2024 BluePrint

FACULTY SPOTLIGHT with Dr. Mihai Podgoreanu PAGE 4

GLOBAL HEALTH BEYOND BOUNDARIES p28

SICKLE CELL PAIN

INNOVATIVE RESEARCH

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What We Do Changes The World

MISSION: Extraordinary care through a unique culture of innovation, education, research, and professional growth.

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Contents Volume 14 . 2024

COVER 2 Message from the Chair 10 Division Highlights DREAM CAMPAIGN 41 Donor Honor Roll

Empowering health

beyond boundaries

42 About DIG 44 2024 DREAM Innovation Grant

Recipient

INNOVATIVE RESEARCH 48 Novel Adrb3 Antagonists

for the Treatment of Chronic Pain Andrea Nackley, PhD

50 Exploring Microbiota-Immune

Interactions in Surgery and Critical Illness Mara Serbanescu, MD

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52 Advancing Pain Omics

Shad Smith, PhD

GLOBAL HEALTH

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FACULTY SPOTLIGHTwith

Dr. Mihai Podgoreanu

54 Blogs from Abroad: Ghana RESIDENCY RECAP 60 Resident Spotlight 62 Alumni Shoutout ALUMNI NOTES 64 Q &A with

Maher J. Albahrani, MBChB

DEPARTMENTAL

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68 Departmental Faculty

FEATURE | PERSISTING to HELP

Children in Pain

BLUEPRINT 2024 | 1

MESSAGE FROM THE CHAIR

BluePrint is published once a year by Duke Anesthesiology. This issue was published in October 2024. Your comments, ideas and letters are welcome.

VIEW ISSUES ONLINE: blueprint.duhs.duke.edu PLEASE CONTACT US: Duke Anesthesiology BluePrint Magazine DUMC 3094 Durham, NC 27710 blueprint@duke.edu EDITOR IN CHIEF Stacey Hilton CREATIVE DIRECTOR Stacey Hilton GRAPHIC DESIGNER Lacey Chylack, phase5creative.com CONTRIBUTING WRITERS Stacey Hilton Lindsay Key Ratna Swaminathan Duke Anesthesiology Faculty & Staff PROOFREADERS Lynet Gonzales Christopher Keith Melinda Macalino John “Jack” Newman CONTRIBUTING PHOTOGRAPHERS John “Jack” Newman Duke Anesthesiology Faculty & Staff WEB ADMINISTRATOR Christopher Keith CONNECT WITH US: anesthesiology.duke.edu

I

was recently shown a graphic representing the “Hidden Rules Among Classes” developed by author Ruby Payne (https:// kathyescobar.com/wp-content/uploads/2013/12/Hidden-RulesAmong-Classes.pdf). In it she describes the differences in outlook between people in poverty, the middle class, and those with wealth.

The first area she addresses is possessions. For many in the wealthy class, our wealth, she posits, is defined by “one-of-a-kind objects, legacies, and pedigrees.” For the middle class, possessions are defined by “things.” Most fascinating to me is that for those living in poverty, possessions are defined by “people.” I know we all started with valuing people as our greatest “possession” but where and when did we lose sight of that priority? And should we not pivot back to investing more in our people? John Maxwell, a noted author on leadership, said it best when he described the single most important task of leaders as “valuing people and adding value to them.”

So, would you join me today in resetting our priorities? Pursue relationships anew, seek restoration of broken ones, invest more in the people around you, value people and add value to them…and do not expect anything in return. In this context, the following is a Greek proverb worth remembering: “a society grows great when old men plant trees in whose shade they know they shall never sit.”

And this is why we publish BluePrint every year. It gives us another opportunity to highlight the incredible people that make Duke Anesthesiology great. I hope you will enjoy reading about all of them but keep in mind that the people represented in this edition are a mere fraction of the whole. This year, as we turn the pages of BluePrint, let it not just be an acknowledgment of what has been achieved, but a call to action to plant seeds for a future we all believe in—a future where the true measure of our wealth is the well-being of our people.

Sincerely, Joseph P. Mathew MD, MHSc, MBA

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https://anesthesiology.duke.edu/alumni

BLUEPRINT 2024 | 3

SHAPING THE FUTURE OF ANESTHESIOLOGY

Faculty SPOTLIGHT Dr. Mihai V. Podgoreanu

By Ratna Swaminathan

H

e has always been driven by a deep desire to heal. Disturbed by his father’s diagnosis of diabetes, described at that time as “incurable” in his native Romania, an inquisitive five-year-old began to think deeply about solving conundrums that perplexed his young mind. Today, as chief of the Cardiothoracic Anesthesiology Division at Duke, Mihai V. Podgoreanu, MD, continues to search for solutions as he seeks to transform perioperative medicine and critical care into a system that is not just reactive, but predictive, preventive, and personalized.

His vision is bold and clear: to prevent organ injury and predict clinical deterioration with timely and tailored responses to help patients recover faster and heal better. “I like tackling complex issues and big ideas that disrupt the way we deliver acute care, and central to this theme is the ability to make care more precise,” informs Podgoreanu.

Using cardiac surgery as a unique lens, Podgoreanu examines why surgical stress affects patients in diverse ways. He explores the mysteries surrounding why some individuals withstand surgical injury with resilience while others face complications that seem inevitable.

As a clinician-scientist, Podgoreanu studies what differentiates these groups using genomic science, systems biology, and data science to bridge the gap between research and clinical practice.

Podgoreanu was raised by economist parents in Bucharest, Romania, where he

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FACULTYSPOTLIGHT

first studied mathematics and physics for a strong analytical foundation, and followed that with medical school, which was fueled by his passion and commitment to science.

A journey that was ignited by a personal challenge brought him to the US for residency in anesthesiology at Yale University.

His early days in the US were marked by a deep sense of determination mixed with profound uncertainty. “Deciding to come to the US was a super hard decision, and arriving here with exactly $120 in my pocket, sleeping on the floor with my coat as a pillow, and being a completely unknown entity in need of ‘proving myself’ in a new world are all early memories,” recalls Podgoreanu. The stress of emigration and the strain of cultural adjustment took their toll on his marriage.

The heartache was compounded when his two children moved across the Atlantic back to Romania.

Podgoreanu was faced with a heartwrenching choice – to return to his children or create a better future for them in the US. Guided by faith, he stuck to his resolve and fell in love with his adoptive country that had “its system of governance with checks and balances, democratic rule of law, a value system set right based on competence, performance, and hard work.” Life did give him a second chance at happiness; he remarried, and together with his wife remains close to his five children, two daughters as bookends with three boys in the middle.

“They are my biggest life accomplishment by a long shot,” says Podgoreanu proudly, reflecting on the family he cherishes and the new life he has built.

While Podgoreanu did not specialize in diabetes, his academic pursuits focused on altered metabolism in disease. His research trajectory began during residency at Yale under the mentorship of anesthesiologist David Silverman, MD. His exploration into how small blood vessels adapt in response to non-pulsatile flow during cardiac surgery has implications for patients supported with

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FACULTYSPOTLIGHT

long-term centrifugal heart pumps and was recognized at the New York Post Graduate Assembly in 2001.

Attracted to Duke Anesthesiology for its academic might and innovation, Podgoreanu was inspired by visionaries in the department. Then Dr. Podgoreanu with Dr. Reves, one chair Jerry Reves, MD, of his mentors, former chair, and cointroduced him to the founder of the Duke Heart Center. role of genetic variation in postoperative outcomes – a concept advanced further by Mark Newman, MD, Debra Schwinn, MD, and Joseph Mathew, MD. Supported by an American Heart Association grant, Podgoreanu joined Duke in 2000 and completed three years of training that included fellowships in cardiothoracic anesthesiology and critical care medicine, and post-doctoral research with Schwinn, a pioneer in molecular pharmacology. The lab experience ignited his interest in the nascent field of genomic technologies applied to surgical patients, now recognized as perioperative genomics.

Podgoreanu began his Duke faculty career in 2004 already armed with a National Institutes of Health (NIH) R01 grant. In 2008, another R01 grant enabled Podgoreanu to explore adaptive mechanisms preserved through evolution that confer protection against organ injury. He studied the responses to simulated

Key Components of

Precision Health

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Exploring the identification of the unique genetic and advanced ‘omics’ fingerprint of each patient to determine potential factors that may increase or decrease susceptibility to complications following cardiothoracic surgery

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Determining the patient’s stressor model and redefining critical illness based on shared biological abnormalities in response to injury as ‘treatable traits’

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Implementing strategies to integrate all pertinent patient information during their surgical and ICU admission in a format that is digestible for clinical practitioners through clinical decision support tools

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cardiac surgery in three species using comparative biology approaches and was subsequently awarded the prestigious American Society of Anesthesiologists Presidential Award for his efforts.

The heart of the matter for this driven clinicianscientist is to develop novel therapeutic approaches.

He is proud of the genetic research on the impact of intense inflammatory responses in some patients – colloquially termed ‘inflamers’ – in cardiac surgery.

His seminal work on metabolomic pathways published in the journal Circulation in 2009 provided insights into how the heart uses fuels during cardiac surgery. This new knowledge contributed to a significant shift in clinical practice — removing glucose from the cardioplegia solution used during heart operations, which significantly improved blood sugar control during and after surgery.

As a clinical and translational researcher, Podgoreanu leads the Duke PEGASUS (Perioperative Genomics and Safety Outcomes Study) group that investigates how genetic variability predicts acute organ injury after cardiothoracic surgery, particularly in elderly patients. Involving more than 5,000 cases at Duke, his work discovered key genetic variants associated with post-surgical complications, using the first wave of genome-wide association studies in the perioperative field.

Podgoreanu expanded the scope of the PEGASUS program from human observational studies to animal models of cardiac surgery. In collaboration with the Institute for Arctic Biology at the University of Alaska in Fairbanks, he investigated the adaptive responses to surgical stress in Arctic ground squirrels.

He found that the adaptations to extreme metabolic stress in hibernating mammals may offer insights into potential resilience mechanisms in humans that can be targeted to improve surgical outcomes.

A co-inventor of six patents, Podgoreanu has authored several review articles and book chapters to introduce perioperative genomics and precision medicine to the broader academic community. He is also credited with writing the first genomics chapter in a premier anesthesiology textbook to increase genomic literacy among perioperative clinicians.

He says, “Nearly 19 years ago, we introduced and coined the concept of ‘perioperative genomics.’ We have since become among the first to have robustly characterized and published how genetic variation is associated with different types of adverse outcomes, with a resurgence through OneDukeGen – a new Duke-wide precision health initiative.”

A dynamic sequence of events took place in

FACULTYSPOTLIGHT

”

We have become the largest thoracic organ failure program in the country. The fundamental challenge unique to this division is sustaining our growth while equitably balancing clinical and academic efforts and controlling the call burden. This extraordinary patient complexity demands a unique level of clinical expertise, a deep leadership bench, and continued focus on innovating in education and research to deliver the highest standard of care to severely ill patients.”- DR. MIHAI PODGOREANU

2013 when Podgoreanu took on a pivotal leadership role as the cardiothoracic division chief. This period was marked by other significant changes, including the opening of the new Duke Medicine Pavilion that led to the multifold expansion of operating rooms (ORs) and cardiothoracic intensive care unit (CTICU) beds, and the introduction of a culturechanging, new electronic health record. Amidst these professional developments were personal milestones as Podgoreanu welcomed his fifth child into the family, all while remaining focused on a division in transition that provided care for the most complex surgical patients.

Embracing a collaborative leadership style, Podgoreanu crafted a vision to build on the strong foundations laid by his predecessors and take the division to greater heights. Podgoreanu knew he had big shoes to fill to further the legacies of his mentors who had expanded the role of anesthesiology in the Duke Heart Center and built an infrastructure to foster academic growth and education, while continuing the tradition of clinical excellence.

With the expansion came the growth in the number of patients, which was also accompanied by an increase in complexity and severity of illness.

“The Duke University Hospital CTICU has indeed been maintaining a very high patient acuity level for many years,” he explains. This has required a substantial increase in the number of faculty – from 13 in 2013 to 31 in 2024 – that included an exclusive anesthesiologist CTICU team that ensures 24/7 continuity of care.

Under his leadership, the CT division has seen robust growth in the delivery of multidisciplinary care for complex surgeries. An expanded team of anesthesiologists that includes many dual trained in cardiothoracic anesthesiology and critical care medicine provide seamless transitions of care between the OR and the CTICU, a source of great pride for him. Cutting-edge tools like echocardiography help these well-trained experts make critical, real-time decisions and ensure high-quality care, informs Podgoreanu. He says, “The key is that we’ve developed, as a corollary of this integrated care model, what we call an ‘academic school for comprehensive training in cardiothoracic anesthesia and cardiothoracic critical care,’ which has become a national model. There is an extreme ownership displayed by our team with 24/7 coverage of both the CTORs and CTICU; it’s challenging, but certainly necessary.”

Determined to break down barriers between different specialties, Podgoreanu’s approach envisions teaching the next generation of doctors, including residents and 24 anesthesiology fellows, the impact of integrated care beyond the traditional siloed textbooks. Today, division faculty are experts in managing heart failure, shock, emergencies, and high-tech mechanical circulatory support systems like extracorporeal membrane oxygenation (ECMO).

The care of complex, high-acuity patients requires sophisticated decision-support tools. Podgoreanu has spearheaded an innovative data-driven strategy called Symphony to guide decision-making and

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Leadership Lessons

for Comprehensive Cardiothoracic Perioperative and Critical Care: Flat hierarchy, clear roles and responsibilities; ‘for you to increase I must decrease’ leader style Deep bench of multicultural, diverse, and inspirational leaders empowered to step up and take action, enabling cross-functional leadership teams Flexible leadership approach as a metacompetency, balancing emotional intelligence with strategic thinking Foster a sense of family and otherscenteredness Shared mental models, clinically and academically; extreme ownership and continuity of care Radical candor, a razorsharp focus on fairness and clinical scheduling equity A focus on trainees’ comprehensive clinical and academic development and faculty growth, maintaining national academic flagship status Relentless pursuit of multidisciplinary collaborations (eg, cardiothoracic collaboration lab)

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Medicine is a series of decision making, akin to navigating with a GPS – this precision health approach empowers us to choose our path based on the unique information of each patient. Just as a GPS allows for rerouting based on real-time data, this approach integrates precision data from various sources like omics and physiology, leading to more informed and dynamic decision-making processes.” - DR. MIHAI PODGOREANU enhance patient safety. Part of a concept he proudly calls “A CT Anesthesiology Learning Health Unit,” Symphony integrates patient monitoring and medical device data into clinical surveillance and decision support tools. These efforts have positioned the CT division as a leader in adopting innovative practices that not only improve patient outcomes but also streamline care delivery. The division has

taken significant strides in enhancing educational and operational practices, according to Podgoreanu. A forum known as the CT Scholarship meeting sparks collaboration among faculty, while a focused mentorship initiative guides fellows through their education and research using advanced digital training tools. Smart, data-driven dashboards boost operational efficiency, track and

Dr. Podgoreanu and his teenage son, Joseph, share a triumphant moment after completing a five-day karate bootcamp a biannual commitment and an integral part of Podgoreanu's holistic wellness regimen, strengthening the mind to overcome physical limitations. With a core emphasis on respect and humility, he firmly believes in surpassing personal barriers to elevate the standard of patient care, asserting that the ultimate competition resides within oneself.

FACULTYSPOTLIGHT

enhance performance, and provide critical feedback to this learning unit.

Podgoreanu is optimistic about laying the foundation for precision perioperative care. He shares his enthusiasm about expanding partnerships through the institution-wide OneDukeGen initiative, which aims to merge whole exome sequencing with physiological data to pinpoint genomic indicators that might predict complications after major surgeries with plans to study 150,000 patients over the next 10 years.

Podgoreanu is co-leading the Surgery Perioperative and Critical Care Working Group of OneDukeGen and has been appointed to the leadership team of the newly-created Center for Precision Health within the Duke Clinical and Translational Science Institute.

The CT division has also embarked on an NIHfunded Bridge2AI project alongside CHoRUS, a coalition of 14 academic medical centers, to create a comprehensive, and possibly the largest, AIready dataset of critically ill patients to transform recovery from acute illnesses. The team is involved in refining, standardizing, and labeling multimodal data ranging from electronic health records to imaging and high-resolution physiologic signals.

Other key areas include developing innovative tools to securely manage AI data, tackling ethical challenges to protect patient privacy and reduce bias, and nurturing the next wave of AI experts in perioperative and critical care through dynamic educational initiatives, informs Podgoreanu.

As the division boosts its role within the Heart and Vascular Service Line, it envisions solidifying its expertise in the management of shock, participating in advanced cardiogenic shock teams, and taking an increasing role in ECMO procedures, including exploring mobile ECMO setups. Podgoreanu is proud of the division’s growing national and international reputation in precision health tailored for cardiothoracic surgery and critical care with a special focus on thoracic organ transplantation.

Advancing, albeit through vertical leaps, is still what gets him excited each day. He strongly believes “the key roles and responsibilities of any leadership position are to create and cultivate.” Over the past 10 years, Podgoreanu has seen the multifaceted evolution of the division into a vibrant and diverse multicultural team. A substantial increase in women faculty assuming leadership roles locally, nationally,

Innovations in:

Data Science PEGASUS/OneDukeGen – generating evidence for precision health care delivery in perioperative and critical care through multi-omics analyses Symphony – unified communication framework consisting of integrated high-resolution physiologic data streams from patient monitors, organ support devices, and the electronic medical record to enable clinical surveillance at the point of care and remotely, and reduce failure to recognize and failure to rescue after deteriorating events along the surgical patient journey Bridge2AI/CHoRUS – large multimodal data harmonization project among 14 academic medical centers to develop a granular, diverse, and ethically sourced AI-ready dataset from critically ill patients, and to train robust AI algorithms of clinical deterioration through federated learning

and internationally has highlighted this growth.

Podgoreanu is proud to work with a team that cares and supports each other “in times of loss and in times of glory.”

While bridging the gap between discovery and actionable knowledge remains a work in progress for this clinician-scientist, Podgoreanu is happiest when taking care of patients in the operating rooms, the CTICU or electrophysiology labs. This is what he feels he was meant to do as his main purpose and calling in life.

“A key recipe for happiness in a human being is a very, very distinct and strong sense of purpose.

Generating new knowledge, delivering knowledge, and leading amazing teams are all very important to me. I have the best job in the world; it’s amazing that I also get paid to do it,” says Podgoreanu with a smile. BP

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DIVISIONHIGHLIGHTS

AMBULATORY ANESTHESIOLOGY

Driving Innovation and Expanding Care The Ambulatory Anesthesiology Division has experienced a remarkable year filled with key achievements and growth.

Called upon by the Duke University Health System to improve utilization and efficiency across all ambulatory surgery centers (ASCs), our dedicated faculty have worked closely with surgeons, nursing staff and health system leadership to implement numerous initiatives. With dynamic scheduling, targeted use of resources and a commitment to access, they have achieved the highest utilization, largest number of surgeries and optimal staffing since the establishment of the ASCs. The Duke Ambulatory Surgery Center Arringdon continues to thrive, with collaborative efforts leading to continued growth in surgical case demand, seamlessly passing the Accreditation Association for Ambulatory Health Care recertification and surpassing 1,000 total joints.

This division plays a crucial role in expanding the ambulatory surgical footprint across the health system. Our dedicated team is collaborating closely with the health system to design the future Duke Cary ASC, a state-of-the-art, six-room multispecialty

facility, specifically designed to meet the increasing demands of the population in the Dr. Emily Chen Dr. Christopher Young state’s thriving Triangle region.

Furthermore, this team is playing a critical role in the expansion of the North Pavilion ASC, which will introduce two additional cutting-edge operating rooms, tailored to accommodate robotic surgery and advanced technologies. This expansion reflects the division’s commitment to providing exceptional patient care and staying at the forefront of medical innovation. In addition, the division welcomed two new team members, Drs. Emily Chen and Christopher Young, whose expertise and contributions have been instrumental in the significant growth and success of the division that continues to drive innovation in the field and shape the landscape of health care.

CARDIOTHORACIC ANESTHESIOLOGY

Symphony of Healing: Transforming Cardiothoracic Care at Duke recruitment of ACTA fellows from the department’s residency The Cardiothoracic (CT) Anesthesiology Division continues program, including five residents this year. Its distinguished to stand at the forefront of comprehensive perioperative and reputation nationally stems from the fellows’ high-quality research, critical care for patients undergoing complex CT, major aortic with a substantial proportion of fellows recognized by the SCA with and electrophysiology (EP) procedures. Duke serves as a US leader Best of Meeting and Early Career Investigator (ECI) awards. This for its cardiothoracic program. The team completed 161 heart success is a testament to the team’s robust research infrastructure transplants in 2023 – the most in the program’s history or any guided by Drs. Anne Cherry and Bottiger, supported by the Clinical transplant program in the nation in one year. They joined an elite group of only five US centers to transplant more than 2,000 hearts. Research Unit led by Dr. Kamrouz Ghadimi, data analytic resources provided by Ashok Bhatta and team, and notable faculty support In 2024, Duke implanted its 1,500th durable ventricular assist from Dr. Alina Nicoara, who has mentored all four ECI finalists. device. Meanwhile, Duke continues to lead the nation in lung The maturation of this team in the clinical trials space is transplant volume (2,500+) since the lung transplant program was highlighted by high-impact publications reporting findings of established in 1992. the landmark INSPIRE-FLO trial, led by Ghadimi. Continuing The division’s clinical expertise is also evident in both a tradition of disruptive innovation, the division is expanding external ratings and hospital-based quality measures: continued perioperative genomics investigation as part of the institutional three-star STS ratings and a four-star rating for the NCDR EP OneDukeGen initiative and the new device implant program. Data-driven Center for Precision Health, while iterative multidisciplinary quality advancing data science and AI applications improvement initiatives, represented by A Leader in the US in CT surgery through the NIH Bridge2AI Drs. Negmeldeen Mamoun, Ian Welsby, Duke Cardiothoracic Program program.

