Department of Surgery Newsletter Winter 2019

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“ON THE CUTTING EDGE” NEWS FROM THE DEPARTMENT OF SURGERY 06

Integrating Research Will Distinguish Rutgers NJMS Surgery

08

Dr. Mosenthal Receives Olga Jonasson Award

10

Study Goal to Raise Standards of Surgical Care Around the World

12

First Civilian Doctor to Complete USAF Critical Care Air Transport Training

16

Welcome Dr. Flavio Paterno

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30 DR. ADAM FOX

Rutgers NJMS Surgery Plays Leading Role in “Stop the Bleed” Campaign 20 NJMS SURGERY

#ThisIsOurLane

Root Cause Data of Firearms Injury

24

Prominent National Speakers Highlight Grand Rounds

26

Award-Winning Resident Papers

28

Dr. Melissa Alvarez-Downing Receives Alumni Award

34

ACS Clinical Congress

36

Dr. Edward Lee: New Plastic Surgery Chief

37

Honors and Awards: Dr. David Livingston

The go-to source for the exciting developments and major advances in education, research and clinical missions within our Department.

Contents Honors & Awards

Welcome DR. FLAVIO PATERNO

OLGA JONASSON DISTINGUISHED MEMBER

Highlights DR. EDWARD LEE DR. ADAM FOX

DR. DAVID LIVINGSTON

RESIDENT PROFILE: DR. PETE JOHNSTON

DR. MELISSA ALVAREZ-DOWNING DR. MARK GRANICK

On the Scene

Features

Speakers

RESIDENTS PRESENT AT ACS AWARD-WINNING RESIDENT PAPERS: DR. MICHELE FIORENTINO AND DR. FRANCHESCA HWANG

NATIONAL SPEAKERS AT GRAND ROUNDS

RUTGERS TAKES THE LEAD ON “STOP THE BLEED” DR. STEPHANIE BONNE: NJ CENTER FOR GUN VIOLENCE

Have a great story to tell?

SHARE IT WITH YOUR COLLEAGUES: CONTACT DONNA SHORE, EXECUTIVE ASSISTANT TO THE CHAIR, DSHORE@NJMS.RUTGERS.EDU

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Inside this issue

DR. STEPHANIE BONNE:

NJMS AND THE

DR. ANNE MOSENTHAL:

#ThisIsOurLane Movement

Integrating Research Root Cause Data Will Distinguish of Firearms Injury Rutgers NJMS Surgery for New Jersey Gun Violence PAGE 6

PAGE 20

PAGE 18

DR. PETE JOHNSTON:

DR. ADAM FOX:

Study Goal to Raise Standards of Surgical Care Around the World

First Civilian Doctor to Complete USAF Critical Care Air Transport Training

PAGE 10

PAGE 12

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Welcome New Surgeon: Dr. Flavio Paterno PAGE 16

SURGICAL NOTES FROM THE CHAIR:

Integrating Research Will Distinguish Rutgers NJMS Surgery

By Anne Mosenthal, MD, FACS, Benjamin F. Rush, Jr., MD, Endowed Chair, Department of Surgery

Welcome to the Winter 2019 issue of “On the Cutting Edge.”

I call your attention to the importance of research being highlighted throughout this issue of “On the Cutting Edge.”

Our Residents are “taking center stage” presenting their research at national conferences, conducting award-winning Palliative Care studies, and first-time Global Health reviews of surgical protocols in developing nations.

The Department of Surgery is supervising collection of data of the root cause of gun violence for the New Jersey Center for Gun Violence at Rutgers. Congratulations to Dr. Stephanie Bonne for taking this leadership role.

Our new liver transplant and hepatobiliary surgeon brings an MPH in Biostatistics to organize outcomes research for the division. Welcome, Dr. Flavio Paterno.

These are just a few examples.

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Our residents are receiving regional and national attention for their research presentations at prominent events such as the American College of Surgeons Clinical Congress in Boston last Fall.

Our continued integration of research into clinical areas of

Dr. Pete Johnston, PGY 4, is the subject of our first

excellence is the critical element of academic distinction

“Resident Profile” series. As the first Benjamin Rush, Jr.

that will distinguish Rutgers New Jersey Medical School

Global Surgery Fellow, Pete conducted one of the first

Department of Surgery.

studies to investigate whether U.S. humanitarian surgical

I am particularly interested in research in areas that will improve the health of communities we serve.

I want to expand our concept of surgical research to include patient-reported outcomes research and end of life care.

The downward health spiral elderly people may experience after a fall-related injury is a research opportunity for us. We need to better understand how the elderly value

non-profit organizations were following protocol-based care when operating in developing nations.

National Attention: Rutgers NJMS Surgery is at the forefront of a local, statewide and national “Stop the Bleed” education campaign with Dr. Adam Fox and medical student Brad Chernock.

independence and function compared to prolonging life so

Dr. David H. Livingston, Professor, Division Chief of

the care we provide is aligned with their goals.

Trauma and Critical Care is among the first group of 91

Highlights: Our residents are receiving regional and national attention for their research presentations at prominent events such as the American College of Surgeons, (ACS) Clinical Congress in Boston last Fall.

Dr. Franchesca Hwang, PGY 4, received third place recognition for “Best Resident Presentation” at the American Association for the Surgery of Trauma in San Diego.

