Gas Pipeline Fall 2016

A Message from the Chairmain

As 2016 comes to a close, this has been another extraordinarily successful year for the department. We have had continued clinical growth in the operating room, in pain medicine, in critical care, in obstetrical anesthesia, and in our satellite locations. We have expanded our faculty, both in the clinician educator line and in the more research-focused faculty lines. We have had record clinical profitability, allowing us to support our educational and academic programs. We have implemented the perioperative surgical/interventional home (PSH) concept at Stanford with an emphasis on care pathways in multiple areas, resulting in improved patient outcomes and decreased lengths of stay. We again had a spectacular residency match, with similar superb matches in all our fellowship programs. We continue to lead the country in residency training, with our extensive simulation programs, the Learnly Foundations programs, our daily didactic teaching, and the excellence of our multiple rotations. This year we will be adding a perioperative medicine rotation which includes co-management of surgical patients, and we will be expanding our residency training in leadership and related competencies. The FARM research track in our program continues to graduate residents who will become leaders in academic medicine. The Medicine X conference this year resulted in over 20 million social media impressions and was the most widely discussed academic conference in the world. We have continued to expand our research programs in terms of breadth, depth, and national impact. This year we had record NIH research funding, and we have been ranked among the top 4 programs in the country for each of the past five years. Our research is highly cooperative and translational, and should result in the development of new anesthetics, advances in personalized medicine in anesthesiology and in pain medicine, methods to decrease injury from stroke and myocardial infarction, techniques to replace failing organs, methods to prevent and alleviate chronic pain, and interventions to improve outcomes after trauma and surgery and in critically ill patients.

As we celebrate this year’s success, it is important to think about what will change in future years. One change will be the opening of the new pediatric tower next year and the new adult hospital the following year. These new buildings will not only provide state-of-the-art facilities but will increase hospital beds by 30%, OR rooms by 40%, and ICU beds by 50%. This expansion will provide opportunities to increase residency training and to recruit new faculty. We plan a small increase in our resident numbers which will allow more non-clinical rotations and a major increase in clinical electives.  Faculty recruitment will allow more subspecialty expertise as well as expansion of our educational and research programs. In addition to the new hospital buildings, we are expanding activity at our current satellite locations, will open an ambulatory surgery center in Emeryville in the spring, and anticipate involvement at ValleyCare in Pleasanton in the future.

Our clinical profits during the past decade have been the result of a unique Stanford funds flow system where the hospital pays the department an ASA unit value which is significantly greater than collections. This has been possible because our adult and pediatric hospitals have had record profits during this time. However, the hospital business is cyclical, so future changes may limit their ability to sustain the current funds flow system. In addition, our payment from the hospital is based on the net income per ASA unit in private practice, and the growth of large practice groups may result in a decreased value.  Finally, with the recent presidential election, there is great uncertainty around the future of the current health care system and reimbursement models for professional and for hospital services. We therefore need to be prepared for change. Fortunately, we have used our profits over the past years to increase our financial reserves, so that we will be able to continue investment in education and academic programs while maintaining faculty salaries even with decreases in revenue.

As we start a new year, we should look back with pride on our accomplishments during the past year and look forward to continued success in the future, both individually and for the entire department.

2nd Back Pain Day

Presenters in the morning sessions, from left: Dr. Heather King, Dr. Beth Darnall, Dr. Sean Mackey and Dr. Jordan Newmark 

Back pain is the most common type of chronic pain, and the single leading cause of disability in the world. More than 26 million Americans suffer from it. The cost of treatment in the US last year was $50 billion. As a leading center in pain treatment, Division of Pain Medicine launched Stanford Pain Day in 2015 which received coverage from Good Morning America on ABC. Although doubled capacity this year, the 2nd Stanford Back Pain Day was “sold out” long before the event.

“This is great information so relevant for today's pain sufferers and health care providers alike”, commented by Dr. Margaret Aranda, a physician-turned-patient and well known author. “Thank you for increasing awareness and providing great Patient Education”

At the end, Dr. Mackey also reminded the audience of the main points highlighted in the Institute of Medicine's report on chronic pain and a follow-up action plan, the National Pain Strategy, underlining key areas of chronic pain treatment. Successful implementation of this action plan will allow clinicians to “treat chronic pain as a chronic disease…., and as a public health crisis”. 

Dr. Mackey’s presentation

The aim of this event was to educate back pain sufferers, and provide them with an improved understanding as well as tools for their managing the condition. The co-chairs are well-known leaders in the field, Dr. Sean Mackey and Dr. Beth Darnall.

Participants at the 2nd Stanford Back Pain Day

The day was organized around short presentations by specialists on Pain and the Brain, Movement as Medicine for Back Pain, The Psychology of Pain, Sleep Your Way to Pain Relief, Medication Safety, and Cutting Edge Procedures for Back Pain. The audience could consult these experts on the spot. 

Stanford Back Pain Day Recording

The full day event was record and is available at YouTube.

Medicine X

5 years on, Stanford Medicine X is going stronger than ever

When Dr. Larry Chu started Medicine X as its Executive Director, he had a vision to build the platform as a catalyst for new ideas about the future of medicine and health care. 5 years on after 5 annual conferences, the initiative has reached more than 20 million people and arguably become “the most-discussed academic medical conference in the world”. 