Sharon McCartney, and Brandi Bottiger, Beyond the hospital walls, this year have resulted in reduced incidence of lung transplants marked the fourth annual Duke Heart major morbidity and mortality (including for Honduras mission trip where a prolonged mechanical ventilation, heart transplants multidisciplinary team, including Duke reoperation rates, CLABSI, and CAUTI). durable VAD implants ACTA fellows, conducted CT surgical The division excels in the education procedures. sector with high teaching scores and 10

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DIVISIONHIGHLIGHTS

COMMUNITY

Growing Programs and Perioperative Leadership Over the past year, the Community Division has made great strides in the pursuit of excellence in patient care. The division grew with the addition of two new faculty, Drs. William Crocker and Reed VanMatre. These talented anesthesiologists bring years of medical expertise as subspecialty physicians with significant leadership experience and are a testament to the great talent that the department recruits.

This year, the division began sharing the responsibility with the Neuroanesthesiology Division of providing anesthesia care for electroconvulsive therapy at the Duke Regional Behavioral Health Center and also began providing care to patients having outpatient endoscopy at the Medical Office Building at Duke Raleigh. Recent innovations in the Community Division include the increased use of regional blocks, performing spinal blocks in the preoperative area and the refinement of standardized enhanced recovery postoperative pathways.

In early 2024, Dr. Richard Runkle was appointed medical director of Duke Regional Hospital, Dr. Reed VanMatre Dr. William Crocker and Dr. Gary Pellom was appointed the anesthesia site lead at Davis Ambulatory Surgery Center.

Now more than ever, the division is involved in leading the operating room platforms at Duke Raleigh and Duke Regional hospitals, and the medical directors at those sites work daily to improve access to surgical care for our patients while maximizing efficiency. The collective achievements of the division not only impact patients across three counties, but also the greater Duke community.

CRITICAL CARE MEDICINE

Progress Across all Pillars for research, including The Critical Care Medicine (CCM) Division’s mission is to rigorous analysis improve the lives of critically ill patients at Duke and worldwide through its clinical, research and education programs. This division of improvement projects, as well as the experienced another year of significant progress in each of its three ability of the ICU pillars. In the clinical domain, the division augmented its team Dr. Nazish Hashmi Dr. Rebecca Himmelwright data infrastructure to by recruiting faculty members from both Duke and across the support research projects. Collaborative research efforts included nation to lend their expertise and provide unparalleled care across the first-ever CCM Datathon and the Critical Care Collaborative the division’s six intensive care units (ICU), covering more than Research Symposium (with a focus on collaboration around critical 150 beds. Additionally, the Duke Critical Care Collaborative care medicine clinical trials at Duke) in April of 2024.

(CCC) was established, representing all adult ICUs in the Duke Recent endeavors have cemented the program’s standing as one University Health System engaging in examining Duke CCM of the pre-eminent critical care training programs in the world. data, conducting improvement projects and sharing learnings, Under the leadership of Dr. Nazish Hashmi, fellows benefit from and participating in the system-wide Duke CCC Quality an innovative curriculum that encompasses clinical, simulation, Improvement Committee and the Duke CCC learning health research, and didactic experiences. conferences. Informatics efforts have Enhancing the educational experience, been instrumental in establishing an the Critical Care Grand Rounds series has ICU data infrastructure, data reports, been significantly revamped, now featuring an exploratory data dashboard, and renowned experts from Duke and around embedded analytics. These efforts have the globe. All fellows (along with their resulted in reduced health care-associated mentors) had the opportunity to present infections, enhanced care processes and improved patient outcomes across their research findings at international conferences in the spring. Greater various domains. innovation and a more personalized In the research domain, the division approach to fellowship training have also continued successful programs in basic led to unique training opportunities, science, translational research, clinical including welcoming our first dual-trained trials, and population health. Informatics OB/CCM fellow (and now faculty efforts in the clinical operations domain Dr. Tetsu Ohnuma presenting his poster on member), Dr. Rebecca Himmelwright. have also translated to opportunities sepsis research at the inaugural symposium.

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DIVISIONHIGHLIGHTS

GENERAL, VASCULAR & TRANSPLANT ANESTHESIOLOGY

ERAS 2.0: A Cornerstone of Care In the latest wave of innovation sweeping through the General, Vascular and Transplant Anesthesiology Division, there’s a renewed vigor and commitment to advancing patient care through the reimplementation of enhanced recovery after surgery (ERAS) practices. This initiative, termed ERAS 2.0, is led by Dr. Michael Manning, who has been appointed the clinical director of ERAS. In this role, he collaborates across divisions and with multidisciplinary teams to update existing programs, design and implement new pathways, educate and train providers and trainees, and develop research initiatives to evaluate the effectiveness of ERAS programs and identify opportunities for improvement.

ERAS was designed to reduce recovery times, improve patient outcomes and optimize the perioperative process. The effectiveness of ERAS programs hinges on consistent application and teamwork. As the division embarks upon this journey of reinvigoration, the roles of our anesthesiologists, certified registered nurse anesthetists (CRNAs) and residents cannot be overstated. Each member of the team plays a pivotal part in ensuring that our protocols not only take root but flourish, transforming the landscape of patient care within the division.

Anesthesiologists are at the forefront, guiding the implementation of these ERAS protocols and tailoring anesthesia plans to align with ERAS principles.

CRNAs bring their invaluable expertise Dr. Michael Manning and hands-on experience to the table, ensuring that these protocols are seamlessly integrated into daily practice. Residents, with their fresh perspectives and eagerness to learn, are the bridge to the future, driving innovation and ensuring the longevity of these practices.

Moving forward, there’s a collective understanding of the profound impact that a fully implemented ERAS program will have on our patients and the health care system at large. It serves as a call to action for each team member to wholeheartedly embrace these pathways with renewed enthusiasm and unwavering commitment, making ERAS 2.0 a cornerstone of our practice and a testament to our steadfast dedication to patient care. Together, we’re not just following best practices, we’re setting them; leading the way in perioperative care and exemplifying the excellence that Duke Anesthesiology is known for.

NEUROANESTHESIOLOGY, OTOLARYNGOLOGY & OFFSITE ANESTHESIOLOGY

Advancing Academic Research in Neuroanesthesiology revealing that In the past year, faculty of the Neuroanesthesiology, changes in brain Otolaryngology and Offsite Anesthesiology Division continued electrical activity to be recognized for excellence in the field and success in with opening one’s advancing the academic mission. Dr. Miles Berger became Dr. Leah Acker Dr. Miles Berger eyes before surgery the eighth anesthesiologist elected to the American Society is associated with for Clinical Investigation (ASCI) — a nonprofit medical attentional deficits and delirium severity after surgery among honor society for physician-scientists — and the second Duke older patients with normal preoperative cognitive screening anesthesiologist to be elected to the ASCI. The Berger lab scores. received a total of $2.27 million in funding in fiscal year 2023 Division chief, Dr. Nicole Guinn, through four National Institutes of was selected for and completed the Health R01 and R01 supplement Executive Leadership in Health Care grants, and published 17 manuscripts, (ELH) track of the Hedwig van including the largest human study Ameringen Executive Leadership in to-date showing that blood brain Academic Medicine barrier dysfunction plays a key role in (ELAM) program, postoperative delirium and increased a yearlong leadership program through hospital length of stay in older surgical Drexel University. She is the third patients. Dr. Leah Acker received a anesthesiologist from Duke to be selected 2023 New Investigator Award from the since the program began in 1995. Dr. American Delirium Society and a 2024 Amanda Faulkner was selected for the National Institute on Aging-American 2024 Duke Clinical Leadership Program, Geriatrics Society Resilience Rising Star and Dr. Jennifer Hauck became co-chair Award; she was also the first author on of the Black Box Committee and was a publication in the British Journal of Dr. Nicole Guinn at ELH graduation selected for the departmental Academy Anaesthesia, a collaboration with Berger, in April of 2024. for Building Leadership Excellence Program.

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DIVISIONHIGHLIGHTS

ORTHOPAEDICS, PLASTICS & REGIONAL ANESTHESIOLOGY

Breaking the Mold, Redefining Medical Education learners to practice competency in crisis Long gone are the simple days of “see one, do one, teach one.” resource management, refining both technical The Orthopaedics, Plastics and Regional Anesthesiology and non-technical skills, such as situational Division is internationally recognized for its innovation in awareness. It offers an opportunity for a lowmedical education. Created in 2018 by Dr. Amanda Kumar, the stress and fun environment for learning, while Regional Anesthesiology and Acute Pain Medicine Fellowship Dr. Amanda Kumar allowing our fellows to practice management simulation curriculum has been featured by the American Society of rare clinical events that they may not of Regional Anesthesia and Pain Medicine in both its podcast encounter otherwise during their training. A series on education in regional anesthesiology and in its popular highlight of the course is the debriefing online “How I Do It” series. This sessions allowing for immediate high-fidelity course encompasses feedback and reflection. Fellows are intraoperative emergencies, out of fortunate to learn from experts in the OR scenarios, and simulated patient field, including Drs. Jeff Gadsden, encounters specific to the practice of Michael Bullock, Michael Kent, and regional anesthesiology and acute pain Kumar. This full-day course would medicine. not be possible without the support The scope of the regional of the department, the director of the anesthesiologist is not just limited Duke Human Simulation and Patient to nerve blocks, but rather demands Safety Center, Dr. Ankeet Udani, and practice as an expert clinician and Regional Anesthesiology and Acute Pain Medicine our health care simulation operations consultant. In a similar vein, this Fellowship simulation training at the Duke Human specialist, Carlos Falcon. simulation curriculum allows our Simulation and Patient Safety Center.

PAIN MEDICINE

Fellowship Awarded, Division Growth receive this prestigious The Pain Medicine Division’s mission is to 1) improve the lives award and would like of patients through providing early, comprehensive diagnosis for to thank everyone for pain management and wellness treatments, 2) lead pain medicine their contributions residency/fellowship education with exposure to innovative and to the Duke Pain advanced pain medicine treatments and strategies, and 3) provide Dr. Evander Britt Dr. Jean Elie Tabbal Medicine Fellowship,” a clinical framework for translational pain medicine research. says Dr. Peter Yi, director of the Pain Medicine Fellowship.

Over the past year, this division has experienced an expansion “Without the tremendous efforts of our entire staff and the in its ambulatory pain faculty with the addition of Drs. Evander high-quality teaching of our faculty, this award would have not Britt and Jean Elie Tabbal, as well as three advanced practice been possible.” providers. This strategic recruitment effort has enabled us to Moreover, the training curriculum enhance our focus on the early assessment and underwent revision this year to provide treatment of patients afflicted by acute, chronic more exposure to clinical and advanced and cancer-related pain conditions. Duke Pain procedures, including an increase in Medicine remains dedicated to employing peripheral nerve stimulator and vertebral a multidisciplinary approach, utilizing the augmentation procedures.

The fellowship latest evidence-based practices, across our also aims to cultivate collaborative research five ambulatory sites and the Inpatient Pain opportunities for fellows, in line with the Service. This commitment is also evident in the overarching mission of the Duke Pain comprehensive training opportunities provided Medicine Fellowship. This mission is centered for residents and fellows. on fostering the development of competent, In recognition of these achievements, the well-rounded pain physician leaders equipped American Academy of Pain Medicine (AAPM) Dr. Peter Yi accepting the Pain to address the diverse needs of patients and selected the Duke Pain Medicine Fellowship as a Medicine Fellowship Excellence drive impactful changes within the field of recipient of the 2024 Pain Medicine Fellowship Award at the 40th Annual AAPM pain medicine.

Excellence Award. “We are excited and honored to Meeting in March of 2024.

BLUEPRINT 2024 | 13

DIVISIONHIGHLIGHTS

PEDIATRIC ANESTHESIOLOGY

Honoring Commitment and Excellence This year, we celebrate the exceptional contributions of two pioneers of our specialty, Drs. Allison Ross and Guy Dear. Through their advocacy for access and opportunity, establishment of centers of clinical excellence, and mentorship in our professional development, they stand as esteemed figures (and our very own “giants”) in pediatric anesthesiology. Together, they have devoted a combined total of 65 years of service to Duke Anesthesiology.

Ross, professor of anesthesiology and pediatrics, is our rock and our north star. Since arriving in 1992, she has been an integral part of the Duke community. She served as chief of the Pediatric Anesthesiology Division from 2006 - 2021 and was the perioperative medical director of Duke Children’s; she is currently the department’s director of professional development.

On the national stage, she was on the Society for Pediatric Anesthesia Board of Directors, Board of Editors for the journal of Pediatric Anesthesia and is on the Board of Directors of the Pediatric Anesthesia Leadership Council. Ross has had a very rich and influential research career publishing on pediatric regional anesthesia, mitochondrial disorders, and pharmacokinetic and pharmacodynamic effects of both anesthesia and pain

medications. She has been an outstanding educator and clinician and is now a trained leadership coach and Dr. Allison Ross Dr. Guy Dear mentor, guiding trainees and faculty alike in their careers.

Dear, an associate professor of anesthesiology and pediatrics, is our very own renaissance man and “knower of all things.” He arrived at Duke in 1991, and his breadth of skills has led to a richly diverse and impactful career. He was chairman of the Equipment Selection and Product Standardization Committee for 25 years and the clinical director of anesthesia services at the Duke Eye Center for many years. Throughout Dear’s career, his clinical and research interests have been in Duke’s hyperbaric chamber and in the use of electronic medical records. He has held leadership roles, both locally and nationally, serving as the Duke Epic System physician champion, and serving on many national electronic medical record steering committees and boards at a societal level and at the Epic head office. We celebrate the accomplishments of these two extraordinary pediatric anesthesiologists.

VETERANS AFFAIRS ANESTHESIOLOGY SERVICE

Elevating Excellence in Veterans Affairs The purpose of the Veterans Affairs Anesthesiology Service Division is to deliver the Duke Anesthesiology standard of world-class care to those who have served and defended our nation. This past year, the division continued to grow across all three pillars of its mission.

Clinically, the division expanded the scope and volume of the Acute Pain Service, offering a wide array of services, including regional techniques, ketamine infusions and a host of non-pharmacologic interventions, such as music listening, aromatherapy and battlefield acupuncture. Also active is the Transitional Pain Service, a multidisciplinary team offering preoperative optimization, evidence-based comprehensive perioperative care, intensive follow-up after hospital discharge, and a smooth transition back to primary care management for patients with chronic pain conditions requiring surgery. In other areas, GI endoscopy has doubled in volume while close collaboration with cardiology facilitated the launch of the Structural Heart Program. Furthermore, our critical care team has spearheaded multiple system-wide initiatives related to airway management and resuscitation while overseeing the Surgical Intensive Care Unit.

The education realm also experienced growth and development. Each year, the division hosts more than 75 medical students, residents and fellows with the hallmark of its rotations being a hands-on, experiential learning curriculum; this includes workshops on regional anesthesia, point of care ultrasound, intraosseous line placement, suturing, defibrillator 14

| DUKE ANESTHESIOLOGY

Trainees during an OR mock code drill to enhance critical thinking and skills.

use, communication skills, and more. Monthly multidisciplinary mock codes and other didactic sessions are held with residents and fellows focused on topics of greatest interest to our trainees.

Turning the lens, the division has focused on growing as educators by collectively exploring best practices for providing feedback to trainees and customizing approaches to meet the individual needs of learners.

Lastly, the research enterprise is thriving with several externally funded projects focused on exploring mechanisms of chronic post-amputation pain, delivery of prehabilitation for frail veterans undergoing surgery and several large epidemiologic analyses of specific surgical populations.

DIVISION | CENTERS & PROGRAMS | HIGHLIGHTS

WOMEN’S ANESTHESIOLOGY

Growing with Demand, Enhancing Care The delivery rate at the Duke Birthing Center has shown an increase of 22% compared to 2019, accompanied by a rise in acuity and comorbidities. To address these growing demands, the Women’s Anesthesiology Division has been expanding its faculty pool and talent, which includes 12 fellowship-trained obstetric anesthesiologists, with prior fellows, Drs. Rebecca Himmelwright and Sara Feldman, joining the faculty. Dr. Jennifer Mehdiratta has also assumed the role of interim medical director of obstetric anesthesia for the Duke Birthing Center and is responsible for the clinical operations within the division.

The division’s ability to attract applicants pursuing dual fellowships has been supported by faculty members who possess expertise in both obstetric anesthesiology and either cardiothoracic (Dr. Marie-Louise Meng) or critical care (Dr. Melissa Bauer). We are proud that the first fellows with dual training, Drs. Liliane Ernst (cardiothoracic and obstetric anesthesiology) and Himmelwright (critical care and obstetric anesthesiology), graduated this year. Additionally, in 2024, Dr. Heather Acuff joined the program for dual training in obstetric and cardiothoracic anesthesiology.

In 2023, the Duke University Medical Center received a renewal of the prestigious Center of Excellence designation by

Dr. Jennifer Mehdiratta

Dr. Liliane Ernst

Dr. Rebecca Himmelwright

the Society for Obstetric Anesthesia and Perinatology (SOAP).

This designation recognizes institutions and programs that demonstrate excellence in obstetric anesthesia.

Throughout the past year, numerous esteemed awards were bestowed upon several faculty members within the division: Dr. Jennifer Dominguez received the Duke School of Medicine Excellence in Professionalism Award and the SOAP Teacher of the Year Award; division chief, Dr. Ashraf Habib, received the Duke School of Medicine Leonard Palumbo Jr., MD, Faculty Achievement Award; and Bauer was chosen by the SOAP Board of Directors to deliver the prestigious Gerard W. Ostheimer Lecture at this year’s SOAP annual meeting. She joins an elite group of prior Ostheimer lecturers who are chosen based on recognition as established experts in the field with a track record of excellence in research and knowledge translation.

CENTER FOR PERIOPERATIVE ORGAN PROTECTION The Center for Perioperative Organ Protection (CPOP) continues to excel in neuromodulation, new techniques of stimulation, and neuronal biomarkers that are providing critical information about the functional organization of the nervous system and the clinical potential of these mechanisms in immune and metabolic disorders. Dr. Luis Ulloa, the director of CPOP, reported the fundamental somatotopic autonomic neuronal networks for metabolic and immune surveillance and neuromodulation in the journal Neuron. These studies have major clinical implications and pave the way for novel treatments of bioelectronic modulation of metabolism and immunity. He was invited to present his research at the National Center for Complementary and Integrative Health symposium on novel strategies of neuromodulation during the 2023 Society for Acupuncture Research international meeting.

Additionally, Ulloa reported in the International Journal of Surgery a collaboration in a prospective, parallel-group, singleblinded, randomized controlled trial with 229 participants, previously scheduled for elective surgery, that found personal music intervention (with patient-selected songs played ad libitum by the patient) improved postoperative systolic blood pressure, anxiety, nausea, emesis, and overall satisfaction as compared to a therapist-designed intervention of 30 minutes of pre-recorded classical music started upon arrival to the Post Anesthesia Care Unit.

Dr. Jamie Privratsky published his study, “A Macrophage-

Dr. Luis Ulloa

Dr. Vijay Krishnamoorthy

Dr. Jamie Privratsky

Endothelial Immunoregulatory Axis Ameliorates Septic Acute Kidney Injury” in the journal Kidney International and was invited to present his research at the 2023 American Society of Nephrology meeting. The study’s findings are particularly relevant to the efficacy of anti-interleukin-6 therapies during COVID-19, an infectious disease associated with high rates of acute kidney injury and endothelial dysfunction.