Her topic: “Pre-Injury Palliative Performance Scale, PPS, Predicts Functional Outcomes at 6 Months in Older Trauma Patients.”

Dr. Michele Fiorentino, PGY 4, was the winner of the New Jersey ACS Committee on Trauma, (COT) Resident Paper Competition. Her research paper, “Palliative Care in Trauma: Not Just for the Dying.”

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surgeons from seven countries inducted in the inaugural class of esteemed surgeon educators to the new American College of Surgeons Master Surgeon Educators™ as an associate member. Congratulations to David for this recognition of a career devoted to surgical education.

Transitions: Dr. Edward Lee was named the Division Chief of Plastic and Reconstructive Surgery in December, succeeding Dr. Mark Granick, who has assumed a new role as clinical Director of the Wound Care Center at University Hospital.

We are fortunate to welcome Dr. Lee to our leadership team and express our gratitude to Dr. Granick for his service to the Division since 2001.

DR. ANNE MOSENTHAL RECEIVES

Olga Jonasson Distinguished Member Award from AWS “I find it so rewarding to help bring along the next generation of women and men in this job.”

Nearly 30 years after first meeting Dr. Olga Jonasson as her general surgery certifying examiner, Dr. Anne Mosenthal says it is “so meaningful” to be the 2018 recipient of the Olga Jonasson Distinguished Member Award from the Association of Women Surgeons, (AWS) Foundation.

Dr. Mosenthal received the award at the American College of Surgeons Clinical Congress in October. The Olga Dr. Olga Jonasson was a pioneering woman in the field of academic surgical leadership, as the first female chair of an academic department of surgery.

She was the first woman to perform a kidney transplant in 1968 and was a founding member of the National Tissue Typing and Histocompatibility Organization.

Dr. Jonasson was Chief of Surgical Education and Research at the American College of Surgeons.

Jonasson Award is given “to the AWS member, who through outstanding mentorship, enables and encourages

ways, I know I was nominated by several mentees who are in this room and I am incredibly grateful.

I find it so rewarding to help bring along the next generation of women and men in this job.

It is also meaningful that it is in honor of Olga Jonasson. I reached out to her in 2001 when I began to think about palliative care in surgery.

Olga was very instrumental in creating

personal and professional goals.”

our palliative care committee in the

Dr. Mosenthal, Benjamin F. Rush Jr. MD Endowed Chair, Department of Surgery at Rutgers New Jersey Medical School, recalls being “afraid” of Dr. Olga Jonasson when she first met the

American College of Surgeons.

She chaired our first Palliative Care Committee meeting. She was humble and gentle and so wise. It was amazing I got to know her a little bit better.

renowned first woman surgical chair in

An example of her kindness, our first

1989.

committee meeting was September 10,

“I was intimidated by her. She was

implemented the 1983 National

incredibly tall and had this really deep

Organ Transplant Act. As an

voice. I was fortunate or unfortunate to

educator, she won the

have her as one of my examiners when

1971 “Outstanding Educator in

I did my certifying exam in general

America Award.”

surgery. She was really tough, but fortunately, I passed.”

Greg Wimmer, Artist

“This is meaningful to me in several

women surgeons to realize their

She chaired the task force that

Illustration credit:

received the award.

Following are excerpts from Dr. Mosenthal’s remarks as she

2001 in Chicago. After the meeting I flew home to New York City. The next day was September 11. The one person who called me to see if I was okay was Olga Jonasson. I have been moved by that gesture ever since.

I am so proud and humbled to receive this award in her honor and wish she was here to see this.”

Residents and faculty members celebrate with Dr. Anne Mosenthal, Chair, Department of Surgery, after she received the Olga Jonasson Award.

“The award is given to the AWS member, who through outstanding mentorships, enables and encourages women surgeons to realize their personal and professional goals.�

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DR. PETE JOHNSTON:

Study Goal to Raise Standards of Surgical Care Around the World EDITOR’S NOTE: This is the first in a series of profiles of residents at Rutgers NJMS Surgery.

Have a suggestion for a resident story?

Contact Donna Shore, dshore@njms.rutgers.edu

“I learned to look at everything as a problem to be solved, like a puzzle.”

During his undergraduate days

whether U.S. humanitarian surgical

Most commonly, deviations from

studying biomedical engineering at

nonprofit organizations were

standard U.S. practice were reported

Columbia University, Pete Johnston

providing protocol-based care when

in pain management, pre-operative

“learned to look at everything as a

operating in developing nations.

workup and operative technique

problem to be solved, like a puzzle.”

As the first Benjamin Rush, Jr. Global Surgery Fellow, Dr. Pete Johnston, applied this approach to the research he presented in October at the American College of Surgeons 2018 Clinical Congress.

Announcing findings that at least a third of respondents reported that deviation from the U.S. standard of care was common, Dr. Johnston found that 85 percent of such organizations were

which Dr. Johnston attributed in part to on-site resource limitations. “But we may be able to come up with guidelines that should be universally followed, such as perioperative antibiotics.”

interested in using consensus

Study co-authors included Rijul

Dr. Johnston and Rutgers New

guidelines to improve surgical care,

Asri; Vennila Padmanaban, MD;

Jersey Medical School conducted

and 77 percent were interested in

Patricia Dalton, JD and Ziad C.

one of the first studies to investigate

contributing.

