Gaining on Pain

For an estimated 76 million people in the U.S., pain is a way of life, clouding their days and tormenting their nights. In fact, chronic pain affects more Americans than diabetes, heart disease and cancer combined.

UC Irvine’s new Center for Pain Management at Gottschalk Medical Plaza now offers new hope for those suffering from chronic pain. Established by the Department of Anesthesiology & Perioperative Care, it is the only comprehensive, multidisciplinary outpatient practice of its kind in Orange County, providing a complete spectrum of pain management techniques in one location.

“Untreated or poorly managed pain can seriously affect a person’s physical and mental health,” says center director Dr. Justin Hata, an anesthesiology & perioperative care assistant professor. “Our pain management specialists can turn the tide against chronic pain and dramatically improve the quality of our patients’ lives.”

The process begins with a medical history, physical exam and detailed pain assessment. Based on findings, the pain management team – composed of anesthesiologists, neurologists, psychologists, and physical medicine and rehabilitation physicians – formulates a multidisciplinary treatment plan for the patient.

“Each person who suffers from long-term pain has a unique set of physical and psychosocial circumstances,” says Dr. Danielle Perret, assistant professor and pain medicine specialist. “An approach that involves several specialties is critical for successful outcomes.”

Treatment options include:

- Medications: Alone or in combination, they can be injected, taken orally or delivered through a patch.
- Nerve blocks: Injecting an anesthetic close to a nerve pathway prevents pain messages from reaching the brain.
- Spinal cord stimulation: In this procedure, electrodes are implanted near the spinal cord, producing a tingling sensation that suppresses pain.

Patients with distressing musculoskeletal conditions such as arthritis can find relief with anesthetic or anti-inflammatory injections into painful joints and trigger points.

In addition, physical therapy and psychological counseling are often included in treatment plans. Counseling can help reverse some of the effects of pain, Perret says, like depression and a diminished sense of control – major issues for most chronic pain sufferers.

“This integrated approach to pain management enhances quality of life not only by decreasing pain but also by improving patients’ ability to participate in activities they enjoy,” Hata adds. “When pain is controlled, people suffer less, sleep better and have more vitality.”

For complete story please view link below.
http://www.uci.edu/features/feature_painmanagement_091103.php

Creating Advantages in the Face of Coming Health Care Change

Anesthesiology News
Editorial by Zeev N. Kain, MD

Health care changes are coming; we all know this. However, we don’t know what these changes will look like for medicine in general or anesthesiology in particular. We don’t even know when national changes will be instituted or begin to impact practitioners and departments. Given this uncertainty, at a grassroots level, how can we prepare to maximize clinical care, as well as efficiency and fiscal responsibility, while satisfying the demands of future changes?

When health care is remodeled at the national level, departments responding rapidly will likely fare better than those that are slow to change. We suggest that successful departments in the future will be those that welcome change rather than resist it. This may sound easy, but traditions, history and a “this is the way we have always done it” mindset result in real barriers, even when change is essential to survival.

The Department of Anesthesiology and Perioperative Care at the University of California, Irvine recently underwent significant changes. Although our experience is a case study of change in an urgent situation, it may offer valuable insights into ways other departments might cope with and succeed in the face of looming national health care changes.

For our department at UC Irvine, visits by the Centers for Medicare & Medicaid Services (CMS) in 2008, and significant past problems forced us to make sweeping changes on an extremely accelerated time line. One year later, we have a clean bill of health from CMS, a commendation from the Joint Commission, five-year accreditation from the Accreditation Council for Graduate Medical Education (ACGME), and new innovative clinical programs, and we have been ranked No. 24 in funding received from the National Institutes of Health (NIH). This accomplishment took nothing less than wholesale changes to almost every program within weeks to months. We were able to do this through the principles outlined below, and we suggest that these same principles are appropriate for any department or group practice.

For entire story please view the Anesthesiology News link below.      http://www.anesthesiologynews.com/index.asp?section_id=383&show=dept&ses=ogst&issue_id=564&article_id=14076

Resident Recruitment Update: Record year for UC Irvine

The Department of Anesthesiology & Perioperative Care at UC Irvine is seeing the best resident recruitment season in its history with more than 60 applicants for each residency position offered. This follows the June 2009 announcement that we are now a 4-year program with 5-year accreditation.     

As a group, the medical students applying to our department this year represent the strongest pool in the history of our program. Indeed, twenty one (25%) are AOA and all have outstands scores.  Moreover, while in the past 60-70% of our applicant pool has come from the Western Region, this year applicants come from strong medical schools across the country. Cornell, Columbia, NYU, University of Miami, John Hopkins, Penn State, Emory, Baylor, Wake Forest, University of Michigan, Stanford, and UCSF are just a few of the outstanding schools represented.                 

Prospective residents who interview with us will find a truly unique residency program that offers exposure to the newest technology, broad clinical experience, a progressive resident well-being curriculum, and multiple leadership opportunity through our advanced academic tracks and general program. Those who join our program will also find themselves working with some of the finest residents and faculty in the country.

University of California, Irvine Improves Operating Room Efficiencies with Perioperative Information System from Surgical Information Systems

University of California, Irvine Improves Operating Room Efficiencies with
Perioperative Information System from Surgical Information Systems
New anesthesiology system significantly improves billing revenue while
reducing errors

ATLANTA, Oct. 13 /PRNewswire/ — University of California, Irvine Medical
Center has used an automated perioperative solution from Surgical Information
Systems (SIS) to increase operating room efficiencies, improving quality
assurance, enhancing billing revenue and improving compliance.