CPOP seminars have continued to establish critical collaborations for grant submission, including Dr. Vijay Krishnamoorthy’s $3 million R01 NIH grant for his project, “Impact of Autonomic Dysfunction on Multi-Organ Dysfunction Following Severe Traumatic Brain Injury: The AUTO-BOOST Study.” This study holds significant importance since more than 60% of severe traumatic brain injury (TBI) patients experience multi-organ dysfunction, leading to exacerbated clinical outcomes and decreased survival rates within the first year following TBI. BLUEPRINT 2024 | 15

HIGHLIGHTS | CENTERS & PROGRAMS

CENTER FOR TRANSLATIONAL PAIN MEDICINE Members of the Center for Translational Pain Medicine (CTPM) hosted the Inaugural Maixner Pain Research Symposium on November 16, 2023. This symposium was established in honor of one of Duke Anesthesiology’s most esteemed and cherished faculty members and a pioneer in the field of pain research, Dr. William “Bill” Dr. William Maixner Maixner, the Joannes H. Karis, MD, Professor of Anesthesiology and founder of the CTPM. He dedicated his life to unraveling the complexities of chronic pain, striving to translate his groundbreaking findings into innovative diagnostics and treatments to transform the lives of countless patients. More than 120 people attended the event to share knowledge and discoveries with the collective goal of advancing the frontiers of pain medicine, improving patient care, and alleviating the burden of chronic pain. Guest speakers included leaders from in-state universities, Japan and Sweden.

Dr. Sven-Eric Jordt

Dr. Sairam Jabba

A recent study (published in JAMA), led by Drs. Sairam Jabba and Sven-Eric Jordt, finds synthetic chemicals that mimic menthol’s cooling sensations are being added to newly introduced “nonmenthol” cigarettes in states that have banned the additive. Jabba and Jordt are among the researchers who identified new compounds that achieve similar cooling sensations to menthol, which has long been added to tobacco to reduce harshness.

Recent research (published in Brain Behavior and Immunity) from a Duke Health team, led by Drs. Ru-Rong Ji and Thomas Buchheit, director of the Dr. Thomas Buchheit Duke Regenerative Pain Therapies Program, uncovers the mechanisms of extended pain relief for autologous conditioned serum, a well-known biologic therapy.

Symposium speakers and organizers (pictured second from left, Dr. Andrea Nackley, and far right, Dr. Ru-Rong Ji) in the Mary Duke Biddle Trent Semans Center for Health Education.

Dr. Ru-Rong Ji, William Maixner Professor of Anesthesiology, was awarded a $2,569,851 National Institutes of Health R01 grant to study checkpoint inhibitors for pain control – specifically investigating how the PD-L1/PD-1 checkpoint pathway controls physiological and pathological pain and opioid analgesia via neuronal, immune and glial mechanisms.

DEPARTMENTAL RECOGNITION Division Chief Earns Tip of the Spear Award Congratulations to Dr. Vijay Krishnamoorthy, chief of the Critical Care Medicine (CCM) Division, on receiving Duke Anesthesiology’s Tip of the Spear award. This trophy is given to a member of the team who has significantly advanced the mission of the department. Chairman Dr. Joseph Mathew presented Krishnamoorthy with the award in recognition of outstanding clinical care through his 1) leadership of CCM faculty through the Duke University Health System (DUHS) intensive care units (ICU), 2) creation of the DUHS ICU Collaborative Learning Health System, 3) establishment of a board-approved DUHS ICU Quality Improvement Committee, and 4) development of the Duke ICU Universe for data-driven advancement. Learn more about Duke Anesthesiology’s critical care medicine advancements and innovations in the 2023 issue of BluePrint magazine.

The Tip of the Spear award was established in 2017. Previous recipients include Dr. Edward Sanders, Dan Cantrell, Dr. Thomas Buchheit, Dr. Raquel Bartz, Lori Bell, and Dr. Nitin Mehdiratta.

16

| DUKE ANESTHESIOLOGY

IN REMEMBRANCE

Duke flags were lowered

Bruno J. Urban, MD September 1935 - January 2024

“Bruno was always professional, compassionate and a fierce patient advocate. He was also a brilliant neurosurgical anesthesiologist and innovative pain management specialist who helped define the field. His pipe was an ever-present sartorial accompaniment. He will be missed, but his contributions remain relevant and form the basis of current practice.”

– Dr. Philip Lumb, Duke Anesthesiology Alumnus

on March 11 to honor the life and legacy of Dr. Bruno Urban, a beloved member of our Duke Anesthesiology family and a professor emeritus of anesthesiology for more than two decades. He will be remembered as a pioneer in our field for advocating an integrated, multidisciplinary approach to pain management that transcended traditional specialty boundaries.

In 1974, Dr. Urban became the first dedicated pain management specialist within Duke Anesthesiology and founded the Duke Pain Medicine Clinic, an innovative effort that resulted in one of the nation’s first multidisciplinary pain clinics. By combining the expertise of physicians trained in anesthesiology, psychiatry and neurosurgery, the Duke Pain Medicine Clinic — the first in the Southeast — adopted a comprehensive, collaborative, multidisciplinary approach to pain management, including psychiatric, neurosurgical and neurostimulation techniques. A true trailblazer, Dr. Urban’s background in neurosurgery led him to adopt and advance techniques of spinal cord stimulation in the 1970s. He proudly claimed the distinction of being the first to prescribe methadone for pain in the state of North Carolina. Dr. Urban’s contributions extend beyond outpatient care, as he also developed Duke’s multidisciplinary inpatient pain program—one of the first such programs in the country.

Read more at bit.ly/BJURemembrance

“Dr. Urban was my mentor, friend and father during my training at Duke Pain Medicine Clinic. My stay culminated with the publication of several articles and the edition of the only book published today by the International Association for the Study of Pain in Spanish. It is an honor for me to have shared that time with him. I join in the feeling of sadness for such a regrettable loss. I am still proud of the training he gave me as a doctor and as a person.”

– Dr. Carlos Nebreda, Duke Anesthesiology Alumnus "Bruno Urban played a pioneering role in the emergence of outpatient (Pain Medicine Clinic) and inpatient pain programs (e.g. the Clinical Specialties Unit) at Duke. He was the epitome of the scientist-practitioner. He was a true scholar who believed in integrating high quality, empirically validated assessments and treatments into his pain practice and taught others how to do so. His contributions to Duke’s pain clinical and research-based pain programs cannot be overstated."

– Dr. Francis Keefe, Duke Psychiatry & Behavioral Sciences

“When I think about Dr. Urban, I always remember his passion for teaching - fellows, residents, students, nurses, and ancillary staff. His clinical diagnostic skills were impeccable. He was one of the most knowledgeable physicians under whom I had the honor to study. I always felt a responsibility to impart the knowledge I gained from Dr. Urban to my patients and the next generation of Duke Anesthesiology consultants.”

– Dr. Anne Marie Fras, Duke Anesthesiology Alumna

TO PRESERVE DR. URBAN’S LEGACY, Duke Anesthesiology established and hosts the distinguished Bruno Urban Lectureship in which a national leader in pain medicine is invited annually to deliver this esteemed lecture series in his honor.

BLUEPRINT 2024

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NOTEWORTHYSTATS

Duke Anesthesiology Duke Anesthesiology BYTHENUMBERS B Y TH E N UM B ERS BY THAnesthesiology E N UM B ERS Duke JULY 1, 2020 - JUNE 30, 2021 July 1, 2023 JULY 1, 2022 2020--June JUNE30, 30, 2021

CASES CASES 15,018 15,018 AMBULATORY

OR CASES: OR CASES: 167,821

167,821

ANESTHESIOLOGY AMBULATORY ANESTHESIOLOGY

5,772 5,772 NEURO-

7,788 7,788 CARDIOTHOR ACIC

76,792 76,792 COMMUNIT Y

26,054 26,054 GENER AL,

ANESTHESIOLOGY CARDIOTHOR ACIC ANESTHESIOLOGY

COMMUNIT Y

9,781 9,781 ORTHOPAEDICS,

10,087 10,087 PEDIATRIC

8,047 8,047 VETERANS AFFAIRS

ANESTHESIOLOGY VETERANS SERVICE AFFAIRS ANESTHESIOLOGY SERVICE

ANESTHESIOLOGY WOMEN’S ANESTHESIOLOGY

OTHER SERVICES: 67,395 OTHER SERVICES: 67,395

22,569 22,569 CRITICAL CARE

31,313 31,313 PAIN CLINIC VISITS

13,513 13,513 INPATIENT PAIN

CRITICAL CARE

PAIN CLINIC VISITS

PLASTICS AND ORTHOPAEDICS, REGIONAL PLASTICS AND ANESTHESIOLOGY REGIONAL ANESTHESIOLOGY

ANESTHESIOLOGY NEUROANESTHESIOLOGY

428 428

ANESTHESIOLOGY PEDIATRIC ANESTHESIOLOGY

CARDIOTHORACIC ANESTHESIOLOGY

89

CRITICAL CARE MEDICINE

78

CENTER FOR TRANSLATIONAL PAIN MEDICINE

41

GENERAL, VASCULAR AND TRANSPLANT ANESTHESIOLOGY

39

PUBLICATIONS

PUBLICATIONS

NEUROANESTHESIOLOGY

34

CENTER FOR PERIOPERATIVE ORGAN PROTECTION

33

WOMEN’S ANESTHESIOLOGY

33

VA ANESTHESIOLOGY SERVICE

27

PAIN MEDICINE

22

ORTHOPAEDICS, PLASTICS & REGIONAL ANESTHESIOLOGY

15

PEDIATRIC ANESTHESIOLOGY

13

AMBULATORY ANESTHESIOLOGY

3

COMMUNITY

1

18

| DUKE ANESTHESIOLOGY

VASCULAR AND GENER AL, TR ANSPLANT VASCULAR AND ANESTHESIOLOGY TR ANSPLANT ANESTHESIOLOGY

8,364 8,364 WOMEN’S

SERVICE VISITS INPATIENT PAIN SERVICE VISITS

52 NEW GRANTS

(all sources)

totaling more than

$27 million BASIC SCIENCES 20

~

ORTHOPAEDICS, PLASTICS AND REGIONAL ANESTHESIOLOGY CRITICAL CARE MEDICINE NEUROANESTHESIOLOGY CARDIOTHORACIC ANESTHESIOLOGY WOMEN’S ANESTHESIOLOGY HYPERBARIC MEDICINE PAIN MEDICINE PEDIATRIC ANESTHESIOLOGY

~$7.5 million TOTAL OF 21 NON-COMPETING CONTINUING GRANTS

$16,073,818

5 5 7 5 3 4 2 1

$4,246,028 $2,103,265 $1,870,816 $1,141,469 $876,748 $607,084 $325,806 $50,000

181 CURRENT ACTIVE RESEARCH GRANTS

31 Research Laboratories and Programs (*early investigator) Medical Countermeasures and Pain Translational Laboratory Satya Achanta, DVM, PhD

Pain Relief and Opioid Mitigation Innovation Science (PROMIS) Laboratory Padma Gulur, MD

Human Pharmacology and Physiology Laboratory (HPPL) David MacLeod, MBBS

Pain Omics and Informatics Research Laboratory Shad Smith, PhD

Anesthesiology, Cognitive Neuroscience and Engineering Research (ACkER) Laboratory *Leah Acker, MD, PhD

Sensory Plasticity and Pain Research Laboratory Ru-Rong Ji, PhD

Human Affect and Pain Neuroscience Laboratory Katherine Martucci, PhD

Neuroinflammation and Cognitive Outcomes Laboratory Niccolò Terrando, PhD

Community Engagement and Implementation Project to Reduce Maternal Sepsis (CIPRES) Melissa Bauer, MD

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

Neurocognitive Outcomes Research Group Joseph Mathew, MD, MHSc, MBA

Outcomes and Clinical Epidemiology in Anesthesiology (OCEAN) Laboratory Miriam Treggiari, MD, PhD, MPH

Peri-Operative Neurocognitive Research Team (PORT) Laboratory Miles Berger, MD, PhD

Mechanistic and Clinical Pharmacology Laboratory Evan Kharasch, MD, PhD

Regenerative Pain Therapies Program Thomas Buchheit, MD

Pain Equity and Disparities Research Laboratory *Martha Kenney, MD

Mechanisms of ICU-Acquired Neurocognitive Disorders (MIND) Laboratory *Michael Devinney, MD, PhD Neuroimmunology and Applied Pain Research Laboratory Christopher Donnelly, DDS, PhD Oxygen Transport Laboratory Heath Gasier, PhD

Critical Care and Perioperative Population Health Research (CAPER) Program Vijay Krishnamoorthy, MD, MPH, PhD, and Karthik Raghunathan, MBBS, MPH Molecular Pharmacology Laboratory Madan Kwatra, PhD

FG Hall Environmental Laboratory Richard Moon, MD, CM, MSc, FRCP(C), FACP, FCCP

Neuromodulation Laboratory Luis Ulloa, PhD, MS

Translational Pain Research Laboratory Andrea Nackley, PhD

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

Kidney Protection Laboratory Jamie Privratsky, MD, PhD

Duke Multi-Disciplinary Metabolic and Body Composition Assessment Team (MCAT) Laboratory Paul Wischmeyer, MD

Duke Anesthesiology Microbiome Profiling (Duke AMP) Laboratory *Mara Serbanescu, MD Multidisciplinary Neuroprotection Laboratory Huaxin Sheng, MD

Molecular Neurobiology Laboratory & Multidisciplinary Brain Protection Program Wei Yang, PhD, FAHA

BLUEPRINT 2024

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DEPARTMENTALRESEARCH

HONORSOCIETY BASIC SCIENCES (CPOP/CTPM)

Sangsu Bang

National Institute of Dental and Craniofacial Research: $161,000 Resolvin Receptor Signaling in Trigeminal Sensory Neurons

#

Christopher Donnelly

National Institute of Arthritis and Musculoskeletal and Skin Diseases: $5,734,530

Neural Architecture of the Murine and Human Temporomandibular Joint

National Institute of Dental and Craniofacial Research: $616,920 Neuro-Immune Modulation of Pain in Health and Disease

National Institute of Dental and Craniofacial Research: $544,726 Sexually Dimorphic Pain Signaling Mechanisms

National Institutes of Health: $118,837

Identifying Non-Opioid Strategies to Manage Oral Cancer Pain

Sairam Jabba

National Institute on Drug Abuse: $103,007 S/R-Nicotine in Commercial Products Containing Synthetic Nicotine: Product Survey by Chemical Analysis and Toxicological Properties

Ru-Rong Ji

United States Army Medical Research Acquisition Activity: $1,608,140

Developing Non-Opiate GPCR Signaling Biased Agents for Pain Management

United States Army Medical Research Acquisition Activity: $371,000

Pain Management in Critical Combat Casualty Environments Using Resorbable Poly(ester urea) Films for Sustained Delivery of Meloxicam and Bupivacaine

Sven-Eric Jordt

National Institute of Environmental Health Sciences: $482,024 Pulmonary Cell Fate and Lung Repair in Rodent and Porcine Models of Chlorine and Phosgene Inhalation Injuries

National Institute on Drug Abuse: $416,512

Nicotine Pouches: Chemical Composition, Toxicity and Behavioral Effects of a New Tobacco Product Category

20

| DUKE ANESTHESIOLOGY

3

Departmental Research $100,000+ July 1, 2022—June 30, 2023

in NIH Funding SOURCE: 2023 BLUE RIDGE INSTITUTE FOR MEDICAL RESEARCH

Madan Kwatra

Mihai Podgoreanu

Anti-Fibrotic Mechanisms of IL-31 Blockade in Prurigo Nodularis

Patient-Focused Collaborative Hospital Repository Uniting Standards (CHoRUS) for Equitable AI

Galderma: $369,093

National Institutes of Health: $192,501

Katherine Martucci

Madhav Swaminathan

Neurobiological Consequences of Long-Term Opioid Therapy in the Brain and Spinal Cord

Guard Akita 21-ROS-05

National Institute on Drug Abuse: $634,116

Huaxin Sheng

National Institute of Neurological Disorders and Stroke: $499,100

Guard Therapeutics International AB Novartis Pharmaceuticals Corporation Novartis TIN816

CRITICAL CARE MEDICINE

Duke Testing Site for Stroke Preclinical Assessment Network

Michael Devinney

Shad Smith

REPOSE

Single-Cell Omics Approaches to Investigate TMD

National Institute of Neurological Disorders and Stroke: $714,338

Merck Sharp & Dohme: $621,326

National Institute of Dental and Craniofacial Research: $402,487

Vijay Krishnamoorthy

Niccolò Terrando

Impact of Autonomic Dysfunction on Multi-Organ Dysfunction Following Severe TBI: The AUTOBOOST Study

National Institute on Aging: $2,244,681 Immunovascular Interactions in Postoperative Delirium Superimposed on Dementia

National Institute on Aging: $991,397

Microglia-Amyloid Interactions in Delirium Superimposed on Dementia

Wei Yang

National Institute of Neurological Disorders and Stroke: $442,750 Targeted Neuromodulation to Enhance Recovery of the Aged Brain After Ischemic Stroke

National Center for Complementary and Integrative Health: $241,500

Vagal Control of Tissue SUMOylation as a Novel Anti-Inflammatory Target in IBD

CARDIOTHORACIC ANESTHESIOLOGY

Miriam Treggiari

National Heart, Lung and Blood Institute: $743,776

Randomized Trial of Endotracheal Tubes to Prevent Ventilator-Associated Pneumonia - Prevent 2 Study

HYPERBARIC

Heath Gasier

Office of Naval Research: $383,244

The Role of GABA in Susceptibility to Oxygen Toxicity with Repeated HBO2 Exposure

Richard Moon

Office of Naval Research: $118,980

Metabolic and Inert Gas Monitoring for Human Diving Research

Kamrouz Ghadimi

NEUROANESTHESIOLOGY

LEX-211 Octapharma

National Institute on Aging: $161,000

Octapharma AG: $310,917

Leah Acker

The Role of the Aging Brain-Heart-Immune Axis in Postoperative Delirium

DEPARTMENTALRESEARCH

Inside the CRU: Innovation at its Core

Role of the Splanchnic Vascular Compartment in Heart Failure with Preserved Ejection Fraction

Pacira BioSciences, Inc. Pacira 402-C-124

Zynex Monitoring Solutions ZMS-2023

Department of Defense: $576,446 NIRSense: Argus Oximetry System

Norbert Health

Norbert Health (NCP-0003) Cyban Brain Pulse Oximeter - Bsp02

h rc

Su

at or ig st

ea

ve

Biobank of >100K Human Specimens from Study Participants for Translational Research

s Re

In

e ur

Anesthesiology CRU

Career Development of Research Staff for High Quality Retention & Engagement

ut rF

fo

Pacira IIT

ds

Pacira BioSciences, Inc.: $191,216

ho

Haisco-USA Pharmaceuticals, Inc. Covance HSK3486-305

et

Ashraf Habib

lM

HEMCS-044

na

HemoSonics, LLC

tio

Terrence Allen

sla

WOMEN’S ANESTHESIOLOGY

an Tr

Cyban Pty Ltd.

t

Doris Duke Charitable Foundation, Inc.: $164,596

en

David MacLeod

m

REGIONAL ANESTHESIOLOGY

op

Biohaven BHV-3000-317 TMD Study

el

Biohaven Pharmaceuticals

ev

Aurelio Alonso

rD

PAIN MEDICINE

re e

Low Neurophysiologic Resistance to Anesthetics as a Marker of Preclinical/Prodromal Alzheimer’s Disease and Neurovascular Pathology, Delirium Risk and Inattention

Ca

National Institute on Aging: $784,183

t&

APOE4 Dependent Regulation of CSF Complement Pathway Activation in the Development of Alzheimer’s Disease

or

National Institute on Aging: $810,435

pp

Miles Berger

independent research programs, the CRU, directed by Dr. Kamrouz Ghadimi, stands out for a departmental its unique initiatives. One such section that further innovation is the development organizes clinical of a neurocognitive testing core, and translational research missions garnering national acclaim for its in all areas of anesthesiology, critical involvement in federally-funded care medicine, pain medicine, and investigations through the rigor and perioperative research at Duke reproducibility by which testing is University Medical Center, its performed. In addition, the CRU affiliated local sites, and serves as a has invested in the growth and coordinating center or participating development of personnel through site for multisite research. For more the use of a Clinical Research Career than two decades, the CRU has Development Ladder. In partnership grown to include more than 40 core with the Duke University School personnel who currently support of Medicine’s Master of Biomedical more than 80 prospective trials and Sciences (MBS) program, the observational studies each year.

CRU has recruited several MBS Recently, the CRU has supported graduates who have started their a growing NIH-funded clinical career in clinical research as entryresearch portfolio from departmental level specialists and then often faculty that approached 20 grants in promoted to the level of clinical the past year. research coordinator. In 2023, Distinguishing its capabilities, the unit introduced a monthly the CRU excels in biospecimen seminar, referred to as the Clinical repository development with Research Initiatives, Staff, Planning, translational methods for and Education (CRISP-E) series, biospecimen acquisition, which offers a structured in-person protocolized sample processing in platform for CRU staff to engage in its laboratory, sample provenance mutual learning, benefit from faculty and governance, and freezer storage expertise, and exchange knowledge. and maintenance. The CRU In January, the CRU introduced the biorepository houses nine -80 Celsius Team Lead Committee to provide a freezers with more than 100,000 structured team-based collaboration human biospecimens that may between its lead coordinators be utilized for follow-on and leadership team to provide translational investigations learning opportunities for and collaborations. research operations and Sustained Beyond supporting to enhance quality Excellence in faculty investigators improvement within Research Operations in their ability the multiple for > 20 years to cultivate domains of and sustain the CRU. Duke The Clinical Research Unit (CRU) is

Patient-Centered Approach

BLUEPRINT 2024

| 21

EDUCATION

UNPRECEDENTED HEIGHTS

A CENTENNIAL ACADEMIC EVENING

A

wealth of scholarly activity and scientific prowess were showcased at Duke Anesthesiology’s distinguished 32nd Annual Academic Evening — formally recognized as a Duke Centennial event.

