Carolina
UNC ANESTHESIOLOGY NEWS VOLUME 5 • ISSUE 1 SPRING/SUMMER 2020
INSIDE THIS ISSUE COVID-19 Preparedness: UNC Anesthesiology Keeps Pace
DREAMING COVID-19: Protecting the Frontline, Serving the Critically Ill UNC Anesthesiology Dives Into Peri-Op Preparedness
Numbers At a Glance Chair’s Note CRNA Update Team CVTICU Can You Guess Who? Leadership: Dr. Stuart Grant Residency/Fellowship Update Featured Publications, Awards & Presentations In Memory: Ginger Norfleet
MAKE A
GIFT Support the missions of UNC Department of Anesthesiology by donating med.unc.edu/ anesthesiology/donate For more information med.unc.edu/anesthesiology
Can You Guess Who?
More on page 6
Visit us on Facebook UNC Anesthesiology Follow us on Twitter @UNC_Anesthesia Connect with us on LinkedIn UNC Anesthesiology Alumni
OB Anesthesia Division Chief Dr. Kathleen Smith and Fellow Dr. Jeremy Gue prepare for a Caesarean section in PPE designated for COVID-19 patient cases.
A
s stay-in-place orders swept North Carolina in March, UNC Anesthesiology joined disciplines across UNC Health, planning for a range of scenarios to fast-track COVID-19 preparedness. Alongside leaders system-wide, UNC Department of Anesthesiology Chair Dr. David Zvara was tapped to oversee the Triangle Command Center for COVID-19 response at UNC Medical Center, UNC Hospitals Hillsborough campus, Chatham Hospital, UNC Rex Hospital and Johnston Health. As UNC Medical Center’s newly named Associate Chief Medical Officer, Dr. Peggy McNaull joined top hospital decision-makers to lead planning efforts. To guide UNC Anesthesiology through frontline preparedness, Dr. Anthony Passannante was appointed Acting Chair. As COVID-19 preparedness began across the University and statewide, Dr. Balfanz was named the Department’s new Vice Chair of Quality Improvement. As UNC Anesthesiology deployed a team to work with providers across UNC Medical Center, Dr. Balfanz helped lead the creation of intubation and perioperative strategies for the COVID-19 era. As priority, Dr. Greg Balfanz collaborated with Medical ICU (MICU) leaders to create first intubation guidelines to optimize both patient and provider safety. “COVID-19 presented truly unique challenges. We had to rethink how we intubate critically ill patients, trying to limit provider contact while also maintaining the highest safety standards for patients,” he noted. Simultaneously, the COVID-19 pandemic placed unprecedented stress on medical supply chains. The Governor’s office requested a rapid assessment of equipment and supply availability from hospitals across North Carolina. A team consisting of CRNAs Aaron Lemmon, Meaghan Locke, Lynn Harris, anesthesia support manager Kimberly Stack and Dr. David Flynn tallied anesthesia machines, viral filters, and disposable anesthesia supplies. They submitted both these totals and projections of potential shortages to the North Carolina Department of Health and Human Services in less than 24 hours. continued on page 2
Carolina Dreaming
continued from page 1
“COVID-19 presented truly unique challenges. We had to rethink how we intubate critically ill patients, trying to limit provider contact while also maintaining the highest safety standards for patients.”
Dr. Sam McLean: Recovery a “Camp COVID” Family Affair
– Vice Chair of Quality Improvement Dr. Greg Balfanz
“We had a tight deadline and no time to waste. We dropped everything, worked as a team, and got it done with a few hours to spare,” noted Locke. Next, the teams focused on perioperative care. Dr. Samuel Blacker developed transportation recommendations addressing the unique challenges posed by COVID-19 patients, incorporating infection prevention recommendations as well as logistical considerations. “We had to devise a safe way to transport highly infectious patients from their isolation rooms to the operating rooms [ORs] without exposing other patients and clinicians to the virus,” noted Blacker. “We had to rethink everything. Rather than choosing the quickest routes, we selected those that minimized potential exposure to patients and staff.” After devising the transportation plan, the team left nothing to chance. “Simulation is an essential part of emergency preparedness,” added Harris. “We went to the MICU and practiced every step of the transportation process from the patient room to the OR. It allowed us to fine-tune the plan in a low-stress setting.” The team had to select ORs best suited for COVID-19 patients. Additionally, the teams had to consider how best to protect everyone in the room, both during and after the surgery. Collaboration with infection prevention, nursing, pharmacy, anesthesia technicians, and environmental services produced guidelines to limit exposure and properly decontaminate the rooms following cases. “A major limitation of ORs is air pressure,” noted Blacker, “With COVID-19, you want negative pressure so that pathogens don’t escape the room. ORs are designed with positive pressure to keep pathogens out. We had to find the rooms with the best air clearance, but also needed rooms that were large enough to accommodate complex surgeries.” Lemmon noted: “We created COVID-19 carts and medication bags containing essential anesthesia gear and meds. The goal is to prevent entry to the room once the patient is in, while also avoiding contamination of the equipment stored in the anesthesia machine and Pyxis.”
