgang Liedtke, MD, PhD

Professor, Departments of Neurology, Anesthesiology and Neurobiology

Andrea G. Nackley, PhD Director, The Nackley Laboratory

Director, Center for Translational Pain Medicine

Duke Anesthesiology offered the opportunity to broaden the horizon and create a clear view of how to integrate research, education and patient care for the first time.”

According to Dr. Maixner, about one-tenth of chronic pain patients are suffering from opioid addiction and abuse due to excessive exposure to opioids which are often misappropriated.

He believes the only way to deal with the abuse and addiction is to discover new medications and innovative pain therapies which require research. “Our society does a very poor job of funding fundamental discovery work in this area that could impact both pain patients and alleviate the opioid epidemic.

Shad B. Smith, PhD

Assistant Professor in Anesthesiology

Thomas J. Van de Ven, MD, PhD Director, Nerve Injury and Pain Mechanism Laboratory

David S. Warner, MD

Distinguished Professor of Anesthesiology, School of Medicine Vice Chair, Research Chief, Division of Basic Sciences

CoverStory

“The Hidden Epidemic”

100MILLION MORE THAN

ADULTS IN AMERICA SUFFER FROM CHRONIC PAIN

CHRONIC PAIN COSTS SOCIETY

$635BILLION / MORE THAN

YR

MORE THAN THE COST OF CANCER, HEART DISEASE AND DIABETES, COMBINED

Dr. William Maixner testified at the U.S. Senate’s HELP Committee hearing in 2012, titled “Pain in America: Exploring Challenges to Relief.” Watch the full hearings: TinyURL.com/SenatePain2012

The team I’ve hand-picked from across the nation is able to work all the way from fundamental molecular science, discovering novel pathways involved in pain, development of new analgesics and pain processing, to individuals who can tease apart the molecular systems in pain patients that mediate the science and symptoms they experience.”

The CTPM further expands Duke Anesthesiology’s existing clinical and research program in innovative pain therapies by bringing together, under one umbrella, leading basic scientists, clinicians and clinical researchers – a comprehensive team made up of about 40 faculty and researchers, and five basic science labs. Its guiding principal is the recognition that patients suffering from painful conditions require a multidisciplinary, multidimensional approach for diagnosis and treatment.

“Chronic pain is one of the last bastians of patient care that has gone unrecognized as a priority. We are providing a unique model of pain medicine to treat a group of individuals who often feel marginalized by society and their health care provider(s).”

Richard L. Boortz-Marx, MD, MS Medical Director

“Dr. Maixner now leads what one could argue is the finest translational scientific team in the country, if not the world,” says Dr. Thomas Buchheit, chief of the Division of Pain Medicine whose role in the CTPM is to build collaborative and translational research projects, casting a wide net to bring solutions and protocols to clinical deployment. “I think the CTPM can and will bring about some of the solutions to the opioid crisis in America. We’ve seen very little changes in our therapies over the past decades; pain medicine has relied fairly heavily on steroid injections and medications. I believe the advances that Dr. Maixner’s team is going to bring are critical to advancing the field.

They are in fact the future of pain medicine in this country.”

For Dr. Buchheit, the unanswered question is, how 20

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4¢/PAIN PATIENT LESS THAN

SPENT EACH YEAR ON PAIN RESEARCH, NATIONWIDE

does pain “chronify?” Part of the research at the CTPM is devoted to understanding the epigenetic processes and signatures of what causes acute pain to become chronic.

He believes once they can understand what drives the “chronification” of acute pain, they should be able to intervene to reduce the burden of chronic pain.

“Pain is a multidimensional sensation that is important for our survival. However, in some cases, the pain outlasts the stimulus and becomes chronic, which then becomes a disorder in and of itself,” adds Dr. Andrea Nackley, CTPM researcher and lab director. She says researchers at the new center’s labs focus on three main objectives: to determine the factors that put people at risk for maladaptive chronic pain conditions, elucidate the mechanisms whereby genetic, biological and environmental factors drive chronic pain, and improve pharmacologic management of pain. Labs operating under the CTPM integrate molecular genetics, patient-relevant animal models and clinical epidemiologic measures in effort to reveal pathogenic processes. “Conventional therapies such as opioids, antidepressants and anticonvulsants have poor efficacy for managing persistent pain, as well as central side effects, including altered mental states, addiction and life-threatening depression. We are focused on identifying therapies that will provide more immediate pain relief and reduce the physical and emotional burden that accompanies the ‘trial and error’ approach.”

In order to move discovery from concept to reality, Dr. Maixner notes that there must be an established team, such as the CTPM, that can handle large data that originates from multiple sources, including patient populations, genetic data, human genetic association studies, and the progress of data from the benchtop to bedside – all requiring the collection and management of big data sets. In the past year, nearly two-thirds of the CTPM team has been put in place, new labs have been constructed, behavioral units created, the biorepository is near comple-

THE DEMYSTIFIC ATION OF PAIN

DRIVING THE DISCOVERY OF INNOVATIVE THER APIES

Tradition Innovation | Translation Tradition|— Innovation — Translation

“One of the most exciting opportunities is to have a full integration of basic science research, translational research, and clinical management at the CTPM. Only a few places in the world can do this.”

Ru-Rong Ji, PhD Distinguished Professor of Anesthesiology, School of Medicine Chief, Pain Research

tion, the pipeline to education is opening, and the new pain practice at Brier Creek, which will integrate pain medicine, orofacial pain and some of the most innovative novelties to treat pain while developing collaborations with a number of international teams, is now open to patients.

Introducing Duke Innovative Pain Therapies

Described as the first-of-its-kind pain practice in the world, Duke has developed its vision of a portal of entry for pain patients to receive diagnosis, treatment and investigation of what causes their conditions. This new medical pain practice opened its doors to patients in September of 2016, marking yet another milestone for Duke Anesthesiology. “For the first time, we’re combining large scale clinical research projects with high-volume clinical practice,” adds Dr. Maixner, who will see patients at the practice on a second-consultation basis.

“There is a critical need both regionally and nationally to develop these therapies for chronic pain patients,” says Dr. Buchheit, one of the lead clinicians at the new pain practice who will also facilitate some of the clinical and translational trials there. “The lack of therapeutic options has helped lead to the overuse of opioids. The only solution is to develop new, non-opioid therapies by studying translational medicine solutions, pathways of risk and vulnerability, and therapeutic pathways. Duke Anesthesiology is at the forefront of translational, scientific solutions to solving this complex problem.”

One of the novel features at this new practice is the treatment of orofacial pain, a substantial health issue, led

by Dr. Aurelio Alonso. He’s notably the first boarded orofacial pain clinician at Duke and one of only five dentists certified by the American Board of Orofacial Pain in North Carolina. Dr. Maixner believes with this new practice, Duke has become the first institution to begin to collectively integrate multiple pain conditions while providing treatment avenues, and will for the first time, bring orofacial pain into the basic fabric of the hospital and health care system.

“Orofacial pain can have a debilitating effect on quality of life, but we need to be able to diagnose and manage our patients’ painful conditions as soon as possible so they don’t become chronic health issues. That begins with changing the culture of practitioners prescribing opioids to patients,” says Dr. Alonso.

Another novel feature at this new practice is acupuncture and Asian medicine, led by world-renowned acu-

(Above) Duke Innovative Pain Therapies at Brier Creek

puncturist, Dr. Jongbae Jay Park, who (Below) Dr. Jongbae Jay Park and Dr. Aurelio Alonso will treat patients and be involved in clinical research at the practice.

“Asian medicine has preserved its core essence of health and healing, and offers a great asset to this new, non-opioid approach. Acupuncture utilizes the body’s innate capacity for self-healing without leaving any residual, active ingredients. And, more often than not, these approaches offer additional insights and perspectives of the illness.”

“One of the challenges we see in dealing with patients with chronic pain is understanding complex psychological drivers, including their history, background, genetic influences and their environmental stresses they experience. It’s hard to understand all of that in the context of a typical clinic visit which is one of the reasons we branched out to this model,” adds Dr. Buchheit. He notes that there are surgeries that frequently result in chronic nerve pain syndromes, such as breast cancer surgeries, thoracotomy and amputation. He believes if this team can understand the drivers that lead to the development of chronic pain in situations where nerve injury often occurs, then they can potentially reduce the burden of chronic pain in society and reduce the need for the medication management and therapies that are currently offered.

“The future lies in novel therapies but that’s only going to come about with translational science work. We now know that, but the challenge in the next ten years will be to develop those non-opioid therapies,” says Dr. Buchheit.

“It’s a moment in time where there have been significant societal needs, medical crises to deal with, and the right leadership in our department to bring together this group of translational physician-scientists.”

“By the end of the year, I’d like to see our visions become more integrated and to work more like a clock rather than individual pieces being built,” concludes Dr. Maixner. “Over time, we’ll see how they turn together to create new discoveries.” n BluePrint 2016

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Feature

Preventing an Electrical Storm FACULT Y SPOTLIGHT

Dr. Arturo Suarez

Just days after the new year, Dr. Arturo Suarez and Jennifer Reilly gave each other a fist bump and headed into the operating room for a surgery that has never before been documented. This 28-year-old patient was like none other Dr. Suarez had treated before – she has Brugada syndrome, a potentially life-threatening heart rhythm disorder, and was diagnosed with end-stage liver disease, desperately in need of a liver transplant. She also has an implantable cardioverterdefibrillator, a device that can shock her to return her heart to normal rhythm should it go into lethal arrhythmia, making her transplant exceptionally challenging. Looking back, Reilly describes Dr. Suarez, chosen for this year’s “Faculty Spotlight,” as “a little piece of a miracle.”

Reilly’s journey to the OR began in August of 2015 when she noticed her eyes were jaundice and she was diagnosed with mononucleosis. Three months later when her skin also turned jaundice, she went straight to the ER for another round of steroids and additional testing. On December 21, Reilly was diagnosed with end-stage liver 22

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DUKE ANESTHESIOLOGY

disease. After spending the holiday with her family in Pennsylvania, she was admitted to Duke University Hospital with spontaneous bacterial peritonitis (SBP), an infection of the ascitic fluid accumulated in the abdomen. On January 2, her name was placed at the top of the liver transplant list.

Just three days later, she was matched with

a liver and introduced to Dr. Suarez.

“He sat down on my bed with me and explained that he spent many nights at home researching my case to make sure that I was going to be safe during anesthesia. That brought me to tears,” remembers Reilly, who had never before been anesthetized.

“I was so appreciative of that because you rarely find that personal touch in a doctor.”

“The prevalence of Brugada syndrome is very low,” says Dr. Suarez. “To couple that with a liver transplant is remarkably rare.”

Brugada syndrome is a genetic disease that is characterized by abnormal electrocardiogram findings and an increased risk of sudden cardiac arrest, most frequently diagnosed in adult men. Knowing this risk, Dr. Suarez spent weeks developing a detailed plan, outlining every step of the anesthesia protocol and researching drugs that he could use to not only put Reilly to sleep, but that could support her during the most stressful stages of surgery.

“We could not afford for Reilly to become hemodynamically unstable, or have her

Photos Courtesy of Dr. Arturo Suarez

By Stacey Hilton

FACULT Y SPOTLIGHT

PRE VENTING AN ELEC TRIC AL STORM: DR. ARTURO SUAREZ

Feature

“It’s fair to say that he saved my life. I was very sick.

His diligence was a key part in saving my life.”

Photos Courtesy of Dr. Arturo Suarez

heart stop, because the drugs we normally use to bring a patient back from those challenging periods, such as epinephrine, could trigger an electrical storm in this specific patient. This was the most challenging from our standpoint,” says Dr. Suarez.

Another medical challenge this patient presented included SBP, which required medical treatment with antibiotics before surgery to prevent the potential spread of infection after transplantation and initiation of immunosuppression. Due to Reilly’s liver disease, the medical team also had to correct her significantly low plasma sodium levels to prevent water influx into the neurons which could have caused brain edema with parallel increase of intracranial pressure.

According to Dr. Suarez, the most crucial stage of the surgery was when the sur­ geons released the clamps from the previously connected blood vessels, caus­ing all of the toxins that had accumu­lated in the body and the high levels of potassium used to preserve the new liver, to suddenly find access to main circulation which could have caused significant hemodynamic changes.

“We had to make sure that when that stage arrived, it was a win-win,” says Dr. Suarez.

“During the procedure, we needed to be in a battlefield that would allow us to survive on our own with the resources we had.”

The donated liver also came with complications because it was preserved at such a cold temperature. “When all of that blood comes, it has to go through the liver. Those combined factors can significantly drop

the blood pressure, which could cause a stroke or a heart attack. These are all risks in a typical patient. Reilly’s pathology made these circumstances even risker.”

In effort to avoid these complications, Dr. Suarez and his team (including then CA3 resident, Dr. Brittany Merk) used alternative drugs to keep Reilly’s blood pressure and heart rate up. “All of the drugs that we would use in a typical patient to help them survive the surgery, we could not use on this patient. They would have killed her. It’s like we went to fight and the help was now the enemy.”

“I would have never thought an anesthesiologist would have had this big of an impact on my surgery,” says Reilly. “I didn’t realize all of the surgical risks with Brugada syndrome. So, when I was in tears, which is very rare for me, he sat on my bed, reassured me, and took my surgery down to a human level. For him to have the compassion to do that, gave me confidence in him. He’s a remarkable man.”