Sifri, MD, FACS.

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“... people are willing to break out of their silos, to see what everybody is doing, willing to work together, being open-minded and willing to help those struggling on their own.”

During his Global Surgery Fellowship from 2016 to 2018, Dr.

In a blog Dr. Johnston wrote for the Association of Academic

Johnston observed “lots of ways to go about addressing the

Surgeons, he addressed “a sense of responsibility we have

lack of access to surgical care in developing countries.”

to audit ourselves to measure actual impact before we pat

Discovering a 2016 paper that reported 400 non-

ourselves on the back for a job well done.”

governmental organizations providing humanitarian surgical

Dr. Johnston described staying behind alone following a

care, Dr. Johnston said, “It got me wondering if there were

surgical mission to Ghana for an additional week to provide

data on guidelines for clinical practice.”

follow up after the surgical team had completed 58 free

He created a survey “with these questions in mind to study how clinical practices deviated from normal standards of care in the United States.”

Ziad C. Sifri, MD, FACS, Director, Office of Global Health at NJMS, said, “The ultimate goal is to enhance the quality of care for everybody. Standards of care and aiming for best practices will move quality of care overall. Then we can have progressive improvement, raise the bar and standardize care for all NGOs.” (non-governmental organizations) A University Hospital trauma surgeon and Associate Professor of Surgery at Rutgers NJMS, Dr. Sifri said a

operations to reassure himself that the patients would recover adequately.

He saw 40 patients postoperatively the first day, and ultimately all 58, discovering clean incisions and only a few minor complications he could treat.

“I left with a sense of closure. I could sleep soundly knowing not only that our patients were well, but we did not burden the local staff with extra work or complications.”

surprise outcome of the study was “people are willing to break out of their silos, to see what everybody is doing, being willing to work together, open-minded and willing to

What’s next for Dr. Johnston?

help those struggling on their own.”

“I’m focusing on finishing my residency and applying for a

Dr. Sifri said, “Pete is bright, smart, a quick learner and

and make it a focus of my future career, I first need to be

independent thinker. I’m impressed he is able to come up

trained well so the local healthcare providers I hope to work

with ideas from his engineering background to troubleshoot

with will actually respect me and want to work with me.”

for intervention, research and problem solve to push the field forward. He is a good ‘people person’ with cultural sensitivity to best connect with local community and hospital staff and gain feedback from local health care workers on things we can improve.”

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trauma/critical care fellowship. To succeed in global surgery

DR. ADAM FOX:

First Civilian Doctor to Complete USAF Critical Care Air Transport Training “Remember that scene from ‘An Officer and a Gentleman’ where they are playing cards and patty cake in the altitude simulator at 25,000 feet? So, I saw what hypoxia can do to me and my patients as part of my flight physiology training.” Dr. Adam Fox The cramped quarters of a “Flying ICU” in the rear of a U.S. Air Force C-130 airframe was part of a two-week program this spring as trauma surgeon Dr. Adam Fox became the first civilian physician trained to “elevate” his critical care experience to a “higher level.”

The U.S. Air Force “recruited” Dr. Fox to train as part of CCAT, the Air Force Critical Care Air Transport Teams. The Air Force is expanding its capability to evacuate critically injured military personnel in “forward areas” anywhere in the world.

Dr. Fox, Assistant Professor in the Department of Surgery at Rutgers New Jersey Medical School, is a member of the Trauma Critical Care Team of the National Medical Surgical Response Team, and the Mobile Acute Care Strike Team of the National Disaster Medical System. Dr. Fox has experience providing emergency surgical and critical care around the world.

Dr. Fox trained to serve in a three-person

Practicing with computer-controlled patient

CCAT crew as the critical care physician,

mannequins in an aircraft simulator, Dr. Fox

along with a critical care nurse and a

and his team were challenged to adapt

respiratory therapist. CCAT teams fly into

to the changing conditions of critically

what the Air Force terms “combat theaters

ill “patients” affected by high altitude air

as close to the point of injury as possible.”

transport in tight quarters amidst turbulence,

The CCAT mission is to deliver critical care to stabilized, ventilator-dependent patients

temperature changes and noisy engines that challenge communications.

with traumatic injuries to help speed transport to hospitals in the United States, often within 36 to 72 hours.

The Air Force says replacing its “forward area” footprint of ground-based hospitals with flying CCAT teams has improved care and saved lives of injured soldiers. Some 40 percent of the patients have suffered bilateral lower extremity amputation from explosive blasts.

CCAT teams manage military patients with multi-system trauma including TBI, burns, gunshot wounds and respiratory failure.

The Air Force envisions deploying CCAT teams to mass casualty events in homeland security situations.

Dr. Fox participated in the first two weeks of a four-week training with the 711th Human Performance Wing in the U.S Air Force School of Aerospace Medicine lab at Wright Patterson Air Force Base, Ohio and

“It was a phenomenal experience. The people who do this are amazing.

I am in awe of them.

They are remarkable people. I loved it so much, I looked into joining the Air National Guard, but I am too old and too busy. However, I am now prepared, and 100 percent committed to respond with my team if we need to be deployed with the Air Force in a disaster somewhere.”

at C-STAR, the Center for Sustainment of Trauma and Readiness Skills at the University of Cincinnati Hospital.