The pinnacle of the department’s research endeavors, nearly 180 junior-level investigators and faculty gathered at this year’s celebration to share the results of their research pursuits, spanning diverse areas of study including basic science, clinical and translational research, population health, and quality improvement.

This year marked a milestone with an unprecedented number of 104 abstracts presented at the event, which took

place on May 7 at the JB Duke Hotel and was chaired by Drs. Miriam Treggiari and Anne Cherry.

In her opening remarks, Cherry reflected on her first interaction with the department 17 years ago while attending Academic Evening as a medical student. “While I felt a strong sense of ownership in my work, I recognized that it represented years of effort by numerous individuals before me. Our presenters tonight have invested a great deal in this work, which also represents the contributions of mentors, faculty, statisticians, data scientists, research staff, students, and even patients who believe in its significance.”

Treggiari initiated the reception by reverently ringing the bell belonging to the late

Dr. David S. Warner, symbolizing the commencement of presentations and paying tribute to Warner’s enduring legacy.

This gesture acknowledged Warner’s key role in the event, profound influence as a mentor to countless investigators, and his pivotal contribution to the advancement of both basic science and clinical research within the department. The David S. Warner Award for post doc basic science research is one of three awards which bear the names of esteemed departmental members, perpetuating their remarkable legacy in Duke Anesthesiology. The Dick Smith Award for fellow clinical research honors Smith, who was a highly regarded statistician who made significant contributions to the department’s ability and reputation in conducting high-level science with unrivaled ethical and moral standards.

Another anticipated highlight of the annual event is the presentation of the Bill White Award for resident research. White was involved in the design, data control and examination, and statistical analysis of biomedical studies in both observational and clinical trials within Duke Anesthesiology for more than two decades. Dr. George Cortina received first place in this category (see below). He says, “I’m honored to receive an award. Our project arose out of a partnership between the Reker lab in Duke Biomedical Engineering and the Ji lab in Duke Anesthesiology, highlighting the strong support for novel ideas and interdisciplinary teamwork within the department.

This would not have been possible without the dedication

2024 ACADEMIC EVENING AWARD WINNERS: Post Doc Basic Science Research (David S. Warner Award)

1st Place: Jing Xu, “GPR37L1 Regulates Astrocyte Signaling in Neuropathic Pain” Mentor: Ru-Rong Ji. 2nd Place: Ayman Youssef, “Sciatic Stimulation Stabilizes Glycemia in Sepsis via Hepatic Cholinergic M3R Receptors” Mentor: Luis Ulloa.

3rd Place: Yanting Chen, “Kidney Macrophage IL-1 Receptor Limits Endoplasmic Reticulum Stress and Nephrotoxic Serum Nephritis” Mentor: Jamie Privratsky.

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Fellow Clinical Research (Dick Smith Award)

1st Place: Katherine Sun, “Right Ventricle-Pulmonary Artery Coupling as Predictor of Major Organ Morbidity and Mortality after Cardiac Surgery” Mentor: Alina Nicoara.

2nd Place: Benjamin Andrew, “National Practice Patterns for the Use of Regional Anesthesia for Pediatric Cardiac Surgery and Impact on Postoperative Outcomes: An Analysis of the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society (STS-CCAS) Database” Mentor: Lisa Einhorn.

3rd Place: Mara Serbanescu,“Conserved Alterations in Gut Microbiota-Mediated Metabolic Pathways Underlie Aging-Related Neurodegeneration in Humans and Mice” Mentor: Paul Wischmeyer & Niccolò Terrando.

EDUCATION

GUEST JUDGE

Dr. Seun Johnson-Akeju Chairman, Department of Anesthesia, Critical Care and Pain Medicine Harvard Medical School

and expertise of every team member involved.”

Dr. Seun Johnson-Akeju, chairman of the Department of Anesthesia, Critical Care and Pain Medicine at Harvard Medical School, was selected to serve as this year’s guest judge.

In this role, he received the honor of reviewing the work and presiding over the selection of the award winners in each of the five categories.

“Being part of the Academic Evening was a privilege. The department’s research, mentorship and staff engagement showcased unparalleled breadth, depth and quality. The Duke Department of Anesthesiology stands among the institutions that set the benchmark for academic excellence in our field, both present and future. Experiencing this commitment firsthand only deepened my admiration,” says Johnson-Akeju.

“Three decades later, the mission of Academic Evening remains constant; to propel forward the field of anesthesia, critical care and pain management, ultimately enhancing the care of our patients,” asserts Treggiari, vice chair for research. “We take immense pride in witnessing the remarkable achievements made in this relatively short span of a year. It stands as a testament to our department’s robust culture of driving breakthroughs and making a tangible difference in the world, fueled by an unwavering dedication to our academic mission.”

Resident Research (Bill White Award)

1st Place: George Cortina, “Machine Learning-Assisted Novel Local Anesthetic Nanoparticles Demonstrate Extended Analgesia in a Mouse Model of Postoperative Pain” Mentor: Ru-Rong Ji & Daniel Reker.

Medical Student Research

First place winners: From top, George Cortina, Jacqueline Emerson, Jennifer Ricano, Katherine Sun, and Jing Xu

Grad/Undergrad/CRNA/DNP Research

1st Place: Jennifer Ricano, “Activation of Beta-3 Adrenergic Receptors with the Selective Agonist Mirabegron Elicits Multi-Site Mechanical Hypersensitivity, Grimace, and Increased IL-6 Levels in Mice” Mentor: Andrea Nackley.

2nd Place: Vinith Upadhya, “Increased Grey Matter Microstructural Abnormalities in Patients with Post-Operative Delirium” Mentor: Miles Berger.

1st Place: Jacqueline Emerson, “Changes in Human Central Nervous System Monocyte Counts (within the Cerebrospinal Fluid) and Cognition Following Major Non-Cardiac/Non-Neurologic Surgery in Older Adults” Mentor: Miles Berger.

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EDUCATION CLINICAL OPERATIONS:

Dr. Muhammad Farooq Anwar

Dr. Kathleen Claus

Dr. Jennifer Hauck

CLINICAL RESEARCH:

CONGRATULATIONS

to our 2024 ABLE Scholars Creating a culture of coaching in which every faculty member is invested and engaged in professional growth.

The ABLE Program is designed to accelerate career development for junior faculty in their chosen pathway by pairing them in a one-year program with a personal coach. The program involves training in aspects of career development that include strategies to build resilience, enhance professional skills, and learn the infrastructure that supports their chosen domain.

Dr. Blair Costin

EDUCATION:

Dr. Mara Serbanescu

Dr. Jean-Elie Tabbal

INNOVATION AND DATA SCIENCE:

Dr. Sophia Dunworth Dr. Sarah Cotter Dr. Sachin Mehta

Duke Anesthesiology Fellowship Programs Training World-Class Anesthesiologists

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Your future starts here! anesthesiology.duke.edu/education/fellowships

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| DUKE ANESTHESIOLOGY

4/24/24 2:17 PM

morpheusconsortium.org

NEW! Duke Online Clinical Nutrition Course and Fellowship in Collaboration with the Morpheus Consortium

Obtain CME/CE credit through an interactive clinical nutrition training program led by internationally renowned experts.

Participants will learn: • The newest cutting-edge science on nutrition risk identification

Course Co-Director Paul E. Wischmeyer, MD, EDIC, FASPEN, FCCM

• Evidence-based nutrition care of pediatric and adult patients • How to optimize patient outcomes with nutrition therapy

Available Online

https://anesthesiology.duke.edu/clinical-nutrition-course

Course Co-Director Sundar Krishnan, MBBS

#DukeNutritionCourse

AI TECHNOLOGY

Pushing the Boundaries of Care Delivery Through Data-Driven Innovation

D

uke Anesthesiology improve operational efficiency, and support data-driven proudly launched decision-making processes within the department. a central hub for In addition to these collaborative efforts, the team data-driven decisionis exploring the potential of novel large language making and innovation models to streamline departmental data pipelines. this year. Led by Dr. By utilizing these AI-powered tools, data flow and Michael Kent and Dan data cleaning processes have begun to be optimized, Cantrell, the hub’s ensuring the integrity and reliability of the information Dr. Michael Kent and Dan Cantrell mission is to transform we work with. For example, AI was utilized to review perioperative and hundreds of specific procedure names and categories critical care through cutting-edge research, advanced to generate a meaningful taxonomy for health system analytics and collaborative innovation – ultimately financial analysis, significantly saving time compared empowering clinicians, researchers and stakeholders to traditional methods. Additionally, the team is with the tools and insights needed to optimize patient leveraging large language models to assist with reusable outcomes, streamline workflows, and drive sustainable code banks for data acquisition and cleaning with the improvements in health care delivery. goal of decreasing time until data insights. As early Over the past year, the Duke Anesthesiology IT group testers of the groundbreaking nference platform, has been actively engaged in collaborating with various which combines traditional and natural language groups within the Duke University Health System and processing across all patient records, this Duke team is Duke University to evaluate and implement cuttingpaving the way for more efficient and targeted research edge machine learning and data cohort creation. Lastly, the analytic models. These initiatives team is pleased to announce AI WAS UTILIZED TO REVIEW have focused on critical areas, the pilot deployment of AI such as drug diversion prevention, HUNDREDS OF SPECIFIC PROCEDURE tools within the Microsoft 365 predicting patient “readiness suite, working closely with a NAMES AND CATEGORIES for surgery,” establishing a select group of faculty members TO GENERATE A MEANINGFUL comprehensive critical care analytic to assess the usefulness and TAXONOMY FOR HEALTH SYSTEM infrastructure, and optimizing potential applications of these FINANCIAL ANALYSIS, SIGNIFICANTLY staffing needs. By leveraging these technologies across diverse SAVING TIME COMPARED TO innovative technologies, this team research and clinical settings TRADITIONAL METHODS. aims to enhance patient safety, within the department.

Critical Focuses: Drug Diversion Prevention

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Predicting Patient “Readiness for Surgery”

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Establishing a Comprehensive Critical Care Analytic Infrastructure

Optimizing Staffing Needs

SCHOOLOFMEDICINE

CELEBRATING EXCELLENCE Anesthesiology Faculty Earn Esteemed School of Medicine Awards

T

he Duke University School of Medicine (SoM) selected two Duke Anesthesiology faculty members as recipients of a 2024 SoM Faculty Award. Dr. Annemarie Thompson, vice chair for education and residency program director, received the Leonard Palumbo Jr., MD, Faculty Achievement Award in honor of her dedication to compassionate patient care and excellence in the teaching and mentoring of young physicians.

Dr. Madhav Swaminathan received the Master Clinician/Teacher Award, recognizing his superlative accomplishment in teaching and/ or clinical care and his extraordinary commitment “above and beyond” normal expectations.

Duke leadership, including Dean Mary Klotman and Vice Dean for Education Edward Buckley, presented the awards to the recipients at the annual Spring Faculty Celebration on May 13 at the Doris Duke Center.

“

I am deeply honored to receive the Palumbo award, and it is especially meaningful to be nominated by the Duke community of physicians whom I very much admire and respect. It is a choice and a privilege to work alongside them with the shared goals of patient care, education, and discovery.”

Dean Klotman, Dr. Thompson, and Chairman Joseph Mathew

- ANNEMARIE THOMPSON

“

It is with great reverence and gratitude that I accept this distinguished accolade. While the award recognizes one individual, it truly belongs to the department that fosters a learning environment that strives for excellence every day.”

Vice Dean Buckley, Dr. Swaminathan, and Dean Klotman

- MADHAV SWAMINATHAN

The World’s Influential Researchers

Revealed

Two of Duke Anesthesiology’s distinguished professors, Dr. Evan Kharasch (left), Merel H. Harmel Professor of Anesthesiology, and Dr. Ru-Rong Ji (right), William Maixner Professor of Anesthesiology, have once again made the prestigious list of the world’s most highly cited researchers, released by Clarivate in November of 2023. For these pioneers to make the cut, a paper must be ranked in the top one percent for its field for the last decade.

2023 LIST of Highly Cited Researchers

6,849

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From 1,300+ institutions in 67 countries and regions

United States ranks #1 in research influence; 37% of the honorees

individual scientists

Duke faculty on the list

2

Duke Anesthesiology faculty

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COVERSTORY

EMPOWERING

HEALTH BEYOND BOUNDAR COVERSTORY

By RATNA SWAMINATHAN

“Wherever the art of medicine is loved, there is also a love of humanity.”

– HIPPOCRATES

F

or three months every year, Adeyemi J. Olufolabi, MBBS, excitedly puts boots on the ground in Africa as part of Duke Anesthesiology’s Global Health Program (GHP) to serve those disadvantaged by geography.

The reasons he does so are compelling, personal, and rooted deeply in humanity.

“It’s humanity from the prospect of people who don’t have anything by virtue of where they were born,” Olufolabi says, adding, “we have a role to play in global health to make the world a better place.

For me, as an obstetric anesthesiologist, it’s caring for a very vulnerable group, the poor yet pregnant sick mother with or without a sick baby and finding the heart and the effort of helping her navigate a complex experience towards a healthy outcome.”

Fondly called Yemi by colleagues, Olufolabi plays a pivotal role in the department’s outreach efforts in Africa as he works hard to narrow the chasm in health care created by the stark inequity in the global distribution of resources. Duke Anesthesiology’s motto - What we do changes the world - inspires Olufolabi, program director of the Anesthesia Global Health Fellowship that aims to address health disparities in low-resource countries while creating career opportunities for anesthesia residents and fellows. “That human experience is

what I want others to experience because it is so enriching on a personal basis,” he emphasizes.

According to the Women’s Anesthesiology Division chief, Ashraf Habib, MBBCh, “The GHP is very important to the women’s division; it addresses maternal morbidity and mortality, something that members of the division are very passionate about. Our obstetric anesthesia fellowship program is known as being the only one to consistently offer its fellows the opportunity to spend time with Yemi in Ghana. The experience has been very rich and rewarding, allowing those participating in it to have a different perspective, more appreciation of what we have here in the US, and maybe viewing problems with a different lens.”

The hard facts about health care inequities tell a disturbing story. According to the World Health Organization (WHO), a woman dies of pregnancyrelated causes every two minutes. Even as the global maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births, has come down by 34% (from 339 deaths in 2000 to 223 in 2020), more than two-thirds of these occur in the African Region. In 2020, the MMR in the African Region was 531, a far cry from the WHO goal of reducing them to 70 by 2030. Seventy-five percent of all maternal deaths are due to major

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COVERSTORY

RIES “

My global health mission in Ghana ended up being one of the best experiences I have had in my medical training. One of my biggest clinical takeaways was that providing safe and effective anesthesia can be done with simple resources, and perhaps we sometimes overcomplicate things in our resource-rich environment.” – Dr. Liliane Ernst, Duke Anesthesiology ’24 Fellow

complications, including severe hemorrhage, infection, high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications during childbirth and unsafe abortion, according to WHO data.

The right care at the right time, however, can prevent many deaths. And that’s what Olufolabi sees as his life’s work. He began working in Ghana in 2005 as a volunteer under the banner of Kybele, a global nongovernmental organization founded in 2001 by Wake Forest School of Medicine obstetric anesthesiologist Medge D. Owen, MD. It comprises medical, nursing, and public health officials from the USA, Canada, and England, dedicated to improving the quality and safety of childbirth in low- and middle-income countries.

Duke has played a big role in Kybele, and every year, Olufolabi engages up to three volunteers, including colleagues, residents, and fellows to collaborate and improve maternal health by reducing labor pain and maternal mortality and stillbirths across many health systems in some African countries.

This is also a way to reconnect with a continent that made Olufolabi a doctor. Of Nigerian descent, Olufolabi was born in England but developed a wider world perspective when his father’s job in the Nigerian Diplomatic Service took him across several continents.

He went to school in Ghana, acquired his medical degree from the College of Medicine, University of Ibadan, in Nigeria and returned to England to train as an anesthesiologist. Involved from the very beginning of his career in humanitarian programs, Olufolabi joined Duke in 1999.

It is an overwhelming sense of gratitude and responsibility that propels Olufolabi to give back to 30

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the continent from which he received so much. Habib concurs, “I have seen him work tirelessly by keeping connected to his colleagues in Africa while he is back here in the US. I have also seen him hosting visitors from Africa in our institution to help them learn firsthand from our systems. To be able to travel to Africa for those extended periods of time, Yemi chose to work exclusively night shifts while he is at Duke.”

Coincidentally, this physician’s great desire to serve intersects with a greater need for trained doctors, equipment, and supplies in Africa’s resource-challenged countries. “We in America have so many resources, to the point that we waste them and throw them away.

Over there, they just need a little bit more. Very little of what we have already will make life so much better for them,” informs Olufolabi, adding, “how the lack of resources not only disrupts life for the individual, but also for the community.”

Personal experiences have had a powerful impact on him. The Fulbright scholarship in 2018 took him to Rwanda for a project involving interviewing men who lost their wives during childbirth. “Just sitting in their homes and listening to them talk about what they have been through changed the way I saw life. It was a very human experience that I want others to experience.”

Caring for patients in challenging environments that woefully lack basic health care is as sobering as it is enlightening. “Duke Anesthesiology is full of very bright people who are problem solvers. They can be very engaging to a group of people who can really benefit from the expertise that we have,” adds Olufolabi, always excited about carrying forward Duke’s cutting-edge program to distant lands and opening a

COVERSTORY

“

Yemi has an innate ability to quickly connect with people and earn their trust – usually with a wide smile on his face! By listening to their needs, asking insightful questions, and focusing on what can be done today, he is uniquely able to spring global health partners toward their shared vision."

new world of opportunities for those in the medical field. Not surprisingly, Duke anesthesiologists have been on the forefront of global health efforts in low resource countries like Guatemala, Haiti, Ghana, Uganda, Sierra Leone, Honduras, and South Africa, among others.

And behind Duke Anesthesiology’s global health efforts is its supportive leadership that is invested in the creation of leaders passionate about addressing health inequities.

“That’s where our global health program fits nicely with the idea that you cannot lead without experience, you cannot lead without listening, and you cannot lead without understanding,” says Annemarie Thompson, MD, residency director and vice chair for education.

She highlights how Duke Anesthesiology, through fundraising and departmental funds, offers a monthlong global health experience to residents as a bona

– Dr. Eric JohnBull, Duke Anesthesiology Faculty

fide elective rotation, approved by ACGME and the American Board of Anesthesiology.

For trainees, involvement in the GHP that serves low-resource regions is transformative. According to Thompson, “Duke is one of the very few residency programs that offers global health as an optional training. It started out with one or two people choosing this experience over 15 years ago to almost four to six in a senior class of 15 now.” Their feedback has been BLUEPRINT 2024 | 31

COVERSTORY

overwhelmingly positive, especially about how Olufolabi helps them navigate an uncomfortable space in a distant land and makes it into this amazing educational opportunity for residents, she adds.

“So far, 23 residents have gone on global health trips and over 20 faculty have been involved in one form or another. Few fellows have gone on several trips, including with surgical specialties like orthopedics, neurosurgery, and pediatrics,” informs Olufolabi proudly. “I have to highly applaud the efforts of Adam Flowe, chief nurse anesthetist, and Kent Smith, chief anesthesia technologist, who have brought teams and helped supply equipment to Ghana so many times,” adds Olufolabi.

He observes that Africa has a dearth of teachers, but an abundance of learners who thirst for information. At Duke, global health interactions are a two-way process. The program supports the sponsorship of medical personnel from Africa visiting Duke to observe workable organizational structures so that they can return home to implement quality improvement measures that work within their systems. Besides sharing of expertise, through observation in the ORs, meetings, and simulations, there is also sharing of medical equipment, informs Olufolabi. “This is the strength of Duke; we are good at training people.”

The goal, informs Olufolabi, is for people to stand independent so that local medical workers can take on local patient challenges. Statistics point to a great need. Sub-Saharan Africa has 25% of the global disease burden, but only 3% of the world’s health care workers.

That’s where innovation can help. Olufolabi highlights the success of a pilot program that leveraged WhatsApp, a mobile messaging platform, to expedite communication between hospital staff to facilitate high-risk obstetric referrals between far-flung health care facilities in the Greater Accra Region. “Global health, for me personally, is more about building capacity. You study a system and collaboratively identify holes that need to be improved. We are trying to increase the numbers who are trained,” emphasizes Olufolabi.

Another successful example of capacity building was the establishment of a nurse anesthesia training school in Accra, Ghana, in 2009. The humanitarian organization partnered with the Ghana Health Service (GHS) to set up an 18-month nurse anesthesia training program, a hands-on collaborative effort between local schools in Ghana and the visiting Kybele leaders from eminent US academic medical centers.