Like other UNC physicians, when the COVID-19 pandemic reached our hospital, I changed my routine: switched from running shoes to work clogs, showered in the hospital after work, donned and doffed. I discovered that it is incredibly satisfying to try to provide kindness and care to individuals hospitalized with COVID-19; who often feel vulnerable and afraid. My personal COVID-19 experience began one morning when I pretty suddenly went from energetic to enervated. I took my temperature several times a day the next few days, but never developed a fever or cough, and after a few days the lassitude largely remitted. I figured I had had had some typical bug, until 10 days after my initial symptoms, when the lassitude return much more severely, along with cough, fever, and very disconcerting feeling of chest restriction/difficulty breathing unique to COVID. My wife and 20-year-old son came down with these classic symptoms right after my second wave started, and for the next week our house became Camp COVID. We all worked some, took naps, watched classic movies, and played many games of H-O-R-S-E in the driveway, which we changed to C-O-V-I-D. I ate a bowl of Moose Tracks Ice Cream each day, which I am certain is anti-COVID. I got a far higher level of support from everyone at UNC than I could ever hope to describe. My family are all grateful to be healthy, and we are reminders that for the great, great majority of folks who get
as procedure volume increases while new outbreaks emerge throughout the world. Relaxation of stay-at-home orders could increase the spread of COVID-19 across North Carolina.
“We are moving to the next stage of the pandemic for UNC Anesthesiology – resuming elective cases while maintaining COVID-19 vigilance and keeping “Nobody knows what to expect with this virus, but we need to continue to patients and our providers healthy,” Dr. Balfanz notes. “The threat is not care for patients, conserve equipment and PPE, and keep each other and gone, but due to an immense amount of work and preparation, we now our future patients safe,” notes Flynn. “We’ve done everything possible to have the training, equipment and plans necessary to manage it.” achieve this and are well positioned to move forward.” Nonetheless, there are many challenges UNC Health faces ahead. Global equipment supply chains have been fractured. New shortages could arise
2
UNC ANESTHESIOLOGY NEWS | VOLUME 5 • ISSUE 1 • SPRING/SUMMER 2020
NUMBERS AT A GLANCE
Anthony N. Passannante, MD Professor of Anesthesiology Acting Chair
UNC Department of Anesthesiology
COVID-19 at UNC*
29,972 Total Tests
2,115 27,857 273 Positive
Negative
Pending
590 Total Hospitalizations
8,837 Virtual Video Visits (per week)
5,972 Virtual Phone Visits (per week)
Chair’s Note
U
NC Anesthesiology is an integral part of UNC Health’s response to COVID-19. Our Chair, Dr. David Zvara, was instrumental in the rapid creation of the Respiratory Diagnostic Center, a facility near our Ambulatory Surgery Center that allows rapid COVID-19 diagnosis while minimizing exposure to other patients. He has been temporarily reassigned to the Triangle Command Center, tasked with effective preparation of UNC Health’s institutions. There has been remarkable coordination of effort between the institutions. Dr. Peggy McNaull is leading the UNC Physician/APP COVID Response team, tasked with organizing physician and APP redeployment to areas of stress. She has worked with many institutional leaders to match the skills and availability of our clinicians with areas of need. UNC Anesthesiology is ready to help with our talented attending physicians, resident physicians, nurse anesthetists, nurse practitioners and physician assistants. Areas of redeployment will include intensive care units, emergency department, medical wards, a massively expanded Occupational Health Service (to manage disease confinement, employee quarantine and return to work), and emergency response teams across campuses. Drs. Samuel Blacker, Greg Balfanz and David Flynn, along with CRNAs Lynn Harris, Aaron Lemmon and Meaghan Locke, developed our institutional strategy for taking care of surgical patients with, or suspected of having COVID-19. This faculty and nurse anesthetist planning team facilitated preparing two COVID-19 operating rooms and coordinating patient transport pathways to the designated ORs. Anesthesia Tech Kimberly Stack invaluably assisted supply chain planning critical to overall COVID-19 preparedness. The pandemic has not been kind to medical education in general. Elective surgery has been postponed across the UNC System, limiting clinical training opportunities for our resident physicians. Drs. Harendra Arora and Susie Martinelli have quickly transitioned our resident didactic series to Zoom experiences, and are actively incorporating more simulation experiences into the resident curriculum. UNC Health and UNC Anesthesiology entered this crisis from a position of strength. While the next six months will definitely be difficult, filled with clinical and financial challenges, I am confident that the Department will be able to successfully navigate these uncharted waters.
*May 2020 data
3
Carolina Dreaming
CRNA Update
6th Annual CRNA Conference
Nurse Anesthetists: Caretaking Patients, Protecting Providers
N
urse Anesthetists Aaron Lemmon, Meaghan Locke, and Lynn Harris have led case simulation for staff education and development of a COVID-19 policy supplement and pathway. In addition to Department of Anesthesiology discussion on these guidelines, feedback during simulation was incorporated from surgery, perioperative nursing, infection control, MICU nursing, respiratory therapy, pharmacy, OR staff and environmental services.