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Professional Profile Flavio Paterno, MD, MPH, FACS -

Liver Transplant and Hepatobiliary Surgery Associate Professor, Surgerysion

Medical School -

University of Palermo Medical School

Residency -

University of Palermo Medical School

Residency -

General Surgery

Fellowship -

Yale University, New Haven, Connecticut

Multi-Organ Transplant Surgery

Baylor University Medical Center, Dallas, Texas

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Welcome Dr. Flavio Paterno, LIVER TRANSPLANT AND HEPATOBILIARY SURGEON Dr. Flavio Paterno, MPH, FACS still remembers the fascination of seeing his first liver transplant surgery. “It was love at first sight. You remove the old diseased, scarred liver and put in the

“It was love at first sight, I want to do it again and again.”

new one. At the beginning the new liver is cold and pale, then you connect all the vessels, remove the clamps and the liver comes back to life, pink and warm.

The most gratifying thing is that whenever I see a patient with end stage liver disease, after transplant, they get a new chance at life. They would die otherwise. They get to go back to family, to see children and grandchildren grow up.”

Dr. Paterno, Associate Professor of Surgery, comes to Rutgers New Jersey Medical School from the University of Cincinnati College of Medicine in the Division of Transplant Surgery.

He is excited about “the opportunity here to help build a great program,” with the liver transplant team headed

by Dr. James Guarrera.

Dr. Paterno was part of an expanding liver transplant program in six years at Cincinnati that tripled its volume.

“It takes time, we worked up recipients, found good donors, optimized organs

outcomes research, to improve outcomes and deliver better quality health care using data base analytics and research into health care disparities.”

The move to New Jersey is also a chance for Dr. Paterno, his Connecticut native wife, and their two young children to be closer to her family.

and developed referrals and took good

Growing up in Italy, Flavio liked

care of patients.”

science and biology and chose

In New Jersey, Dr. Paterno says, “With the population here, there is an opportunity to assure health care for people in need. I am sensitive to the fact that in liver failure you should try to give a chance to everybody who needs it. I appreciate that it is part of the mission here at Rutgers and University Hospital to care for everyone.”

While in Cincinnati, Dr. Paterno earned a Master’s in Public Health in Biostatistics. “My main fields are

medical school “to use science to help other people.” He chose to pursue residency in the United States because of its leadership in liver and kidney transplantation.

“I came for training in America as a good opportunity to do research and develop in the field of transplantation.”

DR. STEPHANIE BONNE:

Looking for Root Cause Data of Firearms Injury for Rutgers Gun Violence Research Study Dr. Stephanie Bonne, like many trauma surgeons,

Dr. Bonne, Assistant Professor, of Trauma and Critical

is often the last line of defense for victims of firearms

Care Surgery at Rutgers New Jersey Medical School, is

injuries. But now thanks to a State of New Jersey grant

working with the Rutgers Biostatistics and Epidemiology

to Rutgers University, Dr. Bonne will help lead a new

Center and state agencies to cast a wider net of the

effort to look at root causes and find solutions in a

scope of firearms injuries.

public health study of gun violence.

She said the challenge of gathering firearms injury data

The New Jersey Center on Gun Violence Research,

is that there are so many variables to the way gunshot

based at Rutgers, gathers the University’s resources

injuries are reported.

and expertise in public health and criminal justice to study causes, consequences and solutions to firearmrelated violence such as homicides, assaults, suicides and accidental shootings.

“We’re not trying to advocate for particular policies in the study. We want to understand what we can do to bring down gun violence within the system and the laws in which we operate in New Jersey.”

As the study’s Surveillance Core Director, Dr. Bonne’s job is to develop comprehensive data on firearms injury in New Jersey. “The problem with the firearms injury data is that it is pretty incomplete. It is not hard to count the dead bodies, but we know we are missing at least half of all firearms injuries.”

“Not all non-fatal gunshot injuries present to the same level of care. Some may go to urgent care or emergency room, but not a trauma center. Some gunshot victims die at the scene and don’t go to the hospital. They are not part of firearms injury data in vital statistics reported to the department of public health.”

Inconsistencies with billing and coding information may not accurately capture the full scope of injuries caused by firearms.

“So, if we are missing half the firearms injuries, it makes it hard to look at demographics and patterns. We don’t know the extent of the population in New Jersey being injured until we have the surveillance to build a more comprehensive data set,” Dr. Bonne said.

State funding for one year gets the study underway.

Dr. Bonne is hopeful it will be part of the state budget in the future. “I’m excited and happy that this will be a productive research program going forward.”

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Dr. Stephanie Bonne, like many trauma surgeons, is often the last line of defense for victims of firearms injuries. But now thanks to a state of New Jersey grant to Rutgers University, Dr. Bonne will help lead a new effort to look at root causes and find solutions in a public health study of gun violence.

Former U.S. Rep. Gabrielle Giffords at the announcement of the Rutgers New Jersey Center on Gun Violence Research.