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“

Dr. Olufolabi has been our backbone since the School of Anaesthesia at Ridge Hospital was established in 2009, and he still plays a vital role in the running of the school today. His zeal for the work he does cannot be underestimated. A lot of mothers and babies are alive today because of his intervention.”

– Dr. Evans Atito-Narh, Director, School of Anaesthesia, Accra

“

EMPOWERING HEALTH BEYOND

To say my Duke global health rotation was pivotal in my journey would be an understatement; it served as my first experience outside of the United States and was integral in transforming my worldview. A true pioneer, Dr. Olufolabi taught me that when you are truly passionate about something, you do not take no for an answer, and you find innovative ways to meet the challenges facing those who are in need.”

– Dr. Savion Johnson, Duke Anesthesiology Alumnus

COVERSTORY

“

My time in Africa with Dr. Olufolabi during my anesthesia residency has had a profound impact on my life and changed my philosophy on helping others. Help in any way is obviously valuable, but helping others learn to help themselves is how progress is able to be sustained and built upon over time. I witnessed the power of personal connection and passion for improving a system that could then go on to improve the maternal health and well-being of an entire nation… he epitomizes what it takes to affect long lasting change.” – Dr. Kayla Bryan, Duke Anesthesiology Alumna

BOUNDARIES

Dr. Olufolabi holding baby Yemi, one of several children who have been given his name by grateful parents in Ghana and Rwanda; baby Yemi's mother was in extremis during labor and was administered an epidural.

“The school has now graduated over 800 nurse anesthetists, and countries such as Sierra Leone, Malawi, and Nigeria have sent nurses to be trained here, further increasing anesthesia provider capacity in African countries,” adds Olufolabi. He is currently involved in an effort to create a maternity center of excellence in four regional hospitals with a goal to reduce neonatal mortality and stillbirths in Ghana.

Olufolabi has also participated in the setting up of an obstetrics fellowship in Nigeria, under the aegis of the World Federation of Societies of Anesthesiologists, a global organization that helps augment the training capacity of anesthesia providers in low- and middle-income countries. The fellowship aims to increase their skillset to become leaders in anesthesia once they return to their countries. “So far, eight specialists from different countries have trained as obstetric anesthesia fellows,” he informs. Once the COVID threat subsided and travel restrictions lifted in late 2020, Olufolabi was one of the first people to travel to Rwanda to establish an epidural service and IV pain relief protocol for women in labor in the country’s biggest hospital in Kigali and train its residents to carry the program forward.

The global health work requires strategy to overcome barriers and patience to sustain longevity.

There are also challenges about safety of the staff, language issues, and geographic accessibility, informs Olufolabi. “You cannot put a pin on the map and say I am going to this country. You have to find a place and spend time long term.” Relationships must be established, and trust won. “You cannot just helicopter in and feel that you are going to change the system without knowing it. And to know their system takes time,” he adds.

Even though Olufolabi shies away from using clichés like ‘making an impact’ or ‘making a difference in people’s lives,’ that’s precisely what he is accomplishing. Building capacity through collaboration gives this dedicated anesthesiologist a sense of purpose. The real heroes in this story, however, adds Olufolabi, are the people on the ground determined to play the hand they are dealt and turn potentially bad outcomes into good.

When helping humankind, Olufolabi epitomizes both – human and kind. His compassionate efforts were recognized in 2021 by Duke University School of Medicine with the prestigious Leonard Tow Humanism Award. A man supported by his family and guided by his faith, Olufolabi’s desire to help humanity comes from his heart and feeds his soul. BP BLUEPRINT 2024 | 33

FEATURE

PERSISTING TO HELP CHILDREN IN

PAIN

Witnessing a childhood friend in severe pain from sickle cell disease left a lasting

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impression on Dr. Martha Kenney and set her on a path to helping others.

BY LINDSAY KEY

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FEATURE

S

eeing a child in severe pain is an unforgettable experience at any age, but for Martha Kenney, MD, an assistant professor of anesthesiology and pediatrics at Duke, it came early. Her childhood playmate in Ghana had sickle cell disease, an inherited blood disorder in which abnormal hemoglobin causes red blood cells to become sticky and C-shaped. When these cells move through small blood vessels, they can get stuck and clog blood flow, causing debilitating pain and other complications like infection, stroke, and eye problems.

Limited health care access in Ghana made it difficult for Kenney’s friend to receive treatment; watching her friend suffer from pain left her feeling powerless and helpless, which sparked Kenney’s interest in medicine.

When her family moved to the United States when she was seven, she already knew that she would become a doctor who could help others like her friend. But what she didn’t know yet were the twists and turns that her career would take as she zeroed in on exactly how to help.

FINDING HER NICHE Kenney’s family settled in northern Virginia, and she majored in biochemistry at Brown University before entering medical school at Johns Hopkins University.

Early on, Kenney planned to train in hematology oncology to become a pediatric hematologist caring for sickle cell patients. But an experience in the National Institutes of Health’s Clinical Research Training Program between her third and fourth year of medical school changed her perspective.

“I encountered a really young patient who had metastatic leukemia that had pretty much spread everywhere,” recalls Kenney. His parents came to the

United States from abroad, selling their possessions to try treatment after treatment before landing at the clinical center where Kenney worked to see if he could benefit from her mentor’s immunotherapy trials. Unfortunately, he was too sick and did not qualify.

“That brought back a lot of early memories from childhood because this child was in excruciating pain, and there wasn’t a lot that could be done for his pain,” says Kenney. “It got me thinking about how to best take care of children in those circumstances and provide relief for their pain.”

The field of anesthesiology appealed to her as a way to help children manage pain from sickle cell disease and other types of painful diseases as pediatric anesthesiologists are not only trained to provide specialized care in the operating room, but to manage pain after surgery.

After talking with her sickle cell research mentor, Dr. John “JJ” Strouse, who encouraged her to go for it, Kenney completed a combined residency in pediatrics and anesthesiology followed by a one-year fellowship in pediatric anesthesiology at Johns Hopkins University.

Looking back, it was the best career change she could have made.

“When I decided to go into anesthesia, I felt a little unsettled at first because I had gone into medicine to make an impact on people who have sickle cell disease, and I wanted to remain true to this calling,” she says. “But JJ reassured me that going into anesthesia would present an opportunity for me to really develop a unique niche by focusing on research within sickle cell pain and that I could make a great impact in a different way.”

PERSISTENCE PAYS OFF At the end of her fellowship training, Kenney landed a role as an assistant professor of anesthesiology and

INNOVATIVE INSIGHTS Since the FDA approval of gene therapy (a “cure”) for sickle cell disease (SCD), Dr. Kenney is often asked, “What are you going do in your research now?” She believes the future for SCD is filled with hope but should be approached with cautious optimism.

Sickle cell disease is BOTH an inherited blood disorder and an acquired chronic pain disorder. It is possible for the blood disorder to be “cured” with gene therapy or bone marrow transplant and still have a significant number of individuals with chronic or persistent pain.

Dr. Kenney’s findings from large cross-sectional analyses of SCD: • The burden of chronic pain is significant • Adolescence and young adulthood are the greatest periods of vulnerability for high pain severity and pain impact • Chronic pain appears to have a disproportionate impact on pain impact and pain-related disability compared to biological markers of disease severity 36

| DUKE ANESTHESIOLOGY

• To fully cure SCD, we need to work to prevent chronic pain, first understanding why it occurs • The burden of disease doesn’t correlate with where there are resources to address the disease; there is limited understanding of chronic SCD pain in sub-Saharan Africa, the region where the majority of the disease is concentrated

• Curing SCD must be paired with addressing long-standing interpersonal and systemic racism, bias and stigma that has hindered access to care and led to poor outcomes

FEATURE

find scientists working in sickle cell disease and pain, and I would just email them, tell them who I was, and that I was really passionate about sickle cell disease.”

Some never responded, but some did. Their encouragement led her to apply for and receive funding from the UNC Children’s Hospital and Dean’s Office to buy out some time in her daily schedule for research.

Ultimately, she found a role at Duke Anesthesiology that allows her to spend 70 percent of her time on research and the rest caring for children in the operating room.

“My path was nontraditional,” Kenney says. “Most physician-scientists have a PhD in addition to the MD, or if not, they have some other type of formal research training. I didn’t have any of those things, and I think most people in my situation end up getting lost, but the thing I did have that I depended on the most was my drive and my sense of purpose.”

UNDERSTANDING PAIN PROGRESSION

“Never let anyone decide for you — what dreams to have, or what your worth should be. Only you truly understand your journey.

So, stand by your dream and protect it fiercely.” -DR. MATHA KENNEY Dr. Kenney and a research assistant demonstrating the use of an algometer to determine pain thresholds for pressure application in soft tissue, muscles and joints.

pediatrics at the University of North Carolina. There, she gained ample clinical experience and benefited from the mentorship of Dr. Jane Little, professor of medicine and director of the UNC Comprehensive Sickle Cell Disease program.

Kenney felt called to not only care for children with sickle cell disease, but to make strides in improving health care access and treatment options. She knew this would require research, and her busy day job in the operating room didn’t allow any time for such pursuits.

There are also very few anesthesiologists doing research in the sickle cell disease pain space.

But, as the old adage goes, “if there is a will, there is a way.” In the mornings before work, Kenney scoured the latest sickle cell disease research papers, familiarizing herself with recent discoveries and applying to small grants that could jumpstart her research career. She even cold-emailed potential mentors.

“I had no mentors in the research space at that time.

I was a clinician who worked in the operating room,” says Kenney. “So, I started going on NIH Reporter to

Since Kenney joined Duke in 2022, her research career has taken off, thanks in part to the invaluable guidance from two key mentors, Drs. Nirmish Shah and Francis Keefe, who have helped shape her trajectory and amplify her success. She received a five-year career development award from the National Institutes of Health – known as a “K” award – that provides support and mentorship for her research endeavors. Currently, Kenney is working to better understand sickle cell pain in adolescents and young adults.

She is tracking a cohort of people living with sickle cell disease between the ages of 15-40 for four years to better understand biological and psychosocial predictors for the development of severe and persistent pain in adulthood. For people living with sickle cell disease, acute pain can come on suddenly at any time and last for any length of time. Although it can happen in any area of the body, it commonly occurs in the hands, chest, feet, and back. Meanwhile, chronic pain is daily, ongoing pain that lasts for more than six months. The prevalence of chronic pain in kids is around 30 percent, but in adults, it is around 50-60 percent, notes Kenney.

“The risk of someone transitioning from acute to chronic pain significantly increases when they reach the adolescent period,” she says. “People in their midtwenties and early thirties make up the bulk of patients being treated for pain in the health care system. The young adult period is a period of great vulnerability and that’s why I’m especially interested in studying it.”

Patients who transition from having episodes of acute pain to long-term chronic pain present a challenge to physicians trying to help them. Although opioids are effective in treating some episodes of acute pain, they are ineffective and potentially harmful for chronic pain, says Kenney. What’s more, the number one factor in a BLUEPRINT 2024

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TOPHEADER

GUIDING PRINCIPLES

to Building an Interdisciplinary Research Program: Anesthesiologists interact with nearly every medical specialty and provide care in all corners of the hospital. Colleagues in the perioperative environment trust and look to anesthesiologists for their broad knowledge and expertise. Dr. Kenney believes that if anesthesiologists want to have a greater impact on public health, they must think broadly and see themselves as the true interdisciplinary leaders that they are.

Find and define the purpose of your research program Science is both a discipline of reason and passion, so it’s important to be clear on what inspires you personally about your research endeavors.

Allow your research to go where there is a need that you are uniquely positioned to address Ask yourself…Who are the people that I want to serve in my research?

And why? What are their challenges and why do their problems matter to me? What solutions would be most valuable to them?

Why do I feel connected to them? “Answering these questions is what took my research into the sickle cell clinic, a place that you would rarely see an anesthesiologist, but it’s where I saw the greatest opportunity to make that kind of impact I seek in my career and life.”

One mentor will not check all the boxes One mentor is not enough because no one is an expert on everything, and you will have a different relationship with each mentor. What you need is a board of mentors and sponsors.

Deciding what not to do is equally as important as deciding what to do The demands of academia can be overwhelming and even conflicting, but not every opportunity that comes along is the right one, or even comes at the right moment. So, it is important to learn the art of strategic refusal – a skill that helps you safeguard your time, energy and focus for what truly matters and aligns with the purpose of your research and career.

Build authentic and meaningful relationships with mentors and collaborators This requires investment of your time and energy.

You can’t rely on casual networking to seek the kind of mentors and collaborators that you need.

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FEATURE

patient’s development of chronic pain is having acute pain that was treated poorly, leading to changes within the patient’s central nervous system.

“The chronic pain that they have is really hard to assess and hard to manage as well,” says Kenney. “In fact, emerging research shows that chronic pain can persist in the absence of sickle cell disease, after a patient has been cured of the disease by bone marrow transplantation or gene therapy.”

Kenney aims to secure funding to study an even larger population during this critical time of their lives. The research will help physicians develop personalized treatment plans to prevent the development of disabling, severe pain, she adds.

AN EYE TO THE FUTURE As her research career continues to grow, Kenney aspires to explore many other questions related to sickle cell disease pain, and from all angles. From a biological perspective, she plans to use functional magnetic resonance imaging capabilities at Duke to explain how structural changes in the brain play a role in disease-related pain.

From an environmental perspective, Kenney and collaborators aim to look at the environmental influences of pain.

Using geospatial data, they will evaluate if and how the place where someone living with sickle cell disease is located affects pain outcomes, in terms of access to sickle cell clinics as well as everyday exposures to pollutants.

From a social science perspective, she strives to better understand what drives a patient’s decision to participate in sickle cell clinical research and what can be done to make sure marginalized communities are better represented. She recently applied for funding from the Patient-Centered Outcomes Research Institute with an advocacy partner, Sickle Cell 101, to further explore this topic.

“It’s hard to talk about sickle cell disease without talking about racism, stigma, and discrimination,” says Kenney. “This is a disease that affects marginalized black and brown people. And for quite a while, it seemed nobody cared. Historically,

there have not been a lot of federal funds dedicated to research in sickle cell disease, but thankfully, over the last few years, this has started to change, and I want to see it continue to change.”

PAYING IT FORWARD Kenney’s ultimate goal is to bring her work full circle back to Ghana through global health research collaborations. “My dream is to figure out how to take the things that I've learned here and see if they even apply in sub-Saharan Africa because it’s a different environment there and pain is treated very differently there,” she says.

Duke’s commitment to creating an environment that supports early career researchers has made all of the difference for Kenney. “When I mentor or coach people now, I always tell them that when you’re thinking about the next step—whether it be a new job or training location—consider whether the environment is going to nurture and grow your potential. You can have incredible talent but not really grow to your full potential because you’re just in the wrong environment. I’m blessed to be here at Duke.”

Hanging in Kenney’s home office is a sign that says “I can do anything, But I can’t do everything”—an idea that she often emphasizes as a career coach. If a new professional project doesn’t contribute to her ultimate goal of improving the lives of people from marginalized communities who are living with pain disorders, then it’s easy to say no.

“I’ve learned to draw boundaries and to be very clear about what’s important to me,” says Kenney, who is a devout Christian, wife, and mother to a seven-year-old daughter and four-year-old son.

“Really, I just want to make my kids proud. I want them to see me living out my values and the values that are important to our family.

As a Christian, I don’t believe I’ve been given these opportunities by pure luck. I believe that God has a certain expectation and a call, and it’s really for me to serve other people who are suffering.” BP

CULTIVATE a Meaningful and Fulfilling Career

The late Maya Angelou is credited with saying “success is liking who you are, what you do, and how you do it.” For Dr. Kenney, this quote highlights that career success and fulfilment is incredibly personal. She says for some, success is about recognition; for others, it is about contributing quietly in the background. Both perspectives are equally right since success and fulfilment have deeply personal meaning.

1.

2.

3.

Be clear on who you are; continually seek greater awareness about your passions, strengths, weaknesses, etc.

Understand what truly matters to you, aka your values, and why Be clear on what being authentic to what truly matters to you in your life and work looks and feels like for you

DOUBLE IMPACT: Anesthesiologist + Life & Career Coach Empowering busy women to build careers they love FOLLOW DR. KENNEY @: drmarthakenney.com @“Time Matters” @timematters.today @Dr. Martha Kenney

BLUEPRINT 2024 | 39

By encouraging the entrepreneurial spirit, unfettered imagination, and unchecked ambition, the DREAM Campaign inspires Duke Anesthesiology faculty and provides them with the wherewithal to achieve the impossible. Together with our supporters, we are transforming the future of patient care.

Help us continue to train the leaders of tomorrow, develop the careers of our faculty, and protect quality of life for years to come.

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Thank you to our 2023 donors DREAM CAMPAIGN | WILLIAM MAIXNER PROFESSORSHIP | PAUL G. BARASH PROFESSORSHIP | DAVID S. WARNER PROFESSORSHIP

Aaron Ali

John McManigle, Jr.

Timothy Angelotti

Richard Moon

Bruce Burnett

Eugene Moretti

Enrico Camporesi

Mark Newman

James Caruso

Stephen Packer

James Doughton

Helen Pavilonis

Lisa Einhorn

Gary Pellom

Susanne Evans

Ann Pflugrath

James Feix

Vincent Phillip

Brenda Gerhardt

Keith Phillippi

Katherine Grichnik

Jamie Privratsky

Dhanesh Gupta

Jennifer Sposito

Lawrence Haynes

Thomas Stanley, III

Michael "Luke" James

Timothy Stanley

Douglas King

Stanley Research Foundation

Michael Lasecki

Kevin Vorenkamp

Andrew Lutz

Rose Warner

Family of William Maixner

Richard Watson

Joseph Mathew

Richard Wolman

David McDonagh

16 years of giving DREAMCAMPAIGN.DUHS.DUKE.EDU

BLUEPRINT 2024 | 41

DREAMCAMPAIGN

The

Duke DREAM Campaign was established to support

Duke Anesthesiology’s research programs and initiatives. As implied by our motto, we empower great minds to turn dreams into reality.

The DREAM Innovation Grant (DIG) supports innovative high-risk investigations with potential for high-reward to accelerate anesthesiology, perioperative, critical care, and pain management research.

Read more about the campaign and make a gift! Visit: dreamcampaign.duhs.duke.edu

DREAM CAMPAIGN UPDATE

16 Years of the DREAM Campaign

>

in DREAM Innovation Grants have led to more than . . .

DREAM CAMPAIGN GOALS 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.

Establish Philanthropic Support as

a long-term mechanism of limiting the adverse consequences of cyclical federal funding.

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17M

$1,061,109 $ >

in extramural funding received to-date

DREAM INNOVATION GRANT

Bridging the gap

DIG IMPACT:

“The Dream Innovation Grant (DIG) has been extremely helpful in allowing my research laboratory to collect novel spinal cord imaging pilot data. With these funds and through collaboration with the Duke Brian Imaging and Analysis Center, we have used diffusion weighted imaging (DWI) sequences to collect, for the first time, data spanning from the brain to the cervical spinal cord. To our knowledge, we are the first using this combined brain-to-spinal cord DWI technology in the world. Enabled by our DIG-funded pilot data, we are establishing a novel line of research to understand how axon tracts connecting between the brain and cervical spinal cord are altered in chronic pain, with further potential of this application to understand myriadrelated conditions.”

- DR. KATHERINE MARTUCCI, 2020 DIG RECIPIENT

DREAM INNOVATION GRANTS ARE FUNDED THROUGH A COMBINATION OF: Alumni Faculty Private Companies Private Donors

2023 TOP DONOR: Stanley Research Foundation:

$15K

DIG IMPACT:

“The support provided by the DREAM Innovation Grant (DIG) gave me the flexibility to try innovative and new research avenues that continue to drive my research to this day. As a junior investigator, these funds were crucial to establishing my research group, which helped me to obtain R01 funding. I will be forever grateful for the DIG!”

between research training and progression to independent investigator status.

What is “DIG?” The concept behind the DREAM Innovation Grant (DIG) – first launched in 2010 – is simple, yet brilliant.

An annual competition is held among early to midcareer faculty members within Duke Anesthesiology, who do not have established NIH funding (past or present). Competitors submit their most innovative research ideas to a panel of judges for review. Proposals that demonstrate the perfect blend of ingenuity and practicality are selected, and winners are announced at the department’s annual alumni reception.

$

DIG recipients can receive up to $40,000 in seed money for their innovative pilot studies, which ultimately help 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.

DIG funds are reserved to support an early career scientist (within five years of completion of a residency, fellowship or PhD) and/or used as a seed grant to help mid-career investigators obtain preliminary data to support a new application to the National Institutes of Health or other federal agency.

- DR. JAMIE PRIVRATSKY, 2018 DIG RECIPIENT

BLUEPRINT 2024 | 43

DREAM INNOVATION GRANT

Dr. Tetsu Ohnuma BACKGROUND

MD: Gunma University PhD: Tokyo Medical and Dental University MPH: University of North Carolina, Chapel Hill Internal Medicine Residency: Jichi Medical University Critical Care Medicine Fellowship: Jichi Medical University

PILOT STUDY “Antimicrobial De-escalation and Outcomes in Sepsis”

D

r. Tetsu Ohnuma is an intensivist,

epidemiologist and health services researcher who conducts pragmatic population health research within the Critical Care and Perioperative Population Health Research (CAPER) Program and currently serves as CAPER’s methods core director.

