Associate Vice Chair for Clinical Research Appointed

Paul Wischmeyer, MDWe are pleased to announce that with more than 20 years of experience in critical care, perioperative care and clinical nutrition, Paul Wischmeyer, MD, officially joined Duke Anesthesiology on October 31 as a Tenured Professor of Anesthesiology and Surgery. He has been appointed as the Associate Vice Chair for Clinical Research and the Co-Director of the Academic Career Enrichment Scholars (ACES) Resident Research Program within our department. Additionally, he has been named the Director of Perioperative Research at the Duke Clinical Research Institute (DCRI). Dr. Wischmeyer joins us from the University of Colorado School of Medicine in Aurora where he was a Professor of Anesthesiology and Pediatrics.

After attending medical school and completing his residency training, fellowship training in clinical research and clinical pharmacology, and the NIH K30 clinical research scientist training program at the University of Chicago’s Pritzker School of Medicine, Dr. Wischmeyer went on to serve as a pediatric anesthesiologist at Shriners Hospital in Chicago. In 2002, he began to rapidly expand his role as a leader in all three pillars of academic medicine at the University of Colorado. He was appointed as the Associate Director of the Surgical Intensive Care Unit and as the Director of Nutrition Support Services in which he established a nationally recognized clinical nutrition program that is currently used as a nationwide model in an underserved discipline. Dr. Wischmeyer also assumed the roles as Director of Medical Student Research and Associate Chairman of Clinical and Translational Research. It was in these roles that he developed the first medical student education program in clinical nutrition and grew his passion for mentoring and training the next generation of physician-scientists.

Dr. Wischmeyer’s interdisciplinary research and translational approach to challenges in perioperative and critical care medicine have garnered international recognition. His research interests include perioperative optimization, nutrition therapy, post-illness lean body mass and functional recovery, and probiotics/microbiome. He developed the first large-scale multicenter perioperative, ICU and nutrition trials group to examine the role of glutamine and antioxidants in critical illness which led to a key publication in the New England Journal of Medicine. He has played an instrumental role in developing regularly updated clinical nutrition guidelines in perioperative and critical care medicine, and conceived/completed the first multi-center description of the effects of critical illness on the microbiome, a rapidly emerging field in medicine.

Dr. Wischmeyer’s international reputation in perioperative and critical care nutrition is highlighted by his role as Editor-in-Chief for the Journal of Parenteral and Enteral Nutrition and the numerous awards he has received for his contribution to research and teaching, including: the John M. Kinney International Award for significant contribution to the field of general nutrition and metabolism, the prestigious Stanley J. Dudrick Research Scholar Award for significant contribution to research in nutrition, and the Jeffrey Silverstein Award and Memorial Lecture for Humanism in Medicine. He was also named a 2016 inductee of the FAER Academy of Research Mentors in Anesthesiology.

In his new roles with our department and the DCRI, the largest clinical research institute in the world, Dr. Wischmeyer will spearhead opportunities to grow national and international clinical trials, develop an innovative, comprehensive, perioperative, hospital-based nutrition program to improve the care of our patients, and assist in establishing Duke Anesthesiology as not only the premier academic department in the nation, but also the leader of clinical research in perioperative and critical care medicine.

Dr. Wischmeyer currently resides in Durham with his wife, Michelle, and their three children, Eli, Samuel and Joshua. Michelle joined our colleagues at Duke Regional Hospital as the newly appointed Director of Advanced Practice for Surgery and Critical Care. Please join us in welcoming Dr. Wischmeyer and his family to Duke Anesthesiology!

Chris KeithAssociate Vice Chair for Clinical Research Appointed
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Inaugural Workshop Positions Duke as Nation’s Leader in POCUS

Point-of-Care Ultrasound for the Perioperative PhysicianDuke Anesthesiology recently hosted a first-of-its-kind, intensive hands-on course designed around one of the hottest topics in health care. Held on November 5-6 in the Duke Medicine Pavilion, the inaugural “Point-of-Care Ultrasound for the Perioperative Physician” course drew in 26 attendees from not only Duke but also other regions in the southeast. A mix of faculty, attending physicians, residents, and fellows from a variety of disciplines were provided the basic knowledge and skill set required to perform a focused, diagnostic ultrasonographic assessment of different body systems – a skill that will help physicians and other health care providers better manage their perioperative and critically ill patients.