On January 5 at 11 p.m., just two hours before Reilly’s transplant, Dr. Suarez arrived at her bedside. “We explained that we were going to fight for her life. It was going to be she and us.”

“He sees what you need in that moment,” says Reilly. “He somehow saw through my fear and knew that all I needed was a fist bump and for him to tell me that it would be okay.”

Reilly was extubated just two hours after surgery and four days later, she was discharged to go home.

“It’s fair to say that he saved my life,” says Reilly. “I was very sick.

His diligence was a key part in saving my life.”

“There are always chances of side effects from drugs or infections, but her age is a very determining factor. I think she has a beautiful life in front of her,” concludes Dr. Suarez. “We were all an instrument to provide her a second chance, and this is her second Recent Duke Anesthesiology residency graduate, Dr. Brittany Merk, monitors Jennifer chance in life.” n Reilly’s vitals during her liver transplant in January 2016.

Living the American Dream Known for his humble spirit, Dr. Suarez often helps his patients, like Jennifer Reilly, overcome their fear of the operating room by sharing with them one of his greatest obstacles and achievements — his escape from communism in Cuba. “The only thing I had in my head was freedom. My dad thought I was crazy. He sat me down and asked, ‘You’re going to leave everything you have to wash dishes in America?’ I remember telling him, ‘but I’m going to be free.’” And at the age of 28, the practicing anesthesiologist in Cuba got on a boat in search of that freedom. With no money to his name, he arrived in Florida. Realizing that he couldn’t take the medical tests to continue practicing anesthesia in the states because he couldn’t read or speak any English, he started over. With his father’s help, he moved to Detroit to work in a slaughter house. He went on to become an emergency medical technician at Henry Ford Hospital where he met his mentor, Dr. Emanuel Rivers, who selected him to do research with him in critical care. In 2010, Dr. Suarez became the chief resident of anesthesia at Henry Ford Hospital and four years later, he accepted a critical care fellowship at Duke Anesthesiology. “And the rest is history,” says Dr. Suarez, whose love for anesthesia first began in Cuba when he saw a patient in cardiac arrest. “I remember someone arriving and putting in a tracheal tube and an IV. I asked, ‘Who is that person?’ My friend said, ‘It’s an anesthesiologist!’ I said, ‘Wow, I want to do that!’ So, I got into anesthesia,” Dr. Suarez says, chuckling. “But I never pictured being at this level. All of this is a dream for me; performing transplants and going home to my wife and four beautiful children. You see, it’s not about me. It never has been. It’s about the people around me who have helped me and made it possible for me to live this beautiful dream.”

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We empower great minds to turn dreams into reality.

BY ENCOUR AGING THE ENTREPRENEURIAL SPIRIT, UNFET TERED IMAGINATION, AND UNCHECKED AMBITION, THE DREAM CAMPAIGN INSPIRES DUKE ANESTHESIOLOGY FACULT Y AND PROVIDES THEM WITH THE WHEREWITHAL TO ACHIEVE THE IMPOSSIBLE. TOGETHER WITH OUR SUPPORTERS, WE ARE TR ANSFORMING THE FUTURE OF PATIENT CARE.

HELP US CONTINUE TO TR AIN THE LEADERS OF TOMORROW, DEVELOP THE CAREERS OF OUR FACULT Y, AND PROTECT QUALIT Y OF LIFE FOR YEARS TO COME.

DEVELOPING RESEARCH EXCELLENCE IN ANESTHESIA MANAGEMENT DREAMCAMPAIGN.DUHS.DUKE.EDU

DE VELOPING RESE ARCH E XCELLENCE IN ANESTHESIA MANAGEMENT

New Chairwoman of DREAM Named Elizabeth Allardice was “extremely honored” to be named chairwoman of the board of the Duke DREAM Campaign on August 1, 2016. She first joined the campaign as a board member in 2010, three years after its launch. The Duke DREAM (Developing Research Excellence in Anesthesia Management) Campaign was established to raise philanthropic support for Duke Anesthesiology’s research programs and initiatives focused on improving patient outcomes, pain management and quality of life, as well as to establish endowed professorships.

Allardice, a leader in the local real estate industry since 2001, is driven by her commitment to educate people on the importance of medical Elizabeth Allardice was named the new chairwoman research, quality patient care, caregiver support, of the Duke DREAM Campaign in August. funding for research, and organ donations. After losing her husband to chronic traumatic encephalopathy (CTE), Allardice also became involved in the support community of others who are dealing with this devastating disease. She currently serves on the Family Advisory Board for the Concussion Legacy Foundation and is actively involved in the West Point Association of Graduates in honor of her late husband. She is also a proud donor for the Feagin Leadership Program whose mission is to provide a learning experience that develops effective, ethical leaders who will positively influence health care.

“There are many worthy causes to which I do or should contribute. However, this one is close to home and I see the huge impact a DIG award has on a young investigator’s career.

My annual contributions are part of a seed that becomes a tall tree. We need a forest!”

Campaign Update

MORE THAN

$1.5

MILLION

30% 24% DONATED 3+ YEARS

DONATED $1,000+

38%

ALUMNI

351 DONORS 40%

FRIENDS OF THE DEPT.

David S. Warner, MD

Vice Chair, Research Chief, Division of Basic Sciences Director, DREAM Innovation Grant

Visit our new DREAM web pages to read more about the campaign and make a gift online!

DREAMCAMPAIGN.DUHS.DUKE.EDU

RAISED TO-DATE

22%

FACULTY

37% 59% FIRST TIME DONORS THIS YEAR

DONATED MORE THAN LAST YEAR

December

CALENDAR MONTH WHEN MOST DONATIONS RECEIVED

DRE AMC AMPAIGN.DUHS.DUKE.EDU BluePrint 2016

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Campaign Goals

Endowed Professorships The Duke University School of Medicine’s endowed professorships honor exceptional achievement, fuel scientific discovery, and invest in teaching and mentoring the next generation of leaders. For philanthropic individuals and organizations, these permanent partnerships provide an extraordinary opportunity to make a difference. They confer academia’s highest honor upon our most accomplished medical scientists and educators, allowing (Left to Right) Drs. Joseph Mathew, Joseph “Jerry” Reves and Mark Newman. these dedicated individuals to pursue research that ultimately inspires future innovations in medicine and improves patient care.

Duke Anesthesiology believes that investing in the promotion of our faculty’s professional growth and the enhancement of learning for our students is vital to the future of medicine. In order to maintain this high level of scholarship, we must compete for the most outstanding professors and physician researchers. Creating endowed professorships provides distinguished faculty with the means to discover unprecedented breakthroughs adding to the thriving academic environment at Duke.

Duke Anesthesiology’s Endowed Professorships

Joseph P. Mathew, MD

Mark F. Newman, MD

Jerry Reves, MD, Professor of Anesthesiology

Merel H. Harmel Professor of Anesthesiology

Ru-Rong Ji, PhD

Establish endowed professorships to invest in world-class faculty who would, in turn, secure extramural funding. Interest dollars from these endowments are to be used to support investigator salaries and provide them with the time and resources necessary to develop research programs.

Raise funds to support research through the DREAM Innovation Grant, known as DIG. (learn more on page 28)

Establish philanthropic support as a long-term mechanism of limiting the adverse consequences of cyclical federal funding.

David S. Warner, MD

Distinguished Professors of Anesthesiology, School of Medicine

2012 DIG recipient, Dr. Mihai Podgoreanu, conducting research relating to hibernating arctic ground squirrels in his Duke laboratory.

Joannes H. Karis Endowed Professorship

Maxwell Weingarten, MD, Endowment Fund

Make a gift to the Duke DREAM Campaign today in recognition of one of our outstanding clinicians or researchers!

DREAMCAMPAIGN.DUHS.DUKE.EDU

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2013 DIG recipient, Dr. Michael Manning, reviewing a patient’s vitals with other Duke anesthesiologists in the OR.

THE DUKE ANESTHESIOLOGY DRE AM C AMPAIGN

DE VELOPING RESE ARCH E XCELLENCE IN ANESTHESIA MANAGEMENT

Thank You to Our Valued Donors * Donated 3+ Years † Donated $1,000+

Dr. Jonathan Jay Aarons Dr. John Aladj Alcoa Foundation Alfred Williams and Company † Drs. Aaron and Genevieve Ali *† Ms. Elizabeth Allardice *† Dr. Mike Alvis *† Mr. and Mrs. James I. Anthony, Jr. *† Dr. and Mrs. Solomon Aronson † Mr. Vincent Asaro Mr. and Mrs. H. Ashworth Ms. Jeanne M. Aufiero Dr. David Scott Bacon and Mrs. Victoria E. Taub Dr. and Mrs. Ralph P. Baker, Jr. † Dr. Robert Hans A. Ballin Ms. Charlotte E. Banks Dr. Paul G. Barash *† Dr. Raquel R. Bartz Dr. and Mrs. Douglas J. Bell Dr. Peter B. Bennett † Dr. Elliott Bennett-Guerrero and Mrs. Karin Bagan *† Dr. and Mrs. Jerry J. Berger Dr. Miles Berger Dr. and Mrs. Arthur Francis Bergh Mr. and Mrs. Michael Boch Ms. Sharon P. Bode Mr. and Mrs. Edward Boiar Bojangles † Dr. Cecil O. Borel *† Mr. and Mrs. John Borrelli *† Dr. Helen Hall Bosse Dr. and Mrs. Frederick O. Bowman Dr. Randall P. Brewer *† Ms. Laura B. Bromhal Mr. Paul Bronson Mr. and Mrs. Hay G. Brown Dr. Thomas Buchheit * Dr. John D. Buckwalter and Dr. Esther Poza † Dr. William Paul Bundschuh Dr. and Mrs. Robert McKinnon Califf Mrs. Parker N. Call Dr. John David Campbell Dr. Enrico M. Camporesi † Dr. and Mrs. John Cann Dr. Christopher W. Cary Dr. and Mrs. James Caswell Ms. Margaret Cathcart Mr. Willard L. Causey Jr Dr. Hsiupei Chen Mr. H. Thomas Chestnut Dr. James J. Chien and Dr. Michelle W. Lau * Dr. and Mrs. James Michael Chimiak * Mr. and Mrs. Paul C. Chou † UI Chung Mr. and Mrs. Toby Church Clancy and Theys † Mr. Tim Clancy *† Dr. Andrea C. Clark * Dr. Carrie Clarke and Mr. Robert Clarke *† Dr. Thomas H. Collawn * Drs. William and Paula Corkey Dr. Joseph Corless † Dr. Brian Alan Craig Mr. and Mrs. Jerry Craig Dr. George W. Crane, Jr. Drs. Steven and Anna Lisa Crowley Dr. and Mrs. Ron Cumbie Dr. and Mrs. Jonathan Davidson

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DREAM Innovation Grant (DIG) 2016 RECIPIENTS Background

Anne D. Cherry, MD 2016 DIG RESEARCH PROJECT

Interface of Mitochondrial Dysfunction and Inflammation in Heterotopic Mouse Heart Transplant These studies will continue to investigate the impact of impaired mitochondrial function on primary graft dysfunction and consequent immune activation. Specific investigations into the interaction of mitochondrial function and oxidative stress with inflammatory injury also apply to patients with ischemia/reperfusion (I/R) injury (i.e. myocardial infarction). Mechanistic insights will support new interventions to prevent organ graft dysfunction and I/R injury, as well as promote recovery.

Dr. Cherry says she is profoundly grateful to the donors who support the DREAM Innovation Grants for their sponsorship in developing a promising avenue of investigation. She is enthusiastic about continuing this work in collaboration with her colleagues in the Department of Surgery.

DIG funding has supported the initial characterization of their model as it applies to heart transplant dysfunction, the application of novel tools (echocardiographic strain) for more sensitive quantification of dysfunction, and generation of preliminary data on the effects of mitochondrial regulatory defects on transplanted hearts. Data from these initial studies will help to justify extramural support for further studies and, ultimately, to facilitate improved treatments for patients in Duke’s cardiac operating rooms and ICUs.

What is the “DIG?” The DREAM Innovation Grant (DIG) supports innovative high-risk and potentially highreward investigations to accelerate anesthesia and pain management research. Funding provided by DIG will support each researcher for one year, during which pilot studies can be conducted. DIG recipients can receive up to $25,500 in seed money for their innovative pilot studies, which ultimately helps them apply for and obtain extramural funding. This grant creates an avenue for healthy competition among faculty, inspires ingenuity, promotes the careers of young physician investigators, enhances donor communication, and furthers the department’s academic mission.

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To-date, $542,900 in DIG donations have led to...

NEARLY

$4

• Grew up in Iowa on the south shore of Clear Lake.

• Graduated with a B.S. in physics and a minor in chemistry from the University of Iowa.

• Awarded the James Van Allen Award for an outstanding senior physics student.

• Received her M.D. from Duke University School of Medicine.

• Mentored by Dr. Richard Moon in Duke’s hyperbaric chamber where she helped run a study of hemodynamics in exercising divers at simulated depth.

• Offered a position in the Academic Careers Enrichment Scholars (ACES) Program.