Recently, Ohnuma has focused on the optimization of antibiotic strategies in sepsis, which is a leading cause of mortality among critically ill patients; appropriate empiric antimicrobial therapy is the cornerstone of sepsis management. Ohnuma and his group conducted an investigation studying patients with bacteremia in the United States and found that the use of appropriate empirical antimicrobials was associated with lower in-hospital mortality. In addition to the initial choice of empiric antimicrobials, clinicians should review their appropriateness on an ongoing basis to de-escalate the antibiotic spectrum or potentially discontinue therapy, if infection is unlikely based on diagnostic testing. Although guidelines recommend antimicrobial de-escalation for patients with culture-negative sepsis, de-escalation is applied in only 40–50% of the cases. The low uptake of antimicrobial de-escalation may reflect the reluctance to change antimicrobials in critically ill patients due to a lack of conclusive findings regarding the safety and efficacy of this approach. Therefore, well-designed studies are needed to examine the outcomes associated with de-escalation of antimicrobial therapy in sepsis.

With the DREAM Innovation Grant, Ohnuma

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and investigators will launch a new study to identify factors associated with antimicrobial de-escalation in patients with culture negative sepsis and determine whether de-escalation strategies are associated with improved outcomes. The team proposes to investigate the patterns of de-escalation, escalation, or no change in antimicrobial regimens, measured within five days after the initiation of at least one antimicrobial for sepsis, using data from Duke’s electronic health records. Antimicrobial classes will be classified into three distinct and mutually exclusive categories: narrow-spectrum, broad-spectrum and extendedspectrum. The primary aim of the study is to estimate the association between antimicrobial de-escalation and 30-day cumulative mortality in patients with culture positive and negative sepsis.

This proposal builds on strong and productive collaborations of investigators who have made important contributions to the literature on sepsis and epidemiology research using advanced methodology, including Drs. Miriam Treggiari and Vijay Krishnamoorthy. This contribution is significant because such a strategy could be implemented in the clinical workflow to promote wider implementation and safer de-escalation or discontinuation practices.

At the conclusion of this project, the team will have the necessary data to support future pragmatic randomized controlled trials to examine the efficacy and safety of antimicrobial de-escalation in patients with culture-negative sepsis.

2023 RECIPIENTS

With the DREAM Innovation Grant, Dr. Tetsu Ohnuma and investigators will launch a new study to identify factors associated with antimicrobial de-escalation in patients with culture negative sepsis and determine whether de-escalation strategies are associated with improved outcomes.

BLUEPRINT 2024 | 45

3

INNOVATIVE

RESEARCH Providing state-of-the-art methodology for clinical, basic science and translational research empowers Duke Anesthesiology to explore revolutionary clinical inquiries by using innovative investigation methods.

Through significant research in neuroscience, molecular biology, molecular and human pharmacology endeavors, our team is making crucial advancements for patients worldwide.

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DREAM INNOVATION GRANT RECIPIENTS

Andrea Nackley, PhD

RESEARCH: Novel Adrb3 Antagonists for the Treatment of Chronic Pain

Mara Serbanescu, MD

RESEARCH: Exploring Microbiota-Immune Interactions in Surgery and Critical Illness

Shad Smith, PhD

RESEARCH: Advancing Pain Omics

BLUEPRINT 2024

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INNOVATIVERESEARCH

Novel Adrb3 Antagonists for the Treatment of Chronic Pain

C

ANDREA NACKLEY, PHD hronic primary pain conditions (CPPCs), including fibromyalgia, headache, low back pain, and irritable bowel syndrome, affect one in every three Americans, predominantly females.

CPPCs are characterized by pain lasting three months or longer in the absence of obvious injury or infection and they tend to co-occur. This co-occurring pain creates serious problems for patients, adding to the suffering and disability caused by a single pain condition. Health care providers who manage one type of chronic pain often are at a loss to manage pain occurring elsewhere in the body. All

too often, patients are referred from one specialist to another at great expense and little relief. Conventional medications such as opioids and antidepressants have poor efficacy for managing chronic pain and possess serious central side-effects, such as altered mental state, addiction and life-threatening respiratory depression.

Dr. Andrea Nackley is committed to improving pain management strategies for patients with CPPCs and, together with her team of investigators, she has identified a novel target for analgesic development.

In clinical studies, they determined that patients with CPPCs have increased levels of catecholamines alongside

FIGURE 1: Schematic overview of proposed shared mechanisms of CPPCs in mouse and human. Interactions between low COMT activity genotype and environmental stress lead to increased levels of catecholamines, which then bind to Adrb3 to stimulate the production of pro-inflammatory cytokines that sensitize nociceptors, activate spinal cord microglia and astrocytes, and ultimately lead to multi-site body pain and comorbid depression and anxiety.

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reduced levels of the enzyme catecholO-methyltransferase (COMT) that metabolizes catecholamines. Consistent with clinical findings, the Nackley lab has shown that pharmacologic inhibition or genetic knockdown of COMT in rodents produces pain at multiple body sites. Catecholamines are produced by numerous cell types in peripheral, spinal and central tissues where they may bind different types of adrenergic or dopaminergic receptors to produce pain. After an extensive pharmacologic campaign, together with site-of-action studies, Nackley and her team have determined that catecholamine activation of adrenergic receptor beta-3 (Adrb3) in peripheral tissues is a key driver of primary pain.

Adrb3 is predominantly expressed on adipocytes in adipose tissue, where it regulates energy storage and temperature.

New data in the Nackley lab suggest that adipocyte Adrb3 also plays a critical role in pain by promoting the synthesis and release of catecholamines, inflammatory mediators and microRNAs that regulate expression of pain-relevant genes. Adrb3 and its downstream effectors promote both nociception, characterized by increased activity of pain-sensing neurons, and neuroinflammation, characterized by increased activity of microglia and astrocytes in regions of the spinal cord and brain that transmit and modulate pain. To directly test the role of adipocyte Adrb3 in pain, Nackley and her team generated mice with conditional Adrb3 knockout only in adipocytes. Remarkably, adipocyte Adrb3 knockout mice do not develop multisite body pain, inflammation or neuroinflammation. Thus, Adrb3 is an exciting new target for development of peripherally-restricted therapies with the potential to overcome the limitations of specificity and central side-effects

INNOVATIVERESEARCH

Adrb3 Drug Discovery Timeline:

2018

2019

2022

2023-25

R03 to generate adipocyte Adrb3 knockout mouse and viral vector tools

R01 to perform Adrb3 target validation

R61/R33 to generate novel CPPC mouse model for testing mechanisms and screening drugs

R61 & Eshelman Award to develop and test new Adrb3 antagonist

7 $6.5M 5 YEARS OF STUDY

associated with current treatments.

To translate these research findings into improved analgesic strategies for patients with CPPCs, Nackley recently made two significant advances. First, through an NIH HEAL (Helping to End Addiction Long-term®) Initiative R61 award, she assembled a multidisciplinary team of experts in drug discovery and development to synthesize new Adrb3 antagonists. Inhibition as a therapeutic indication of Adrb3, especially in the context of pain, represents a significant innovation as no Adrb3 antagonists are currently approved for clinical use. The objective of this project is to synthesize, screen and test new potent, selective and peripherally-restricted Adrb3 antagonists.

Second, through an NIH IGNITE (Innovation Grants to Nurture Initial Translational Efforts) R61/R33 award, the Nackley lab developed a novel mouse model of CPPCs that integrates clinicallyrelevant factors that can be used for testing Adrb3 antagonists as well as other pharmacologic and non-pharmacologic analgesics. Current animal models of CPPCs typically induce pain using

chemical irritants and infectious agents that are not implicated in the biological basis of disease. Further, current models typically focus on site-specific pain. Their new model integrates clinically-relevant genetic (COMT knockdown) and environmental (stress) factors to generate multi-site body pain and depressive-like behavior lasting more than three months.

In line with the female predominance of CPPCs clinically, the pain and depressive-like behavior in the CPPC mouse model was of greater magnitude and longer duration (>12 months) in females compared to males. Further, they demonstrated the predictive validity of the model as pain was effectively alleviated by an Adrb3 antagonist, but not by drugs that previously failed clinical trials for neuropathic or inflammatory pain.

Successful completion of this ongoing research will advance new peripherallyrestricted analgesics into human trials with the potential to reduce the use of opioids in clinical practice and positively impact the quality of life for the 100 million patients across the nation alone who suffer from chronic primary pain. BP

PUBLICATION REFERENCES: Zhang X, Kanter K, Chen J, Kim S, Wang Y, Adeyemi C, O’Buckley SC, and Nackley AG. Low catechol-O-methyltransferase and stress potentiate functional pain and depressive behavior, especially in female mice. Pain 2020 Feb 161(2):446-458.

Wang Y, Kim SH, Klein ME, Chen J, Gu E, Smith SB, Bortsov A, Slade GD, Zhang X, and Nackley AG. A novel mouse model of chronic primary pain conditions that integrates clinically relevant genetic and environmental factors. Science Translational Medicine.

2024 Apr 10;16(742).

IN FUNDING

TOTAL GRANTS

01/15/2018 - 12/31/2020 NIH/NINDS R03 “Defining the Role of Adipocyte Adrb3 in Chronic Pain” Total Award: $160,000 09/15/2019 - 06/30/2024 NIH/NINDS R01 “Defining the Role of Peripheral Adrb3 in Chronic Pain and Inflammation” Total Award: $2,623,436 04/01/2022 - 03/31/2025 NIH/NINDS R61/R33 “A Novel Clinically-Relevant Mouse Model of Chronic Overlapping Pain Conditions for Screening Analgesics” Total Award: $1,150,797 04/01/2023 - 3/31/2025 Eshelman Institute for Innovation Grant “Peripherally-Targeted Adrb3 Antagonists for the Treatment of Pain” Total Award: $765,444 09/08/2023 - 08/31/2025 NIH/NINDS R61 “Development of Adrb3 Antagonists for the Treatment of Pain” Total Award: $1,846,202 BLUEPRINT 2024 | 49

INNOVATIVERESEARCH

Exploring Microbiota-Immune Interactions in Surgery and Critical Illness MARA SERBANESCU, MD

T

he community of microbes residing in the gastroOne of the lab’s primary focuses is investigating intestinal tract (i.e., the gut microbiota) plays a how gut microbial composition influences microbial crucial role in various processes essential to recovtranslocation, or the microbes and microbial components ery after surgery and critical illness. Through direct signalthat enter the blood in settings of heightened intestinal ing and indirect effects mediated by secreted molecules, the permeability induced by trauma, surgery and sepsis. microbiota communicate with local and systemic host imMicrobial translocation has long been suspected mune cells. The types of microbes present (composition) to contribute to inflammatory responses in these can thus influence immune cell activation, release of inconditions, though seminal studies relied on growth flammatory cytokines, neuronal machinery, and metabolic in culture for microbial identification and shaped responses. Following surgery or during critical illness, pathe current understanding that microbe-associated tients demonstrate a profound loss of benmolecular patterns (MAMPs) are eficial commensals and a relative increase stochastically released from the gut and in opportunistic or pathogenic species. indiscriminately promote systemic In animal models, these changes can inflammation. However, recent lead to complications, such as inculture-independent sequencing flammation-induced organ dystechnologies like 16S ribosomal function, infection and sepsis.

RNA (rRNA) profiling However, if, and how, certain have since revolutionized gut microbial signatures inthe ability to identify fluence immune responses microbial components. in critically ill and post Emerging data using surgical patients is poorly these techniques suggests understood. that microbial components Dr. Mara Serbanescu, dican be protective or harmful, rector of the Duke Anesthesiolinfluencing discrete immune cell ogy Microbiome Profiling (Duke activation pathways and functions.

AMP) Laboratory, is dedicated to Using 16S rRNA profiling in a unraveling the complex host-microbiperioperative mouse model of severe ome relationships contributing to cominflammation, Serbanescu previously plications in critically FIGURE 1: executed a proof-of-concept study to ONE OF THE LAB’S ill and postoperative This study is poised to be the examine whether the composition of the PRIMARY FOCUSES patients. Leveraging first in trauma to use culturegut microbiota influences microbial DNA systems-level approachindependent sequencing signatures in the blood, as well as immune is investigating techniques to investigate gut es integrating microbiresponses. She found that following an how gut microbial and blood microbial DNA al genome community inflammatory insult, both the extent of composition signatures. profiling, immune funcmicrobial translocation and the types of influences microbial tion markers, metaboloblood microbial signatures were directly translocation, or mics, and clinical data, as well as ex-vishaped by patterns in the gut microbiota present before the the microbes and vo techniques, Serbanescu’s lab aims insult and associated with specific changes in the immune to identify how dynamic changes in cell landscape. Serbanescu is now aiming to translate her microbial components microbiota-immune crosstalk modify preclinical insights to clinical practice. Building upon that enter the blood in clinical trajectory and outcomes. Her her previous work, she aims to identify whether gut and settings of heightened long-term goal is to uncover modifiblood microbial patterns in postoperative and critically ill intestinal permeability able features of the microbiome that patients underlie inflammation-induced organ dysfunction induced by trauma, can be targeted to improve outcomes and development of secondary infections – the leading after surgery and critical illness. causes of morbidity and mortality in these populations. To surgery and sepsis.

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INNOVATIVERESEARCH

FIGURE 2: Schematic overview of hypothesized mechanisms under investigation by Dr. Serbanescu’s Duke AMP Laboratory. Some degree of dysbiosis is known to occur in the perioperative period; however, if, and how, changes in the types and amounts of certain gut microbes after surgery or during critical illness can regulate immune responses and clinical outcomes is still unknown. Based on findings from her animal studies, Serbanescu hypothesizes that patients with less dysbiosis (i.e., less loss of certain beneficial microbes as well as less enrichment of opportunistic species, left), will have reduced entry of microbial DNA products into the circulation.

Moreover, the products that do enter are hypothesized to have a reduced ability to trigger pro-inflammatory cascades on circulating immune cells, resulting in less systemic inflammation and less susceptibility to infections by other pathogens.

In contrast, severe dysbiosis accompanied by expansion of opportunistic gammaproteobacteria (right) may lead to enhanced translocation of microbial DNA from these opportunists. These products, in turn, are suspected to promote proinflammatory signaling and lead to downstream consequences on host immune defenses, increasing susceptibility to infection by these pathogens and others that may be encountered in the postoperative period.

support her novel area of exploration, she has been awarded a two-year Mentored Research Award for her project titled, “Role of Nutrition on Gut Microbes and Translocation After Trauma Laparotomy” by the International Anesthesiology Research Society (IARS), as well as the Duke Physician Strong Start Award.

To accomplish her research agenda, Serbanescu has assembled a multidisciplinary team of collaborators, including her mentor, Dr. Paul Wischmeyer, a professor of anesthesiology and surgery renowned for his expertise in perioperative nutrition, and biostatistician Mary Cooter Wright, who has extensive expertise in computational modeling, as well as collaborators from the Duke Microbiome Center, including Dr. Jason Arnold. In her IARS-funded study, Serbanescu is additionally partnering with Duke Surgery’s Dr. Krista Haines and her team, leveraging the SeND Home Trial — a Department of Defense funded randomized controlled trial led by Haines and Wischmeyer.

SeND Home (Figure 1) aims to evaluate the effect of an early personalized structured nutrition program that

includes early parenteral nutrition on functional outcomes in critically ill patients admitted after severe abdominal trauma. Serbanescu and her team hypothesize that early structured nutrition may also mitigate certain derangements in gut microbial composition and intestinal permeability, thus reducing microbial translocation and inflammation in the days following emergent surgery. To delineate these complex host-microbe relationships, the researchers will use integrated analyses of gut and blood microbial profiles and inflammatory biomarkers from patient samples collected during ICU stay. This study is poised to be the first in trauma to use culture-independent sequencing techniques to investigate gut and blood microbial DNA signatures and will additionally reveal the impact of readily available nutritional interventions on microbial translocation. Findings from this work and her other planned experiments have the potential to revolutionize our understanding of microbiota-immune interactions in surgical and critical care settings and vitally contribute to the development of novel therapies to improve patient care and outcomes. BP BLUEPRINT 2024

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INNOVATIVERESEARCH

Advancing Pain Omics SHAD SMITH, PHD

P

ainful temporomandibular disorders (TMD) are a common set of multifactorial health conditions associated with the temporomandibular joint and surrounding tissues. Estimates suggest that 5% of adults in the United States suffer from TMD pain, making it the leading cause of chronic orofacial pain. There are at present few available mechanism-based tests, and no objective biomarkers, to assist diagnosing or treating TMD. Patients and physicians have therefore struggled with challenges of diagnosis and proper care, as visible signs of trauma or deterioration of the joint are not always present or do not necessarily correspond with the severity of the disorder.

Based on evidence from a 15-year prospective study of TMD, known as the OPPERA study, Dr. Shad Smith’s research

TMD can be categorized as arthralgia (affecting the joint) or as myalgia (affecting the muscles of mastication). Contraction of the masseter muscle, shown in green, raises the mandible closing the mouth during chewing or speaking. It is innervated by the masseteric nerve, a branch of the trigeminal nerve. Other muscles that may be painful or tender in TMD include the temporalis muscle and the medial and lateral pterygoid muscles, also shown.

approaches TMD as one of a family of “chronic overlapping pain conditions” (COPCs), which arise from a variety of

FIRST STUDY TO... ... look at masseter muscle in TMD patients ... examine painful masseter muscle tissue using single-cell techniques to discover pathological mechanisms in critical cell populations and characterize their transcriptomic profiles ... conduct simultaneous assessment of multiple tissue types to discover biomarkers correlated with localized pathology in clinically available blood within the same patient ... use these techniques within the context of understanding the origins of TMD pain 52

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peripheral and central mechanisms that sensitize nociceptors. He has previously identified innate factors that underlie these conditions using large genome screens to identify genes and pathways associated with COPCs. The OPPERA study was also used to identify patterns in predictive characteristics, such as psychological distress and mechanical pain hypersensitivity, that are useful in clustering COPC patients into groups with similar long-term outcomes. Smith believes that identifying clusters of patients with homogeneous features, regardless of their pain diagnosis, could shed light on the underlying mechanisms that are responsible for producing pain.

A recent multiphase UH2/UH3 award funded by the National Institute for Dental and Craniofacial Research (NIDCR) will allow Smith’s team to investigate genetic mechanisms of TMD

INNOVATIVERESEARCH

“Temporomandibular disorder (TMD) significantly restricts essential functions such as speaking and eating, thereby profoundly impacting patients’ connections to their loved ones and even their sense of self. However, the intricate interplay between changes in the nervous and immune systems to produce chronic TMD pain remains ambiguous. Our goal for this study is to gain more insight into these processes, enabling us to target the pathology directly rather than mere symptomatic management.” – DR. SHAD SMITH

at a far greater resolution than previously has been possible. New single-cell RNA sequencing technologies (scRNA-seq) are able to identify individual cells and their transcriptional activity, allowing the ability to visualize precisely the cells that are contributing to hypersensitivity and pain. In collaboration with other NIDCR researchers, including Dr. Sunil Kapila of UCLA and Dr. Ryan Tomlinson of Thomas Jefferson University, this project will use scRNA-seq to examine TMJ tissues at cellular resolution for the first time.

A limited understanding of pathological processes in local tissues has hindered the identification of diagnostic, predictive or prognostic biomarkers in more accessible tissues like blood.

This project will be the first study to examine painful masseter muscle tissue using single-cell techniques to discover pathological mechanisms in critical cell populations and characterize their transcriptomic profiles. This project will also be the first simultaneous assessment of multiple tissue types to discover biomarkers correlated with localized pathology in clinically available blood within the same patient. The availability

of multiple tissue types for analysis is made possible through the assistance of Duke Anesthesiology’s Center for Translational Pain Medicine biorepository, which also under the direction of Smith enrolls COPC patients at the Duke Innovative Pain Therapies (DIPT) clinic and collects specimens and clinical data for research studies. Collaborators in this work include Dr. Daniela Vivaldi, orofacial pain specialist at the DIPT clinic, and other Duke researchers with extensive experience working with scRNA-seq data, Dr. Christopher Donnelly and Dr. Zhicheng “Jason” Ji. A preliminary phase of this project, currently underway, is a pilot study to develop novel methods of specimen collection and analysis for masseter muscle and blood suitable for high-resolution scRNA-seq techniques. Following development and optimization studies, the team will enroll a cohort of TMD patients and TMD-free controls to identify patterns of phenotypic and molecular expression that distinguish disease-relevant mechanisms. This analysis will also look at clusters of patients with common clinical features to identify specific pathological mechanisms in these subgroups in order to

refine diagnostic approaches and identify potential new therapeutic targets.

Different but complementary approaches will be taken between blood samples and masseter muscle tissue.