“Teamwork during this atypical time has served to strengthen our common goals of protecting patients, providers, and the prudent use of resources. It has been a great opportunity to work with many groups in making patient care safer for all providers.” – CRNA Lynn Harris
O
ur 6th Annual CRNA Conference in March was a great success! We had over 80 CRNAs and SRNAs in attendance, as well as speakers from UNC, Duke, and Wake Forest. This conference has evolved from a grassroots effort to becoming an established annual event that draws CRNAs from across the state. Not only does this conference allow for highquality continuing education; it has also provided opportunities for leadership and professional growth among our staff CRNAs. Some speakers have gone on to speak at a national level, as well as to lecture in nurse anesthesia programs through exposure from this conference. Our 6th Annual UNC CRNA Anesthesia Meeting has been a useful avenue for recruiting CRNAs to our group as well as networking with CRNAs at other institutions. As an added bonus, it’s a great opportunity to interact with coworkers outside of the daily stressors of the operating room.
4
Nurse Anesthetists James McCallion & Twila Dekanich prepare for their COVID-19 OR assignment.
UNC ANESTHESIOLOGY NEWS | VOLUME 5 • ISSUE 1 • SPRING/SUMMER 2020
Team CVTICU: Offsite Comradery = Offset Stress
In February 2020, the CVTICU’s UNC Anesthesiology-organized inaugural social event at a downtown Durham microbrewery attracted 30+ team members from all unit clinical disciplines.
I
n hospital ICUs, producing optimum patient outcomes in caring for the critically ill relies upon cohesive multi-disciplinary teams. In November 2019, UNC Anesthesiology assumed the managing responsibilities of the Cardiovascular and Thoracic ICU (CVTICU). Managing a unit of diverse practitioners, improving unit teamwork and communication and ensuring adequate Advanced Practice Provider (APP) staffing became fundamental to setting outcomes-driven goals of sustaining strong team dynamics. As CVTICU Medical Director, Dr. Rob Isaak and a multi-disciplinary UNC Medical Center leadership group including Tracie Rivet (nurse manager) and Associate CVTICU Medical Director Dr. Ben Haithcock (thoracic surgeon) developed several initiatives-driven goals for 2020. Goals included: 1) employing “Just Culture Teamwork Process Mapping” (JCTPM); 2) planning interdisciplinary, multi-professional educational sessions; and 3) social gatherings for all CVTICU members. Adapted to hospital practice, JCTPM processes optimize the means (unit team performance) to produce the desired outcomes (optimal ICU patient health) within the CVTICU. Isaak stated: “The CVTICU has lots of critically ill patients who require a coordinated effort from all team members to lead to a satisfactory outcome for our patients.” In 2020, Assistant Professor of Anesthesiology and Critical Care Dr. Duncan McLean joined managerial efforts to produce team-building initiatives that advance CVTICU leadership goals. Assisted by several CVTICU nurses, Dr. McLean is devising structured unit debriefings and educational sessions to teach team members strategies for preventing detachment when affected by unusual, challenging and distressing CVTICU events. In late February 2020, the CVTICU’s inaugural, strictly social event at a downtown Durham microbrewery was an early-stage planning success.
It attracted 30+ CVTICU nursing, physical therapy, respiratory therapy, pharmacy, nutrition and faculty team members to relax and bond together at an off-campus setting. Dr. McLean noted: “These social events aren’t necessarily intended as a place for discussion of cases. They aim to foster a healthy and collaborative team relationship, and to reduce perceived barriers between the professional groups who work in the CVTICU. Along with our other excellent efforts, a successful kickoff social provides evidence we’re making encouraging progress with cultivating a collaborative and congenial workforce.” Cardiothoracic CVTICU nurses Sarah Latham and Salley Nash will organize complementary monthly social events with Dr. McLean to sustain ongoing unit comradery in this unit. Latham shares McLean’s vision of sustaining a team dynamic where unit members recognize a common goal within their collective caregiving. Latham noted: “Situations can quickly become tenuous. Frustrations arise in caring for critically ill, complex patients. It is important to remind ourselves we are all human and require social interaction with each other outside of the work environment. These social gatherings provide an outlet to release builtup work tensions and foster growth in trusting, interdisciplinary relationships.” As the CVTICU reaches near or full capacity serving COVID-19 patients, unit members come together to keep pace. McLean noted: “The CVTICU team has worked tirelessly to ensure that we maintain the highest level of vigilance in protecting our incredibly vulnerable patients, many of whom are immunosuppressed. Despite the barriers of wearing masks, physical distancing and the anxieties of the COVID-19 pandemic, we are facing this together with a strong sense of camaraderie.”
5
Carolina Dreaming
Can You Guess Who??
