Tuesday, October
17, 2006
Reves stresses need for research, researchers
Academic panel offers keys to success
Session looks at ASRA recommendations for avoiding infectious complications
Journal announces new Editor-in-Chief, takes post in January 2007
PPM abuse on increase, with unexpected geographic distribution
See you next year
Reves stresses need for research, researchers
Academic anesthesiologists performing important research do exist, but they are far too few in number, according to Emery A. Rovenstine Memorial Lecturer Jerry Reves, M.D.
Dr. Reves, Vice-President for Medical Affairs and Dean of the College of Medicine at the Medical University of South Carolina, Charleston, shared some hard facts with his standing-room only ASA audience on Monday.
“We are a proud group … but it is time to look at transforming the research mission of our specialty,” Dr.
Reves said.
As a specialty, anesthesiology is way down
on the current National Institutes of Health’s
(NIH) list of grantees, tied for last place
with orthopedic surgery.
“This is a list of NIH awards per faculty member in each specialty, and, as you can see, anesthesiology is … at the bottom of the 25 specialties,” Dr. Reves said. “Of
the NIH funding anesthesiologists receive,
half of that is found in only 10 departments.
A majority of our departments are not players
in the NIH arena at all, and this is a very
serious problem for our profession.”
Dr. Reves called research “the lifeblood of today’s universities” and
said anesthesiologists cannot hide from
the fact that the specialty, as a whole,
has allowed its research arm to atrophy
to a dangerous state.
“Our research problem is not one of poor quality, but insufficient quantity,” he said. “We have good researchers in our departments, but there just aren’t
enough of them. Other specialties are getting
out there in the basic sciences and making
discoveries, but there is a reason for that.”
Dr. Reves said the disparity in the number of full professors in anesthesiology is far below the percentages found in other areas of medicine. The root causes for this problem start with the lack of resident anesthesiologists choosing research for a career.
“Academic research is not required by deans, chairs, faculty or the American Board of Anesthesiology,” Dr. Reves said. “Were these (individuals and organizations) to require research during residency, we would certainly have it in our programs. One thing is for sure — residents
do what is expected of them.”
This issue is exacerbated by the fact that it has existed for some time, thinning the ranks of experienced researchers and creating an environment that feeds into the downward spiral anesthesiology is now experiencing from a research standpoint, Dr. Reves said.
“I think we need to ask ourselves whether we run trade schools or professional ones?” he
said.
Of course, financial issues are also tied into the picture. According to Dr. Reves, the average income for the average anesthesiologist in private practice is roughly $75,000 above the NIH cap.
“So even if these guys are fully funded, an anesthesiologist would make significantly more in private practice,” he
said. That leads to some tough choices.”
But however bleak a picture it is, Dr. Reves said the problems can be addressed with hard work and a palpable paradigm shift.
“For the good of our patients, we need to be explorers in this exciting new world,” he said. “We
have done too little for too long, but the
good news is that it is not too late.”
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Academic panel offers keys to success
Ascending through the academic ranks can be a daunting task, but ASA is here to help mark a clear path.
Monday’s “Secrets to Success in an Academic Career” professional
issues session offered up a panel of expert
academicians to do just that.
Moderator Lois L. Bready, M.D., Professor
of Anesthesiology at the University of
Texas Health Science Center, San Antonio,
led off the session with “Teaching: How
to Document It and Make It Count for Promotion.”
“Obviously we need to recruit and retain good people in the academic environment,” Dr. Bready said. “We want to help you expand your ability to get promoted in the academic environment … and
you need to understand that rising through
the ranks is a team sport.”
Dr. Bready and her panelist colleagues — Rosemary Hickey, M.D., Peter Rock, M.D., M.B.A., and Rita M. Patel, M.D. — outlined
the key areas that make educational institutions
take note and promote.
“You need to know the rules ... and the promotion guidelines,” Dr. Bready said. “Knowing
what is going to get you a promotion is absolutely
fundamental.”
Dr. Hickey, Professor of Anesthesiology
at the University of Texas Health Science
Center, talked about the three important
components in the ladder to academic success
for anesthesiologists — research, teaching and service — focusing
on the best way to choose service opportunities.