• Completed her residency at Duke Anesthesiology.

• Pursued research with Dr. Claude Piantadosi (Duke Department of Medicine, Pulmonary Division) where she learned the most fundamental principles of mitochondrial function in disease states and how to assess the underlying mechanisms.

• Spent a year as chief Cardiothoracic Anesthesiology fellow.

• Joined Duke Anesthesiology faculty as an assistant professor in the Cardiothoracic Anesthesia Division where she continues to work with Dr. Piantadosi studying mitochondrial quality control in disease to address the contribution of mitochondrial function to cardiac dysfunction after heart transplant; problems that she and her colleagues see in their cardiac operating rooms on a daily basis.

DREAM Innovation Grants are funded by: Private donors Private companies

MILLION EXTRAMURAL FUNDING RECEIVED TO-DATE

Alumni Faculty Executive Board members

DRE AM INNOVATION GR ANT (DIG) 2016 RECIPIENTS

DE VELOPING RESE ARCH E XCELLENCE IN ANESTHESIA MANAGEMENT

Background

Ulrike Hoffmann, MD, PhD 2016 DIG RESEARCH PROJECT

Argon as a Potential Therapeutic in Stroke; Effects on Oxygen Utilization and Cerebral Blood Flow Response after Cortical Spreading Depression and Injury Depolarizations Dr. Hoffmann has been studying cortical spreading depression (CSD), an electrophysiological phenomenon important to the pathophysiology of not only migraines but also brain injury states such as stroke, subarachnoid hemorrhage and traumatic brain injury. Injury depolarizations are important in the progression of tissue damage in ischemic stroke, subarachnoid hemorrhage and trauma. In addition to her clinical work with patients, Dr. Hoffmann focuses her bench research on the changes in neurovascular coupling and the occurrence of spreading ischemia as an important injury mechanism.

With the generous funds awarded by the DREAM Innovation Grant, Dr. Hoffmann will continue to explore how spreading depolarizations in the acutely injured brain evolve, supporting her work to characterize time patterns and options to diminish their occurrence thereby preventing the progression of an initial lesion. Argon as a potential therapeutic in stroke was tested regarding its potency to afford neuroprotection, and she will continue to assess its effect on the occurrence of spreading depolarizations and their accompanying cerebral blood flow characteristics. Data from these initial studies will help to obtain extramural support for further studies, and in the future, develop much needed new therapies for patients with acute brain injury.

• Grew up in East Germany.

• Moved with her family to West Germany in 1989, before the fall of the Berlin Wall.

• Received her M.D. and completed her doctoral thesis from The Charité, a large teaching hospital in Berlin.

• Mentored by Professor Uwe Heinemann, Institute of Neurophysiology Charité Berlin, who interested her in neurophysiology and electrophysiology.

• Completed her residency in anesthesiology at the University of Regensburg, Bavaria, where she established a strong focus in neuroanesthesia and neurointensive care medicine.

• Completed her postdoctoral fellowship at Harvard Medical School.

• Worked with Dr. Michael Moskowitz and Dr. Cenk Ayata in the Neurovascular Protection Laboratory at Massachusetts General Hospital, where she began to devote her research to the development and exploration of new therapeutic options for acute brain injury.

• Completed her residency and also her Ph.D. in neuroscience at the Technical University of Munich.

• Joined Duke Anesthesiology in 2015 as a junior faculty member in the Division of Neuroanesthesiology, Otolaryngology and Offsite Anesthesia Division, where she continues to conduct brain research.

Background

Niccolò Terrando, PhD 2016 DIG RESEARCH PROJECT

The Systemic Milieu and its Role in Postoperative Cognitive Dysfunction Cognitive decline following hospitalization and critical illness is a leading cause of functional impairment worldwide. To begin addressing the pathogenesis of anesthesia and surgery-induced cognitive decline, Dr. Terrando developed an orthopedic surgical model in rodents and described a key role of the innate immune response, including pro-inflammatory cytokines and alarmins, in mediating neuroinflammation and cognitive decline. Through modulation of anti-inflammatory and pro-resolving mechanisms, he has been able to limit neuroinflammation, restoring cognitive function in preclinical models. Although clinical trials are beginning to evaluate neuroinflammatory changes in patients after surgery, the mechanisms underlying POCD remain controversial and without effective treatment.

The DREAM Innovation Grant has helped Dr. Terrando further understand how peripheral surgical trauma contributes to the processes of neuroinflammation and memory dysfunction. Through the support of the DREAM Campaign, he will continue to foster a multidisciplinary approach to establish novel methodologies in understanding how the brain is affected by anesthesia and surgery. These initial data will provide the basis for an application to the National Institutes of Health. Dr. Terrando’s long-term goal is to identify relevant targets in the pathogenesis of POCD and develop safe and effective therapeutics.

This will help his team translate these findings into novel clinical trials and improve personalized care.

• Originally from the countryside of Torino, Italy.

• Moved to the U.K. after high school.

• Received a dual B.S. with honors degree in neuroscience and biochemistry at Keele University.

• Received his Ph.D. from Imperial College London.

• Worked at Chelsea and Westminster Hospital and the Kennedy Institute of Rheumatology under the mentorship of Professors Mervyn Maze, Sir Marc Feldmann and Claudia Monaco.

• Completed his postdoctoral training at the University of California, San Francisco.

• Studied the signaling between peripheral inflammation and memory dysfunction, focusing specifically on macrophage activity and bloodbrain barrier disruption after surgery.

• Formerly an assistant professor at the Karolinska Institute in Stockholm, Sweden.

• Developed a program on the effects of general anesthesia on the developing brain in collaboration with several investigators throughout Europe and the European Society of Anesthesiology.

• Joined Duke Anesthesiology faculty in 2015 as an assistant professor in the Basic Sciences Division • Established the Perioperative Neurocognitive Outcomes Laboratory.

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InnovativeResearch

Morpheus Consortium

A Duke/UCL Collaboration

By Stacey Hilton Wednesday, June 8, marked a significant day for Duke Anesthesiology. Putting pen to paper in her office, Dean Nancy Andrews officially launched the “Morpheus Consortium” by signing the memorandum of understanding for academic cooperation between Duke University School of Medicine and University College London.

“I think it’s very exciting,” says Dean Andrews. “Collaborations like this are important because getting different perspectives and having people approach problems from different disciplines and

backgrounds help us get to great solutions faster. This signing sends a message of institutional commitment to the department and this collaboration.”

The Morpheus Consortium is the branding of two universities with one shared goal – to be leaders in perioperative medicine and enhanced recovery after surgery, ultimately improving the patient’s journey from the moment their surgery is contemplated to full recovery.

“I believe this may be the first program in the nation to have a collaborative agreement with a respected, well-established entity in the U.K., in an area that we’re only now beginning to understand in our country,” says Dr. Sol Aronson, who was on hand for the signing. “It’s really a phenomenal opportunity for us to leapfrog so far ahead to establish and provide a premiere educational asset to the next generation of specialists who wish to focus on the rapidly evolving world of perioperative medicine.”

Named after the ancient Greek god of dreams, Duke and UCL leaders say Morpheus signifies their shared aspiration to help patients achieve (Left to Right) Dr. Joseph Mathew, Dean Nancy Andrews and Professor Monty Mythen the dream of drinking, eating at the signing of the memorandum of understanding for Morpheus Consortium.

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Dean Nancy Andrews officially launched the Morpheus Consortium with the Duke and UCL collaborators on June 8.

and mobilizing as soon as possible after surgery. “There’s a crossover of how our health systems run. They are significantly different and I think there is a massive opportunity to learn from each other and take the best from both sides of the Atlantic,” adds Professor Mike Grocott of UCL. The Morpheus Consortium creates opportunities for Duke and UCL to collaborate in research, education and international training, as well as the ability to test the edge of hyperbaric medicine and physiologic extremes, all in effort to improve patient care. The first formal collaboration under this brand is the new Duke Perioperative Medicine Fellowship which begins in July of 2017.

“I think the new fellows in perioperative medicine are the new breed of anesthesiologists going forward. They are our future,” says Professor Monty Mythen of UCL. “The new physician anesthesiologist is a perioperative physician as well, so they must be fully trained and educated to perform in that arena. We have to make sure that we can play our part, and we must contribute fully to the research and education that forms perioperative medicine.”

According to Professor Mythen, a new curriculum is being defined for the physician anesthesiologist; perioperative evaluation, communication of risk, strategy for mitigation of that risk, as well as clinical service and managerial competencies, are crucial components in the fellowship’s learning modules.

“We are a very innovative department and we at Duke want to be leading the way as we move into this new era of health care,” says Dr. Timothy Miller, program di-

rector of the new perioperative fellowship, one of only eight in the nation.

But what makes this fellowship novel and unique, says Dr. Miller, is the opportunity for fellows to enroll in the UCL master’s program in perioperative medicine, the largest in the world. Additionally, fellows can spend two weeks in London and receive mentoring from national and international experts in both clinical service design and research projects.

“In the continuum of a life cycle of an entity, you begin by surviving, then you evolve to growth, and if you’re fortunate enough you enter that sphere of ‘lead.’

With this collaboration, I believe we’re

“We are a very innovative department and we at Duke want to be leading the way as we move into this new era of health care.”

looking at ‘lead’ in the rearview mirror and we’re all about shaping the future,” says Dr. Aronson. “I think the creTimothy E. Miller, MB, ChB, FRCA ation of the Morpheus Associate Professor of Anesthesiology Consortium is one giant Chief, Division of General, Vascular, and Transplant Anesthesiology step toward that goal Program Director, Duke Perioperative Medicine Fellowship and that mission.”

“It is a great pleasure to join forces with our colleagues at Univery innovative institutions will undoubtversity College London to improve patient edly transform patient care, research outcomes and quality of life,” concludes and education. I am grateful to Professor Dr. Joseph Mathew, chairman of Duke’s Mythen (Duke alumnus) and his colleagues Department of Anesthesiology. “The for their partnership in this shared vision mixing of talent and leadership from two of “changing the face of anesthesiology.” n

Study Suggests Sildenafil May Relieve Severe Form of Edema in Swimmers Swimmers and divers who are prone to a sudden and potentially life-threatening form of pulmonary edema in cold water could benefit from a simple and readily available dose Richard Moon, MD of sildenafil, according to a small study by Duke researchers.

The drug — best known as Viagra™ — is normally used for treatment of male impotence, but also for pulmonary arterial hypertension. It dilates blood vessels, giving it the potential to ease an abrupt cold water-induced constriction of blood vessels in the arms and legs that can lead to blood pooling in the heart and lungs. Athletes and others with this condition — called swimming-induced pulmonary edema, or SIPE — cough-up blood, labor to breathe and have low blood-oxygen typically brought on by swimming or scuba diving.

“During immersion in water, particularly cold water, people have an exaggerated degree of the normal redistribution of blood from the extremities to the chest area, causing increased pressure in the blood

vessels of the lungs and leakage of fluid into the lungs,” says Dr. Richard Moon, medical director of the Duke Center for Hyperbaric Medicine & Environmental Physiology and lead author of the study published in the AHA journal, Circulation.

Dr. Moon, Dr. John Freiberger and DIG winner, Dr. Anne Cherry, works with a participant during a study about colleagues studied these responses swimming-induced pulmonary edema at the Duke Hyperbaric Center. in 10 athletes who had experienced the condition while exercising or competthe same underwater exercise, the presing in triathlons. During a carefully monisures were no longer as elevated. tored test in Duke’s hyperbaric center, the “It appears that the drug, which dilates researchers had the participants exercise the blood vessels, could be creating more under water in a dive pool that recreated capacity in the blood vessels in the arms the conditions of a swim that could trigger and legs, reducing the tendency for blood the SIPE response. They compared those to redistribute to the thorax, therefore reparticipants with 20 others who did not ducing the high pressure in the pulmonary have a history of SIPE. None of the particivessels,” concludes Dr. Moon, noting that pants in either group had heart abnormallarger studies are needed to learn more ities, but the SIPE-susceptible athletes had about possible side effects of the drug. n higher pulmonary arterial pressure and pulmonary artery wedge pressure during Source: the underwater exercise, confirming that Duke Health Marketing and Communications, Sarah Avery SIPE is a form of pulmonary edema caused (2016). Study Suggests Sildenafil May Relieve Severe Form of Edema in Swimmers [Press release]. Retrieved from http://corpoby high pressure in the blood vessels with- rate.dukemedicine.org/news_and_publications/news_office/ news/study-suggests-sildenafil-may-relieve-severe-form-ofin the lungs. When the SIPE participants edema-in-swimmers were given sildenafil and then performed BluePrint 2016

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Innovative Research

Polar Profiling Discoveries of the Arctic Ground Squirrel

By Stacey Hilton In a first-of-its-kind study on hibernation biology, a team of Duke Anesthesiology researchers have revealed that hibernating mammals are protected against heart damage in an experimental model of cardiac surgery with the arctic ground squirrel. It’s a significant finding, published in the June 2016 issue of the journal, Anesthesiology, that the team believes will pave the way to identifying novel mechanisms of organ protection for patients undergoing cardiac surgery and transplantation.