6
UNC ANESTHESIOLOGY NEWS | VOLUME 5 • ISSUE 1 • SPRING/SUMMER 2020
Leadership: Dr. Stuart Grant Regional Anesthesia in the Ultrasound Era
I
t’s an exciting time for UNC Anesthesiology’s Division of Regional Anesthesia (RA). Our team is employing novel RA techniques that optimize pain management via advanced analgesic care. Our practitioners are exploring a range of approaches to nerve blocks with the advent of ultrasound-guided RA. During this era of dynamic RA clinical practice, UNC Anesthesiology is fortunate to have an academic anesthesiologist with decades of RA experience as new Division Chief of our Regional Anesthesia team. Professor of Anesthesiology Dr. Stuart Grant was appointed Division Chief of Regional Anesthesia in September 2019. He brings to UNC 30 years of RA training and practice, half spent within the United Kingdom’s National Health Service.
pain management to non-opioid medications. Strong division leadership is needed to establish “best fit” RA options with opioid-tolerant patients who have poorly controlled post-operative pain, and in those who are administered opioid-free anesthetics. “The emergence of the national opioid crisis and state restrictions on opioid prescribing open up opportunities for the [RA] division to make a real difference for our patients.” Offering RA subspecialty training at UNC as an accredited graduate medical education track is another goal of Dr. Grant’s in his first year. Division Chiefs like himself are highly aware of their role in sustaining UNC’s reputation for providing top-tier medical education at a major academic institution.
Division Chief of General Anesthesiology Dr. Greg Balfanz has worked with Dr. Grant learned RA practice in its nascency, when little training in it was the Department’s RA team at UNC Ambulatory Surgical Center for years. offered. As a Senior House Officer (SHO) training in anesthesiology (1992– He notes: 1995), he earned board qualification (ABA board certification equivalent) and was named a Fellow of the Royal College of Anesthetists in 1995. Dr. “[RA] seems to be constantly coming up with research ideas and/or ways to improve practice. Dr. Grant hopes to lead the change of our fellowship Grant subspecialized in RA as a Specialist Registrar (SpR), earning his program into the new ACGME accredited phase. This will take tons of work, Certificate of Completion of Specialist Training (2002), also at the Royal but he will undoubtedly accomplish this goal. This will create a much more College of Anesthetists. robust education both for our fellows and also for the residents that proceed “[RA] was a perfect fit for me. I chose it to improve patient outcomes and through their rotations as the fellows play a critical role in their education.” viewed it as the original ‘enhanced recovery.’ I started [learning RA] when Dr. Grant concludes: “Regional anesthesia is on the increase across the training was a mixture of paresthesia and nerve stimulation for nerve country and is now an ACGME-accredited fellowship. My goal is to provide location. Ambulatory anesthesia in surgery was in its infancy. the best training in the country for our residents and fellows.” The future was full of growth in number and complexity of cases. As bigger operations were performed, effective pain management was going to dictate success, minimize readmission and keep hospital length of stay shorter.” Dr. Grant was licensed by the European Specialist Register in Anaesthesia to enter independent practice in 2002. Two months later, he had a transAtlantic start to medical practice when appointed Assisted Professor of Anesthesiology at Duke University Medical Center. Over the next 15+ years, Grant helped guide a large academic medical center toward using novel RA techniques that are now gold standards for longer-acting local anesthetics and adjuvants to patient care. “Long before ultrasound, I started sending patients home [during fellowship training] using peripheral nerve catheters in the late 1990s. Now that ultrasound is revolutionizing the success and efficiency of [RA], it has been rewarding in my six months at UNC to watch the delight of long-time team members as they innovate [using ultrasound] and improve early rehabilitation and patient satisfaction.” In his first year at UNC, Dr. Grant has established several areas of focus. Across his division, faculty can easily fall behind in learning newly rolled-out [RA] techniques. Dr. Grant is leading efforts to help those not long out of fellowship refresh on old techniques and master RA gold standards such as neuraxial and peripheral nerve blocks. Ensuring peri-operative clinical competence amongst all team members is also high priority, given the universal role of RA in multimodal analgesic and enhanced recovery after surgery (ERAS) pathways. To mitigate opioid misuse in UNC patients, Dr. Grant must also ensure his RA team employs a variety of multimodal analgesics techniques that shift
In February 2020, Dr. Grant (R) instructed residents on using ultrasound in regional anesthesia at this year's UNC-Duke Ultrasound Guided Regional Anesthesia Workshop for residents.
