PENN STATE OTOLARYNGOLOGY-HEAD AND NECK SURGERY
Division Update Spring/Summer 2018
hmc.PennStateHealth.org/otolaryngology
Message from the Chief After a protracted winter season, Spring/ Summer 2018 is finally upon us. Penn State Health’s Division of Otolaryngology – Head and Neck Surgery continues to be central Pennsylvania’s premier otolaryngology resource.
We are thrilled about our inaugural “The Cutting Edge – Update in Otolaryngology Head and Neck Surgery” conference in Marco Island, Fla. The meeting was a resounding success, and plans are well underway for the 2nd Annual “The Cutting Edge in Otolaryngology” meeting in Marco Island in January 2019.
We are excited to offer cutting-edge procedures, including Inspire upper airway stimulation for sleep apnea, led by Drs. Neerav Goyal and Meghan Wilson.
As chief of the division, I am inspired by our talented faculty, residents and dedicated staff who take care of a growing number of patients each year.
Learn more here: hmc.pennstatehealth.org/otolaryngology/patient-care-andtreatment/obstructive-sleep-apnea
I invite you to peruse the pages of our newsletter and learn more about what we are up to as we continue to discover, teach and heal.
We are also offering sialoendoscopy and flexible robotic surgery for head and neck cancers.
Best wishes for a happy spring and summer season.
The new ESTEEM—Penn State Health Cosmetic Associates location has opened. Thanks to Dr. Jessyka Lighthall for much of this effort.
David Goldenberg, MD, FACS Steven and Sharon Baron Professor of Surgery, Professor of Surgery and Medicine, Chief, Division of Otolaryngology-Head and Neck Surgery
How to Refer a Patient
In this Issue
• Adult and pediatric otolaryngology, head and neck cancer, facial reconstructive surgery, audiology and hearing aid services: 717-531-6822
Esteem Opens its Doors
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Otolaryngology in the News
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Sleep Surgery
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Inaugural Skull Base Course
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• Facial Nerve Disorders Clinic: 717-531-1405
Meet Our New APCs
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• Pediatric Airway Clinic: 717-531-6822
Academy of Audiologists
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Visiting Professors
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Alumni News
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• Cosmetic facial plastic surgery consults: 717-531-1386
• Fax records for triaging review: 717-531-6160
The Cutting Edge in Otolaryngology 2
Inaugural “The Cutting Edge in Otolaryngology” Meeting a Success! Dr. David Goldenberg and Dr. Neerav Goyal of Penn State Health’s Division of Otolaryngology led the inaugural meeting of “The Cutting Edge in Otolaryngology - Update in Head and Neck Surgery” Jan. 11-14 in Marco Island, Fla. Practicing otolaryngologists, head and neck surgeons, physician assistants and other health care professionals attended the event and learned the latest techniques and best practices in otolaryngology. Faculty, residents and advanced practice clinicians of the Division of Otolaryngology joined Penn State College of Medicine alumni, faculty from our neighboring academic institutions and South/Central Florida otolaryngologists at the meeting at the JW Marriot. Sessions featured presentations by experts in all subspecialties of otolaryngology. Keynote speakers were D. Bradley Welling, MD, PhD, FACS, Chair Otolaryngology - Massachusetts Eye and Ear, Chief of Otolaryngology, Harvard Medical School, and David Eisele, MD, Andelot Professor and Director, Department of Otolaryngology - Head and Neck Surgery Johns Hopkins University School of Medicine. Sponsors showcased their newest technologies at exhibitor stations, while attendees refueled on coffee and camaraderie. Each day concluded with a panel that led to lively discussion and debate. Penn State Health Milton S. Hershey Medical Center’s Katie Kugler, PA-C, president of the Pennsylvania Society of Physicians Assistants, led a panel on the effectiveness of including advanced practitioners in an otolaryngology practice. Drs. Ron Mitzner (alum 2011) and Antonio Portela (alum 2013) took part in the panel and offered perspectives on training with PAs and bringing PAs into a practice after residency. Dr. Michael Orsini (alum 1983) participated in a panel that focused on the challenges of working in a private practice versus being university-based. Dr. Mark Klingensmith (alum 1986), Dr. Rafael Portela (alum 1981), Dr. Barry Schaitkin (alum 1990), Dr. Ramon Franco Jr (alum 1977) also presented at the inaugural meeting. After the daily sessions, participants had free time to walk the beach, collect seashells and bird watch. Some members of the group tested their flexibility and vestibular systems with a sunset yoga session. Each evening concluded with an exploration of local cuisine, providing participants ample opportunity to build the personal bonds that make our program so special. This year’s “The Cutting Edge in Otolaryngology” was a great success! The second annual meeting is set for Jan. 17-20, 2019, at the Hilton Marco Island Beach Resort and Spa.
