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Research: A Brief Summary of Research within the DepartmentResearch is an important component of an academic department as it defines qualities of intellectual curiosity and accomplishments that will enhance the clinical and educational missions by pushing new knowledge to the forefront. Our goal is to develop focused areas of basic, translational, clinical, and outcomes research that will directly address questions and needs that are relevant to clinical practice now and in the future. This research is directed by scientists, clinician-scientists, and clinicians within the Department, frequently with collaboration from other Departments within URMC. In 2002 we set out to establish an internationally recognized focus of basic science research in an area that was just emerging and is now one of the hottest areas in biological science, specifically mitochondrial regulation with normal aging and with acute stress superimposed on chronic genetic, environmental, or other pathological conditions. This area of mitochondrial science will also serve as a focus for translational research as knowledge developed in the laboratory is brought to understanding disease in cells, organs, and finally whole organisms, with the goal of moving to human clinical trials through the synthesis and development of novel molecules that will enhance mitochondrial function. (see below Section on MRIG ). The combination of significantly increased clinical burdens and decreased industry funding in the traditional areas of anesthesiology research related to development of new anesthetics or neuromuscular blocking agents and technology evaluation has resulted in a decreased amount of clinical research in these areas. Concurrently, there has been a substantive increase in our research in the areas related to pain management, specifically due to the internationally recognized expertise of Dr. Robert Dworkin in developing therapeutic approaches to the very difficult to treat syndromes of neuropathic pain. In response to the clear need to enhance our clinical research activity despite increased competition and decreases in NIH funding levels for research along with departmental and partial seed funding from national groups to help new investigators. We have been able to provide support to a limited number of clinical research projects during the past 5 years from Departmental resources. Very unfortunately for us, a recruitment effort of over one year to recruit a major clinical investigator from Europe eventually came to naught due to his concerns over NIH funding levels and our government's policies. We are reinvigorating our search for a senior clinical researcher during this coming year. We revamped the Departmental Research Committee with the charge of not just reviewing and approving clinical research submissions prior to submission to the RSRB (IRB), but to pro-actively define those faculty who have the interest and ability to become involved in clinical research, define mentors for them within our Department or outside it as needed, and become actively involved in facilitating the processes of learning how and performing clinical research in our environment. Dr. Michael Eaton has accepted the responsibility as the Chair of the Research Committee along with monetary resources dedicated to launch projects and recently Dr. Dworkin has accepted the position of Vice-Chair for Clinical Research within the Department. Under Dr. Dworkin, a psychologist within the Division of Pain Management, an extensive internationally recognized program in clinical research in the area of treatment of post-herpetic neuralgia, a neuropathic pain syndrome, has evolved to a level that major industry and combined industry-NIH funding of a multi-institutional study is being pursued. Given the marked increase in regulatory processes needed to begin and carry out clinical research in these times, we have addressed the real and substantive concerns of our faculty that the RSRB (IRB), without input from clinical anesthesiologists, could not be expected to fully understand the clinical arena that we work in nor appreciate the nationally recognized expertise underpinning some of our research submissions. To address this problem to the satisfaction of our faculty and to the very positive response of the RSRB, we have provided the resources for Dr. Raymond Zollo, who as both an active clinical anesthesiologist in the Department with three years of basic science training, to join the RSRB in an innovative role. With the full support of the RSRB, Dr. Zollo joined one of the two RSRB review groups as a full member, specifically the group that does not deal with submissions from the Department of Anesthesiology. He was given the time to attend all the needed coursework and to acquire a deep understanding of how the system works while contributing his expertise to reviewing submissions from other departments to the RSRB. The uniqueness of his position is that the RSRB has agreed that he can function as the external advisor to the RSRB group that reviews our faculty submissions and the departmental investigator should they so wish his help. The present web based system for submissions allows Dr. Zollo to be "invited as a guest" to see submissions from our faculty and make pro-active suggestions as to address faults or improve the presentation minimizing negative feedback from the RSRB to young investigators and acting as our non-voting advocate when he believes the science and methodology has been optimized and risks reduced as much as possible while still being able to obtain useful results. Dr. Zollo served actively for almost two years on the formal RSRB Committee and continues to participate on the Departmental Research Committee, closing that loop and further enhancing a coherent approach to developing our clinical research base with a highly knowledgeable source of background. Long term substantial Departmental support for clinical research in the area of respiratory control in human subjects under Dr. Denham Ward has produced publications, support for student, resident and junior faculty development, and a three year American Diabetes Association grant. Dr. Ward mentored Dr. Suzanne Karan, an Assistant Professor in the Department, and presently the Director of our Residency Program, who has worked with him on respiratory control issues over the past six years. Dr. Laurent Glance is actively pursuing health outcomes research focusing on quality of medical care and performance profiling. Dr. Glance's initial work, funded by a K08 career development grant from the Agency for Health Care Research and Quality (AHRQ), and mentored by Dr. Thomas Pearson (Senior Associate Dean for Clinical Research), has evolved into an R01 grant ($0.9M) investigating methodological issues in health care quality reporting and the regionalization of health care delivery. (see Health Outcomes Research). Dr. Richard Wissler, Director of Obstetric Anesthesiology at URMC, in collaboration with Dr. Glance has been exploring the regional obstetric databases to better define outcome and process measures in order to assess quality of care in obstetrical patients. During the past year the Department's Liver Transplant Anesthesia Service has completed analysis of the first 100 patients who were donors in our Living Related Donor Transplantation program at URMC. These results describe the evolution of the clinical protocols that evolved during this experience, the largest to our knowledge in the world. The study was published by Drs. Chhibber A, Dziak J, Kolano J, Norton JR, Lustik S in the journal Liver Transpl. 2007 Apr;13(4):537-42. Dr. Paul Bigeleisen , a Professor in the Department has recently returned from a two year stay at the University of Pittsburgh to expand his recognized expertise in the area of ultrasound mapping of neural pathways to improve the quality of regional anesthesia blocks using ultrasound images in real time. In collaboration with colleagues at the Univ. of Pittsburgh and at the Carnegie Mellon Institute has continued to advance the quality of imaging possible. Dr. Bigeleisen has trained a growing number of faculty interested in regional anesthesia, and published papers that have challenged the previously accepted dogma of how regional anesthesia may affect neural function.
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