7
Carolina Dreaming
Word from Our 2019–2020 Chief Residents
I
t’s hard to believe that our time here is coming to a close and that in a few short months, we will be scattered across the US, pursuing our various chosen career paths. However, we have not forgotten our first few months as “baby interns,” navigating our new lives as freshly minted doctors and attempting to navigate UNC’s bewildering hallways and corridors. That first year was filled with nervous excitement and confusion, which later gave way to competence and, dare we say it, confidence. It was also the first year we went to Asheville together, learned about Dr. Elizabeth Snow’s passion for roofing (which kicked off the infamous “Things Liz Says” list) and laid the strong foundation for friendships that have supported us these past few years and will continue to sustain us as we move on beyond residency. The last four years have seen us grow in our professional lives. From new CA-1s struggling with alarm fatigue to CA-2s deftly balancing the seemingly insurmountable demands of senior call to CA-3s managing complex cases semi-independently (and being able to call Dr. Heller “Ben”!). We have also won scholarships to ASA Practice Management, given podium presentations at major conferences and won awards for those presentations. We matched into competitive fellowships in Cardiac, Pain, Regional, Peds and OB, with the bravest amongst us jumping head first into the job market. We have also grown tremendously in our personal lives. Our family increased by four new babies (Clara, Olivia, Jane and Hannah!), with a fifth on her way. We celebrated four weddings during our tenure here and look forward to a few others. While a few of us are staying in Chapel Hill next year, most of us are leaving, dispersing across the US to Los Angeles, Nashville, Lexington, Philadephia, Pittsburgh, Chicago, Seattle, Houston and Birmingham. We may no longer all be together at UNC, but we will not forget the foundations we built, the memories we made and the family we forged here. – Drs. Candy Ezimora, Matt Hallman, and Brent Harkrider
Residency / Fellowship Update
The Goal: ACGME Regional Anesthesia and Acute Pain Fellowship Accreditation
U
NC Anesthesiology has a high-quality Regional Anesthesia Fellowship program, and seeking accreditation is the next step in its evolution. Over the years, we have built a solid fellowship experience and are prepared to take it to the next level. We provide a highquality educational experience to our regional fellows by incorporating a variety of learning methods, including clinical teaching, simulation, journal clubs, live ultrasound, mock-oral exams, and OSCE practice sessions. Our fellows are consistently involved in quality improvement programs to provide non-opioid pain reduction strategies to the surgical population. They additionally work on scholarly projects and present their work at regional and national meetings. Our core fellowship faculty includes nationally and internationally recognized researchers, speakers, book authors, and fellowship trained experts.
There is an increasing demand for performing regional anesthesia by many surgical services, as more and more evidence accumulates that the use of regional anesthesia during perioperative period dramatically reduces opioid consumption in the perioperative period and reduces the risk of opioid addiction. Our nerve blocks have shown tremendous documented successes in improving outcomes in various orthopedic surgeries, vascular surgery limb amputations, AV fistula creations, CABG patients, donor nephrectomies, burn surgery and many more. Having a well-functioning regional anesthesiology team makes it possible to do these blocks safely and efficiently in a constantly increasing caseload. We also have an increasing pool of opportunity to provide regional anesthesia to patients at UNC Hospitals Hillsborough Campus and UNC's
8
Ambulatory Surgical Center. The case volume is more than adequate to support three fellows without compromising the residency experience and leaving adequate numbers for the residents to perform. Our fellows are continuously involved in teaching residents during their rotation and make great role models in patient care and procedures. We believe that we have the resources to obtain ACGME accreditation of UNC’s Regional Anesthesiology and Acute Pain fellowship. Training high-quality fellows in an accredited program will help sustain a top-tier Regional Anesthesia workforce once graduating fellows enter full-fledged anesthesiology practice.
American Society of Regional Anesthesia and Pain Medicine (ASRA) 2019 Annual Meeting (L to R): Drs. Jaqueline Linton (2018–19 fellow); CA-2 Michael Richman; CA-2 Vivian Doan; Fellowship Director Monika Nanda (RA faculty); CA-3 Andres Rojas; Sally Stander (RA faculty); and Daniel McMillan (2018–19 fellow, RA faculty).
UNC ANESTHESIOLOGY NEWS | VOLUME 5 • ISSUE 1 • SPRING/SUMMER 2020
UNC Anesthesiology in the COVID-19 Era Keeping Distance, Coming Together
ORs for COVID-19 cases are stocked with supplies and equipment before surgery to minimize movement in and out of the room.
UNC Anesthesiology NPs redeployed to support the Occupational Health Call Center.
Assistant Professor Dr. Irina Phillips conducts a telehealth patient visit using a UNC Health backdrop.
Negative pressure rooms that keep pathogens from escaping are used to intubate COVID-19 patients prior to transporting them to the OR.
Pain Medicine Fellow Dr. Jonathan McBride conducts one of UNC’s 5700+ weekly virtual provider-patient visits via UNC Health’s Telehealth Epic EHR workflow.
Dr. Robb Wasserman & CRNA JoAnn Bussey maintain social distance at UNC Hospitals Hillsborough campus.
CVTICU team PPE pride! (L to R): CA-3 Patrick Steele (MD); Assistant Professor Duncan McLean (MBChB); Drew Eckstein (PA-C); Brian Morris (PA-C); CA-3 Liz Snow (MD).