The concept of the point-of-care ultrasound (POCUS) workshop evolved from a Regional Anesthesiology divisional retreat this past February, where faculty identified the need for this type of educational activity. According to the group, POCUS has the potential to revolutionize value-based patient care, save health systems millions of dollars on an annual basis, and improve patient outcomes. They say the once bulky ultrasound machines have shrunk drastically over the years and are now being replaced by portable, diagnostic ultrasonography at the patient’s bedside in the form of laptops and tablets. As these devices are becoming less expensive, they’re also becoming more accessible to physicians and specialists. Thus, there is a current demand for specialized training courses, such as the POCUS workshop, but very few opportunities for perioperative physicians to acquire these skills.

“We’re flying the flag here at Duke for perioperative medicine,” said Dr. Jeff Gadsden, course program director, who also noted that Duke Anesthesiology is at the leading edge of the curve for using these new ultrasound techniques. “We’re very proud to be one of the first to offer this kind of perioperative-focused workshop, but there will be others as the need grows.”

Overall, the course received great feedback from participants who seemed especially excited to learn these new skills and appreciated the workshop’s intimate, small group, hands-on style. According to Dr. Gadsden, one of the challenges that can arise with hands-on workshops is when there are too many people around the table at once, participants may never get a chance to “get their hands dirty.” For this workshop to be a success, he felt it was crucial to provide the opportunity for all of the attendees to get a lot of scanning time with the ultrasound probe. Dr. Gadsden added that one of the attending physicians even asked him whether Duke Anesthesiology could turn the course into a “road show” and travel to various hospitals, signifying the need for this type of course.

For Dr. Gadsden, one of the highlights from the weekend occurred near the conclusion of Saturday’s workshop, when participants were presented a series of real-life patient cases and asked how they would use POCUS to sort out the problem. “What struck me was how proficient these participants became in such a short period of time,” he recalled. “Seeing all of that evolve just over the course of the first day was incredibly rewarding. It was inspiring to watch as they used this technology and newfound knowledge in a really meaningful way.”

Ten faculty from Duke Anesthesiology presented at the conference with the hope that participants will use this workshop as a starting point for the integration of POCUS into their daily practice. “We were extremely fortunate to make this a cross-divisional collaborative effort and feature the amazing talents of faculty within other Duke Anesthesiology divisions,” noted Dr. Gadsden.  “We had designed this to be a taste of POCUS and hopefully inspire them to go on to learn more. “

When asked about his long-term vision for the course, Dr. Gadsden expects it to develop over time and said, “When people think of POCUS and where to go for training, I want them to think of Duke Anesthesiology.” After the success of this workshop, the planning team has developed a list of ideas to implement for the next one, such as additional case-based modules. The next POCUS workshop is tentatively planned for the spring of 2017 with the goal of attracting a broader audience both geographically and across different disciplines.

Point-of-Care Ultrasound for the Perioperative Physician Course
Point-of-Care Ultrasound for the Perioperative Physician Course
Point-of-Care Ultrasound for the Perioperative Physician Course
Point-of-Care Ultrasound for the Perioperative Physician Course
Point-of-Care Ultrasound for the Perioperative Physician Course
Point-of-Care Ultrasound for the Perioperative Physician Course
Point-of-Care Ultrasound for the Perioperative Physician Course
Point-of-Care Ultrasound for the Perioperative Physician Course
Point-of-Care Ultrasound for the Perioperative Physician Course
Chris KeithInaugural Workshop Positions Duke as Nation’s Leader in POCUS
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2016 FAER Inductees Announced

Drs. William Maixner and Paul WischmeyerDuke Anesthesiology’s William Maixner, DDS, PhD, and Paul Wischmeyer, MD, have been appointed as members of the Foundation for Anesthesia Education and Research (FAER) Academy of Research Mentors in Anesthesiology.