Circulating cells, known as peripheral blood mononuclear cells (PBMCs), will be analyzed using a method called ATACseq to identify not just the immune cell signatures that differentiate health and disease states, but also epigenetic regulatory networks that may help sustain immune dysregulation. In painful muscle tissue drawn from the masseter muscle, a technique called spatial transcriptomics will be used to localize cell populations which are altered in abundance in TMD patients versus healthy controls and determine whether these alterations correlate with nerve fiber density.

Notably, this will be the first time these techniques have been used within the context of understanding the origins of TMD pain. The proposed experiments are expected to yield novel insights into the cellular and molecular drivers of TMD pain, and their successful completion will establish a pipeline that can be generalized to other COPC disease cohorts for deeper exploration of pain mechanisms. BP BLUEPRINT 2024 | 53

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Blogs from

Abroad

GHANA

Making a Difference 5,365 Miles from Durham

Fintan Hughes, MBBCh, BAO RESIDENCY CLASS OF 2024

I

Simulated cardiac arrest training in the UGMC Intensive Care Unit; Demonstrating loss of resistance on a coconut.

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n September of 2023, we traveled to Accra, the capital city of Ghana in West Africa. Our main roles during the trip were to assist Dr. Adeyemi Olufolabi in establishing the use of labor analgesia and to teach local residents about neuromuscular monitoring and video laryngoscopy.

We were primarily based at the newlyopened University of Ghana Medical Center (UGMC).

We worked alongside Dr. Olufolabi, teaching UGMC residents the skills required to place epidural catheters. UGMC has a simulation center with an excellent model for neuraxial placement, but to facilitate widespread access to simulation we experimented with a variety of items from a local market. After much trial and error, we found that a coconut with holes drilled through the outer husk provides a crisp loss of resistance as a Touhy passes from the white flesh into the hollow liquid filled inner space. Pineapples were a close second when the Touhy was advanced from the base, but became much less consistent as the fruit ripened.

We delivered lectures to the anesthesia residents on the monitoring of neuromuscular blockade. Additionally, we gave tutorials on emergency airway management to the residents and nurses. Day-to-day in the operating room, we demonstrated the practical use of both train-of-four monitoring and video laryngoscopy.

A highlight for me was the simulated cardiac arrest sessions that we ran in the Intensive Care Unit. Navigating the culture’s differences while practicing closedloop communication led to a lot of laughter all around. This was all made a little more exciting as we used a live defibrillator at 4 joules rather than a training unit.

It was fascinating to see two very different approaches to global health work being undertaken in Ghana.

During our time at the hospital, we met a cardiac team from another US academic center. The primary aim of this group was to complete a large volume of surgeries in their time in the hospital. While this well-oiled machine provided excellent care to many patients, their work was met by local staff with varied responses. This is a completely different philosophy to Dr. Olufolabi’s capacity building model. Capacity building in global health seeks to develop long-running partnerships with local doctors and nurses. Listening and responding to the needs of local health care workers, both sides collaborate to develop sustainable solutions, and in time, the local teams become independent.

This trip was an inspiring window into the vast need for effective global health work that exists even in the more developed countries of the global south. BP

GLOBALHEALTH

Keith VanDusen, MD

Left to right, the Duke team leading a mock code at the UGMC ICU; Dr. Cortina demonstrating lumbar epidural placement at the UGMC.

RESIDENCY CLASS OF 2024

I

recall feeling apprehensive as I embarked for Accra, Ghana, where Bert Cortina, Fintan Hughes and I spent four weeks on a global health rotation under the mentorship of Dr. Adeyemi Olufolabi last September. As outsiders entering an unfamiliar medical system, we didn’t know what to expect.

Would we be embraced or mistrusted?

Could we provide meaningful service, or would we be a distraction?

What followed was the most formative month of my residency training. We spent most of our clinical time at the University of Ghana Medical Center (UGMC), where Dr. Olufolabi taught neuraxial techniques to enhance its obstetric anesthesia program. Throughout the rotation, we gave lectures, assisted with cases, and learned to conserve resources when administering anesthesia. We also toured public hospitals and explored the study of global health more broadly with an emphasis on program development, outcomes assessment, and sustainability.

While these clinical and academic pursuits were uniquely educational, the opportunity to experience Accra proved even more valuable. Dr. Olufolabi encouraged us to visit museums, restaurants and civic landmarks. He

brought us to the historic Jamestown district, where we explored a community-run school, searched for street art, toured a boxing gym, and learned about ongoing exploitation of the area’s limited resources. He led us through the dense Makola Market, took us on a weekend road trip, and even convinced us to go dancing. He also showed us the Cape Coast castle,

which provided a harrowing look into the region’s prior slave industry.

Throughout the trip, Dr. Olufolabi served as a full-time guide, driver, historian, and mentor. This surely was exhausting for him, but it provided an incredible experience for us.

Beyond even the history and culture we experienced, it was the people we met in Ghana that made the trip truly

The Duke Anesthesiology team arrives in Accra. Front to back, left to right: Dr. Adeyemi Olufolabi, Dr. Fintan Hughes, Marc Ayoub, Dr. George “Bert” Cortina, Dr. Keith VanDusen, and Maurice Ayoub.

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unforgettable. Dr. Olufolabi’s colleagues and friends welcomed us into their homes, prepared meals and offered gifts. Even the UGMC staff, whom I worried would consider us a distraction, have kept in touch via text and social media. The warmth with which they invited us to learn about their lives, careers, and country stood out among the highlights of our rotation.

Our rotation in Accra was easily the most important month in my residency training.

It was a perspective-altering experience, and I’m sincerely grateful to my co-residents, both those on the trip and those covering shifts while we were away, our department for sponsoring the adventure, our numerous hosts in Ghana, and, of course, Dr. Olufolabi, who enabled every part of the adventure. BP

Dr. VanDusen assisting with a difficult intubation.

George Cortina, MD, PhD RESIDENCY CLASS OF 2024

O

pportunities during residency to expand one’s training outside of their own institution, much less the country, are rare. When applying to Duke Anesthesiology, I heard about the global health rotation and, as a CA-3, had the fortunate chance to join Dr. Adeyemi Olufolabi on a rotation in Ghana. These four weeks proved to be some of the most valuable for my training.

In the days before leaving, I had a general sense of the intended goals, but upon arrival, I realized that much like language immersion, experience is the most effective teacher. Most days were spent at the University of Ghana Medical Center (UGMC), but every day varied. One constant was our work with and teaching of anesthesia trainees. The spontaneous conversations throughout the day, where we traded insights, taught both of us the most. Ghana is resourcelimited, but UGMC had received some newer equipment not available in many hospitals in the country. Often, it was 56

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the trainees’ first experience with such equipment, and they would come to us with questions about it and seek advice about care. We set up a series of both lectures and informal sessions.

The most popular was a mock code we designed, where we emphasized crisis communication just as much as advanced cardiac life support.

Throughout the days, they also demonstrated how they approached many of the same challenges that we face in the OR with limited resources.

One thing that struck me was their adaptability and commitment to training and medicine.

Most importantly, we built friendships and connections that continued even after we returned.

Everyone was proud to welcome us to Ghana and share their culture. They invited us to their houses, shared incredible food, and took us to their favorite places in Accra. Their passion for medicine, in the face of several systemic challenges, was inspiring.

These great experiences provided context for our learning and teaching

Duke Anesthesiology residents with Dr. Ernest Ofosu-Appiah, head of anesthesia at the University of Ghana Medical Centre.

at UGMC, enhancing the depth of our engagement. This was a life-changing introduction to global health that has provided a background for getting involved in similar initiatives later in my career. I am deeply grateful for the opportunity to have been a part of this rotation. BP

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

“We have a role to play in global health to — Adeyemi J. Olufolabi make the world a better place.”

MBBS, DCH, FRCA Professor of Anesthesiology Affiliate, Duke Global Health Institute Global Health Champion, EDI Leadership Team

Ready to make a difference?

Visit https://anesthesiology.duke.edu/global-health

Our Class of

Residents

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RESIDENCYRECAP

MEET THE GRADUATES (left to right): Drs. Sydney Reed, John Ward, Fintan Hughes, George Cortina, Tiffany Dong, Keith VanDusen, Jessica Liu, Jatin Anand, Janice Hu, Thomas Bunning, Brian Barron, Stephen Davies, Emily Barney, Kevin Merola, and Matthew Harrell (not pictured).

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residentspotlight Dr. Ashley Vincent | CA-2 Born and raised in Flushing, Queens, the most ethnically diverse county in the United States, I have experienced crosscultural living from childhood.

As a first-generation American from a working class, singleparent household, a career in medicine seemed improbable - if not impossible. My teachers’ investment in my education enabled me to challenge myself academically, and I developed a strong interest and background in chemistry at Cornell University. There, my desire to become a doctor solidified both in and outside of the classroom.

My interest in medicine led me to shadow an anesthesiologist in New York, which ultimately influenced me to begin my medical training. During my anesthesiology rotations, I was immediately drawn to the emphasis on patient safety, advocacy, and maintenance of calm in the fast-paced operating room. I observed anesthesiologists respond to the hum of the monitors; they reacted precisely to changing physiology with medications and ensured the delivery of balanced anesthetic throughout the case. Safe and effective care was practiced daily by the anesthesiology care team, inspiring my desire to contribute. I felt empowered

when caring for patients, and as a third-year medical student, I recognized and addressed a near-miss situation in the operating room. My voice was valued and changed the actions of the team. I was excited to join a field in which this culture is celebrated.

As a budding anesthesiologist, I am committed to promoting service within my community, nurturing leaders of tomorrow, and providing humanistic value-driven care. As a Duke Anesthesiology resident, I fulfill this as resident champion in the Equity, Diversity and Inclusion (EDI) Program. As resident champion, I work closely with residents and faculty to cultivate an inclusive culture where our differences are celebrated. Several exciting projects are coming out of our group, such as recruiting and retaining diverse residents and faculty, developing an EDI curriculum, and working to decrease discrimination and improve diverse patient experiences in perioperative settings. It is my hope that as we continue to foster EDI in our department, we nurture residents to become diverse leaders within anesthesiology and advocate for quality service within our communities. As an aspirant obstetric anesthesiologist, I envision myself providing humanistic, patient-centered care while working to uncover and ameliorate inequities experienced by parturients.

Dr. Andrew Whang | CA-3 I have a running joke that one of my proudest accomplishments was attending and training in all four ACC universities in North Carolina. I earned my undergraduate degree at UNC, pursued my master’s degree at NC State, attended medical school at Wake Forest, and now find myself at Duke for residency. Despite being born and raised in New York City, my relocation for college marked a significant turning point, and I haven’t looked back since.

While the natural beauty of North Carolina initially drew me in—the skies, mountains, trees, and beaches—it’s the people that have compelled me to stay. As I reflect on my residency journey, I am once again struck by the incredible individuals I am surrounded by. From the world-class faculty who mentor me to the diverse and supportive group of co-residents I train alongside, and the hardworking anesthesia techs and staff who make it all possible, I am continually inspired by those around me. Residency has been a transformative experience, shaping my identity 60

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from a student to a professional, healer, and leader, and the unwavering support I have received from faculty and coresidents alike has made all the difference.

My decision to pursue anesthesiology stems from its unique ability to care for patients across all stages of life— neonates, infants, children, teens, parturients, adults, and the elderly. During medical school, I found myself drawn to every medical and surgical specialty I encountered, and anesthesiology emerged as a perfect blend of elements from each. Moreover, anesthesiologists play a crucial role in managing the physiology of every organ system perioperatively. Patients’ pre-existing medical conditions do not simply vanish during surgery. It is our responsibility as anesthesiologists to see our patients as individual persons with distinct histories and experiences, and tailor our care accordingly. Anesthesiology is not a simple universal on-off switch; it requires meticulous planning and execution based on each patient’s unique needs as well as the flexibility to solve problems as they arise in the intraoperative setting. It is for these reasons I chose to pursue anesthesiology, and I am convinced that there is no better place to train than at Duke.

RESIDENCYRECAP

Match Class of Alejandro Carruyo Duke University

Grace DeSena University of Florida

Caroline Fields Medical University of South Carolina

2028

Brock Goeglein Indiana University

Logan Holley University of Virginia

Romel Holmes Duke University

Anna Jenkins Mayo Clinic

Sunny Yang Liu Duke University

Carson Nizialek Georgetown University

Andrew Ordille Rowan University

Caden Schlund University of Cincinnati

Vaishnavi Sharma Tufts University

Jose Perdomo Trejo University of Virginia

Imoh Udoh Duke University

Thomas Voss Medical College of Wisconsin

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alumnishoutout

with Drs. Nathan Waldron and Jenna Falcinelli

Nathan Waldron, MD, MHSc ‘16

3

TRACKS

Cardiothoracic and Critical Care, Mayo Clinic in Florida How has your training at Duke Anesthesiology accelerated your practice of anesthesiology?

I feel very grateful for the time I spent at Duke.

During the time that I was there (medical school, residency, two fellowships, and a foray as faculty), I was constantly surrounded and mentored by experts in every perioperative domain whilst being involved in the care of incredibly complex patients.

The depth and breadth of my training at Duke built a strong foundation for my career, and it’s been my honor and pleasure to continue building upon that foundation in my post-Duke life.

How did your training prepare you for being an anesthesiologist in a pandemic and now, postpandemic?

While I’d venture that none of us were really prepared for the seismic cultural changes that accompanied the pandemic, my training at Duke made the work part reasonably straightforward. My broad-based residency training meant that I was comfortable pivoting between different roles, tasks and venues to provide care to patients during the pandemic. Our didactic training in evaluating medical literature and the process of generating evidence gave me a good base to evaluate the rapidly-changing evidence base during the pandemic. Finally, my time spent as a critical care fellow at Duke helped cultivate a sense of comfort and familiarity with essentially all phenotypes of critical illness, which proved a tremendous boon during COVID. In the post-pandemic phase, the work ethic and collaborative ethos that we cultivated during training has been tremendously helpful in navigating my career.

What are your greatest lessons learned from the Duke Anesthesiology Residency Program?

This is a challenging question as a good chunk of my formative adult years were spent as a part of the Duke Anesthesiology department and I learned many lessons during this time, both personal and professional. From a professional standpoint, one of my biggest take-home messages was that trainees are not dissimilar to the somewhat fictitious aspect of goldfish – if you give them a big enough tank with enough great opportunities, they’ll continue to grow 62

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far beyond their initial expectations. From a personal standpoint, my time at Duke definitely helped me learn about appropriately valuing and nurturing my relationships with the people I love – my family.

What do you miss the most about Duke/Duke Anesthesiology?

The people. Being a part of Duke Anesthesiology – and Duke Health, in general – gives you access to true world-class experts in essentially any and every aspect of medicine. Not only does that mean that one can always tap into those folks’ knowledge base as a resource, it means that you get the privilege of being colleagues and forming friendships with people who are both frighteningly smart and wickedly fun to be around.

Categorical ACES

(Academic Career Enrichment Scholars) A highly-selective resident research track designed to increase the number of graduates pursuing academic careers and help them gain status as independentlyfunded researchers.

R-position

Why did you choose anesthesiology as your specialty?

I had an early interest in critical care medicine (CCM) and spent much of my time in medical school trying to figure out the best way to get there.

During this germinal period, I was fortunate to come across a number of Duke Anesthesiology faculty who showed me the value of an anesthesiologist’s background in caring for critically ill patients. During residency, I happened to fall in love with adult cardiothoracic anesthesiology (ACTA) – again, due to the tremendous role models I was surrounded by at Duke. When it came time to choose what I did after residency, I chose to pursue both ACTA and CCM training as I wanted to be an expert in caring for the “sickest of the sick.” I love the type of clinical medicine that this training pathway set me up for – I’m at home in a variety of inpatient practice settings and it generally takes a lot to get me rattled. While the two years of fellowship were challenging, I look back upon them very fondly and am grateful for the knowledge/skills that I gained and the friends/colleagues I made along the way.

What keeps you going?

I’m blessed with a lot of really amazing aspects to my life. My wife and kids are the primary thing that keeps me excited to wake up in the morning. But every day I go to work, I’m sincerely honored to be able to provide clinical care to patients – they’re

60 RESIDENTS 40

STATES

(medical schools)

6

COUNTRIES (birthplace)

100%

BOARD CERTIFICATION FOR 10+ YEARS Data representative of 2025-2028 Residency Program Classes

RESIDENCYRECAP

FACULTY

almost like an accessory family who I get to care for and protect during our time together. Finally, my compatriots at Mayo Clinic Florida are really amazing. I love spending time teaching the residents, joking with the CRNAs, nurses, OR/ICU staff, and chatting with attendings from a variety of specialties.

Advice for graduating residents?

If you’re training at Duke, you’re probably good at many things. Some of those things will garner recognition, but not all of them will engender a true sense of fulfillment. Pay attention to the overlap in the Venn diagram and maximize your efforts in that space.

Jenna Falcinelli, MD ‘17

Pediatrics, American Anesthesiology of the Carolinas

Dr. Annemarie Thompson Director Residency Program Vice Chair for Education

Dr. Angela Pollak Assistant Director Residency Program

How has your training at Duke Anesthesiology accelerated your practice of anesthesiology?

My experience at Duke prepared me to live in the moment and handle whatever comes my way. I feel really fortunate to have trained under the best of the best. Coming out of training and being “on my own” was intimidating, but I quickly realized that I had the skills and preparation I needed to take on the spectrum of cases to take great care of patients. I also learned communication and leadership skills that are instrumental in my every day.

How did your training prepare you for being an anesthesiologist in a pandemic and now, postpandemic?

No one in our current generation had experienced a pandemic like COVID-19 before. I had completed my training when COVID-19 hit, and I was really grateful to have been trained in an environment that emphasized teamwork and leadership. We learned together, vented to each other, and ultimately prevailed because we stuck together.

What are your greatest lessons learned from the Duke Anesthesiology Residency Program?

Dr. Sarah Cotter Assistant Director Residency Program

KEEP IN TOUCH! Update your alumni profile today:

https://anesthesiology. duke.edu/alumni

Where to begin! At Duke, I learned how to take care of the sickest patients undergoing the most novel procedures and techniques to give them hope and a chance. I learned how to stay calm during chaos, take on leadership in the OR without needing acknowledgement, cherish all components of a good team, and how to debrief during physically/ mentally/emotionally challenging situations.

What do you miss the most about Duke/Duke Anesthesiology?

Without hesitation, the people! The relationships – with attendings, fellow residents, CRNAs, techs – formed during my training are unparalleled. The trials and tribulations we went through together formed bonds that are incomparable. I’m fortunate to still be in touch with several of these wonderful people!

Why did you choose anesthesiology as your specialty?

I love anesthesia because it combines medicine and surgery. We take care of patients during some of their most vulnerable moments and formulate a plan to help them stay safe and comfortable. I love the spectrum of our field – from utilizing critical thinking pre/intra/post-op, to placing lines or nerve blocks, to comforting women in labor or during C-sections. What we do is awesome and impactful. I especially love the pediatric population because their ailments are not their fault, thus it’s never difficult to be empathetic. Kids are incredibly resilient and honest – and tough. They’re just the best.

What keeps you going?

At home, my family – having three young kids and a supportive husband to come home to gives me great perspective on what’s most important. And at work, taking care of severely ill babies/kids gives me purpose.

I feel like my training was long and rigorous, but so worth it every time that I have a pediatric patient who needs to have a procedure/surgery – I’m grateful that my training has enabled me to take great care of them.

I especially love that our pediatric surgical/anesthesia team supports pediatric patients and their families so they can stay closer to home in eastern NC for at least some (if not all!) of their care, preventing frequent long trips to the Triangle.

Advice for graduating residents?

Give yourself grace. Be honest with yourself.

Recognize you’re human and thus not perfect.

Stay Connected Follow the Duke Anesthesiology Residency-Run Twitter Page and Instagram Page @DukeAnesRes | #DukeAnesRes | dukeanesres

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Q& A ALUMNINOTES

Maher J. Albahrani, MBChB

with Senior Consultant, Department of Anesthesia and Critical Care Royal Hospital, Sultanate of Oman Fellow, Duke Adult Cardiothoracic Anesthesiology, Duke Critical Care Medicine Why anesthesiology?

During my undergraduate training in the UK, I always wanted to be an internist, but after graduation I realized my passion in anesthesiology, especially when no other Omani doctor wanted to join this challenging field.

Anesthesiology is unique in integrating complex medical knowledge with procedural skills to provide holistic and meticulous care of patients. This was demanding for others but not for me. I found the practice of anesthesiology quite rewarding; every day offers an opportunity to expand knowledge and refine skills to ensure patients’ safety and comfort during some of the most vulnerable moments in health care. This always gives me a profound sense of accomplishment.

You credit your fellowship training at Duke Anesthesiology to shaping your approach to anesthesiology and impacting the way you operated/ practiced when you returned to your home country of Oman. How so?

At Duke Anesthesiology, I was fortunate to have high level mentors supervising a group of highly enthusiastic and intellectual fellows in a positive and rewarding environment. This dedicated and hard-working environment had a great influence on my future career in anesthesia. Duke Anesthesiology is renowned for its cutting-edge research, patient safety and quality improvement initiatives that greatly inspired my approach to anesthesiology practice in my country.