9
Carolina Dreaming
Featured Publications, Awards & Presentations July to December 2019 ABSTRACTS Whitehouse A, Heller BJ. “Top 12 Medically Challenging Cases: Newly Diagnosed Anterior Mediastinal Mass, Suspected Severe Pulmonary Hypertension & An Unstable Cervical Spine Fracture.” Poster. ASA Annual Meeting. Orlando, FL. Oct 2019. Lund E, Bean H. “Regional Anesthesia Technique for Transforaminal Lumbar Interbody Fusion: A Successful Case Report.” ASRA 18th Annual Pain Medicine Meeting. New Orleans, LA. Sept 2019. Woody N, CSSBB, Gilmore J, Mann J, Pappas A, Nielsen M, McCall C, Chidgey B, McNaull P. “Improving Opioid Stewardship; Standardizing Provider Prescribing and Education for Storage and Disposal.” Vizient Connections Education Summit. Las Vegas, NV. Sept 2019. Short NA, Myers US, Keller SM, Wangelin BC. “Do Sleep Disturbances Interfere with the Completion and Effectiveness of Prolonged Exposure for PTSD?” In: S Blakey (Chair). Expanding impact: Addressing co-occurring and complicating factors during evidence-based treatments for PTSD. ABCT 53rd Annual Convention. Atlanta, GA. Nov 2019. Short NA, Myers US, Keller SM, Wangelin BC. “Do Sleep Dsturbances Interfere with the Completion and Effectiveness of Prolonged Exposure for PTSD?” In: P Colvonen (chair). Trauma, PTSD and Sleep II: Examining the Relationship between Insomnia and PTSD Treatments. ISTSS 35th Annual Meeting. Boston, MA. Nov 2019. Hertz CM, Allred A. "Idiopathic Juvenile Arthritis Contributing to Failure to Intubate Failure to Ventilate." ASA Annual Meeting. Orlando, FL. Oct 2019. MANUSCRIPTS Katz D, Blasius K, Isaak R, Lipps J, Kushelev M, Goldberg A, Fastman J, Marsh B, DeMaria S. “Exposure to Incivility Hinders Clinical Performance in a Simulated Operative Crisis.” BMJ Qual Saf. 2019 Sep;28(9):750-757. doi: 10.1136/ bmjqs-2019-009598. Epub 2019 May 31. Bhatia M, Kumar P. “Pro: VA ECMO is Superior to Impella for Cardiogenic Shock.” J Cardiothorac Vasc Anesth. 2020 Jan;34(1):278-282. doi: 10.1053/j. jvca.2019.06.043. Epub 2019 Jul 4.
10
Chen F, Carter T, Maguire D, Blanchard E, Martinelli S, Isaak R. “Experience is the Teacher of All Things: Prior Participation in Anesthesiology OSCEs Enhances Communication of Treatment Options with Simulated High-Risk Patients.” J Educ Perioper Med. 2019 Jul 1;21(3):E626. eCollection 2019 Jul–Sept. Henley MD, Kumar PA. Tracheal Injury Prior to Sternotomy: A Cautionary Tale. Semin Cardiothorac Vasc Anesth. 2019 Sep;23(3):319-323. doi: 10.1177/1089253218825443. Epub 2019 Feb 1. Warner D, Isaak R, Peterson-Layne C, Lien C, Sun H, Menzies A et al. “Development of an Objective Structured Clinical Examination as a Component of Assessment for Initial Certification in Anesthesiology.” Anesth Analg. 2020 Jan;130(1):258-264. doi: 10.1213/ ANE.0000000000004496. Heller BJ, Williams J, Heller JA, Kang M. “The Anesthetic Management of Obese Patients Presenting for Neurosurgical Procedures: A Narrative Review.” Middle East J. Anesthesiol. Vol. 27, No. 1 Feb. '20. Heller BJ, Demaria Jr. S, Mendoza E, Hyman J, Iloreta Jr. A, Lin HM, Govindaraj S, Levine AI. “Nitrous Oxide Anesthetic Versus Total Intravenous Anesthesia for Functional Endoscopic Sinus Surgery.” Laryngoscope, 00:1–6, 2019. DOI: 10.1002/ lary.28201.
Markovetz M, Arora H, Kumar P, Hill D. et al. “Endotracheal Tube Mucus as a Source of Airway Mucus for Rheological Study” Am J Physiol Lung Cell Mol Physiol. 2019 Oct 1;317(4):L498-L509. doi: 10.1152/ajplung.00238.2019. Smeltz A, Arora H, Bhatia M, Long J, Kumar PA Ref.: Ms. No. JCVA-D-19-00555. “Anesthesia for Surgery of the Trachea and Carina.” J Cardiothorac Vasc Anesth. 2019 Oct. 10. pii: S1053-0770(19)310377. doi: 10.1053/j.jvca.2019.10.004. [Epub ahead of print] Moran KR, Schell RM, Smith KA. Abdel-Rasoul M, Lekowski RW Jr, Rankin DD, DiLorenzo A, McEvoy MD. “Do You Really Mean It? Assessing the Strength, Frequency, and Reliability of Applicant Commitment Statements During the Anesthesiology Residency Match.” Anesth Analg. 2019 Sep;129(3):847-854. Lieber SR, Heller BJ, Martin CF, Howard CW, Crockett S. “Complications of Anesthesia Services in Gastrointestinal Endoscopic Procedures.” A Multicenter U.S. Study from 2010 to 2015. Clin Gastroenterol Hepatol. 2019 Oct 14. pii: S15423565(19)31110-3. doi: 10.1016/j.cgh.2019.10.011. [Epub ahead of print] Cladis F, Lockman J, Lupa MC, Chatterjee D, Lim D, Hernandez M, Yanofsky S, Waldrop W. “Pediatric Anesthesiology Fellowship Positions: Is There a Mismatch?” Anesth Analg. 2019 Dec;129(6):17841786. doi: 10.1213/ANE.0000000000004431.
Merlo A, Fano R, Strassle PD, Bui J, Hance L, Teeter EG, Kolarczyk LM, Haithcock BE. Postoperative Urinary Retention in Patients Undergoing Lung Resection: Incidence and Risk Factors [E-pub: 2020 Feb 11]. Ann Thorac Surg. 2020;S00034975(20)30175-2.