Dr. Chu at the opening of 5th Stanford Medicine X Conference

From an "Annual Meeting” to “a Global Movement", as many key participants put it, Stanford Medicine X explores how emerging technologies will advance the practice of medicine, improve health, and empower patients to be active participants in their own care. Patients are the most underutilized resource, and they have the most at stake. Including the patient voice has moved providers beyond knowing how to treat a disease to learning what it is like to live with a disease. This has enabled the Stanford initiative change how health care providers and patients engage with and learn from one another by amplifying the patient voice in academic medicine. 

A patient at Medicine X

Participants after sessions with Zoe Chu, Chief Mascot & Evangelist, Medicine X

Precision Anesthesia

Precision/personalized medicine is the future of health care. It begins with the observation that individuals vary in their genetic makeup and that their diseases and responses to medications differ as a result. Its success stories in cancer and rare genetic diseases have already transformed lives. So is Anesthesia an area where the future is also P. medicine? Dr. Eric Gross says yes, and he has obtained a NIH grant to develop precision medicine for Asian Americans requiring anesthesia and analgesia, with co-investigators Jim Trudell (Anesthesia) and Daria Mochly-Rosen (Chemical and Systems Biology).

Many people of East Asian ethnicities have facial flushing and increased heart rate when drink alcohol. This is due to a point mutation in aldehyde dehydrogenase 2 (ALDH2*2), the most frequent variant in humans (8% of the world's population, or approximately 560 million people). Beyond the benign response to alcohol, this variant has only recently been recognized as having a major impact on human health and disease and resulting significant differences in outcome measures. For instance, ALDH2 contributes a critical role in the metabolism of nitroglycerin which is commonly used intraoperatively for vasodilation. Surgical patients also receive alcohol injections during procedures such as septal ablation for hypertrophic obstructive cardiomyopathy, embolization surgeries, and neurolysis for pain control. ALDH2*2 variant contributes to nociception, providing a genetic explanation for the differences in pain behavior such as more responsive to painful stimuli for Asians compared to other ethnicities, as Dr. Gross and his collaborators published two years ago in Science Translational Medicine. The findings made the cover of the prestigious journal, as it has broad implications, for example, on post-operative pain management.‡

Patients with the ALDH2∗2 mutation are at risk for a wide range of health concerns.

Physician anesthesiologists evaluate, monitor and supervise patient care before, during and after surgery. This makes them uniquely qualified to develop and practice precision anesthesia for Asian Americans with ALDH2*2 variant. Dr. Gross received the inaugural Maximizing Investigators’ Research Award from National Institute of General Medical Sciences to provide targets, treatments, and models to study reactive aldehydes and enable specific treatment strategies to reduce organ damage caused by reactive aldehydes during surgery. Among over 300 applicants, he is the only anesthesiologist in the country who received the award. His Co-Investigator on the grant, Dr. Daria Mochly-Rosen, has already established the Stanford-Taiwan ALDH2 Research (STAR) consortium, which will be having its third annual meeting in June 2017.

Dr. Gross at the 2nd Stanford-Taiwan ALDH2 Research (STAR) consortium meeting with Drs. Che-Hong Chen and Yasuki Kihara

“To deliver the right treatment at the right time, every time, to the right person”, Dr. Eric Gross projects, “standard of care for surgical or procedural interventions may eventually mandate genotyping Asian Americans for the ALDH2*2 variant and using big data tools and platforms like the Stanford Translational Research Integrated Database Environment”. Combining big data and personalized or precision medicine, two “sexiest” approaches of the 21st century, anesthesiologists continue to be at the forefront of defining ways to benefit from the changing healthcare environment.

Index

Laura Simons

Laura Simons is a psychologist who joins the department after spending 10 years at Boston Children’s Hospital. In addition to spending a portion of her time in the Pain Management Clinic at Stanford Children’s Hospital, Laura directs the Stanford Biobehavioral Pediatric Pain (SBPP) Lab. SBPP focuses on psychological aspects of pain in children and adolescents with a particular emphasis on the role of fear from a neurobiological and behavioral perspective. Current studies in the lab involve assessment scale development to guide treatment targets, evaluating innovative interdisciplinary treatment interventions, and examining learning and memory via psychophysiological and brain imaging measures.  Outside of work Laura enjoys being outdoors with her husband and two boys (ages 4 and 6). 

Ban Chi-Ho Tsui

Dr. Ban Tsui joined Stanford in September as Professor of Anesthesiology, Perioperative and Pain Medicine from University of Alberta, where he was a Professor of Anesthesiology and Pain Medicine and an adult and pediatric anesthesiologist with special interest in ultrasound-guided regional anesthesia. Dr. Tsui directed the Regional Anesthesia and Acute Pain Service at the University of Alberta Hospital, and co-chaired the Pediatric Pain Management Committee at the Stollery Childrens Hospital. He also oversaw the clinical research program of Department of Anesthesiology and Pain Medicine. Dr. Tsui has published over 150 articles in clinical and basic research. Among numerous contributions to medical education, he is the author of the textbook Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia and a co-author of Pediatric Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia as well as Principles of Airway Management (4th edition); Dr. Tsui received many awards in Canada, including Medical Research Clinical Scholar of Alberta Heritage Foundation and a national honor award from the Canadian Anesthesiologists Society “in recognition of significant research contributions to regional anesthesia, acute pain management, and pediatric anesthesia in Canada and around the world”.