This study has made significant strides in the medical field since its inception six years ago when Dr. Mihai Podgoreanu established a transcontinental collaboration with a team of hibernation biologists at the Institute of Arctic Biology at the University of Alaska Fairbanks. The goal of this ongoing study is to develop drugs or techniques that bring about the same kinds of mechanisms in humans so people

“This integrated proteomic and metabolomic analysis has not been done before, particularly following an experimental ischemiareperfusion insult. This is indeed unique to Duke.”

Mihai V. Podgoreanu, MD, FASE Associate Professor of Anesthesiology Chief, Division of Cardiothoracic Anesthesia

can protect themselves in the same way as arctic ground squirrels.

“We need drugs that can protect our patients against ischemia reperfusion injury,” says Dr. Quintin Quinones, the kind of injury an organ sustains when its blood flow is limited and then subsequently restored.

(Left to Right) Dr. Mihai Podgoreanu, Dr. Quintin Quinones, Michael Smith, Dr. Zhiquan Zhang, and Dr. Qing Ma.

“We’ve learned that hibernation is an adaptation to extreme environments known to protect against that injury, a major determinant of morbidity and mortality.”

These researchers have shown that proteins are expressed at different levels in the arctic ground squirrel ’s hearts and that white blood cells don’t respond to injury in the same way, which they say seems to play a major role in their ability to survive these extreme environments. They’ve learned that during most of the year, the innate immune system of the arctic ground squirrel seems to function similar to that in humans, but when they’re hibernating during the winter, it operates quite differently. When hibernators are very cold, Dr. Quinones says they can change the modifications of proteins and that is how he thinks they are able to regulate some of these differences when they’re hibernating. “We need to focus on the molecular switches that govern the change from one phenotype to the other. I think the regulation of genes through post translational modification is going to be the key to understanding that question.”

According to Dr. Podgoreanu, they have identified two potential metabolic switches,

Duke Anesthesiology researchers have taken several trips to Alaska to collect the mammals and to apply their model of ischemia reperfusion to the arctic ground squirrel, one of the deepest, coldest hibernating mammals on earth that live above the Arctic Circle. Each year, they hibernate for six to nine months and remarkably are able to keep their body temperature very low, nearly stop their heart and restart it, with virtually no obvious signs of damage.

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one called Sirtuin 3 and the other called Peroxisome Proliferator Activating Receptor alpha (PPAR-alpha), both of which are potentially druggable targets for cardioprotection. “Given multiple ongoing failures of cardioprotective therapies, we believe such strategies to help ‘switch’ myocardial metabolism to resemble that naturally occurring in mammalian hibernators represents a transformative approach that could ultimately have a significant impact on patients undergoing cardiac surgery and transplantation, as well as those who suffer cardiac arrest, stroke, trauma or hypothermia.”

The team’s new focus is the differences they’ve observed in how innate immunity works in non-hibernating and hibernating mammals. They have designed a panel that can compare innate immune markers across rats and arctic ground squirrels.

2008

2011

“I think the biologic effect of hibernation is such a significant and fundamental issue that I could very well spend my career working on this. There are dozens of different adaptations that accompany hibernation and we have only scratched the surface of a few of them, including the immune difference, cellular energetics and metabolism.”

Quintin Quinones, MD, PhD Assistant Professor of Anesthesiology

Once that phase is complete, they’ll work toward constructing panels that mirror what they use in the mammals and apply that to human patients in effort to see how much of this injury phenotype in rats is also seen in humans. Dr. Quinones says

2012

2013 WINTER Third trip to Alaska – nearly 20 ischemia reperfusion experiments performed

Duke Anesthesiology Cardiopulmonary Pulmonary Bypass Lab publishes cardiopulmonary bypass-based model of ischemia reperfusion injury, a model initially developed by Dr. Hilary Grocott and further refined

by Dr. Burkhard Mackensen

WINTER First trip to Alaska apply cardiopulmonary bypass model to hibernating arctic ground squirrels (AGS) FALL

Dr. Podgoreanu awarded DIG funding for understanding protective mechanisms in hibernating AGS during ischemia reperfusion

FALL – SUMMER’14 WINTER Second trip to Alaska – 20 ischemia reperfusion experiments performed

that will be their first step toward translating this work to humans.

“This phenomenon is robust and has a lot of clinical relevance. Through studies of these mechanisms we may actually be able to protect our patients.” n

2014

SUMMER AGS experiments performed at Duke, including WBC isolation

Flow cytometry panel development and experiments on white blood cells from rat and AGS

2016

SUMMER AGS experiments performed at Duke, including WBC isolation Podgoreanu Research Group publishes review article highlighting potential for translational therapies based on adaptations of hibernating animals

SPRING Dr. Quinones awarded FAER research grant to perform proteomic Proteomic analysis and FALL data analysis on hearts analysis comparing hearts of rats with AGS of rat vs. AGS Dr. Quinones awarded Duke SoM voucher to perform flow cytometric analysis to compare innate immune system of rats with AGS

2015

Dr. Quinones becomes first anesthesiologist to win Vivien Thomas Award for work on proteomic differences in hearts of hibernating AGS vs. rats

SUMMER Dr. Quinones awarded SCA starter grant to investigate molecular basis for differences in innate immunity between rat and AGS

Proteomics studies published in Anesthesiology

Research Timeline BluePrint 2016

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GlobalHealth

A Rising Role in Global Health

By Stacey Hilton

A Unique Culture of Training

For the past six years, Duke Anesthesiology has been committed to taking its residents outside the walls of Duke University Hospital and into underprivileged countries to make a difference in the lives of others.

Duke Anesthesiology offers one CA-3 resident an American Board of Anesthesiology accredited, month-long global health residency rotation each year—a rare opportunity for residents to expand their knowledge and improve the quality of anesthetic care of patients abroad while working alongside an attending physician from Duke at Ridge Hospital in Ghana.

“We live in a bit of a cocoon here where things are pretty perfect,” says Dr. Yemi Olufolabi, the attending physician and obstetric anesthesiologist who has made it his mission to travel with Duke residents on their global health trips to reduce maternal mortality. “The real world tasks you to think outside the box.

The real world requires you to be very creative in low resource countries. It’s really important for our residents to have this type of experience and exposure.”

“I have been passionate about global health for a long time and I knew I wanted that to be part of my education. I don’t know of any other institution that offers this and frankly, it was the reason I chose to come to Duke,” says Dr. Tera Cushman, then CA-3 anesthesia resident who was chosen to join Dr. Olufolabi for Duke Anesthesiology’s mission trip this past January. “Not only was www.kybeleworldwide.org the rotation in Ghana the most Known as the “Greek goddess of fun, month-long board exam I’ve childbirth” in Turkey ever had, but it also challenged me to really hone my craft, to This year, Duke Anesthesiology ask why, and to be adaptable.” celebrates the 15th anniversary Dr. Cushman’s role during the of the founding of Kybele, the non-profit organization that trip was to participate in the edput the department’s Global ucation of anesthetists at a nursHealth Program into motion ing school that Kybele founded and continues to support as part of Duke’s global health mission trips with faculty efforts in Ghana. She lectured and residents. with anesthesia students, taught 34

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DUKE ANESTHESIOLOGY

(Above) Dr. Tera Cushman poses with nurse anesthetist students in Ghana. (Below) Dr. Yemi Olufolabi demonstrates to students how to properly use medical equipment donated by Duke.

them basic life support and anesthesia for various surgeries, and provided simulation training, spending most of her time in general operating rooms. Dr. Cushman says due to limited resources, there are many instances where these CRNA students will graduate and return to their hometowns where they will be the only certified, trained anesthesia provider working at their district hospital.

“It seems scary to think that they are alone at a hospital with no other CRNAs or anesthesiologists to lend a hand, but that’s their reality. It’s crucial that we teach these students how to expand their capacity so they can provide quality anesthesia care to those in their community.”

Dr. Cushman says at the end of her trip, two of her students successfully resuscitated a patient who was coding, applying the lessons they learned, which had a resounding impact on her.

“To see our teaching save a life was an amazing moment for me. This mission trip left me with a strong commitment to global health which I’ll be sure to make time for in my career. I can’t imagine a satisfying career that doesn’t include this for me.”

For Dr. Olufolabi, “I more or less live to go,” he says. “I come alive when I’m down there. We have a role to play in the lives of others who are less privileged. I am proud to take that role on board – to help others see that that role is really important.”

The Duke Guatemalan Project

“When I return from our mission trips, I have a renewed sense of purpose in the fact that what I do makes a difference.”

Over the course of four days, Duke Anesthesiology’s Dr. Brad Taicher and his team helped care for 43 children in Guatemala City, providing them a range of both general and neurological procedures. “All of them went well and most importantly, all of the kids were happy and safe by the end of the week when it was time for them to go home. When they give you a hug it’s something that is very unique. You can feel you’ve changed their life.”

It’s a mission trip Dr. Taicher has taken each year for the past

DUKE ANESTHESIOLOGY GLOBAL HE ALTH PROGR AM

LE ARN MORE ABOUT DUKE ANESTHESIOLOGY ’S GLOBAL HE ALTH PROGR AM: ANESTHESIOLOGY.DUKE.EDU/GLOBALHE ALTH.HTML

E IN THE WOR R E LD H HAS THE W BANN

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Lisa Einhorn, MD

Dayna Seguin, CRNA

Photo credit:

Moon y: Dr. Richard

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n March of 2013 , Richard Moon , MD, CM, MSc, FCCP; his son, FRCP(C), FACP Pete r Moo , n; Euge ne The Trek and Chri s More tti, MD, Young, MD, MHS c; along with a After 21 hour trekkers from group of adve s of air trave around the nture-seeking l, the Xtrem world, ventu like-minded Kathmandu, e Everest 2 red out with fellow trave the first leg group arrive some llers from the of the trek. d in as part of the Unive Kathmandu’s The team spen rsity College, Xtreme Evere Summit Hote t two nights London, UK, st 2 project, l, where the at Camp. Their briefe to the trek leader, d the members Mount Evere goal was to Rob Wymer, st Base learn how huma on their onwa oxygen envir took rd journey. Ther ns succ a short flight onments as essfully adap eafter, the grou to Lukla, the altitude incre t to low aimed to use next stop on p ases Base .

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Camp at an especially as en can be deva altitude of hypoxia or stating to the organs in these patie nt’s brain and diseases. other 32 | DUKE

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From oceanside to mountaintop across the globe, Duke Anesthesiology proudly waves its banner! In 2014, the Duke Xtreme Everest 2 group climbed 8,300 feet, with the banner in hand, to the Mount Everest Base Camp to learn how humans adapt to low oxygen environments as altitude increases. In 2015, the banner set sail during Duke Anesthesiology’s 27th Annual Alumni Event in San Diego, and traveled overseas to Ghana and Guatemala City for mission trips aimed at improving global health.

MEET THE DUKE ANESTHESIOLOGY TEAM

Brad Taicher, DO, MBA

CLUES TO

Updates fro

Photo courtes

five years in collaboration with Duke’s Department of Surgery, all in effort to provide critical medical care to children in an underprivileged area and medical education to Guatemalan nurses, anesthesiologists and surgeons. Since the inception of the Duke Guatemalan Project, Dr. Taicher says it was important that they built it as a team-oriented structure in pediatric care. They wanted a team model so they could offer patients a full range of services and offer providers a full range of education.

This year’s mission was especially significant because it was the first year the Duke team was in the operating room with Guatemalan residents alongside them. “There was a lot for us to learn from them and for them to learn from us,” recalls Dr. Taicher. “For better or worse, we have access to almost everything one could want in the hospital system in the United States. Our Guatemalan colleagues have learned to exist in a resource-constrained environment and they’ve been able to adapt very effectively and quite safely. But sometimes, there are opportunities where the rationale for why we do things the way we do them in the U.S. might be lost, and that’s where some of the great conversations can occur.”

The other notable first in the name of medical education was the rare opportunity for Drs. Taicher and Henry Rice to present a grand rounds lecture to the surgeons and anesthesiologists at the two largest public hospitals in Guatemala City, Roosevelt Hospital and San Juan del Dios. Their lectures highlighted patient safety and quality, and they shared some initiatives that exist at Duke which could be applied to the Guatemalan health system.

“They get immense value in hearing our perspective on things and we get immense value seeing how they are able to accomplish phenomenal things with very little resources,” says Dr. Taicher. “When I return from a mission trip I truly feel invigorated and thrilled about how fortunate we are to do the job that we do, and that Duke provides us the opportunity to care for patients here and abroad. We have a responsibility to not just our country but the rest of the world – to all patients who need our care.” n

Dr. Richard

Moon

Dr. Brad Taicher instructs Guatemalan residents in the operating room.

Lisa Tatko, CRNA

BluePrint 2016

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GlobalHealth

The Gloves Came Off for Global Health

Duke Anesthesiology faculty pose for the camera at the Singapore-Duke Conference gala dinner.

Third Annual Singapore-Duke Conference Dr. Sol Aronson preparing for a pie in the face by Dr. John Buckwalter.

A crowd gathered with anticipation to the theme song of “Rocky” at Duke Anesthesiology’s second annual Pie in the Face global health fundraising event to watch the top donors, Drs. Eddie Sanders (suited-up in full boxing gear) and John Buckwalter, throw the honorary pies at the contest “competitor” who raised the most money, Dr. Sol Aronson!