Linnstaedt SD, Wanstrath B, Chen C, McLean SA et al. “MicroRNA-19b Predicts Widespread Pain and Posttraumatic Stress Symptom Risk in a Sex-Dependent Manner Following Trauma Exposure.” Pain. 2020 Jan;161(1):47-60. doi: 10.1097/j. pain.0000000000001709.
McLean SA, Ressler KJ, Koenen KC, Neylan TC, Germine L, Jovanovic T, Clifford GD, Zeng D, An X, Linnstaedt SD, et al. “The AURORA Study: A Longitudinal, Multimodal Library of Brain Biology and Function after Traumatic Stress Exposure.” Mol Psychiatry. 2020 Feb;25(2):283-296. doi: 10.1038/ s41380-019-0581-3. Epub 2019 Nov 19.
Elbogen EB, Alsobrooks A, Battles S, Molloy K, Dennis PA, Beckham JC, McLean SA, Keith JR, Russoniello C. “Mobile Neurofeedback for Pain Management in Veterans with TBI and PTSD.” Pain Med. 2019 Nov 7. pii: pnz269. doi: 10.1093/pm/ pnz269. [Epub ahead of print]
Martin AK, Yalamuri SM, Wilkey BJ, Kolarczyk L, Fritz AV, Jayaraman A, Ramakrishna H. “The Impact of Anesthetic Management on Perioperative Outcomes in Lung Transplantation” J Cardiothorac Vasc Anesth. 2019 Aug 23. pii: S10530770(19)30904-8. doi: 10.1053/j.jvca.2019.08.037.
Linnstaedt SD, McLean SA et al. “International Meta-Analysis of PTSD Genome-Wide Association Studies Identifies Sex- and Ancestry-Specific Genetic Risk Loci.” Nat Commun. 2019 Oct 8;10(1):4558. doi: 10.1038/s41467-019-12576-w.
UNC ANESTHESIOLOGY NEWS | VOLUME 5 • ISSUE 1 • SPRING/SUMMER 2020
Richmond NL, Dayaa JA, Davis ME, Bowen SB, Iasiello JA, Stemerman R, Haukoos JS, Sloane PD, Travers D, Mosqueda LA, McLean SA et al. “Determining the Ability of Older Adults to Report Elder Abuse: A Cross-Sectional Emergency Department Study.” J Am Geriatr Soc Sept 2019.
Linnstaedt SD, Zannas AS, McLean SA, Koenen KC, Ressler KJ. “Literature Review and Methodological Considerations for Understanding Circulating Risk Biomarkers Following Trauma Exposure.” Mol Psychiatry. 2019 Dec 20. doi: 10.1038/s41380-0190636-5. [Epub ahead of print]
Martinelli SM, Isaak RS, Schell RM, Mitchell JD, McEvoy MD, Chen F. “Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology.” Anesthesiology. 2019 Oct;131(4):908-928. doi: 10.1097/ ALN.0000000000002827.
McLean SA, Ressler K, Koenen KC, Neylan T, Germine L, Jovanovic T, Clifford GD, Zeng D, An X, Linnstaedt S, et al. “The AURORA Study: A Longitudinal, Multimodal Library of Brain Biology and Function After Traumatic Stress Exposure.” Mol Psychiatry. 2020 Feb;25(2):283-296. doi: 10.1038/ s41380-019-0581-3. Epub 2019 Nov 19.
McLean SA. “The AURORA Study: A Longitudinal, Multimodal Library of Brain Biology and Function after Traumatic Stress Exposure.” Mol Psychiatry. 2020 Feb;25(2):283-296. doi: 10.1038/s41380-0190581-3. Epub 2019 Nov 19. Stone D, Bogaardt H, Linnstaedt SD, Martin-Harris B, Smith AC, Walton DM, Ward E, Elliott JM. “WhiplashAssociated Dysphagia: Considerations of Potential Incidence and Mechanisms.” Dysphagia. 2019 Aug 3. doi: 10.1007/s00455-019-10039-4. Bhatia M, Katz JN. “Contemporary Comprehensive Monitoring of the VA ECMO Patient.” Can J Cardiol Mol Psychiatry. 2020 Feb;25(2):283-296. doi: 10.1038/s41380-019-0581-3. Epub 2019 Nov 19. Short NA, Boffa JW, Raudales AM, Schmidt NB. “A Randomized Clinical Trial Investigating Perceived Burdensomeness as a Mediator of Brief Intervention Effects on Posttraumatic Stress Symptoms.” J Affect Disord. 2020 Feb 1;262:344-349. doi: 10.1016/j. jad.2019.11.041. Epub 2019 Nov 11. Smeltz A, Kumar P. “Functional Tricuspid Regurgitation or Rare Congenital Condition?” J. Cardiothorac. Vasc. Anesth. 2020 Mar;34(3):837839. doi: 10.1053/j.jvca.2019.10.034. Epub 2019 Oct 24. Marley BL, Keil DS, Maves GS, Chen F, Jones SW, Baboolal HA. “Improved Intraoperative Hemodynamics in Burn Surgery: An Institutional Change to Pediatric-Specific Hemostasis Solutions.” J Burn Care Res. 2020 Feb 19;41(2):289-292. doi: 10.1093/jbcr/irz175.