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The Cutting Edge in Otolaryngology (continued)
Penn State Health thanks its sponsors and exhibitors for their continued support of our specialty: Conference-Level Exhibitors
Gold-Level Exhibitors
Gold-Level Support
DePuy Synthes
ATOS Medical Inc.
Intersect ENT
Impulse Monitoring Nuvasive
Ethicon US, LLC
Acclarent
Medrobotics
Medrobotics
Stryker
Bard Davol
Medtronic
CBLPath
NuVasive Clinical Services
Cook Medical
Shire Pharmaceuticals
Entellus Medical
Xoran Technologies
Silver-Level Support Cook Medical Zimmer Biomet
Hemostatix
Bronze-Level Support
Hitachi Healthcare
Ethicon Endo-Surgery
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Esteem—Penn State Health Cosmetic Associates Opens Its Doors Dr. Jessyka Lighthall, director of Facial Plastic Surgery in the Division of Otolaryngology, joined forces with multiple cosmetic disciplines to provide holistic care to aesthetic patients when Esteem—Penn State Health Cosmetic Associates opened in January 2018. This unique practice setting allows patients to meet all of their cosmetic needs in a single spa-like location. Esteem includes providers from Facial Plastic Surgery, general Plastic Surgery, Dermatology, Occuloplastic Surgery and Vascular Surgery, as well as two aestheticians. This practice provides a range of services, including skin care programs, laser treatments, resurfacing techniques, facial augmentation with fillers, neuromodulation, cosmetic facial, nasal and ear surgery and all types of body contouring procedures. Additionally, the practice offers minimally invasive to full operative treatments for veins and aging. To obtain more information or to book an appointment, contact: Esteem—Penn State Health Cosmetic Associates 5 Capital Drive, Suite 203 Harrisburg, PA 17110 Phone: (717) 531-1386 Email: esteemcosmeticcenter@pennstatehealth.psu.edu Website: Esteem.PennStateHealth.org.
Otolaryngology in the News
The Esteem—Penn State Health Cosmetic Associates staff gathers for a photo after the broadcast of the Rejuvenate and Renew segment on ABC27 on Feb. 28.
ABC27 news anchor Debra Pinkerton poses with patient Vanessa Bigler and Dr. Jessyka Lighthall after a segment focusing on Bigler’s surgery performed by Lighthall.
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Dr. Neerav Goyal, director of Head and Neck Surgery, discussed the differences between sleep apnea and obstructive sleep apnea on ABC27’s “Good Day PA.”