The three “competitors,” including John Borrelli and Sharon Taylor, raised a total of $4,096 which supports residents’ travel expenses for their global RAISED health missions. Dr. Aronson SINCE 2014 raised $3,346, John raised $550 and Sharon raised $200 ($1,300 more than last year). Despite his best efforts, there was no escaping a pie in the face for John, hand-delivered by Sharon!

Pie in the Face is an annual global health fundraiser that began in 2014 and takes place outside HAFS in December. Three “competitors” are chosen from the department each year. The person who earns the most donations in their name receives the celebratory pie in the face; the top donor receives the honor of throwing the pie. n

$11,314

Singapore played host to the conference, which kicked-off on November 13, 2015, providing three days of lectures, symposiums, panel discussions and workshops at the Suntec Convention Center with the goal of redefining what it means to be an anesthesiologist.

The theme of the conference recognized the importance of staying ahead of the curve as anesthesiologists are increasingly being challenged to move outside of their traditional roles, to be seen as perioperative physicians. For the first time outside of Europe, the European Diploma in Regional Anesthesia and Pain Exams were conducted at the conference, highlighting the importance of pain management for optimum patient care.

Invited speakers included Duke Anesthesiology’s chairman, Dr. Joseph Mathew, and Drs. Michael James, Ankeet Udani, Madhav Swaminathan, Tom Buchheit, Kamrouz Ghadimi, Karthik Raghunathan, Mihai Podgoreanu and Edmund Jooste.

Duke Anesthesiology faculty also spoke about TeamLEAD at Duke-NUS Graduate Medical School in Singapore. It’s an innovative approach that is shaping the future of medical education and is being used in several schools in Singapore.

The Duke-NUS graduate school was established in 2005. It’s Singapore’s first U.S.-style graduate-entry medical school which pioneered a medical training program based on the Duke University School of Medicine’s curriculum. n

NEWLY APPOINTED AFFILIATE FACULT Y TO THE DUKE GLOBAL HEALTH INSTITUTE

Holly A. Muir, MD

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“I am honored…this appointment affords me to teach in the master’s program and creates opportunities for Duke global health students to participate in our projects. The most value comes from the sharing of knowledge and experiences with DGHI which also sponsors visiting global health lecturers.”

DUKE ANESTHESIOLOGY

Brad M. Taicher, DO, MBA

“It’s an honor to be nominated. Duke Anesthesiology as well as students and faculty at DGHI are all interested in accomplishing the same global health goals. Having this faculty appointment formalizes our relationship and provides us an opportunity to move forward with those collaborations.”

WHERE DO YOU WANT TO CHANGE LIVES? Duke Anesthesiology Global Health Program

“We at Duke have a role to play in global health to Adeyemi J. Olufolabi, MB BS make the world a better place.”

Associate Professor of Anesthesiology Program Director, Anesthesia Global Health Fellowship

Anesthesia plays a critical role in global health care, not only in times of crisis, but also in day-to-day events, such as childbirth. Things that we consider routine or trivial in the U.S., such as a hernia repair, can be life threatening in third-world countries that lack adequate supplies or medical education. In response, Duke Anesthesiology’s doctors and staff are committed to actively taking mission trips to countries that need help the most. Across the globe, our goal is to achieve health equality worldwide by meeting the health challenges of today and tomorrow.

Ready to make a difference?

Go to anesthesiology.duke.edu/globalhealth.html for more information on ways you can support our global health mission trips abroad and how you can get involved.

ResidencyRecap

Meet the Match Class of

2020

Jen Anderson

University of Michigan

Charles Horres Duke University

John McManigle

Duke University (ACES)

Jared Roberts

University of Kansas Starting as CA1 in 2017

Rob Schiller

Temple University

Sighs of relief were heard around the nation on Match Day on March 18 as medical students learned where they would be training in their chosen specialty. The Duke Anesthesiology Residency Program welcomed 14 interns as their Match Class of 2020, a class that has the department buzzing because of their broad diversity.

“This is a fantastic class of applicants who have matched with us and we’re thrilled to welcome them to Duke,” says residency program director, Dr. Annemarie Thompson.

Annemarie Thompson, MD “Once again, we’ve gotten people with diverse interests and diverse backgrounds who should work well

Bridger Bach

University of Utah

Luca La Colla

Università Vita - Salute San Raffaele

Bharat Sharma

Louisiana State University

Alison Brown

Stephen Frangakis

Delbert Lamb

William Lane

Duke University

University of North Dakota

Andrew Wong

University of Virginia

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DUKE ANESTHESIOLOGY

Baylor University

Rosalie Yan

Rutgers University

Starting as CA1 in 2017

together as a team.”

“It’s a very exciting time to see all of the amazing people we matched. The wide range of ages and experiences that they bring to the table are really impressive. I think it’s one of the strongest classes we’ve had and I’m really excited to get to know Christopher Wahal, MD everybody,” adds Dr. Christopher Wahal, co-chief resident.

Some of the exceptional qualities of the Match Class of 2020 include a lawyer, a former anesthesiologist from Europe, an Olympic weightlifting competitor and four members of the Alpha Omega Alpha Honor Medical Society. This class is also fluent

Duke Anesthesiology’s graduating residency class of 2016 having some laughs before saying their goodbyes in June.

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Duke University (ACES)

in many languages and one incoming resident has 12 first author publications. “It’s exciting that a lot of these residents have Eun Eoh, MD had other careers and other life experiences. I think that will really enrich our learning environment and the culture here,” says former co-chief resident and current Adult Cardiothoracic Anesthesiology fellow, Dr. Eun Eoh. According to the National Resident Matching Program (NRMP), this was the largest Main Residency Match on record in which more than 42,000 applicants vied for over 30,000 positions resulting in a 75 percent match rate for first-year positions!

As national Match numbers continue to grow each year, it takes a dedicated team to recruit the best and the brightest among the large number of applicants.

This year’s interview season at Duke Anesthesiology included 86 faculty and more than 50 residents. “These numbers give you an idea of the investment this department makes in the future of our anesthesiology residents,” says Dr. Thompson. “The department is really invested in us and it shows with how well we do in our recruitment and in our Match list,” adds Dr. Eoh. Now that the celebrations are over, the real work has begun for the Match Class of 2020 who officially started their Duke Anesthesiology residency in June. As they began their intern year, their leaders left with them these words of wisdom. “Intern year is tough but you’ll get through it,” adds Dr. Wahal.

“You can do anything for a year. You come in as a wide-eyed medical student, not sure what to expect, but by the time the year is over, you have gained so many skills and so much confidence that it’s really a fun year.”

And, as we said a fond best wishes to former co-chief residents, Dr. Eoh and Dr. Stephen Gregory on their cardiothoracic anesthesia fellowships, we said hello to our two new chief residents, Dr. Wahal and Dr. Jenna Falcinelli. “I’m really excited to help try and fill the shoes of the two chief residents who came before me,” says Dr. Wahal. “They did a great job and I’d like to continue to form a strong bond between the faculty and residents, and to continue to make Duke the amazing anesthesiology program that it is.” n

DUKE ANESTHESIOLOGY RESIDENC Y PROGR AM

LE ARN MORE ABOUT DUKE ANESTHESIOLOGY ’S RESIDENC Y PROGR AM: ANESTHESIOLOGY.DUKE.EDU/RESIDENC Y.HTML

By the Numbers

Jason Hall, MD

Resident Quoted in The Wall Street Journal CA-1 resident, Dr. Jason Hall, was interviewed by The Wall Street Journal regarding his involvement with The National Association of Free and Charitable Clinics (NAFC). These clinics are safety-net health care organizations that utilize a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/ or behavioral health services to economically disadvantaged individuals.

Before attending medical school, Dr. Hall initially decided to volunteer for NAFC after watching an MSNBC segment featuring the non-profit. In an interview with commentator Keith Olbermann, the CEO of NAFC, Nicole Lamoureux, mentioned that the organization needed volunteers for their upcoming 2009 New Orleans clinic. “After I went to the first clinic, it was something that I realized I

Resident Wins First Place for Research

enjoyed doing,” said Dr. Hall. “It’s an opportunity to connect patients to care that they can afford. To me, it was an obvious opportunity to do good for patients.”

When first volunteering, Dr. Hall was assigned logistical and organizational roles, such as triage work for incoming patients.

As his medical training advanced, he was assigned more medical responsibilities.

“I’ve always been what they call a ‘Volunteer Captain’ after my first clinic,” noted Dr. Hall, referring to when he was put in charge of a pediatric pod at the Dallas clinic. “I’m always one of the question-and-answer people and make sure the clinic is moving and flowing.”

Since 2009, Dr. Hall has volunteered at four additional clinics in Charlotte, Madison, Kansas City, and Dallas. “Over the course of each clinic, there were definitely patients I encountered where I came away from that day knowing I had an impact on someone,” he explained, when asked how these clinics have impacted him personally.

This past April, Dr. Hall returned to the Dallas clinic and urges that anyone is welcome to join him on future volunteer opportunities with the organization.

NAFC is always looking for volunteers of all backgrounds, especially those who are multilingual. n

2011 2010 2009

2013

100%

2014 2015

BOARD CERTIFICATION PASS RATE FOR THE PAST SEVEN YEARS ACADEMIC YEAR 2015-2016

17

PUBLISHED ARTICLES WITH RESIDENT AUTHORS

991 APPLICANTS

123

APPLICANTS INTERVIEWED

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MATCHED POSITIONS

Read the full Wall Street Journal article: TinyURL.com/JasonHall

CA-1 resident, Dr. Sarah Cotter, competed against 30 trainees at this year’s Duke Clinical Research Day and took home first place for her poster presentation, “Blood-Brain Barrier Permeability and Cognitive Dysfunction After Cardiac and Non-Cardiac Surgery.”

The 2016 Duke Clinical Research Day, sponsored by the School of Medicine, in partnership with the Duke Clinical Research Institute and the Graduate Medical Education office, took place on May 19.

Faculty, staff, trainees, and students came together to Sarah Cotter, MD, presenting her first place poster at Clinical Research Day.

2012

celebrate Duke’s amazing clinical research and the vast and diverse array of activities taking place across our medical campus.

As one of the largest biomedical research enterprises in the country, Duke manages more than $650 million in sponsored research expenditures annually. The School of Medicine oversees the research efforts of 2,000 basic science and clinical faculty members who strive to transform medicine and health through innovative scientific research and rapid translation of breakthrough discoveries. n Source: McKeel J. Celebrating Clinical Research, Transforming Health.

Duke Med School Blog. https://medschool.duke.edu/about-us/ news-and-communications/med-school-blog/celebrating-clinical-research-transforming-health. Accessed May 26, 2016.

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DU K

NESTHESIOL EA

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AlumniNotes DUK E A NES THESIOLOG Y A LUMNI SPOTLIGHT

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Growing the Duke Legacy

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By Stacey Hilton Duke Anesthesiology takes pride in those who play an integral role in strengthening the department and bring the anesthesia specialty to new heights. Its leaders believe that continued engagement with alumni is key to innovation and future success. As the Duke Family Tree continues to grow, we highlight two alumnus this year who may live in different countries but who are dedicated to creating a lasting legacy with the department.

Professor Monty Mythen University College London “I remember one of my mentors telling me that if I wanted to really develop a successful academic career, there were no real opportunities that could match those available at Duke.”

Professor Monty Mythen took those words to heart. After earning his medical degree and completing his anesthesia fellowship in the United Kingdom, he came to Duke in 1995 where he was appointed as assistant professor and acting chief of critical care in the Department of Anesthesiology.

“My time at Duke was a fantastic opportunity. I was young and full of energy and ideas, and I was in this sort of candy shop of bright, energetic people. It was amazing,” says Professor Mythen.

He jumped the pond again in 1997 to become a consultant of anesthesia and critical care at University College London (UCL) Hospitals where he continued to climb the ladder as the director of the Center for Anesthesia at UCL and the director of the UCL Discovery Lab at the London

Institute of Sports Exercise and Health. Professor Mythen has a wide range of research interests including perioperative medicine, enhanced recovery after surgery and human tolerance of hypoxia. He credits his time at Duke, both clinically and academically, for kick-starting not just his career but much of the rest of his life.

“I believe that good universities give you a boost in life and alumni like myself owe them to a certain extent. Alumni events with old friends have produced clinical, academic and other life opportunities that have made me a better person.”

Two of those opportunities created through Professor Mythen’s alumni ties are the new Duke Perioperative Medicine Fellowship in collaboration with UCL and the “Morpheus Consortium,” which Dean Nancy Andrews officially launched on behalf of the School of Medicine on June 8.

“If you have ambition, both clinical and academic, if you can’t get it done at Duke, you can’t get it done anywhere,” say Professor Mythen. “The Morpheus Consortium is a great example of the continued innovation that we can achieve as Duke alumnus.”

While Duke is certainly an institution of higher learning, Professor Mythen says leadership, mentorship and having a “can do” attitude was his greatest takeaway.

“Duke allows you to have ambition without boundaries. Let’s assume we can do it until we prove we can not. Words of wisdom from my time at Duke.”

Professor Monty Mythen and Dr. Joseph Mathew shake hands to kick-off the Morpheus Consortium collaboration.