Short NA, Sullivan J, Soward A, Bollen KA, Liberzon I, Martin S, Rauch SAM, Bell K, Rossi C, Lechner M, Novak C, Witkemper K, Kessler RC, McLean SA. “Protocol For the First Large-Scale Emergency Care-Based Longitudinal Cohort Study of Recovery After Sexual Assault: The Women's Health Study.” BMJ Open. 2019 Nov 21;9(11):e031087. doi: 10.1136/ bmjopen-2019-031087. BOOK CHAPTERS Smith KA, Rosenkrans D. “Keeping Infants Warm in the Perioperative Period is Important, Challenging, and at Times Dangerous.” In: Marcucci C, Gierl BT, Kirsch JR(eds.). Avoiding Common Anesthesia Errors. Lippincott Williams & Wilkins, Philadelphia, PA. Oct 2019. GRANTS NHLBI Small Research Project Pilot Grant. PI: Kenney M. “A Multi-site Retrospective Review of the use of Ketamine Infusion as Adjunctive Pain Therapy for Vaso-oclusive Episodes (VOEs) in Patients with Sickle Cell Disease (SCD).” Nov 2019.
Hallman M, Harkrider B, McKenzie C, Straube L, Doan V, Leopold R. “Opioid Stewardship PostCesarean Delivery: A Quality Improvement Initiative.” ASA Annual Meeting. Orlando, FL. Oct 2019. Chuang A, Tappata M, Enarson C, Byerley JS: “Massively Overhauling the Learning Environment: One Institution’s Journey including Successes, Failures, and Lessons Learned.” ChangeMedEd2019. Chicago, IL. Sept 2019. Coe C, Byerley JS, Steiner B, Enarson C, Beck Dallaghan G, Denniston C. “Fully Integrated Readiness for Service Training.” ChangeMedEd2019. Chicago, IL. Sept 2019. McLean SA. “Molecular Epidemiologic Approaches to Evaluate Potential Biologic Mechanisms Mediating Pain and Other Adverse Health Effects of Socioeconomic Inequality.” The National Bureau of Economic Research. Cambridge, MA. Sept 2019. Blacker S. “Perioperative Brain Health in the Elderly”’ Mayo Clinic Jacksonville Anesthesiology Department. Sept 2019. Woody N. “Improving Opioid Stewardship; Standardizing Provider Prescribing and Education for Storage and Disposal.” Vizient Connections Education Summit. Sept 2019. Kenney M. “Development of New Approaches to Treatment of Acute and Chronic Pain in Sickle Cell Patients.” Presented at the Translational Research Initiative for Pain and Neuropathy Research Meeting. Medical College of VA (VCU). Richmond VA. Nov 2019. Passannante AN. “Update on Intraoperative Fluid Management and Blood Transfusion Strategies.” Audiodigest Anesthesiology 61:41. Nov 2019.
INVITED PRESENTATIONS / LECTURES Smith A. “Addressing Perioperative Do-NotResuscitate Orders: An Overlooked Necessity.” AANA 2019 Annual Congress. Chicago, IL. Aug 2019. Hallman M, Dorinsky N, Kolarczyk L, Kim HJ, MD & Lobonc A. “Incentive Spirometry to Assess Post-operative Pain Control in Surgical Oncology Patients.” ASA Annual Meeting. Orlando, FL. Oct 2019.
11
PLACE STAMP HERE
N2198 UNC Hospitals CB# 7010 Chapel Hill, NC 27599-7010
In Memory: Ginger Norfleet In February 2020, UNC Anesthesiology paused to remember long-time Department friend Ginger Norfleet. A former UNC Anesthesiology “first lady,” Ginger was the 48+ +-year wife of the late Department Chair Dr. Edward A. Norfleet. In February 2020, UNC Anesthesiology paused to remember long-time Department friend Ginger Norfleet. A former UNC Anesthesiology “first lady,” Ginger was the 48+-year wife of the late former Department Chair Dr. Edward A. Norfleet. Ginger Norfleet earned her RN in 1960 from the Rex School of Nursing in Raleigh. A surgical scrub nurse, she met the love of her life, Dr. Edward A. Norfleet, at UNC Memorial Hospital. Once married, the couple began their next life chapter as Dr. Norfleet progressed through medical school and residency. When Dr. Norfleet entered academic medicine as a new Department faculty member, Ginger joined the UNC Anesthesiology family. Ginger Norfleet’s obituary notes: “Rarely did you hear one of [the Norfleets'] names without the other.” The couple enjoyed cheering on the Tar Heels, sunrises on the Pungo River, tending to the rose garden, dancing to beach music at every party and loving on all people with their warm and generous hospitality. Ginger is individually remembered as an avid bridge player, dedicated school and church volunteer, and a devoted mother and grandmother of three grown children and eight grandchildren.
Ed & Ginger Norfleet met working at UNC Hospitals