They received this honor for their contributions as mentors for anesthesia residents, fellows and faculty. The FAER Academy’s objective is to recognize mentors who have not only committed their career to the development and advancement of academic anesthesiologists and others in research, but promoted mentoring among colleagues in the specialty – all in effort to increase the quality of research and advance the scope of academic anesthesiology. The main criterion for membership of the academy is the number of individuals whom the mentor has supported and the quality of work accomplished by those individuals.

Dr. Maixner is a world-renowned pain researcher and the director of Duke Anesthesiology’s newly established Center for Translational Pain Medicine. Dr. Wischmeyer is recognized internationally for his interdisciplinary research and translational approach to challenges in perioperative and critical care medicine. He is the associate vice chair for clinical research and the co-director of the Academic Career Enrichment Scholars (ACES) Resident Research Program within Duke Anesthesiology. Additionally, Dr. Wischmeyer is the director of perioperative research at the Duke Clinical Research Institute (DCRI), the largest clinical research institute in the world.

Chris Keith2016 FAER Inductees Announced
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National Media Features Dr. Jordt Lab Study

Drs . Jordt and Liu

Drs . Jordt and Liu

Duke Anesthesiology’s Drs. Sven-Eric Jordt and Boyi Liu, along with scientists at Zhejiang Chinese Medical University, have discovered a strategy to stop the uncontrollable itch caused by an oily sap, common to poison ivy, poison sumac, poison oak and mango trees.

According to a news release from Duke Health, the research team found that by blocking an immune system protein in the skin with an antibody, they could halt the processes that tell the brain the skin is itchy. The research was done in mice and is described in the November 7, 2016 issue of Proceedings of the National Academy of Sciences.

This cutting-edge research, which could lead to treatments for those allergic to poison ivy (an estimated 80 percent of the population), made national headlines on CBS NewsU.S. News & World Report, HealthDay, STAT, Scientific American, and Univision.

Dr. Jordt is the senior author of the study and director of the Chemical Sensing, Pain and Inflammation Research Laboratory at Duke Anesthesiology. This research was supported with funding from Dr. Liu’s 2015 DREAM Innovation Grant. These grants support innovative high-risk and potentially high-reward investigations to accelerate anesthesia and pain management research – a key component of Duke Anesthesiology’s DREAM Campaign.

Chris KeithNational Media Features Dr. Jordt Lab Study
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Itch Therapies Study Published in National Academy Journal

Drs . Jordt and LiuScientists at Duke Health and Zhejiang Chinese Medical University have developed a strategy to stop the uncontrollable itch caused by urushiol, the oily sap common to poison ivy, poison sumac, poison oak and even mango trees.

The team found that by blocking an immune system protein in the skin with an antibody, they could halt the processes that tell the brain the skin is itchy. The research was done in mice and is described in the November 7 issue of Proceedings of the National Academy of Sciences. They hope their model could lead to potential treatments for people who are allergic to poison ivy — an estimated 80 percent of the population.

For most people, contact with poisonous plants is painful but not life-threatening. Still, there are significant health care costs associated with more than 10 million people in the U.S. affected each year, said senior author Sven-Eric Jordt, Ph.D., associate professor of anesthesiology at Duke.

“Poison ivy rash is the most common allergic reaction in the U.S., and studies have shown that higher levels of carbon dioxide in the atmosphere are creating a proliferation of poison ivy throughout the U.S. — even in places where it wasn’t growing before,” Jordt said. “When you consider doctor visits, the costs of the drugs that are prescribed and the lost time at work or at school, the societal costs are quite large.”

Some symptoms of the fiery, blistering rash can be alleviated with antihistamines and steroids. But in recent years, scientists have determined that the most severe itching doesn’t go away with antihistamines, because it arises from a different source, Jordt said.

Jordt and collaborators determined the itch is triggered by interleukin 33 (IL-33), a protein in the skin involved in immune response.

All people have IL-33 in their skin, but the protein is elevated in people who have eczema and psoriasis, Jordt said. The protein is known for inducing inflammation, but these new experiments show the protein also acts directly on the nerve fibers in the skin, exciting them and telling the brain that the skin is severely itchy.