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DUKE ANESTHESIOLOGY

Words that have never ringed more true as Professor Mythen continues to collaborate with Duke Anesthesiology leaders

Background

• Middlesex Hospital Medical School, UCL • Fellow of the Royal College of Anesthetists • Duke University School of Medicine ° Assistant Professor of Anesthesiology ° Acting Chief of Critical Care, Dept. of Anesthesiology • Director, Center for Anesthesia, UCL • Director, UCL Discovery Lab, London Institute of Sports Exercise and Health • Co-Chairman, Evidence Based Perioperative Medicine Annual Conference • Smiths Medical Professor Anesthesia and Critical Care, UCL

with the shared goal of Duke and UCL to be known as the trailblazers in perioperative medicine.

“Duke is my family. I feel as though I owe a lot to Duke. I want to be close to my cousins. I think we’re better off as a result of our continued relationship.”

AlumniNotes U P D AT E Y O U R A L U M N I P R O F I L E O N L I N E

Dr. Debra Schwinn University of Iowa At a crossroads during her senior year in high school in Ohio, Dr. Debra Schwinn had to choose which path to take - music or chemistry. That decision led her to Duke in 1986 for a cardiac anesthesia and research fellowship where she spent two of those three years in the lab with Nobel Prize winner, Dr. Robert Lefkowitz, and where she stayed for the next 21 years as a physician-scientist under the guidance of former chairman, Dr. Jerry Reves.

“Music and chemistry are a wonderful pairing,” says Dr. Schwinn. “Music is part of the subconscious and chemistry is part of the conscience. We all live in our heads so much that we need to learn to pay atten-

Alumni Spotlight Family Tree

2015 Dr. Chester Buckenmaier, III Dr. Torijaun Dallas Dr. Gerald Maccioli

2016 Prof. Monty Mythen Dr. Debra Schwinn

2017

?

Alumni Spotlight

Who should be featured in next year’s Alumni Spotlight?

Send nominations to Stacey.Hilton@duke.edu

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A N E S A L U M N I . D U H S . D U K E . E D U /A L U M N I

tion to our bodies. It’s not just what you know, but how you interact with people, how you inspire, how you help give people tools so they can see they can do it as well.”

For nearly 18 years at Duke, Dr. Schwinn was the vice chair for research, ran a molecular pharmacology lab, and was actively involved with cardiovascular genomics in the Institute for Genome Sciences and Policy. In 2007, Dr. Schwinn went on to start a university-wide Mitochondria and Metabolism Center and Pain Center as the department chairperson at the University of Washington. Today, as the current associate vice president for medical affairs at the University of Iowa, Dr. Schwinn credits her Duke mentors, colleagues and the School of Medicine’s collaborative environment for giving her the tools that ultimately shaped her career. She says one of her fondest memories was the ability to walk across campus, knock on someone’s door with a proposal, and leave with an agreement to work together.

“Duke is very interdisciplinary. Duke has that in its water. The models you have there for interdisciplinary research don’t exist everywhere across the country, so it’s up to us to treasure them and use them.” One of those interdisciplinary collaborations at Duke was with a senior bioengineering professor. Together, they worked on a genetic test to diagnose the presence of malaria and specific subtypes to be used in Africa.

Dr. Schwin says her love for pharmacology and physiology, coupled with her curiosity, made anesthesiology a perfect fit for her. She believes it’s important for residents and faculty alike to remember that sometimes all it takes to be a scientist is to be curious. “Ask yourself what pieces can I put together in unique ways to improve something? It’s curiosity and knowing you can think of a better way – I think every one of Duke’s residents, faculty and alumni can do that who are trained in an environment like this because Duke supports that curiosity.”

For Dr. Schwinn, her time at Duke ultimately taught her that if you have an idea, you can pull people together around that idea. She adds that as long as you think about where medicine is going in the next five or ten years, you can take whatever

Background

• Stanford University School of Medicine • Anesthesiology Residency, University of Pennsylvania • Cardiac Anesthesiology and Research Fellowship, Duke University School of Medicine • Duke University School of Medicine ° James B. Duke Professor of Anesthesiology ° Professor of Pharmacology, Surgery, Internal Medicine (Cardiology) • Chairperson, Department of Anesthesiology and Pain Medicine, University of Washington • Dean, Roy J. and Lucille A. Carver College of Medicine, University of Iowa • Associate Vice President for Medical Affairs, University of Iowa

pond you’re in at the time, whether it’s the head of a division or the dean of a medical school, and use it as a model to show others how to get to that future that you can see.

“Duke gave me the confidence that you can dream and put feet to that dream so you can march forward into reality in unique ways.”

So, for those who find themselves at a crossroads in their own career, Dr. Schwinn has this advice – the same advice she gave to a room full of colleagues and trainees as guest speaker at Duke Anesthesiology’s 24th Annual Academic Evening this year - follow your passions.

“Whatever you’re interested in; Whatever makes you excited; You can find a way to fit it into anesthesia in unique ways. Drop your preconceptions. Think about what you love. And, find what can give you the ability to follow those passions.”

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TheDepartment DepartmentChairman

DepartmentFaculty

Joseph P. Mathew, MD, MHSc, MBA

AMBULATORY ANESTHESIA

Jerry Reves, MD, Professor of Anesthesiology

CHIEF

Stephen M. Klein, MD Associate Professor of Anesthesiology Medical Director, Ambulatory Surgery Center

Steve Melton, MD Karen C. Nielsen, MD Program Director, Regional & Ambulatory Anesthesiology Fellowship Marcy Tucker, MD, PHD BASIC SCIENCES CHIEF

David S. Warner, MD Vice Chair for Research Distinguished Professor of Anesthesiology in the School of Medicine Professor of Neurobiology Professor of Surgery

SeniorCabinet Solomon Aronson, MD, MBA, FACC, FCCP, FAHA, FASE John Borrelli, MBA Padma Gulur, MD Joseph P. Mathew, MD, MHSc, MBA Holly A. Muir, MD Mark Stafford-Smith, MD, CM, FRCPC, FASE David S. Warner, MD

ExecutiveTeam Solomon Aronson, MD, MBA, FACC, FCCP, FAHA, FASE Raquel R. Bartz, MD, MMCi John Borrelli, MBA Thomas E. Buchheit, MD Adam Flowe, CRNA Alec Graham Padma Gulur, MD Dhanesh K. Gupta, MD Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA Stephen M. Klein, MD William Maixner, DDS, PhD Jonathan B. Mark, MD Gavin Martin, MB, ChB, FRCA, MMCi Joseph P. Mathew, MD, MHSc, MBA Timothy E. Miller, MB ChB, FRCA Holly A. Muir, MD Mihai V. Podgoreanu, MD, FASE Allison Kinder Ross, MD Edward G. Sanders, MD Mark Stafford-Smith, MD, CM, FRCPC, FASE Annemarie Thompson, MD David S. Warner, MD 42

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Gang Chen, PhD Ru Rong Ji, PhD Chief, Pain Research Sven-Eric Jordt, PhD Madan Kwatra, PhD Qing Ma, MD Wulf Paschen, PhD Noa Segall, PhD Huaxin Sheng, MD Niccolo Terrando, PhD Zhen-Zhong Xu, PhD Wei Yang, PhD Zhiquan Zhang, PhD CARDIOTHORACIC ANESTHESIA CHIEF

Mihai V. Podgoreanu, MD, FASE Associate Professor of Anesthesiology Director, Perioperative Genomics Program

Solomon Aronson, MD, MBA, FACC, FCCP, FAHA, FASE Executive Vice Chair Brandi Bottiger, MD Program Director, Adult Cardiothoracic Anesthesiology Fellowship Anne Cherry, MD J. Mauricio Del Rio, MD Michael Fierro, MD Kamrouz Ghadimi, MD Nazish Hashmi, MBBS Mandisa-Maia Jones-Haywood, MD Joern A. Karhausen, MD Miklos D. Kertai, MD, PhD Rebecca Klinger, MD, MS Jerrold Levy, MD, FAHA, FCCM Co-Director, Cardiothoracic ICU Yasmin Maisonave, MD Michael W. Manning, MD, PhD Joseph P. Mathew, MD, MHSc, MBA, FASE Jerry Reves Professor of Anesthesiology and Chairman

Cory Maxwell, MD Sharon McCartney, MD Mark F. Newman, MD President and Merel H. Harmel Professor; Duke Private Diagnostic Clinic Alina Nicoara, MD, FASE Director, Perioperative TEE Services Quintin Quinones, MD, PhD Mark Stafford-Smith, MD, CM, FRCPC, FASE Vice Chair, Education; Director, Fellowship Education Madhav Swaminathan, MD, MMCi, FASE, FAHA Clinical Director, Cardiothoracic Anesthesiology Annemarie Thompson, MD Residency Program Director Eleanor Vega, MD Ian J. Welsby, MB, BS, BSc, FRCA NEW! CENTER FOR TRANSLATIONAL PAIN MEDICINE DIRECTOR

William Maixner, DDS, PhD Professor of Anesthesiology

Aurelio Alonso, DDS, MS, PhD Director, Orofacial Pain Richard L. Boortz-Marx, MD, MS Medical Director, Center for Translational Pain Medicine Andrey Bortsov, MD Thomas E. Buchheit, MD Jongbae Jay Park, PhD, LAc Director, Acupuncture and Asian Medicine Ru-Rong Ji, PhD Sven-Eric Jordt, PhD Francis Keefe, PhD Wolfgang Liedtke, MD, PhD Andrea G. Nackley, PhD Shad B. Smith, PhD Thomas J. Van de Ven, MD, PhD Paul E. Wischmeyer, MD COMMUNITY DIVISION CHIEF

Edward G. Sanders, MD Assistant Clinical Professor of Anesthesiology

Lu Adams, MD David S. Bacon, MD Rachel Beach, MD John D. Buckwalter, MD Nancy L. Centofante, MD Eric Ehieli, MD William J. Fortuner, MD Joshua H. Friedman, DO Christopher Gratian, MD Daniel Kovacs, MD Eugene R. Lee, MD Debabrata Maji, MD Scott V. McCulloch, MD E. Burt Mckenzie Jr., MD

TheDepartment G E T A CQ U A I N T E D W I T H O U R E N T I R E T E A M Elizabeth Nichols, MD William P. Norcross, MD Gary L. Pellom, MD Earl S. Ransom, Jr., MD Richard D. Runkle III, MD Siddharth Sata, DO Michael J. Stella, MD Chris Summers, MD Evan Sutton, MD Neel Thomas, MD Joseph Yurigan, DO NEW! CRITICAL CARE MEDICINE CHIEF

Raquel R. Bartz, MD, MMCi

Assistant Professor of Anesthesiology Assistant Professor in Medicine

Atilio Barbeito, MD, MPH Yuriy Bronshteyn, MD Charles S. Brudney, MB BCh J. Mauricio Del Rio, MD Michael Fierro, MD Kamrouz Ghadimi, MD Ehimemen Iboaya, MD Michael “Luke” James, MD, FAHA, FNCS Co-Director, Neuro Critical Care Fellowship Mandisa-Maia Jones-Haywood, MD Nancy W. Knudsen, MD John Lemm, MD Jerrold Levy, MD, FAHA, FCCM Colleen Moran, MD Medical Director, Duke Raleigh ICU Eugene W. Moretti, MD, MHSc Okoronkwo U. Ogan, MD Mihai V. Podgoreanu, MD, FASE Quintin Quinones, MD, PhD Karthik Raghunathan, MD, MPH Arturo Suarez, MD Madhav Swaminathan, MD, MMCi, FASE, FAHA Annemarie Thompson, MD Eleanor Vega, MD Xueyuan Shelly Wang, MD Ian J. Welsby, MB, BS, BSc, FRCA Paul E. Wischmeyer, MD Christopher C. Young, MD Director, Critical Care Medicine Fellowship GENERAL, VASCULAR AND TRANSPLANT ANESTHESIA CHIEF

Timothy E. Miller, MB ChB, FRCA

Associate Professor of Anesthesiology Program Director, Perioperative Medicine Fellowship Clinical Director, Abdominal Transplant Anesthesiology Vice President, American Society for Enhanced Recovery

Yuriy Bronshteyn, MD Brian J. Colin, MD Assistant Residency Program Director W. Jonathan Dunkman, MD Michael Fierro, MD Jake Freiberger, MD, MPH Program Director, Undersea and Hyperbaric Medicine Fellowship

Ehimemen Iboaya, MD Nancy W. Knudsen, MD Catherine M. Kuhn, MD Director & Associate Dean, Graduate Medical Education; Designated Institutional Official John Lemm, MD Elizabeth Malinzak, MD Director, Eye Center Michael W. Manning, MD, PhD Grace C. McCarthy, MD Richard E. Moon, MD, CM, MSc, FRCP(C), FACP, FCCP Eugene W. Moretti, MD, MHSc Ronald P. Olson, MD, CCFP Quintin Quinones, MD, PhD Iain C. Sanderson, MD, BM, BCh Vice Dean, Research Informatics; Associate Chief Information Officer, Periop Aaron J. Sandler, MD, PhD Arturo Suarez, MD Ankeet Udani, MD Kerri M. Wahl, MD, FRCP(C) Xueyuan Shelly Wang, MD Christopher C. Young, MD Program Director, Critical Care Medicine Fellowship NEUROANESTHESIOLOGY, OTOLARYNGOLOGY, AND OFF-SITE ANESTHESIA CHIEF