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RUTGERS NJMS TRAUMA AND THE

#ThisIsOurLane Movement A photo of bloody shoes and scrubs on an operating room floor. The empty chair in which a surgeon consoles the grieving family of a gunshot victim. A lacerated liver showing the impact of a bullet wound. By themselves these photos are powerful enough. But as illustrations for the social media movement #ThisIsOurLane, they represent trauma surgeons responding to being told #stayinyourlane by National Rifle Association members on Twitter.

“This was just particularly offensive to us as doctors, being silenced. Our voices are valuable, this is what I see in the operating room.” said Dr. Stephanie Bonne, Assistant Professor, Trauma and Critical Care Surgery at Rutgers New Jersey Medical School.

on the front lines of our nation’s gun violence epidemic. #ThisIsMyLane is a call to action to stand up to the @NRA and all those blocking solutions to this crisis.”

Asked by the Newark Star Ledger to submit a guest column, Dr. Bonne’s headline proclaimed: “Dear NRA, I’m a doctor. My lane? I sit in this chair when I tell parents their kids are dead.”

“This has really riled up a lot of people,” said Dr. Bonne.

“But more than just putting a ‘Band-Aid’ on it, we have to talk about this because people are dying in the meantime.”

Her photos and tweets @scrubbedin and those sent by colleagues, including the lacerated liver photo by Dr. David Livingston, Division Chief, Trauma and Critical Care Surgery, have drawn attention in the national media conversation. Dr. Bonne was interviewed by the Wall Street Journal, National Public Radio and the Dr. Oz television program.

New Jersey Governor Phil Murphy, @GovMurphy tweeted, “Doctors like @scrubbedin of Newark are

...

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...

A photo of bloody shoes and scrubs on an operating room floor.

The empty chair in which a surgeon consoles the grieving family of a gunshot victim. A lacerated liver showing the impact of a bullet wound.

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...

“The #ThisIsOurLane effort is a platform to help get the message out to the masses. There is more that I wanted to talk about on ‘Dr. Oz’ than you can tell in six minutes on TV but putting this in front of a national audience with doctors wanting to make a difference, it is important to help gain traction.”

“I am more interested in building bridges to at risk populations and gun owners. Where there is a gun in the home, there is more gun use in domestic violence and more public health issues. We need more of a grass roots effort to provide public knowledge about gun violence and safety.”

Dr. Bonne tweeted her thanks. “My lane is being grateful for incredible mentors like @dhlivingston and @AnneMosenthalMD and @NJMSDeansOffice and many others who have taught me to manage tragedies and to research the evidence-based solutions. #ThisIsOurLane #ThisIsMyLane.”

... #ThisIsOurLane

More than a month after the first round of #ThisIsOurLane tweets, Dr. Bonne found herself in the operating room on a Sunday morning in December. She tweeted as @scrubbedin: “Good morning @nra! Still in my lane because I’m still operating on GSWs and still trying to find evidence-based solutions. This one did make it, but the wounds, chronic pain, PTSD will last a lifetime. #ThisIsOurLane.”

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...

Prominent National Speakers Highlight Grand Rounds Presentations

Welcoming guest speaker Dr. Jean Emond Dr. Lloyd Brown, Dr. Anne Mosenthal, Dr. Jean C. Emond, Dr. James Guarerra, Dr. Flavio Paterno.

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SPE A K E R S

Jean C. Emond, MD, Thomas S. Zimmer Professor of

Steven K. Libutti MD, FACS, presented, “Surgical

Surgery, Chief of Transplantation Services, Columbia

Management of Primary Hyperaldosteronism” in November.

University and The New York Presbyterian Hospital,

Dr. Libutti is Director, Rutgers Cancer Institute, Vice

presented “Liver Transplantation and Hepatobiliary Surgery

Chancellor for Cancer Programs, RBHS, Professor of Surgery,

are Synergistic” in December. Dr. Emond attended resident

Rutgers, RWJ Medical School and senior vice president of

presentations during a luncheon.

Oncology Services at RWJ Barnabas Health.

Andrea Pusic, MD, MHS, FACS, FRCSC presented,

Julio Garcia-Aguilar, MD, PhD presented “Organ

“Patient-Reported Outcomes in Surgery” in November in

Preservation in Rectal Cancer” in September. Dr. Garcia-

conjunction with plastic and reconstructive surgery grand

Aguilar, is the Benno C. Schmidt Chair, Department of Surgery,

rounds. Dr. Pusic is Professor, Department of Surgery at

Division of Surgical Oncology at Memorial Sloan Kettering

Harvard Medical School and Chief, Plastic and Reconstructive

Cancer Center in New York.

Surgery at Brigham and Women’s Hospital in Boston.

Our residents engaged with Dr. Pusic during lunchtime presentations.

2019 promises an equally exciting Grand Rounds schedule.

DR. MICHELE FIORENTINO, PGY 4

“Her research reviewed palliative care services received by elderly trauma victims which survived hospitalization but were discharged with poor functional outcomes.

The paper concluded that a high proportion of patients with poor outcomes would benefit from palliative care but were not receiving it.”

DR. FRANCHESCA HWANG, PGY 4

“Pre-injury PPS can be used on admission for prognostication of short and long-term outcomes and is a potential trigger for palliative care in older trauma patients.”