“Service is the major thing we do,” she said. “It is an important leg for promotion. But you’re
going to have to make choices.”
Dr. Rock, Vice-Chair of Anesthesiology
at the University of North Carolina at
Chapel Hill, gave his talk on “Specialization
and Research: Paths to Academic Success.”
“Everyone can be an expert in something,” Dr. Rock said. “But
you need to look for opportunities to become
that go-to specialist.”
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Session looks at ASRA recommendations for avoiding infectious complications
Hand washing, using
sterile gowns, putting on gloves — the
process is routine for anesthesiologists.
While this inventory of responsibilities
has become second nature, concern for infectious
complications with regional anesthesia
is first and foremost.
During a Monday morning panel discussion, James R. Hebl, M.D., M.S., updated Annual Meeting attendees on the findings and recommendations from recent American Society of Regional Anesthesia and Pain Medicine (ASRA) practice advisories on serious complications for bacterial catheter colonization in regional anesthesia.
While the tenet of hand washing is the most important technique in prevention, said Dr. Hebl, studies show that those who do not remove their jewelry have higher microbial counts.
Even though wearing sterile gloves provides a sterile barrier, microbial counts can occur in glove use, as they leak and provide an avenue for contamination to both provider and patients, said Dr. Hebl, Assistant Professor of Anesthesiology at the University of Minnesota Medical School, Minneapolis.
“We know that masks protect health care workers from blood droplets and blood-borne pathogens, but their role in protecting patients is much less clear,” said Dr. Hebl, who added that friction from moving one’s
mask during procedures may allow microscopic
particles to contaminate the surgical field.
After describing the advantages and disadvantages of povidone iodine and chlorhexidine, he said that the ASRA recommendations state that chlorhexidine gluconate will significantly reduce the likelihood of catheter and site colonization.
In febrile or infected patients, he noted the concern for preventing lumbar puncture-induced meningitis.
“Despite conflicting study results, most experts suggest that neural blockade not be performed in patients with untreated systemic infections,” Dr. Hebl said. “The
decision to perform regional anesthesia should
be made on an individual basis by weighing
the risks and benefits against extenuating
circumstances.”
Dr. Hebl said that a patient with evidence of systemic infection may safely undergo spinal anesthesia provided that appropriate antibiotic therapy is initiated prior to puncture, but epidural anesthesia or analgesia remains controversial.
In immunocompromised patients, the range of microorganisms that can cause invasive infection is much broader, he said.
“Their altered inflammatory responses may mute the clinical signs and symptoms of infection,” Dr. Hebl said. “They
often need prolonged therapy because their
host defenses are mechanically altered. Anesthesiologists
should have a high index of suspicion.”
Among potentially immunocompromised patients are some parturients. ASRA recommends that epidural anesthesia or analgesia does not appear to increase the risk of infectious complications in women with recurrent HSV type-2, he said, and epidural opiods may increase the risk of HSV type-1 reactivation.
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Journal announces new Editor-in-Chief, takes post in January 2007
James C. Eisenach, M.D., M.S., longtime editor for Anesthesiology, has been named Editor-in-Chief of the journal. Dr. Eisenach, the F.M. James III Professor of Anesthesiology in the Section of Anesthesia at Wake Forest University Medical Center, Winston-Salem, North Carolina, will take his post in January 2007.
His predecessor, Michael M. Todd, M.D., said that the selection of Dr. Eisenach, whose contributions to Anesthesiology began in 1991, as editorial leader of the publication was superb.
“His long association with the journal — as an editor, reviewer and author of well over 100 papers published in the journal — as well as his international reputation as both an obstetrical anesthesiologist and pain pharmacologist have prepared him well to deal with both the operational challenges of the journal and to move its scientific status to an even higher level,” said
Dr. Todd, Professor of Anesthesiology at
the University of Iowa, Iowa City.
Dr. Eisenach’s goals for the journal include
building on its international flavor and
increasing its Web presence.
“The number of submissions coming from abroad is increasing, allowing us to expand the number of editors and associate editors from Europe and Asia,” he said. “The
journal has become very Web friendly, and
my goal is to continue to provide information
in this format.
“The journal’s high status among scientific journals is due to Dr. Todd’s
leadership, and I can only go one direction
from there.”
