The Duke Institute for Health Innovation (DIHI) has awarded a multidisciplinary team from the Duke departments of anesthesiology, surgery, medicine and statistical sciences a $50,000 grant for their project titled, “PROMISE – Perioperative Risk Optimization with Machine learning for an Improved Surgical Experience.”
The goal of the project is to use machine learning tools to develop risk stratification models using patient level data to predict surgical risk and direct optimization interventions to reduce this risk. The funding will be used to develop risk stratification tools, and help providers in surgery clinics with optimization goals for their at-risk surgical populations.
The mission of the DIHI is to promote transformative innovation in health and health care, and to help cultivate a community of entrepreneurship across Duke University and its health enterprise. Proposed projects address actual and important problems encountered by care providers, patients and their loved ones in the Duke University Health System and represent urgent health challenges nationally.
Chris KeithAnesthesia Faculty Awarded Health Innovation Grant
Mallinckrodt Pharmaceuticals has awarded Duke Anesthesiology’s Dr. Jeffrey Gadsden $199,734 in funding for a clinical trial titled, “Comparison of Multimodal Analgesic Regimen with Intravenous Acetaminophen to Standard Oral Multimodal Therapy in Primary Total Hip Arthroplasty: A Randomized Controlled Double Blind Trial.”
Little robust data exists comparing the efficacy of oral versus intravenous acetaminophen for postoperative pain following major surgical procedures such as joint replacement. In this double-blind, randomized controlled trial, Dr. Gadsden’s hypothesis is that use of the intravenous formulation will result in a 20 percent reduction in opioid consumption in the first 24 hours.
60 patients scheduled for primary total hip arthroplasty will be enrolled in this trial. Subjects will receive a standardized anesthetic and postoperative analgesic regimen, and prior to surgery will be randomized to receive four doses of acetaminophen every six hours either by the oral or intravenous route. Placebo controls will ensure blinding. Subjects will be evaluated while in hospital for pain scores, satisfaction, opioid use, and rehab outcomes such as range of motion and ability to sit, stand, and walk in the postoperative period. Other outcomes will include total hospital cost, pharmacy-related costs, costs due to opioid-related adverse events, hospital length of stay (raw and criteria-based readiness) and ER presentations/admissions due to pain in the first 30 days.
The Society for Obstetric Anesthesia and Perinatology has awarded Duke Anesthesiology’s Dr. Jennifer Dominguez a two-year, $100,000 Gertie Marx Education and Research Grant for her project titled, “Obstructive Sleep Apnea Screening in Pregnant Women with Chronic Hypertension.”
Pregnant women with chronic hypertension and their babies are at a significant risk for severe morbidity. Chronic hypertension complicates 3-5 percent of all pregnancies, and 17-29 percent of women with chronic hypertension will go on to develop preeclampsia. Both conditions have been associated with increased risk for cardiovascular disease later in life. Obstructive sleep apnea is a risk factor for chronic hypertension and long-term cardiovascular disease. Despite the association of obstructive sleep apnea with adverse pregnancy outcomes, screening for obstructive sleep apnea in pregnancy with validated tools has proved challenging.
In this study, Dr. Dominguez will determine if portable home sleep testing of pregnant women with chronic hypertension is warranted. This knowledge is crucial to the development of screening algorithms that will lead to the early identification and treatment of pregnant women with obstructive sleep apnea. Notably, in non-pregnant adults, treatment of obstructive sleep apnea with continuous positive airway pressure improves blood pressure control; this may be an important intervention that could improve maternal and neonatal outcomes.
Dr. Dominguez is an assistant professor of anesthesiology with Duke Anesthesiology’s Women’s Anesthesia Division and the program director for the department’s Obstetric Anesthesiology Fellowship. Her research interests include women’s anesthesia, high-risk obstetric anesthesia, obesity and pregnancy, obstructive sleep apnea and pregnancy, and postpartum hemorrhage. She is also part of Duke Anesthesiology’s NIH T32 training program.
Duke University’s Mouse Behavioral and Neuroendocrine Core Facility has awarded Duke Anesthesiology’s Niccolo Terrando, PhD, a $5,000 voucher to evaluate the effects of vagal nerve stimulation on cognitive function.
Menthol, the minty and cooling natural product in peppermint, is a highly popular flavor in tobacco products. More than 30 percent of smokers in the United States smoke menthol cigarettes, and most beginning smokers prefer menthols. Chewing tobacco, snuff and snus also come in highly popular mentholated varieties.
“Contributing to Duke Anesthesiology’s pain research efforts, our lab has studied the cooling and soothing effects of menthol that is widely used for topical pain treatment in pain creams and patches,” says Dr. Jordt. “We were intrigued whether menthol would also suppress the irritating effects of nicotine.”
To examine menthol’s effects, Dr. Jordt’s lab scientists presented mice with a choice of water with nicotine or water containing both nicotine and menthol. The mice strongly preferred the mentholated nicotine and did so repeatedly over days. Mice share their aversion to nicotine with humans and also perceive menthol as soothing and cooling, sensing menthol with specific temperature-sensing nerves in the mouth.
“Menthol is not only a pleasant flavor, but has potent sensory effects that make it easier to consume nicotine,” says Dr. Jordt, associate professor in anesthesiology and faculty member of Duke Anesthesiology’s Center for Translational Pain Medicine. “We hope our findings will inform regulatory policies to curtail tobacco use and prevent children from becoming new tobacco consumers.” The study was a collaboration with Dr. Marina Picciotto’s laboratory of the Yale Tobacco Center of Regulatory Science in the Department of Psychiatry, funded by the National Institute on Drug Abuse and the Food and Drug Administration.
Chris KeithStudy Shows Menthol Makes Nicotine More Palatable
The National Institute of Dental and Craniofacial Research has awarded Duke Anesthesiology’s Dr. Ru-Rong Ji and his co-principal investigator, Dr. Maiken Nedergaard, a one-year, $100,000 National Institutes of Health grant for their project titled, “Hemichannels, Astrocytic Release, and Neuropathic Pain.”
Pain conditions are a major health problem in the United States which can lead to medical morbidity and a reduced quality of life for millions of Americans. Chronic neuropathic pain conditions are especially difficult to treat. A largely unaddressed challenge is how the transition from acute pain to chronic neuropathic pain occurs and how to prevent and reverse this transition in patients. This project will employ a multidisciplinary approach including the use of inducible transgenic mice with genetically modified astrocytes, in vivo imaging of ATP release (bioluminescence) and microglia motility and Ca2+ changes (2-photon) in the spinal cord, behavioral testing of evoked and ongoing neuropathic pain after nerve injury, and ex vivo and in vivo electrophysiology in the spinal cord. The proposed studies will provide a step-by-step analysis of neuron-glia interactions initiated by nerve injury and may comprise an efficient means to prevent and treat chronic pain.
Dr. Ji is a distinguished professor of anesthesiology at the Duke University School of Medicine, the chief of pain research at Duke Anesthesiology, a faculty member of Duke Anesthesiology’s Center for Translational Pain Medicine and the director of the department’s Pain Signaling and Plasticity Laboratory. Dr. Gang Chen, the co-investigator of this project, is also a member of Dr. Ji’s lab. This award is a supplement to Dr. Ji’s larger NIH R01 of the same name.
Chris KeithChief of Pain Research Awarded NIH Grant