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Award Winning Resident Papers “Palliative Care in Trauma: Not Just

Authors: Michele Fiorentino,

to high-PPS patients. Persistent

for the Dying”

Franchesca Hwang, Sri Ram

pain and anxiety were common

Pentakota, David Livingston, Anne

among low-PPS patients despite

C. Mosenthal

improvement in function.

Dr. Michele Fiorentino, PGY 4, was the winner of the New Jersey ACS COT Resident Paper Competition.

“Pre-injury PPS can be used on

Her research paper, “Palliative Care

“Pre-Injury Palliative Performance

in Trauma: Not Just for the Dying”

Scale, PPS, Predicts Functional

reviewed palliative care services

Outcomes at 6 Months in Older

received by elderly trauma victims

Trauma Patients”

who survived hospitalization but were discharged with poor functional outcomes.

Dr. Franchesca Hwang, PGY 4, won 3rd place for the resident paper competition she presented at the

The paper concluded that a high

annual American Association for the

proportion of patients with poor

Surgery of Trauma, AAST, meeting in

outcomes would benefit from

San Diego on September 28, 2018.

palliative care but were not receiving it.

Her research paper, “Pre-Injury Palliative Performance Scale, PPS,

Dr. Fiorentino is the Benjamin F.

Predicts Functional Outcomes at 6

Rush, Jr. Research Fellow, working

Months in Older Trauma Patients”

with Dr. Anne Mosenthal, Chair,

concluded that low-PPS patients

Department of Surgery.

fail to improve over time compared

admission for prognostication of short and long-term outcomes and is a potential trigger for palliative care in older trauma patients,” Dr. Hwang concluded.

“Distinguished Alumnus,” Dr. Melissa Alvarez-Downing Credits Influencers for Success Melissa Alvarez-Downing, MD, FACS, FASCRS Assistant Professor of Surgery Assistant Program Director, General Surgery Residency

Honored to receive a “Distinguished Young Alumnus” award from Sam Houston State University, Dr. Melissa AlvarezDowning remembers the influencers who steered the way to her career today as a colorectal surgeon and Assistant Professor of Surgery at Rutgers New Jersey Medical School.

She credits a role model chemistry professor who

Medical School: Mount Sinai School of Medicine

encouraged her, the biology professor who put an

Residency: Saint Barnabas Medical Center

exposure program on her desk, and the track coach

Clinical Research Fellowship: Surgical Oncology, National Institutes of Health, National Cancer Institute

“I found that throughout all the steps of my training, in

Clinical Fellowship: Colorectal Surgery, Cleveland Clinic, Florida Memberships: Fellow, American College of Surgeons Fellow, American Society of Colon and Rectal Surgeons Society of American Gastrointestinal and Endoscopic Surgeons National Hispanic Medical Association Association of Women Surgeons New Jersey Society of Colon and Rectal Surgeons Fellow, New York Society of Colon and Rectal Surgeons.

application for a minority summer medical school who emphasized determination to realize her potential.

medical school, residency and even fellowship, that having someone you identify with, who encourages you and reaches out and supports you is just so important.

So that’s been part of my professional life, to give back in that way.”

Dr. Alvarez-Downing feels she is at home at Rutgers New Jersey Medical School since coming from Mount Sinai St. Luke’s Roosevelt Hospital in New York. “I first met Dr. Mosenthal at a conference. I told her I was a colorectal surgeon, and she asked me if I wanted a job. I was seven months pregnant at the time and was impressed that she could still look at me as a surgeon despite my obvious pregnancy.

When I reached out a year later, she remembered me, and said she had posted the job. I met everyone, spent time with her, and it seemed like a very good fit for my interest in teaching and community-based medicine and surgery that would tangibly affect people’s lives.

I knew Dr. Mosenthal was a person I could work with, not just work for, which is something special.”

At Sam Houston State University in Texas, Dr. AlvarezDowning was on an academic scholarship and on a four-year Division I student-athlete scholarship for track and cross country. She credits coach Greg Hinze for his encouragement.

“He really believed in me. I was not an ‘all-star’ but he pushed me to reach my potential which was great.

The ways he coached and trained us, I use that a lot now with my residents,” in her role as Assistant Program Director for the General Surgery residency.

Dr. Melissa Alvarez-Downing receives the Distinguished Young Alumnus award from Dr. Dana Hoyt, President, Sam Houston State University.

As a chemistry major, Melissa thought she would study to earn a Ph.D. and teach chemistry, like department chair Dr. Mary Plishkner. “She was a big role model for me.

I worked in her lab and did my thesis with her. But she was very encouraging for me to pursue medicine.”

The summer medical school exposure program for minority students at University of Washington opened Melissa’s eyes that a career in medicine could be hers. “I was with so many other minority people who were successful. Visually for me it was very motivating to see the diverse bunch of people, a lot of women. I felt very comfortable and supported.”

Melissa was accepted to medical school at the University of Texas, Houston. But a flyer from the medical school at Mount Sinai Hospital in New York caught her attention.

“My parents are ‘NuYoricans’ and I had gone with them to New York City as a child and still had family there.

babysitter for Melissa and her husband Stuart Downing’s three children.

In a commemorative video about Melissa by Sam Houston State University, surgery department chair, Dr. Anne Mosenthal, said, “She is well-trained and has a wonderful bedside manner. I’ve had the opportunity to partner with her, taking care of more complicated patients. The patients love her, the families love her. She is particularly interested in education and training the next generation and that is what we are about here.”