Reaching physicians in training and physicians
in clinical practice via a more attractive
and easily accessible designer is also
on Dr. Eisenach’s radar for the journal.
Beyond his goals for Anesthesiology, which
is staffed by 13 editors, 35 associate
editors and five editorial office personnel,
he said that he is excited about the journal’s
role in elucidating training and scopeof-practice
issues.
Dr. Eisenach earned his master’s degree
Phi Beta Kappa from the California Institute
of Technology, Pasadena, and his medical
degree in 1982 from the University of California,
San Francisco. He was a medical intern
at Mt. Zion Hospital, San Francisco, anesthesiology
resident at the Mayo Clinic, Rochester,
Minnesota, and fellow in obstetric anesthesia
at Wake Forest University.
In 1986, he joined the Wake Forest faculty,
and he currently also holds the positions
of Vice-Chairman of Research in the Department
of Anesthesiology and Professor in the
Department of Physiology and Pharmacology.
Dr. Eisenach is also on the associate faculty
for the Women’s Health Center of Excellence
for Research, Leadership and Education
and on the graduate faculty for the Center
of Investigative Neuroscience.
He has devoted much of his time and talents to ASA, serving on several subcommittees and committees, most recently as Chair of the Committee on Excellence in Research. He has been president of the American Society of Regional Anesthesia (ASRA), and he currently is on the board of directors for ASRA. Dr. Eisenach has served the American Board of Anesthesiology, for which he is a Diplomate, in a number of capacities, and he currently is a Senior Associate Examiner for the board.
An invited reviewer for more than 30 scientific
journals, Dr. Eisenach serves on the editorial
boards of Anesthesia & Analgesia, the Journal
of Anesthesia, The Journal of Pain and
Pain.
His honors include being named Teacher of the Year by the Department of Anesthesia at Wake Forest, presenting his National Institutes of Health (NIH) research before the U.S. Congress to encourage funding of the NIH and receiving honorary memberships in a number of international societies.
Currently the principal investigator of
five NIH grants, Dr. Eisenach’s research
concentrates on neurophysiology of labor
pain, human pharmacology of spinal analgesia
and drug interactions.
Dr. Eisenach will be in the Resource Center from 3 to 4 p.m. today to meet ASA members.
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PPM abuse on increase, with unexpected geographic distribution
Large areas have a high distribution of abuse, despite the view that drug abuse is associated with the lifestyle of city dwellers.
Researchers at Rush University Medical
Center, Chicago, used data from the National
Survey on Drug Use and Health for 2002–04
to estimate the prevalence of drug abuse
across the U.S. for various illicit and
prescription substances.
What they found regarding PPM abuse surprised them, because its distribution did not follow traditional patterns.
“States with high levels of PPM abuse may not be recognized as such by the local population. The assumption that only those states with high levels of traditional illicit drug abuse should be vigilant is clearly misleading,” said
Mario Moric, Ph.D., a researcher in the Department
of Anesthesiology at Rush.
Distribution of prescription pain medication abuse across the U.S. varied greatly and differed from other seemingly similar drug trends. Prescription pain medication distribution differed substantially from inhalants, heroin and sedatives, was somewhat similar to cocaine and stimulants and was closely related to distribution of tranquilizers.
Furthermore, the researchers found that states with large metropolitan areas (New York, Illinois, Texas and California) did not have a high distribution of abuse, despite the common view that drug abuse is associated with the fast-paced lifestyle of city dwellers.
“Distribution of PPM abuse across the states differs from high-profile street drugs and even particular PPMs such a oxycodone, which has its own specific pattern,” Dr.
Moric said.
He recommends that prescription pain medication abuse be monitored separately from other illicit substances, and the most commonly abused or most problematic PPMs should be monitored individually.
“Clinicians need to be aware of the level
of abuse in their areas and moderate their
vigilance accordingly, Dr. Moric added.
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See you next year
ASA Annual Meeting
Oct. 13–17, 2007
San Francisco, California
Future ASA Annual Meetings
Oct. 18–22, 2008: Orlando, Florida
Oct. 17–21, 2009: New Orleans, Louisiana
Oct. 16–20, 2010: San Diego, California
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