(Logo: http://www.newscom.com/cgi-bin/prnh/20080722/SISLOGO)

UC Irvine recently went live with SIS Anesthesia, an automated anesthesia
information system, as part of a comprehensive perioperative solution
including powerful tools for business intelligence and charge capture.  “We
were up and running with SIS Anesthesia in less than five months, and the
system has already enabled significant turnarounds for our perioperative
environment,” said Dr. Zeev Kain, Chairman of the department of Anesthesiology
and Perioperative Care at UC Irvine.  “Our anesthesia billing time has dropped
from an estimated two weeks to 24 hours in most cases.  Use of the SIS
Solution has allowed us to successfully meet our clinical, financial and
operational goals.”

Improved documentation capabilities with SIS have allowed UC Irvine to
demonstrate higher levels of compliance with regulatory organizations and
institute an advanced quality assurance system.  Additionally, with the new
SIS mobile application for SIS Analytics, physicians have “anywhere-any time”
access to powerful data for decision making from the Apple iPhone or iPod
Touch. 

“SIS applauds the best practices adopted by UC Irvine in their use of SIS
Anesthesia,” said SIS CEO Ed Daihl.  “With comprehensive, legible anesthesia
records and electronic charge capabilities, sites like UC Irvine can reduce
the turnaround time for payment, maximize revenue and realize a decrease in
traditional billing service fees.”

For complete story please view link below.                      http://www.reuters.com/article/pressRelease/idUS112932+13-Oct-2009+PRN20091013

AP Exclusive: Autopsy shocker: Jackson was healthy

LOS ANGELES — Michael Jackson’s outward appearance was marred when he died with puncture marks to his arms, surgical scars around his body and cosmetic tattoos on his lips and scalp.

But internally, the pop star was in mostly fine physical shape for a 50-year-old man, according to his autopsy report obtained by The Associated Press.

The Los Angeles County coroner’s report shows Jackson’s weight of 136 pounds was in the acceptable range for a 5-foot-9 man. His heart was strong with no sign of plaque buildup. His kidneys and most other major organs were normal.

The singer did have health issues, however, including arthritis in the lower spine and some fingers, and mild plaque buildup in his leg arteries. Most serious was the condition of his lungs, which the autopsy report said were chronically inflamed and had reduced capacity that might have left him short of breath.

But the lung condition was not serious enough to be a direct or contributing cause of death, according to the document.

“His overall health was fine,” said Dr. Zeev Kain, chairman of the anesthesiology department at the University of California, Irvine, who reviewed a copy of the autopsy report for the AP. “The results are within normal limits.”

Kain, who was not involved in the autopsy, said most of the scars appeared to be from plastic surgery though others, like a scar on the knee, could have been from a medical procedure.

For complete story please view link below.                  http://www.chron.com/disp/story.mpl/ap/top/all/6648092.html

UCI gets $24 million in Grants

The chairman of anesthesiology and perioperative care at UCI, professor Zeev Kain, will use a $1.7-million National Institutes of Health federal stimulus grant to create a website for parents whose children will be going through surgery.

The site will help parents ease their children’s pre-surgery anxiety, manage post-surgical pain and facilitate healing, the school said.

For complete story please view site below.                            http://www.dailypilot.com/articles/2009/09/17/topstory/dpt-ucifunding091809.txt

Needless Suffering After Tonsil Surgery

Parents may have been reluctant to provide the medication, a combination of Tylenol and Tylenol with codeine, for any number of reasons, said Dr. Michelle A. Fortier, first author of the paper and a pediatric psychologist at the University of California, Irvine. “Nurses responded well to the kids’ pain while they were in the hospital, but we know from other studies that parents hold some misconceptions and fears about pain medication,” Dr. Fortier said. “They may want to withhold it until the pain is very severe; they may want to stretch the time between doses so as not to use too much, and there is still some belief that they may be setting their child up for addiction if they use too much.”

For complete story please view link below.                      http://www.nytimes.com/2009/09/15/health/research/15child.html?_r=2&hpw

Kids Suffer Needlessly After Tonsils Removed

Pediatric Pain After Ambulatory Surgery: Where’s the Medication?

Pediatric Pain After Ambulatory Surgery: Where’s the Medication?, authors Michelle A. Fortier, Jill E. MacLaren, Sarah R. Martin, Danielle Perret-Karimi, and Zeev N. Kain, was published in Pediatrics in September. The purpose of this controlled study was to provide a description of children’s postoperative pain, including pain intensity and analgesic consumption. Results indicated that despite significant pain at home, a large proportion of children received little analgesic medication after surgery. The authors suggest that research efforts should be directed to the discrepancy between high ratings of postoperative pain and the low dosing of analgesics they use for their children.

Pulse Pressure Variation and Stroke Volume Variation: from Flying Blind to Flying Right?

Pulse Pressure Variation and Stroke Volume Variation: from Flying Blind to Flying Right?, Authors Maxime Cannesson, Benoit Vallet, and Frederic Michard, was published online in the British Journal of Anaesthesia on September 1. A review of studies focusing on fluid responsiveness suggests that no two protocols alike. This Letter discusses two recently published articles and suggests that standardized protocols might be useful to allow comparisons between studies and parameters.