As a Spanish-speaking physician, Dr. Alvarez-Downing brings an awareness and a research focus to issues of non-English speaking patients lost to follow-up in postoperative recovery.

There was a lure of the big city for me. I saw myself going to school there.”

Melissa was wait-listed at Mount Sinai. Undeterred, she called the admissions office every week until she got the good news.

Her aunt, “Titi Rose” in Brooklyn was very helpful when Melissa was homesick, and now serves as a loving

“Systems can fail patients who can’t read English, so my patients are grateful I can speak Spanish and help them sort through these issues.”

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DR. ADAM FOX

Rutgers NJMS Surgery Plays Leading Role in “Stop the Bleed” Campaign

Brad Chernock, MS 4

Cesar Grandez, MS 3 used his “stop the bleed” training when a stabbing victim presented in the ER.

“Our patient had multiple stab wounds and was in severe pain. After a thorough evaluation we found no active bleeding. As we were preparing to close the laceration, pulsatile blood began to come out and we had to immediately intervene. Through the Bleeding Control curriculum, I had learned to put pressure on the source of bleeding with my fingers and pack the wound while still maintaining pressure. Through our actions we were able to control the bleeding until we arrived in the operating room for definitive repair.” - Cesar Grandez, MS 3 Dr. Adam Fox and Rutgers NJMS Department

Chernock, a former paramedic and trauma

of Surgery are at the center of the national

surgery physician assistant, worked with

“Stop the Bleed” campaign which has trained

medical school faculty members Dr. Sangeeta

thousands of first responders in addition

Lamba, Dr. Sophia Chen, Dr. Bart Holland,

to 350 New Jersey Medical School Students

Dr. Devashish Anjaria and Dr. Christin

like Cesar Grandez.

Traba to present their curriculum at multiple

At a national level, Dr. Fox, Assistant Professor, Surgery, is chairing the subcommittee on dissemination and outreach for the American College of Surgeons, Committee on Trauma, “Stop the Bleed” program.

Locally, in partnership with the University Hospital Foundation and University Hospital EMS personnel, Dr. Fox and Rutgers NJMS provided training and bleeding control kits for school nurses in the Newark Public Schools.

Now a Rutgers NJMS bleeding control curriculum has the opportunity to “go viral” as a model for medical schools across the county. Fourth-year medical school student Brad Chernock worked with Dr. Fox and NJMS faculty and leadership to create a bleeding control curriculum guide.

conferences including the AAMC Northeast Group on Educational Affairs and NJ American College of Emergency Physicians conferences.

Through this curriculum medical students have an opportunity to become instructors, so they can train the public.

“Stop the Bleed” grew out of a surgeon-led review of the response to the Sandy Hook Elementary School shooting rampage that killed 27 people in 2013. A key finding, that first responders should be able to engage more quickly to provide care also looked at the role of lay people as “immediate responders.”

“First we teach direct pressure, wound packing for deeper holes, and then proper use of a tourniquet.” Dr. Fox said he is working on a research project from a public health initiative to study the impact of public training and equipment on bleeding control.

Dr. Adam Fox was the guest speaker at his alma mater, Binghamton University, and received the university’s “Edward Weissband Distinguished Alumni Award for Public Service” for his leadership in bringing the “Stop the Bleed Campaign” which has trained more than 1,000 people at the school.

The concept that “no one should die from uncontrolled bleeding,” became an impetus for training and equipment for the public as “immediate responders,” to mass casualty events.

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“The basics of ‘stop the bleed’ are two-pronged: education and then equipment.

Last year, Dr. Fox returned to his undergraduate alma mater, Binghamton University, for a bleeding control program in partnership with the university and the student-run volunteer ambulance program. He also presented “Stop the Bleed” at the

At a NJMS Mini Medical School event, 100 high school

National Collegiate EMS symposium there.

students received bleeding control training. The CESL

Binghamton University engaged a state senator who obtained $25,000 in grant funding to help purchase 162 bleeding control

students are reaching out to employers such as Blue Cross Blue Shield for staff training in bleeding control.

kits installed in campus locations that have an AED unit. Now

Dr. Fox is encouraged by the spread of the bleeding control

more than 1,000 Binghamton University faculty, staff and

training programs. The TV show “Code Black” included a

students are trained in bleeding control.

segment on bleeding control in a recent episode. He notes

“Binghamton University is a national model. They are the first college in the Northeast to be bleeding control-compliant,” said Dr. Fox. The University has since recognized Dr. Fox as the recipient of the Edward Weisband Distinguished Alumni Award for public service.

At Rutgers NJMS, Brad Chernock is passing the training program on to medical students, Peter Alshari, Spandana Maddukuri, Wissam Nasser and Priya Kantesaria.

Through CESL, the Community Engaged Service Learning program, medical students are being trained to teach their peers and conduct training programs for the public.

that the National Football League’s New England Patriots have produced a public service announcement bleeding control video and trained its stadium staff in bleeding control.

“I wish there was no need for this, but there is a need to get more people trained before the next big disaster, so I’m willing to keep doing more.”

St o p th e Ble ed

The deaths and horrific blast wounds from the Boston Marathon Bombing further demonstrated that bleeding control training needs to be more widespread.