Penn State Health Offers Sleep Surgery for Adult and Pediatric Patients Obstructive sleep apnea can be a challenging condition for our adult patients. Multiple studies have highlighted the long-term dangers it can pose to the cardiopulmonary system, as well as acute concerns with decreased productivity, daytime drowsiness and nighttime sleep disruption for bed partners. Penn State Otolaryngology is proud to incorporate the latest in surgical sleep intervention: the hypoglossal nerve stimulator (Inspire therapy). Dr. Neerav Goyal, head and neck surgeon, now offers patients this intervention in collaboration with the Penn State Sleep Treatment and Research Center led by Dr. Venkatesh Krishnamurthy. The stimulator provides nighttime inspiration-synchronized stimulation of the protruding muscles of the tongue to reduce anatomic obstruction of the pharyngeal airway. Longitudinal clinical trials have demonstrated the efficacy of this treatment, both objectively (decreased apnea-hypopnea index) and subjectively (improved levels of snoring as reported by bed partners). Additionally, this device provides significantly improved compliance as compared to CPAP. Surgical evaluation involves a drug-induced sleep endoscopy to evaluate the areas of obstruction, followed by an outpatient procedure to implant the device. Following implantation, the device is activated and programmed in the office to customize treatment specific to the patient’s needs. In pediatric patients, advances in sleep apnea include sleep endoscopy and closer evaluation of nasal cavity obstruction. In children with complex sleep apnea, airway disorders and persistent sleep apnea after
tonsillectomy and adenoidectomy, sleep endoscopy is offered to provide better visualization of the levels of obstruction. This allows targeted treatment of each level of obstruction. Multilevel obstruction is increasingly recognized in children. The turbinates and septum can be easily overlooked in the pediatric patient, for whom the mainstay of initial surgical treatment has been tonsillectomy and adenoidectomy. At Penn State Children’s Hospital Division of Otolaryngology, we strive to recognize all areas and causes of airway obstruction and incorporate them into the treatment plan, maximizing the success of surgical therapy when indicated. Dr. Jason May and Dr. Meghan Wilson, both fellowship-trained pediatric otolaryngologists, provide focused care for our pediatric patients with sleep apnea.
Educational Innovations: Penn State Health Inaugural Skull Base Course The Division of Otolaryngology – Head and Neck Surgery, in conjunction with the Department of Neurosurgery, hosted its Inaugural Skull Base Course from Dec. 1-2, 2017, which was organized by program co-directors, Drs. Neerav Goyal and Brad Zacharia. During this hands-on, two-day workshop, participants developed an increased understanding for high-yield sinonasal and skull base anatomy, as well as an appreciation of the technical nuances associated with approaches to the cranial base, through a series of didactic lectures and case presentations. Within a structured cadaver lab, they immediately utilized these concepts via directed cadaveric prosection, as well as by practicing surgeon-led open and endoscopic techniques with key cranial base targets. To foster a collaborative environment, participants implemented a tandem, two-team approach, with an otolaryngology and neurosurgery resident at each station. During the course, each team established image-guided endoscopic transplanurm and sellar corridors and performed open exposures, including coronal, frontotemporalorbitozygomatic and infratemporal fossa approaches. The combination of a simulated operative environment and joint team-based surgery allowed participants the opportunity to enhance clinical knowledge and develop critical surgical skills related to the cranial base. The course co-directors thank the Stryker Mobile Laboratory for its support of this endeavor.
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Meet our new APCs Kimberly Pintarch hails from Hummelstown, Pa. After graduating from Lower Dauphin High School in 2005, she attended the University of South Carolina, where she earned her Bachelor of Science in Business Administration and majored in marketing. Following graduation in 2008, Kim remained in Columbia, S.C., for one year and worked as a paralegal with a law firm specializing in foreclosures. Wishing to return to her roots, Kim moved home to Hummelstown to pursue a career in health care. She became a certified nurse assistant and worked in a memory support unit at a long-term care nursing facility, and then in a transitional care unit at Penn State Health Rehabilitation Hospital. Through her work experience and many hours spent shadowing multiple health care providers, Kim decided that a career as a physician assistant would be the perfect fit. In May 2015, Kim began her graduate training in physician assistant studies at Lock Haven University. She graduated in May 2017 and began her PA career at Penn State Otolaryngology - Head and Neck Surgery in July 2017. Kim has developed a special interest in head and neck cancers, and she is currently pursuing certification in head and neck sonography and fine needle biopsy. In her free time, Kim loves to travel, visit wineries, find new recipes to try on Pinterest and spend time with her family and dog, Stache.