A fluorescence microscope image shows the skin of a healthy mouse (left) and skin from a mouse with a poison ivy rash (right). Interleukin-33, shown in green stain, is a protein that acts directly on the nerves, telling the brain the skin is extremely itchy. Sven-Eric Jordt/Duke Health

A fluorescence microscope image shows the skin of a healthy mouse (left) and skin from a mouse with a poison ivy rash (right). Interleukin-33, shown in green stain, is a protein that acts directly on the nerves, telling the brain the skin is extremely itchy. Sven-Eric Jordt/Duke Health

The researchers used an antibody to block IL-33 and found that it not only reduced inflammation, but also cut down scratching in mice with poison ivy rashes. An antibody that counteracts human IL-33 is currently being evaluated in humans through a Phase 1 clinical trial to determine its safety and potential side effects.

In an additional approach tested in the mouse experiments, the researchers also found they could also alleviate itch by blocking a receptor for IL-33, called ST2.

“There could be translational significance here,” Jordt said. “So our next step will be to look at human skin to see if we see the same activity and the same pathways. We will also look at anti-inflammatory drugs that are already approved to see if they have the potential to alleviate itch.”

In addition to Jordt, study authors include Boyi Liu; Yan Tai; Satyanarayana Achanta; Melanie M. Kaelberer; Ana I. Caceres; Xiaomei Shao; and Jianqiao Fang.

The research was supported by the Duke Anesthesiology DREAM Innovation Grant (2015-DIG LIU), Zhejiang Chinese Medical University Start-Up Funding (722223A08301/ 001/004), the National Natural Science Foundation of China (81603676) and three National Institutes of Health — the National Center for Advancing Translational Sciences (UL1 TR001117), the National Institute of Environmental Health Sciences (R01 ES015056, U01 ES015674) and the National Institute of Arthritis and Musculoskeletal and Skin Disease (R21 AR070554). The authors declare no conflicts of interest.

Source: Duke Health News and Communications press release (Durham, N.C. – November 7, 2016).  Jordt is a faculty member of
Duke Anesthesiology’s Center for Translational Pain Medicine and director of the Chemical Sensing, Pain and Inflammation Research Laboratory.

Chris KeithItch Therapies Study Published in National Academy Journal
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Director of Orofacial Pain Published in AJO-DO

Aurelio Alonso, DDS, MS, PhDAccurate upper airway measurements can play a pivotal role in identifying patients with breathing or sleep disorders. Duke Anesthesiology’s Aurelio Alonso, DDS, MS, PhD, is a co-author of a newly published study that investigated the differences between cone-beam computed tomography (CBCT) and acoustic reflection (AR) in calculating airway volumes and areas. The manuscript, titled “When static meets dynamic: Comparing cone-beam computed tomography and acoustic reflection for upper airway analysis,” was published in the October 2016 issue of the American Journal of Orthodontics and Dentofacial Orthopedics.   

Subjects with prescribed CBCT images as part of their records were asked to have AR performed. A total of 59 subjects had their five areas of their upper airway measured from CBCT images, acoustic rhinometry and acoustic pharyngometry. Volumes and minimal cross-sectional areas were extracted and compared with software.

According to the authors, results of this study reveal that CBCT is an accurate method for measuring anterior nasal volume, nasal minimal cross-sectional area, pharyngeal volume and pharyngeal minimal cross-sectional area.

Dr. Alonso is the director of orofacial pain for Duke Anesthesiology’s Center for Translational Pain Medicine and notably the first boarded orofacial pain clinician at Duke. This new center further expands the department’s existing clinical and research program in innovative pain therapies by bringing together, under one umbrella, leading basic scientists, clinicians and clinical researchers who have a common core mission of unraveling the causes of painful conditions to better improve patient care. Dr. Alonso is also a pain specialist at Duke Innovative Pain Therapies, a medical pain practice that opened in September of 2016 at Brier Creek in Raleigh. Learn more about this first-of-its-kind pain practice in Duke Anesthesiology’s 2016 edition of BluePrint magazine.

Chris KeithDirector of Orofacial Pain Published in AJO-DO
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