Dhanesh K. Gupta, MD Professor of Anesthesiology

Miles Berger, MD, PhD Nicole R. Guinn, MD Director, Center for Blood Conservation Jennifer Hauck, MD Ulrike Hoffmann, MD, PhD Michael “Luke” James, MD, FAHA, FNCS Program Director, Neuroanesthesia Fellowship John C. Keifer, MD Grace C. McCarthy, MD Colleen Moran, MD Charles Andrew Peery, MD, MPH, MA Bryant “Bret” W. Stolp, MD, PhD Jeffrey Taekman, MD Director, Human Simulation and Patient Safety Center David S. Warner, MD PAIN MEDICINE CHIEF

Thomas E. Buchheit, MD

Associate Professor of Anesthesiology Director, Duke Pain Medicine

Richard L. Boortz-Marx, MD Director of Interventional Pain Medicine Emily Davis, ACNP-BC Anne Marie Fras, MD Arun Ganesh, MD Brian Ginsberg, MB, ChB

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Joel S. Goldberg, MD Director, VAMC Pain Service Padma Gulur, MD Christinna J. Haire, ACNP-BC, MSN, NE, RN Thomas J. Hopkins, MD Director, Quality Improvement Hung-Lun (John) Hsia, MD David R. Lindsay, MD Chair of Program Evaluation Committee Karen McCain, FNP-BC Jennifer Parsons, FNP-BC Steven Prakken, MD Director, Medical Pain Service Srinivas Pyati, MD Muhammad Yawar J. Qadri, MD Neil Ray, MD Lance A. Roy, MD Program Director, Pain Medicine Fellowship Scott Runyon, MD Jessica Salyer, ANP Debra Stoia, PA-C Ashley Underwood, PA-C E. Hope Weant, AGACNP-BC, MSN, RN Thomas Van de Ven, MD, PhD PEDIATRIC ANESTHESIA CHIEF

Allison Kinder Ross, MD Professor of Anesthesiology and Pediatrics

Warwick Ames, MBBS, FRCA Guy de Lisle Dear, MA, MB, BChir, FRCA, FUHM John B. Eck, MD Director, Education Development; Program Director, Pediatric Anesthesiology Fellowship Lisa M. Einhorn, MD Andrea Udani, MD Nathaniel H. Greene, MD, MHS, FAAP Director, Research in Pediatric Anesthesia H. Mayumi Homi, MD Edmund H. Jooste, MB, ChB Clinical Director, Pediatric Cardiac Anesthesiology; Director of CARE (Clinical Anesthesiology Research Endeavors) Kelly Machovec, MD, MPH Brad M. Taicher, DO, MBA Co-Director, Quality Improvement ORTHOPAEDICS, PLASTICS, AND REGIONAL ANESTHESIOLOGY CHIEF

Gavin Martin, MB, ChB, FRCA, MMCi Professor of Anesthesiology Assistant OR Director

W. Michael Bullock, MD, PhD Joshua Dooley, MD Ellen M. Flanagan, MD Medical Director, Preoperative Screening Unit Jennifer T. Fortney, MD Jeff Gadsden, MD, FRCPC, FANZCA Andrea Goodrich, MD Stuart A. Grant, MB, ChB, FRCA Director, Medical Student Education

David B. MacLeod, MBBS, FRCA Erin Manning, MD, PhD Brian Ohlendorf, MD Stephen J. Parrillo, MD Michael R. Shaughnessy, MD Alicia Lopez Warlick, MD VETERANS AFFAIRS ANESTHESIOLOGY SERVICE CHIEF

Jonathan B. Mark, MD Professor of Anesthesiology

Atilio Barbeito, MD, MPH Assistant Chief, Quality and Safety Initiative; Interim Director, Surgical Intensive Care Unit Raquel R. Bartz, MD, MMCi Yuriy Bronshteyn, MD Charles S. Brudney, MB, ChB, FRCA Director, Surgical Intensive Care Unit Thomas E. Buchheit, MD Joel S. Goldberg, MD Director, Pain Clinic Jennifer Hauck, MD Juliann C. Hobbs, MD, MPH Hung-Lun (John) Hsia, MD Ryan Konoske, MD John Lemm, MD David R. Lindsay, MD Director, VA Pain Initiative Amy K. Manchester, MD Cory Maxwell, MD Srinivas Pyati, MD, FFARCSI Karthik Raghunathan, MD, MPH Amy M. Rice, MD Rebecca A. Schroeder, MD, MMCI Assistant Chief, Research Administration Arturo Suarez, MD Thomas Van de Ven, MD, PhD Xueyuan Shelly Wang, MD Ian J. Welsby, MB, BS, FRCA Dana N. Wiener, MD Assistant Chief, Clinical Administration; Medical Director, Short Stay Unit WOMEN’S ANESTHESIA CHIEF

Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA Professor of Anesthesiology

Terrence Allen, MBBS, FRCA Matthew Buck, MD Jennifer E. Dominguez, MD, MHS Cheryl A. Jones, MD Abigail H. Melnick, MD Holly A. Muir, MD Anesthesia Medical Director, Periop Services; Vice Chair, Clinical Operations Adeyemi J. Olufolabi, MB BS Program Director, Anesthesia Global Health Fellowship Zaneta Y. Strouch, MD, MPH

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CAREER CORNER Appointments • Nominations • Promotions

C A R DIOTHOR ACIC A NES THESI A

Brandi A. Bottiger, MD Appointed Program Director, Adult Cardiothoracic Anesthesiology Fellowship (April 2016) Nazish Hashmi, MD Appointed Assistant Professor of Anesthesiology (August 2016)

Sharon McCartney, MD Appointed Assistant Professor of Medicine (July 2016)

Mark Stafford-Smith, MD, CM, FRCPC, FASE Appointed to the Review Committee for Anesthesiology, Accreditation Council for Graduate Medical Education (June 2016) CENTER FOR TR A NSL ATION A L PA IN MEDICINE (C TPM)

Aurelio Alonso, DDS, MS, PhD Appointed Director of Orofacial Pain, CTPM, Duke Innovative Pain Therapies (July 2016) Andrey Bortsov, MD, PhD Appointed Assistant Professor in Anesthesiology, CTPM (July 2016)

William Maixner, DDS, PhD Appointed Director, CTPM, Duke Innovative Pain Therapies (January 2016) Appointed to the Board of Directors, European Pain School, International Association for the Study of Pain (August 2016) Andrea G. Nackley, PhD Appointed Associate Professor in Anesthesiology, CTPM (January 2016)

Jongbae Jay Park, PhD, LAc Appointed Director of Acupuncture and Asian Medicine and Associate Professor in Anesthesiology, CTPM, Duke Innovative Pain Therapies (November 2015) Shad B. Smith, PhD Appointed Assistant Professor in Anesthesiology, CTPM (January 2016)

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CERTIFIED R EGIS TER ED NUR SE A NES THE TIS T S (CR N A s)

Natalie Clarke DNP, CRNA Appointed CRNA Manager, Ambulatory Surgery Center (December 2015)

COMMUNIT Y DI V ISION

Eric Ehieli, MD Appointed Assistant Professor of Anesthesiology (August 2016)

Adam Flowe, CRNA, MSN Appointed Chief Nurse Anesthetist, Duke University Hospital (November 2015)

Elizabeth Nichols, MD Appointed Clinical Associate in Anesthesiology (September 2015)

Darren Sessler CRNA, MSN CRNA Clinical Team Lead, GI/Pulmonary Endoscopic Clinic at Duke University Medical Center (August 2016)

Siddharth Sata, DO Appointed Assistant Professor of Anesthesiology (August 2016)

Evan Sutton, MD Appointed Assistant Professor of Anesthesiology (August 2016)

Joseph Yurigan, DO Appointed Clinical Associate in Anesthesiology (April 2016)

CR ITIC A L C A R E MEDICINE

Raquel R. Bartz, MD, MMCi Appointed Division Chief, Critical Care Medicine Division (September 2015)

Michael L. James, MD, FAHA, FNCS Appointed Co-Director, Neuro Critical Care Fellowship (February 2016) Appointed Duke-NUS Clinical Research Liaison (July 2016) 44

Jamie Privratsky, MD (Fellow) Inducted as a Member of the Robert J. Lefkowitz Society (September 2015)

Matt Stamper DNP, CRNA Appointed CRNA Manager, Main Operating Room – Duke University Hospital North and Duke Medical Pavillion (January 2016) DUK E A NES THESIOLOG Y

Atilio Barbeito, MD, MPH Raquel R. Bartz, MD, MMCi Dhanesh K. Gupta, MD Michael L. James, MD, FAHA, FNCS Joern A. Karhausen, MD Elected New Members, Association of University Anesthesiologists (December 2015) Tiffany Bisanar, RN, BSN, CCRP Appointed Assistant Research Practice Manager, Anesthesiology Clinical Research Unit (December 2015) Alec Graham Appointed Anesthesiology and Perioperative Information Technology Director (October 2015) Ashley Grantham, PhD Appointed Medical Education Specialist (November 2015)

CAREER CORNER Appointments • Nominations • Promotions

Stephen M. Klein, MD Gavin Martin, MB ChB Madhav Swaminathan, MD, FASE, FAHA

Appointed Assistant Directors of Anesthesia Perioperative Services, Duke University Hospital (September 2015) G V T A NES THESI A

Yuriy Bronshteyn, MD Appointed Assistant Professor of Anesthesiology (November 2015)

W. Jonathan Dunkman, MD Appointed Assistant Professor of Anesthesiology (August 2016)

Nancy W. Knudsen, MD Selected as the Hippocratic Oath Ceremony Distinguished Speaker, Duke University School of Medicine Graduation (May 2016) Elizabeth B. Malinzak, MD Appointed Clinical Coordinator, Duke Eye Center (August 2016)

Timothy E. Miller, MB, ChB, FRCA Appointed Division Chief, GVT Division (January 2016) Appointed Program Director, Duke Perioperative Medicine Fellowship (March 2016) Aaron J. Sandler, MD, PhD Selected to Serve as an Examiner, American Board of Anesthesiology Part 2 Examinations (February 2016) Ankeet Udani, MD, MSEd Selected to Serve as a Member Anesthesia Patient Safety Foundation Committee on Education and Training (October 2015)

NEUROA NES THESIOLOG Y

Nicole R. Guinn, MD Selected as a Question Author American Board of Anesthesiology ADVANCED Examination (October 2015) Colleen Moran, MD Appointed Assistant Professor of Anesthesiology (August 2016)

Jeffrey M. Taekman, MD Selected to Serve as a Member, Newly-formed Ad Hoc Committee on Screen-Based Simulation, American Society of Anesthesiologists (January 2016)

Brad M. Taicher, DO, MBA Appointed Affiliate Faculty, Duke Global Health Institute (June 2016)

R EGION A L A NES THESIOLOG Y

Ellen M. Flanagan, MD Appointed Medical Director, Preoperative Screening Unit (August 2016)

R ESIDENC Y PROGR A M

Jessica Burkhart Appointed Anesthesiology Residency Program Coordinator (December 2015)

PA IN MEDICINE

Arun Ganesh, MD Appointed Assistant Professor of Anesthesiology (August 2016) Padma Gulur, MD Appointed Professor of Anesthesiology and the Vice Chair for Operations and Performance (August 2016)

Jason Hall, MD, JD (CA-1 Resident) Elected Delegate, American Medical Association Resident and Fellow Section, American College of Medical Quality (December 2015) Stephanie E. Jones, MD (CA-3 Resident) Alexander Reskallah, MD (CA-3 Resident)

David R. Lindsay, MD Appointed Chair, Program Evaluation Committee Appointed Director, VA Pain Initiative Lance A. Roy, MD Appointed Program Director, Pain Medicine Fellowship

Muhammad Yawar J. Qadri, MD Appointed Assistant Professor of Anesthesiology (August 2016)

Appointed New Members, Duke AHEAD – Academy for Health Professions Education and Academic Development (August 2016) VA A NES THESIOLOG Y SERV ICE

Atilio Barbeito, MD, MPH Appointed Director, Surgical Intensive Care Unit (October 2016) Appointed to the Quality and Safety Committee, Society of Cardiac Anesthesiologists (March 2016) WOMEN ’ S A NES THESI A

PEDI ATR IC A NES THESI A

Lisa Einhorn, MD Appointed Assistant Professor of Anesthesiology (August 2016)

Holly A. Muir, MD Appointed Affiliate Faculty, Duke Global Health Institute (June 2016)

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HONOR SOCIET Y Awards • Grants • Honors BA SIC SCIENCES