Christopher Lewis is originally from Carroll County, Md., and completed his undergraduate education at St. Mary’s College of Maryland. During his senior year and the year following graduation, he worked as a medical scribe in conjunction with volunteering as an emergency medical technician in Lexington Park, Md. He then obtained certification as a Surgical Technologist and worked at Howard County General Hospital, until he entered the combined Anne Arundel Community College and University of Maryland – Baltimore physician assistant program. He was drawn to central Pennsylvania because his wife was completing her doctorate in neurosciences with Penn State College of Medicine. She is now a William Penn Fellow with the Department of Drug and Alcohol Programs. Christopher started at Penn State Health in February 2017, and his clinical interests include reconstructive surgery and otology. In his former life, he was a hang gliding instructor at Kitty Hawk Kites and an avid rower. He lives in Harrisburg with his wife, Jordan.
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Tiffany Heikel began her medical career as a certified occupational therapy assistant and worked in geriatric and acute rehabilitation for ten years. During that time, she finished her Bachelor of Science in Psychology through Penn State. While working in New York City at the Spine Institute at Beth Israel Medical Center, she became acquainted with the physician assistant profession and found that she enjoyed the team approach to patient care. She entered Arcadia University’s physician assistant program in 2015. At Arcadia, she had the opportunity to travel to Nicaragua for a medical mission through Global Brigades, a sustainable health services providing organization. In May 2017, she graduated with a Master of Science in Physician Assistant Studies and earned Program Scholar honors. Tiffany began working at Penn State Otolaryngology - Head and Neck Surgery in January 2018. For fun, Tiffany enjoys spending time with her family, hiking, camping and going on adventures.
Erin Roy is originally from a rural area of northwestern New Jersey. She moved to central Pennsylvania eight years ago after receiving her bachelor’s degree from Bucknell University. She graduated from Penn State Health’s Physician Assistant Program as part of its inaugural 2016 class. During her clinical training, she spent time in the otolaryngology clinic. Her clinical interest is in pediatric and adult otology. Shaped by her hometown, Erin still loves the outdoors and enjoys being active by hiking, skiing and running. She hopes to officially settle in the Hershey area with the purchase of a new home and is excited to continue her career with Penn State Otolaryngology.
Hear! Hear! Pennsylvania Academy of Audiologists Holds 24th Annual Convention Audiologists from throughout the commonwealth learned the latest testing procedures and advancements in hearing aids and implantable devices at the 24th annual Pennsylvania Academy of Audiology (PAA) convention Oct. 4-6 in Lancaster, Pa. The three-day educational experience provides audiologists with high-quality continuing education from nationally known speakers and fellow PAA members. They also learn about the most up-to-date assistive listening technologies available to patients. Penn State Health’s Director of Audiology, Dr. Beth Czarnecki, AuD, has served as the PAA vice president of education since 2015 and works vigorously throughout the year to plan the convention’s speakers and presentations. The 2017 PAA Convention featured members of Penn State’s Division of Otolaryngology, including Dr. Huseyin Isildak and Audiology extern Stephanie Malone, BS, who presented on Bone-Anchored Hearing Aid (BAHA) devices and the surgical procedures involved. Additionally, audiologist, Jessica Wagner, AuD, presented on the use of video head impulse (vHIT) testing on balance patients. Finally, Dr. Jason May presented on pediatrics and hearing loss.
Dr. Beth Czarneck, Director of Audiology, and Dr. Jessica Wagner speaking at the PAA Convention.
Visiting Professors Dec. 7, 2017 Dhave Setabutr, MD Assistant Professor Bumrungrad International Hospita Bangkok, Thailand Topic: Complex Management of Cleft Lip and Palate
March 8, 2018 Mark Klingensmith, MD Excela Health Medical Group Greensburg, PA
Dr. Dhave Setabutr and Dr. David Goldenberg
Dr. Dhave Setabutr, Dr. David Goldenberg, Dr. John McGinn, Dr. Huseyin Isildak, Dr. Meghan Wilson
Topic: Local Flap Reconstruction
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Alumni News Alumna Hetal Patel, (2016) marries Sandip Patel on Aug. 25 2017, in Bloomington, Ill. From left are Jacquelyn Scott-Oberman, Shivani Shah-Becker, Russel Becker, Sakeena Payne (2017), Ben Oberman (2016), Layla Payne, Hetal and Sandip Patel and Jessyka Lighthall.