Rutgers NJMS Residents Present at ACS Clinical Congress Rutgers NJMS residents took center stage at the ACS Clinical Congress in Boston in October

Dr. Gregory Grimberg, PGY 5, “Challenging and Unusual Problems in Surgery” (left)

Dr. Ketan Thanki, PGY 4, “Colon and Rectal Surgery.” (below)

Dr. Lloyd Brown and Dr. Nina Glass are inducted into the ACS. They are joined by NJ ACS Governors, Dr. Anne Mosenthal and Dr. Frank Padberg.

Dr. Pete Johnston, PGY 4, “Global Surgery and Humanitarian Outreach.” (right)

Dr. Jacob Schwartzman, PGY 4, “Techniques in Robotic Surgery.” (below)

Dr. Edward Lee NEW DIVISION CHIEF, PLASTIC SURGERY Dr. Anne Mosenthal, Chair, Department

Dr. Mosenthal said, “I also would like to

of Surgery, announced the appointment

express my gratitude to Dr. Mark Granick,

December 10, 2018 of Dr. Edward Lee as

Chief of the Division of Plastic

the new Division Chief, Plastic and

and Reconstructive Surgery since 2001.

Reconstructive Surgery.

Through his leadership he built a nationally

“In this role he will be providing leadership for the Division in quality performance, practice operations, and strategic opportunities. Dr. Lee has a tremendous national reputation for complex reconstructive surgery and we are

and internationally known academic division.

He founded and developed the Integrated Plastic Surgery Residency Program, expanded research to include complex wound care and trauma and oncologic reconstruction.”

fortunate to have him as part of our leadership

Dr. Granick is continuing on as a professor

team,” Dr. Mosenthal said.

and is taking on an expanded clinical role

Dr. Lee graduated cum laude from Georgetown University School of Medicine and completed his residency in Plastic Surgery at the University of Pittsburgh.

In 2012, Dr. Lee was appointed as the Residency Program Director for the Integrated Plastic Surgery Residency.

In 2013, he took on the additional role of

as Director of the Wound Care Center at University Hospital. He plans to continue to be actively involved in the residency education program and academic research of the Division.

“Please join me in supporting Dr. Lee in his new role and thanking Dr. Granick for his service.”

Plastic Surgery Section Chief at the Veteran’s Administration New Jersey Health Care System in East Orange.

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H I G H LI G HTS

Honors and Awards science and practice of education across all surgical specialties.”

Academy members are expected to “identify, recognize and recruit innovators and thought leaders committed to advancing lifelong

Dr. Mark Granick, “Gamechanger of the Year, USA”

surgical education; translate

Dr. Livingston Receives Two National Honors Dr. David Livingston has been admitted to the new American

innovation into actions; offer mentorship to surgeon educators; foster exchange of creative ideas; disseminate advances in surgical education and positively impact the quality of surgical care and patient

Dr. Mark Granick, is the recipient of the 2018 ACQ5 Global Award for “Gamechanger of the Year, USA” in recognition of his

safety.”

15 years of work introducing

Academy of Master Surgeon

Dr. David Hoyt, FACS, ACS

plastic surgery and wound

Educators ™ and has been

Executive Director, said, “This is an

care disciplines.

selected to serve on the National

important time in medicine for such

Quality Forum Trauma Outcomes

an accomplished and innovative

Committee.

group of surgeon educators to come

College of Surgeons, (ACS)

Dr. Livingston is one of just 91 surgeons from seven countries admitted to the inaugural class of The Academy of Master Surgeon Educators.

The Academy is part of the ACS, American College of Surgeons Division of Education. The Academy was established “to recognize the highest level of achievement in the field of surgical education and to create a vibrant community that will take this field to unprecedented heights.”

The goal of the Academy is “to play a leadership role in advancing the

together. Underscoring the critical importance of surgical education in a changing health care environment will be one major focus for the work of the Academy.”

Dr. Livingston is the Wesley J. Howe Professor and Chief of Trauma and Surgical Critical Care. A graduate of Albany Medical College, Dr. Livingston conducted his surgical residency at New York University Bellvue Hospital Medical Center. He completed his trauma fellowship at the University of Louisville.

Dr. Livingston has held leadership positions in the Western Trauma Association and the American Association for Surgery of Trauma.

new technologies to the

On a Personal Note CONGR ATULATIONS IT’S A GIRL!

Congratulations to Preliminary PGY-2 resident Najib “AJ” Allabadi and his wife Leslie on the birth of their baby girl Elianna! Thank you to all the residents, attendings and staff who supported AJ by allowing him to be with his wife and family during this time.

February 10, 2019 at 1:06 pm; 7 lbs 2 oz.

CONGR ATULATIONS IT’S A BOY!

Former Resident Takintope “Tope” Akinbiyi had a boy!

The family are all back home and everyone is doing well (and predictably tired)!

December 29, 2018; 6 lbs 9 oz.

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C o py r i g h t 2 019 R u t g e r s , T h e S t a t e U n i ve r s i t y o f N e w J e r s ey, a n e q u a l o p p o r t u n i t y, a f f i r m a t i ve a c t i o n i n s t i t u t i o n . A l l r i g h t s r e s e r ve d .

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Vol. 1, No. 3 W IN T ER , 2019