Sven-Eric Jordt, PhD Mechanisms of Itch in Poison Ivy-Induced Allergic Contact Dermatitis Award Date: August 2016 Funding Agency: National Institute of Arthritis and Musculoskeletal and Skin Diseases (R21) Grant Amount: $384,780 Madan M. Kwatra, PhD Targeting GBMs with Activated EGFR with Third-Generation, Brain-Penetrating AZD9291 Award Date: June 2016 Funding Agency: Musella Foundation For Brain Tumor Research & Information, Inc. Grant Amount: $8,000 Wulf Paschen, PhD Effect of Age on Brain Ischemia/Stroke Outcome; Pathways, Mechanisms, and Rescue Award Date: June 2016 Award Name: National Institutes of Health Grant (R01) Funding Agency: National Institute of Neurological Disorders and Stroke Grant Amount: $1,043,439 Noa Segall, PhD Right Place, Right Time: Information Design to Support Decisions in Acute Care Award Date: February 2016 Funding Agency: Saint Alphonsus Regional Medical Center/NIH Grant Amount: $100,800 Niccolo Terrando, PhD Neuroprotective Effects of URMC-099 in Postoperative Cognitive Dysfunction Award Date: April 2016 Funding Agency: University of Rochester Medical Center Grant Amount: $3,000 Bioelectronic Medicine and Cholinergic Regulation of Postoperative Cognitive Dysfunction Award Date: July 2016 Award Name: 2016-2017 Research Incubator Award Funding Agency: Duke Institute for Brain Sciences Grant Amount: $75,000 David S. Warner, MD Award Date: 2015 Award Name: Distinguished Alumnus Award for Achievement Presented By: University of Iowa Carver College of Medicine

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Award Date: October 2015 Award Name: FAER Anesthesiology Mentoring Excellence in Research Award Presented By: FAER Academy of Research Mentors in Anesthesiology Wei Yang, PhD ER Stress Response in Recovery of Brain Function After Cardiac Arrest Award Date: May 2016 Funding Agency: American Heart Association Grant Amount: $154,000 Zhiquan Zhang, PhD Proteomic Identification of Novel Sirtuin-3 Regulated Pathways in the Treatment of Acute Myocardial Ischemia-Reperfusion Award Date: June 2016 Funding Agency: Duke University School of Medicine Grant Amount: $10,000

C A R DIOTHOR ACIC A NES THESI A

Kamrouz Ghadimi, MD Role Of Sirtuins in Platelet Aging and Perioperative Thrombocytopenia After Mechanical Circulatory Support Award Date: May 2016 Award Name: ENhanced Academics in a Basic Laboratory Environment (ENABLE) Grant Funding Agency: Duke Private Diagnostic Clinic Grant Amount: $46,000 Joern A. Karhausen, MD Platelet/Mast Cell Interactions as Determinants of End-Organ Injury in Cardiac Surgery Award Date: September 2015 Award Name: NIH High Priority, Short-Term Project Award (R56) Funding Agency: National Heart, Lung, and Blood Institute Grant Amount: $414,362 Jerrold H. Levy, MD, FAHA, FCCM, Initial Experience With Idarucizumabin Dabigatran-Treated Patients Requiring Emergency Surgery or Intervention: Interim Results from the RE-VERSE AD Study Award Date: August 2015 Award Name: Overall Poster Winner, ‘Interventions / Peripheral Circulation / Stroke / Surgery’ Presented By: ESC Congress 2015 (European Society of Cardiology)

Joseph P. Mathew, MD, MHSc, MBA Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest Co-PI: G. Charles Hughes, MD Award Date: July 2016 Funding Agency: National Heart, Lung, and Blood Institute/NIH Grant Amount: $3,500,000 Mihai V. Podgoreanu, MD, FASE Quintin Quinones, MD, PhD Sequencing Technology for Rapid Detection of Fastidious and Resistant Infectious Agents in the Critically Ill

Award Date: June 2016 Funding Agency: Duke University School of Medicine Grant Amount: $10,000 Quintin Quinones, MD, PhD Organ Protective Mechanisms Invoked in Mammalian Hibernation: The Role of Innate Immunity Award Date: May 2016 Award Name: ENhanced Academics in a Basic Laboratory Environment (ENABLE) Grant Funding Agency: Duke Private Diagnostic Clinic Grant Amount: $46,000 Madhav Swaminathan, MD, FASE, FAHA A Randomized, Double-Blind, Placebo Controlled, Phase 2 Study to Evaluate the Efficacy and Safety of QPI-1002 for the Prevention of Acute Kidney Injury in Subjects at High Risk for AKI Following Cardiac Surgery Award Date: January 2016 Funding Agency: Quark Pharmaceuticals, Inc. Grant Amount: $229,715 Nathan Waldron, MD (Adult Cardiothoracic Anesthesiology Fellow) Temporary Autonomic Blockade to Prevent Atrial Fibrillation After Cardia Surgery Award Date: May 2016 Funding Agency: American Heart Association Grant Amount: $154,000

HONOR SOCIET Y Awards • Grants • Honors CENTER FOR TR A NSL ATION A L PA IN MEDICINE (C TPM)

William Maixner, DDS, PhD Genetic and Psychosocial Influences on Transition to Chronic TMD and Related Pain (OPPERA-2) Award Date: April 2016 Funding Agency: University of North Carolina – Chapel Hill/NIH Grant Amount: $134,043 Award Date: June 2016 Award Name: Neuroscience Senior Investigator Research Award Presented By: The International Association for Dental Research Andrea Nackley, PhD Proteins, MicroRNAs and Genes Associated with TMD and Overlapping Conditions.

Award Date: November 2015 Funding Agency: NIH National Institute of Dental and Craniofacial Research Grant Amount: $500,000 CERTIFIED R EGIS TER ED NUR SE A NES THE TIS T S (CR N A’ S )

Brad Dean, CRNA Carrie Kaylos, CRNA

EDUC ATION

Miles Berger, MD, PhD Ankeet Udani, MD, MSEd Educating Anesthesia Residents to Improve Perioperative Care for the Elderly

Award Date: November 2015 Award Name: Geriatrics-for-Specialists Initiative Grant Funding Agency: American Geriatrics Society Grant Amount: $30,000 G V T A NES THESI A

John J. Freiberger, MD, MPH Award Date: August 2016 Award Name: Davis Award For Clinical Excellence and Research in the Field of Undersea and Hyperbaric Medicine Presented By: Undersea and Hyperbaric Medical Society Nancy W. Knudsen, MD Award Date: March 2016 Award Name: Nominee and Runner-up, Golden Apple Awards Presented By: Duke University School of Medicine Student Body Nancy W. Knudsen, MD Xueyuan Shelly Wang, MD The Surgical Intensive Care Unit’s Quality Improvement (SICU QI) Committee

Award Date: May 2016 Award Name: Preceptors of the Year Presented By: Duke University School of Nursing Megan Foureman, CRNA, MSN Award Date: November 2015 Award Name: Friends of Nursing Excellence Award Presented By: Duke Health

Award Date: March 2016 Award Name: Rebecca Kirkland Award – “Best Overall Project” and “Best Poster” Presented By: Duke University Health System Patient Safety Office, 11th Annual Duke Patient Safety and Quality Conference

$6.3MILLION NEW GRANTS TOTALING MORE THAN FOR THE 2015-16 FISCAL YEAR

Ankeet D. Udani, MD, MSEd A Comparison of Two Learning Theories on Emergency Manual Use: Classroom-Based Experiential Learning Versus Electronic-Based Self-Directed Learning Award Date: April 2016 Funding Agency: Anesthesia Patient Safety Foundation Grant Amount: $147,001 A Comparison of Two Learning Theories On Emergency Manual Use: Classroom-Based Experiential Learning Versus Electronic-Based Self-Directed Learning Award Date: April 2016 Award Name: APSF Safety Scientist Career Development Award Funding Agency: Anesthesia Patient Safety Foundation Grant Amount: $150,000 NEUROA NES THESIOLOG Y

Miles Berger, MD, PhD The Significance of Perioperative Changes in CSF Tau Levels in the Elderly Award Date: November 2015 Award Name: Dennis W. Jahnigen Career Development Award Funding Agency: American Geriatrics Society and the Foundation for Anesthesia Education and Research Grant Amount: $25,000 Understanding Mechanisms of Postoperative Cognitive Dysfunction and Delirium and Determining If These Disorders are Associated With Increased Long Term Risk of Developing Alzheimer’s Disease Award Date: May 2016 Award Name: ENhanced Academics in a Basic Laboratory Environment (ENABLE) Grant Funding Agency: Duke Private Diagnostic Clinic Grant Amount: $46,000 Miles Berger, MD, PhD Niccolo Terrando, PhD Role of Anti-Inflammatory Lipids in Postoperative Cognitive Dysfunction and Delirium

Award Date: April 2016 Award Name: Supplemental Award Funding Agency: Duke Translational Research Institute Grant Amount: $25,000

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HONOR SOCIET Y Awards • Grants • Honors PEDI ATR IC A NES THESI A

Nathaniel H. Greene, MD A Study of Practice Behavior for Endotracheal Intubation Site for Children with Congenital Heart Disease Undergoing Cardiopulmonary Bypass Surgery: Impact of Endotracheal Intubation Site on Perioperative Outcomes Co-PI’s: Warwick A. Ames, MBBS, Edmund H. Jooste, MB ChB, Kelly A. Machovec, MD, MPH, Hercilia Mayumi Homi, MD, PhD, and David Freed Vener, MD (Texas Children’s Hospital) Award Date: January 2016 Award Name: Access & Publications Task Force Analysis Award Funding Agency: Society for Thoracic Surgeons Grant Amount: $25,000 A Phase IIA, Open label, Safety and Pharmacokinetic Study of Tivorbex® Capsules in Pediatric Subjects 6 to <17 (exclusive) Years of Age with Mild to Moderate Acute Postoperative Pain Following Elective Surgery Award Date: February 2016 Funding Agency: Iroko Pharmaceuticals, LLC Grant Amount: $72,664 Edmund H. Jooste, MB ChB Evaluation of CATSmart System Award Date: December 2015 Funding Agency: Fresenius Kabi Grant Amount: $60,103

Kelly A. Machovec, MD, MPH Open-Label Evaluation of the Population Pharmacokinetic Profile, Safety, Tolerability, and Efficacy of Tapentadol Oral Solution For the Treatment of Post-Surgical Pain in Children Aged from Birth to Less Than 2 Years Award Date: April 2016 Funding Agency: Grunenthal GmbH Grant Amount: $50,063

Allison K. Ross, MD An Open-Label Study of the Pharmacokinetics and Safety of MNK-155 (7.5 mg in Postsurgical Adolescent Subjects (Ages 12 to 17) With Moderate to Severe Acute Pain Award Date: October 2015 Funding Agency: Mallinckrodt Pharmaceuticals Grant Amount: $115,981

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ENDO EN3319-304 Oxymorphone for Postop Pain Award Date: December 2015 Funding Agency: Endo Pharmaceuticals Grant Amount: $155,104 Using a Duke Specific Educational Tool for Postoperative Pain Management Award Date: June 2016 Funding Agency: Duke Children’s 2015 Gala Grant Amount: $5,000 R EGION A L A NES THESIOLOG Y

Jeffrey Gadsden, MD A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Efficacy, Safety, and Pharmacokinetics of Femoral Nerve Block with EXPAREL for Postsurgical Analgesia in Subjects Undergoing Total Knee Arthroplasty Award Date: March 2016 Funding Agency: Pacira Pharmaceuticals Grant Amount: $184,034 A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Efficacy, Safety, and Pharmacokinetics of Brachial Plexus Block with EXPAREL for Postsurgical Analgesia in Subjects Undergoing Total Shoulder Arthroplasty or Rotator Cuff Repair Award Date: April 2016 Funding Agency: Pacira Pharmaceuticals Grant Amount: $188,912 Stuart A. Grant, MB, ChB CARA CR845 for Abdominal Surgery Pain Award Date: November 2015 Funding Agency: Cara Therapeutics, Inc. Grant Amount: $224,650

R ESIDENC Y PROGR A M

Sarah Cotter, MD (CA-1 Resident) Blood-Brain Barrier Permeability and Cognitive Dysfunction after Cardiac and Non-Cardiac Surgery Award Date: May 2016 Award Name: First Place, Resident/Fellow Poster Competition Presented By: Duke School of Medicine’s Clinical Research Day Russ Horres, MD (Residency Intern) Enhanced Recovery Protocols Do Not Impair Postoperative Renal Function Award Date: April 2016 Award Name: Second Place, Abstract Presentation Presented By: American Society for Enhanced Recovery, 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine VA A NES THESIOLOG Y SERV ICE

Atilio Barbeito, MD, MPH Nazish Hashmi, MD Implementation and Evaluation of the Impact of a Standardized Perioperative Blood Transfusion Protocol for Cardiac Surgery Patients at the Durham VAMC

Award Date: May 2016 Award Name: GME Concentration Award Presented By: Duke Graduate Medical Education WOMEN ’ S A NES THESI A

Durect PERSIST Award Date: December 2015 Funding Agency: DURECT Corporation Grant Amount: $137,354 David B. MacLeod, MB BS Comparison of Compensatory Reserve Index to Changes in Stroke Volume and Intravascular Volume During Continuous Rate Blood Draw & Subsequent Resuscitation via Re-infusion.

Award Date: September 2015 Funding Agency: Flashback Technologies, Inc. Grant Amount: $150,933

Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA Randomized, Double-Blind, PlaceboControlled Study of APD421 (Amisulpride for IV Injection) as Treatment of Established Post-Operative Nausea and Vomiting, in Patients who Have had no Prior Prophylaxis Award Date: February 2016 Funding Agency: Acacia Pharma Grant Amount: $293,163

2015

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