Dr. Sakeena Payne (2017), husband Dr. Russell Payne announce the birth of their son, Luke, with and big sister, Layla, on March 8, 2018.
Dr. Neerav Goyal and his wife, Nitya, welcome twins – son, Nalin, and daughter, Naina, on Dec.12, 2017.
Dr. Guy Slonimsky, Otolaryngology-Head and Neck Fellow, and his wife, Dr. Einat Slonimsky, welcome their third daughter, Danielle, to their family on Feb. 19. She joins big sisters Geffen and Yuval.
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Publications, Presentations and Awards Oral Presentations Isildak H. Experiences with novel bone anchored implants. PA Academy of Audiology 24th Annual Convention. Lancaster PA. Oct 2017. Lighthall JG. Alternatives to Free Tissue Transfer: Locoregional Flaps in Head and Neck Reconstruction. Johns Hopkins University lecture to residents. Baltimore, MD. Nov 2017. Lighthall JG. Incorporating Advanced Technology in Facial Plastic and Reconstructive Surgery. Johns Hopkins University, Department of Otolaryngology Grand Rounds. Baltimore, MD. Nov 2017. Cottrill E, Funk E, Goldenberg D, Goyal N. Transoral Thyroidectomy Using a Novel Flexible Robotic System: A Preclinical Cadaver Feasibility Study. Triological Society Annual Meeting. Scottsdale, AZ. Jan 2018. Goyal N. Bringing Endoscopic Pituitary Approaches Into Your Practice. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Lighthall JG. The Difficult Nasal Septum: How to Manage? The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. McGinn J. Use of Topical Therapy is Rhinology. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Goyal N. Reconstructive Flaps for the Non-Microvascular Surgeon. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Isildak H. Surgical Management of Meniere’s Disease. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018.
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Andrews GA. Cutaneous Malignancies for the Otolaryngologist. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. May JG. Congenital Hearing Loss in the Pediatric Population. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Goldenberg D. Current Approach to the Thyroid Nodule and Thyroid Surgery. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Wilson M. Imaging in Children: Radiation Safety and New Technologies. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Lighthall JG. Mandible Reconstruction Novel Techniques and Approaches. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Pellitteri P, Andrews GA, Goldstein B, Schaitkin Barry. My Most Outrageous Cases? The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Panel Discussion. Marco Island, FL. Jan 2018. Andrews GA. Survivorship in Head and Neck Cancer Caregivers. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Wilson M. Chronic Pediatric Cough: Pinning the Diagnosis. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Goldenberg D. Flexible Robotics Technology: The Future of Transoral Robotic Surgery (TORS) is here. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018.
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Publications, Presentations and Awards (continued) Biery J, Kugler K, Mitzner R, Portela RA. Practice ENT: Incorporating Advanced Practice Clinicians into your Practice. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Panel Discussion. Marco Island, FL. Jan 2018. Lighthall JG. Local Reconstruction for Cutaneous Facial Defects. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Biery J, Klingensmith M, Kugler K, Orsini M, Portela RR. Today’s Challenges in Otolaryngology Private and Hospital-Based Practice. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Panel Discussion. Marco Island, FL. Jan 2018.
McGinn J. Endoscopic Management of Inverted Papilloma. The Cutting Edge – Update in Otolaryngology Head and Neck Surgery. Marco Island, FL. Jan 2018. Isildak H. Surgery for Meniere’s Disease. Stony Brook Medicine, Division of Otolaryngology – Head and Neck Surgery. Stony Brook, NY. Feb 2018. Czarnecki B, Isildak H. BAHA Surgeries and Pre-/Post-Audiologic Outcome Measures. Towson University 7th Annual Medical Audiology Symposium. Towson, MD. Mar 2018. Lighthall JG. Do No Harm: The Bell’s Palsy Dilemma. AO North America Faculty Education Program. Chicago, IL. Mar 2018.