What specific aspects of your training profoundly impacted your ability to advance the practice of anesthesiology in Oman?

Training at Duke Anesthesiology provided me with a solid foundation in both the technical and soft skills necessary to be an effective leader in the field. The ability to manage anesthesia for complex cardiac cases, heart and lung transplantation, minimal invasive cardiac surgery and critical care management of a variety of medical and surgical cases, has nourished my confidence and advanced knowledge.

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In addition, exposure to research and fostering connections with experts in the field, all provided me with the skills to improve the quality of anesthesia services and patient outcomes in my country.

And, what personal qualities did you rely on to achieve such an ambitious goal?

Having good leadership and communication skills and being adaptable and open to change helped me the most in navigating various challenges. At the same time, commitment, hard work and critical thinking were important traits that helped in achieving these goals.

What key lessons did you learn at Duke that equipped you to assume the role as the only Omani anesthesiologist in Oman when you returned from training?

Besides the advanced clinical and problem-solving skills, making critical decisions and working under pressure during the training prepared me for the responsibilities and leadership role I took upon returning to Oman.

And, what did this specific role teach you?

It taught me adaptability, resilience and perseverance, as well as the ability to analyze complex situations and make sound decisions.

What challenges did you face once you returned to Oman, and how did you draw on your drive and training to overcome them?

At that time, anesthesia, intensive care and pain management were undervalued in the country, with shortages in human resources, equipment and advanced technology. With the exception of cardiac anesthesia, there was a lack of qualified expertise in all other subspecialties across the country, leading to either lack of services or suboptimal practice.

To overcome these challenges, I founded the Oman Society of Anesthesia and Critical Care in 2004, which promoted ongoing education and the transfer

TOPHEADER

DIRECTOR Department of Anesthesia and Critical Care, Royal Hospital, 2004-2016

ASSISTANT DIRECTOR GENERAL OF MEDICAL AFFAIRS Royal Hospital, 2016-2022

FOUNDER first president of Oman Society of Anesthesia and Critical care

FOUNDER first chairman of anesthesiology residency program in Oman Established the anesthesiology-led TEE SERVICE in Royal Hospital cardiac operating rooms

DEVELOPED ANESTHESIOLOGY DEPARTMENTS and ICUs across Oman; established the pain unit at the Royal Hospital

FOUNDED RESPIRATORY CARE SERVICES in Oman Member of the esteemed medical team serving His Majesty the Sultan of Oman, 2004-2016 Establishing a GREEN ICU in the Royal Hospital with plans to expand to other Ministry of Health hospitals

Dr. Albahrani in the Royal Hospital OR.

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By combining the experience, skills and insights gained, and mentorship received at one of the best training centers in the world, I was inspired to adopt a similar structure of training in Oman.

Dr. Albahrani pictured in the 2001 Department of Anesthesiology photo during his fellowship (courtesy DUMC archives).

of knowledge and skills to existing anesthesia providers. In the same year, I established an anesthesia residency training program for young Omani doctors, which helped in shaping the next generation of anesthesiologists in the country. The subsequent step involved reaching out to key stakeholders in the Ministry to advocate for the acquisition of state-of-the-art equipment, medications and advanced technology to improve anesthesia services. Moreover, while training in the United States, I recognized the significance of respiratory care. Hence, I established this service in all hospitals in Oman by recruiting practitioners and training Omani staff in this important field, which proved vital during the COVID-19 pandemic. These collective initiatives transformed anesthesiology practice in the country.

In what ways were you able to establish yourself as a respected leader, particularly at a young age, and climb the ladder so quickly in Oman?

I planned my professional development soon after completing my undergraduate training by deciding to pursue postgraduate training in the best centers in the United States and subspecializing in areas of high need in my country. In 2004, I was appointed the director of anesthesiology at the Royal Hospital where my leadership role began by developing anesthesiology services across the country and establishing the anesthesia society and the residency training program. This led to more significant opportunities for collaboration with the medical community in Oman and on an international scale.

This dedication and commitment to excellence set me apart early in my career, with building a reputation as a reliable and effective leader.

How were you able to transition from your initial training to establishing a successful residency program in Oman?

By combining the experience, skills and insights gained, and mentorship received at one of the best training centers in the world, I was inspired to adopt a similar structure of training in Oman. I started the anesthesiology residency training program in 2004, and in 2007, the official Oman Medical Specialty Board was established in which I led the anesthesiology program for another 10 years. This was accomplished by customizing the program to align with the specific needs and resources in Oman while maintaining international standards of education and practice. I was privileged to be supported by qualified faculty members with diverse expertise, which helped in obtaining accreditation from relevant bodies to ensure its credibility and quality.

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How has that program impacted patient care?

Training a new generation of anesthesiologists has contributed to the cultivation of more qualified professionals, ensuring the delivery of consistent and reliable anesthesia services. We currently have 44 residents in the program. Among the 62 who have already graduated, 38 residents have resumed fellowship training in North America and the UK, thus enriching our hospitals with a wealth of knowledge, skills and innovation upon their return. Presently, we have Omani consultants in all subspecialties of anesthesiology, critical care and pain management, some of whom hold leadership positions in their respective departments.

How significant was your establishment of the anesthesiology-led transesophageal echocardiography (TEE) service in the operating room in Oman, and how did your own training in TEE contribute to this development?

In Oman, the intraoperative TEE was led by the cardiology team.

Training in TEE at Duke Anesthesiology provided me with such valuable knowledge, expertise and accreditation; by leveraging this training, I was able to establish an anesthesiology intraoperative TEE service in the Royal Hospital with confidence and effectiveness. Through the procurement of dedicated equipment and the establishment of training in this modality, anesthesiology led intraoperative TEE became a standard of care for every cardiac surgery case in Oman.

What challenges did you face in training others and what lessons did you learn from those teaching experiences?

Teaching TEE requires mastering complex equipment and acquiring skills in obtaining and interpreting echocardiographic images accurately. This was challenging for TEE novice anesthesiologists, particularly in maintaining patient safety during critical moments of anesthesia. Initial limited resources added to these challenges. Having been the sole expert in TEE at that time, I learned to be patient and persevere to accomplish this goal of TEE standardization in cardiac surgery, especially in a TEE novice environment.

Name some critical steps in developing anesthesiology departments across Oman, and how have you transformed those departments?

After acquiring trust of the higher authority in the Ministry of Health, I began by studying the resource needs of each department with an emphasis on the operating rooms and the intensive care units. This enabled me to develop a

ALUMNINOTES strategic plan that outlined specific goals and objectives for departmental improvement. Following that, we proceeded to upgrade our facilities, human resources, equipment, and technology. Additionally, we organized a range of continuous educational activities, including courses, workshops, and local and international conferences, which helped in disseminating knowledge and skills among our team.

strategies include prioritizing preventive health care measures, investing in health care infrastructure and health information systems, supporting professional development, and engaging communities in decision-making and health promotion activities.

How did mentorship influence your path to success?

Mentorship in anesthesiology and critical care at a prestigious institution like Duke had a profound impact on my career.

The guidance and support that I received from my mentors Being in the position of assistant director general for medical during and even after my return to my country helped me to affairs during the pandemic laid a great responsibility to successfully navigate the challenges and offered insights into my navigate the challenges posed. Various dedicated teams and task career paths to reach my professional goals. This mentorship forces were formed, and we ensured effective communication contributed to my personal growth by building confidence, by maintaining transparency during meetings to disseminate resilience and leadership skills that were essential for my success. information and address any concerns. Resource management What do you believe are necessary during the pandemic was a global qualities of a good mentor? challenge. We developed strategies to It is essential for a good mentor to have ensure adequate availability and proper a solid foundation of experience, skills utilization of medical equipment, and knowledge in order to provide supplies and personnel. Supporting the valuable insights and guidance to their mental and emotional well-being of mentee. They should have effective our health care staff was a high priority communication skills and be committed and was managed by a dedicated team. to the mentorship relationship by Due to rapidly changing circumstances inspiring their mentee to strive for and evolving scientific information, excellence. I believe a good mentor we had to be adaptable to different should also be supportive and available waves of the pandemic by adjusting to provide guidance as needed and workflows and protocols to respond to should demonstrate empathy and the evolving situation. We could not respect for their mentees’ perspectives, have succeeded without support from Dr. Albahrani with his family (pictured left to challenges and goals. the higher authorities in the Ministry and collaboration and coordination with right): Jaffer, Ghadeer, Faryal Khamis (spouse), Considering your accomplished Maher, Kawther, and Ali. other health care facilities. Furthermore, career, what is your philosophy on we promoted research initiatives by our work-life balance? clinical scholars sharing their work with peers on regional and I believe in establishing clear boundaries between work and international platforms. personal life to avoid burnout, and maintaining a healthy Core insights from your many leadership roles in Oman? separation between the two is essential. This balance can be Having a clear vision for the organization and developing achieved by identifying priorities, efficient time management strategies to achieve goals is essential. I learned that strong and prioritizing self-care activities to maintain physical and communication skills are vital for conveying expectations, mental well-being, and hence, productivity and satisfaction. fostering collaboration and ensuring a cohesive team What advice do you have for aspiring anesthesiologists? environment. I also believe that every health care organization My advice is to focus on academic excellence and build a should have “people-centered care” strategies for staff and strong foundation of knowledge and skills, and to invest in patients alike. Empowering your staff and providing them with professional development, continuous learning and research. opportunities for professional development, along with staff satisfaction, contribute to the overall success of the organization. It is also important to engage in professional networks and connect with colleagues and professional organizations to Prioritizing patient safety and quality of care should also be at expand opportunities and exchange knowledge. Additionally, the forefront of departmental and hospital management. to make patient-centered care a strategy and to prioritize workWhat essential strategies and actions do you consider life balance for good well-being and satisfaction.

What strategies did you use to lead your team, the Royal Hospital and ICUs in Oman through the COVID-19 pandemic?

fundamental for addressing national health challenges and achieving success?

First, identify the key health challenges and formulate evidence-based policies to address these challenges. Other

Last year, the key word in “Alumni Notes” was curiosity. What are the key words of your journey from Duke to Oman?

Opportunity and transformation. BP BLUEPRINT 2024

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DEPARTMENTALFACULTY

CHIEF: Stephen M. Klein, MD

DEPARTMENT CHAIRMAN Joseph P. Mathew, MD, MHSc, MBA Jerry Reves, MD, Professor of Cardiac Anesthesiology

Ambulatory Anesthesiology Emily Chen, MD Alex Cravanas, MD, MBA Michael Kent, MD Steve Melton, MD Karen Nielsen, MD Christopher Young, MD, FCCM

CHIEF: Mihai V. Podgoreanu, MD, FASE

Cardiothoracic Anesthesiology

CHAIR’S COUNCIL: (pictured left to right) Padma Gulur, MD Gavin Martin, MB ChB, FRCA, MMCi Miriam M. Treggiari, MD, PhD, MPH Evan Kharasch, MD, PhD

LEADERSHIP COUNCIL:

Atilio Barbeito, MD, MPH John Borrelli, MBA, FACMPE Dan Cantrell Jennifer Dominguez, MD, MHS Adam Flowe, CRNA Jeffrey C. Gadsden, MD, FRCP(C), FANZCA Nicole Guinn, MD, MBA Padma Gulur, MD Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA Edmund H. Jooste, MB ChB Michael Kent, MD Evan Kharasch, MD, PhD Stephen M. Klein, MD 68

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Joseph P. Mathew, MD, MHSc, MBA Madhav Swaminathan, MD, MMCi, FASE John Borrelli, MBA, FACMPE Annemarie Thompson, MD, FAHA, MBA

Vijay Krishnamoorthy, MD, MPH, PhD Melinda F. Macalino Gavin Martin, MB ChB, FRCA, MMCi Joseph P. Mathew, MD, MHSc, MBA Timothy Miller, MB ChB, FRCA Mihai V. Podgoreanu, MD, FASE Dana Rawls Neil Ray, MD, MBA Nicole Scouras, MD, MBA Annemarie Thompson, MD, FAHA, MBA Miriam M. Treggiari, MD, PhD, MPH Kevin Vorenkamp, MD, FASA

Brandi Bottiger, MD Anne Cherry, MD Bryan Chow, MD Sarah Cotter, MD Michael Cutrone, DO Kamrouz Ghadimi, MD, MHS Loreta Grecu, MD Nazish Hashmi, MBBS Rebecca Klinger, MD, MS Sundar Krishnan, MBBS Jerrold Levy, MD, FAHA, FCCM Yasmin Maisonave, MD Negmeldeen Mamoun, MD, PhD Luiz Maracaja, MD Joseph Mathew, MD, MHSc, MBA Sharon McCartney, MD, FASE Sachin Mehta, MD Alina Nicoara, MD, FASE Angela Pollak, MD Annemarie Thompson, MD, FAHA, MBA Ian Welsby, MBBS, FRCA Meredith Whitacre, MD

CHIEF: Nicole Scouras, MD, MBA

Community

Lu Adams, MD Lindsey Bewley, DO Ryan Bialas, MD Stephanie Cooper, MD William Crocker, MD Benjamin Dunne, MD Matthew Glass, MD Elsje Harker, MD

DEPARTMENTALFACULTY Erica Heniser, MD Daniel Kovacs, MD Jonathan Mathew, MD Elizabeth Nichols, MD Shannon Page, MD Gary Pellom, MD Lisette Ramos, MD Benjamin Redmon, MD Richard Runkle III, MD Siddharth Sata, DO Zaneta Strouch, MD, MPH Leonard Talbot, MD Neel Thomas, MD Danai Udomtecha, MD Reed VanMatre, MD, FASA Andrew Wong, MD

CHIEF: Vijay Krishnamoorthy, MD, MPH, PhD

Critical Care Medicine

Omar Al-Qudsi, MD Sandy An, MD, PhD Adjoa Boateng Evans, MD, MPH Yuriy Bronshteyn, MD Robert Clark, MD Kathleen Claus, MD Blair Costin, MD, PhD Desiree Coutinho, MD Michael Devinney, MD, PhD Amanda Faulkner, MD Taylor Herbert, MD, PhD Rebecca Himmelwright, MD Ehimemen Iboaya, MD RJ Krom, MD, PhD Nitin Mehdiratta, MD Rachael Mintz-Cole, MD, PhD Jamie Privratsky, MD, PhD Mara Serbanescu, MD Arturo Suarez, MD Miriam Treggiari, MD, PhD, MPH Paul Wischmeyer, MD, EDIC Miguel Yaport, MD

Heath Gasier, PhD Evan Kharasch, MD, PhD Catherine Kuhn, MD Michael Manning, MD, PhD Brian Mendelson, MD Richard Moon, MD, CM, MSc, FRCP(C), FACP, FCCP Eugene Moretti, MD, MHSc Ankeet Udani, MD, MSEd Katherine Sun, MD Elizabeth Wilson, MD

CHIEF: Nicole Guinn, MD, MBA

CHIEF: Edmund H. Jooste, MB ChB

Pediatric Anesthesiology

Leah Acker, MD, PhD Miles Berger, MD, PhD Dhanesh K. Gupta, MD, MBA Jennifer Hauck, MD Michael "Luke" James, MD, FAHA, FNCS Basma Mohamed, MD Andrew Peery, MD, MPH Vijay Ramaiah, MBBS

CHIEF: Jeffrey C. Gadsden, MD, FRCP(C), FANZCA

CHIEF: Atilio Barbeito, MD, MPH

Neuroanesthesiology, Otolaryngology & Offsite Anesthesiology

Orthopaedics, Plastics & Regional Anesthesiology

W. Michael Bullock, MD, PhD Joshua Dooley, MD Amanda Kumar, MD David MacLeod, MBBS, FRCA, Dip IMC Erin Manning, MD, PhD Gavin Martin, MB ChB, FRCA, MMCi Hector Martinez-Wilson, MD, PhD Brian Ohlendorf, MD Neil Ray, MD, MBA

CHIEF: Kevin Vorenkamp, MD, FASA

General, Vascular & Transplant Anesthesiology

CHIEF: Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA

Women’s Anesthesiology

Warwick Ames, MBBS Benjamin Andrew, MD Guy Dear, MA, MB, BChir, FRCA, FUHM Natalia Diaz-Rodriguez, MD, MHS John Eck, MD Lisa Einhorn, MD Michael Greenberg, MD Hercilia Homi, MD, PhD Martha Kenney, MD Elizabeth Malinzak, MD Matthew McDaniel, MD John McManigle, MD Allison Ross, MD Andrea Udani, MD

CHIEF: Timothy E. Miller, MB ChB, FRCA

Chakib Ayoub, MD, MBA Bruce Derrick, MD Jonathan Dunkman, MD Sarada Eleswarpu, MD Arun Ganesh, MD Ryan Gessouroun, MD

Cain Dimon, MD Padma Gulur, MD Dimitri Putilin, PhD Scott Runyon, MD Jean Elie Tabbal, MD Daniela Vivaldi, DDS Peter Yi, MD, MSEd

Veterans Affairs Anesthesiology Service

Sophia Dunworth, MD Juliann Hobbs, MD, MPH Hung-Lun (John) Hsia, MD Diana Hsu, MD Eric JohnBull, MD, MPH John Lemm, MD David Lindsay, MD Grace McCarthy, MD Harika Nagavelli, MD Srinivas Pyati, MD, MBBS Karthik Raghunathan, MBBS, MPH Lance Roy, MD Timothy Stanley, MD Thomas Van de Ven, MD, PhD

Terrence Allen, MBBS Melissa Bauer, DO Jennifer Dominguez, MD, MHS Sara Feldman, MD Jean He, MD Jennifer Mehdiratta, MD, MPH Abigail Melnick, MD Marie-Louise Meng, MD Adeyemi Olufolabi, MBBS, DCH, FRCA Mary Yurashevich, MD, MPH

Center for Perioperative Organ Protection Madan Kwatra, PhD Huaxin Sheng, MD Wei Yang, PhD

DIRECTOR: Ru-Rong Ji, PhD

Center for Translational Pain Medicine

Satya Achanta, DVM, PhD Andrey Bortsov, MD, PhD Christopher Donnelly, DDS, PhD Sven-Eric Jordt, PhD Francis Keefe, PhD Katherine Martucci, PhD Andrea Nackley, PhD Shad Smith, PhD Niccolò Terrando, PhD

Pain Medicine

Aurelio Alonso, DDS, MS, PhD Muhammad Anwar, MD, MBA Evander Britt, MD Thomas Buchheit, MD BLUEPRINT 2024

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S A V E

T H E

D A T E

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O C T O B E R

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DUKE ANESTHESIOLOGY th

34 Annual ASA Alumni Event PHILADELPHIA, PENNSYLVANIA

10.19.24

10.14.23 Uniting in the City by the Bay Duke Anesthesiology marked its 33rd Annual American Society of Anesthesiologists (ASA) Alumni Event by hosting an in-person reception on October 14, 2023 at EPIC Steak along the San Francsico Bay for a night of celebration and innovative cuisine.

The anticipated highlight of the evening was the reveal of the 2024 DREAM Innovation Grant (DIG) recipient, Dr. Tetsu Ohnuma (see page 44), for his project, “Antimicrobial De-escalation and Outcomes in Sepsis.”

The evening’s guests also celebrated a successful ASA meeting; 47 faculty and trainees participated in the conference, including 76 lectures, workshops, panel discussions, presentations, and more.

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RACING

IN REMEMBRANCE In a heartfelt tribute, Dr. Warwick “Wads” Ames successfully completed the 128th Boston Marathon on April 15, 2024, in honor of the late Dr. Kelly Ann Machovec, a beloved Duke Anesthesiology faculty member and esteemed pediatric cardiothoracic anesthesiologist who passed away before achieving her goal of running the Boston Marathon in 2022 with the Dana-Farber running team.

“Finally, as I wandered through the finishing area, I got swept into the Dana-Farber recovery area. My quads had been broken by Boston so I took the option to have a post-race massage. Whilst my masseuse started to work, she quietly asked why I ran for Dana-Farber. For the umpteenth time that day, I talked about Kelly. The highs and the lows. The laughter and the tears. The stories I will never forget. And not embarrassed to say, I cried.

The masseuse was incredibly kind and empathetic. When she had finished, I sat up and thanked her for her wonderful work and her understanding. I apologized for crying into her massage table. It was then I realized I hadn’t asked her name. No word of a lie, on her badge was her name. Kelly Ann.” – AN EXCERPT FROM DR. AMES’ RACE REFLECTION

Raised

$27,805 in Memory of Dr. Machovec

100% of every dollar donated supports the Claudia Adams Barr Program in Innovative Basic Cancer Research at the Dana-Farber Cancer Institute.

BLUEPRINT 2024 | 71

# in NIH funding EXTRAORDINARY SCIENCE. LIFE-CHANGING DISCOVERIES.

2023 Blue Ridge Institute for Medical Research

5

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in the nation

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in the state

D O X I M IT Y 2 0 2 4 -2025

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RE SIDE NCY P ROGRAM

There’s no place like Duke.

V I S IO N:

To be the leader in advancing perioperative medicine and pain management.

M I S S IO N :

Extraordinary care through a unique culture of innovation, education, research, and professional growth.