Poster Presentations Stahl LE, Stewart R, Carr MM, Goldenberg D, Schubart J. Treatment Preferences and Decision Making in Patients Diagnosed with Indeterminate Thyroid Nodules. American Thyroid Association 87th Annual Meeting. Victoria, BC. Oct 2017.
Lee J, Zacharia B, Ba D, Liu G, Leslie D, Goyal N. Applying big data in head and neck cancer research using MarketScan: a claims-based database. Penn State Institute for CyberScience Symposium 2018: Harnessing the Power of Data. State College, PA. Mar 2018.
Lee J, Zacharia B, Leslie D, Liu G, Ba D, Goyal N. Mental Health Disorders Associated with Sinonasal and Skull Base Malignancies: A Large Cohort Study. North American Skull Base Society Annual Meeting. Coronado, CA. Feb 2018.
Kiell EP, Wilson MN, Buzi A. Management of Orbital Complications in the Pediatric Patient with Acute Rhinosinusitis: Ten Years of Experience at a High Volume Children’s Hospital. American Society of Pediatric Otolaryngologists Annual Meeting at Combined Otolaryngology Spring Meetings. Baltimore, MD. Apr 2018. Adelberg J, O’Connell Ferster AP, Benito D, Sataloff RT. Detection of Muscle Tension Dysphonia Using Eulerian Video Magnification. Combined Otolaryngology Spring Meetings: American Laryngological Association. Baltimore, MD. Apr 2018. Patel VA, Pool CD, Dunklebarger M, Goyal, N. Sinonasal Disease in Total Laryngectomy Patients. American Rhinologic Society at Combined Otolaryngology Spring Meetings. Baltimore, MD. Apr 2018. Adelberg J, O’Connell Ferster AP, Benito D, Sataloff RT. Detection of Muscle Tension Dysphonia Using Eulerian Video Magnification. Penn State Health: Resident Research Day. Hershey, PA. May 2018.
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Publications, Presentations and Awards (continued) Publications Saadi R, Oberman BS, Lighthall JG. Dog-Bite–Related Craniofacial Fractures among Pediatric Patients: A Case Series and Review of Literature. Craniomaxillofac Trauma Reconstr. 2017 July.
Khaku A, Patel V, Zacharia T, Goldenberg D, McGinn J. Guidelines for Radiographic Imaging of Cranial Neuropathies. Ear Nose Throat J. 2017 Oct-Nov;96(10-11):E23-E39.
Patel VA, Oberman BS, Zacharia TT, Isildak H. Magnetic resonance imaging findings in Ménière’s disease. J Laryngol Otol. 2017 Jul;131(7):602-607.
Kim Y, Patel VA, Isildak H, Carr MM. An Analysis of Safety and Adverse Events Following Cochlear Implantation in Children Under 12 Months of Age. Otol Neurotol. 2017 Dec;38(10):1426-1432.
Oberman BS, Patel VA, Cureoglu S, Isildak H. The aetiopathologies of Ménière’s disease: a contemporary review. Acta Otorhinolaryngol Ital. 2017 Aug;37(4):250-263.
Wilson M, Snyderman C. Fibro-osseous lesions of the skull base in the pediatric population. J Neurol Surg B. 2018 Feb;79(1):31-36.
Patel VA, Carr MM. Congenital nasal obstruction in infants: A retrospective study and literature review. Int J Pediatr Otorhinolaryngol. 2017 Aug;99:78-84.
Wilson M, Snyderman C. Endoscopic management of developmental anomalies of the skull base. J Neurol Surg B. 2018 Feb.79(1):13-20.
Awards Isildak H. Dean’s Teaching Award. Penn State College of Medicine. Hershey, PA. Jan 2018. Wilson M. 2018 American Academy of Otolaryngology – Head and Neck Surgery Guideline International Network Travel Grant Award. Guideline International Meeting. Manchester, England. Sep 2018.
Dr. May was recently recognized by the pediatric PACU nurses for being extremely kind to patients, as well as helpful and respectful to nurses.
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