RAPM Focus

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is thrilled to welcome Kesavan Sadacharam, MD, and Allison Fernandez, MD, following the April 2024 publication of their original research paper, “Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report.” Unwarranted variation in health care refers to differences in health care delivery that cannot be attributed to patient illness, medical evidence, or patient preferences. Instead, these variations arise from differing local medical practices, resource availability, and physician decision-making processes. Unwarranted variations can lead to sub-optimal patient outcomes, with some patients receiving unnecessary or harmful treatments while others may not receive beneficial interventions. Two individuals are behind a multi-center collaborative initiative that looks at the utilization of regional anesthesia and pain medicine techniques for ACL reconstruction. Dr. Allison Fernandez is an associate professor at Johns Hopkins All Children’s Hospital, practicing pediatric anesthesia, and pediatric acute and chronic pain management. Dr. Fernandez started a video series, Women of Impact in Anesthesia, empowering women in medicine. Dr. Kesavan Sadacharam is a pediatric anesthesiologist and associate professor at Nemours Children’s Health, located in Wilmington, DE. He is currently the director of regional anesthesia and practices both acute and chronic pain management. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is thrilled to welcome Laura Graham, PhD, MPH, and Sesh Mudumbai, MD, MS, following the April 2024 publication of their brief technical report, “Use of natural language processing method to identify regional anesthesia from clinical notes.” One definition of medicine is the science and practice of the diagnosis treatment in prevention of disease. Science itself involves diagnoses and relies on the process of assessing data to determine cause and effect in therapies. However, in the busy world of clinical productivity and limited resources, the science of medicine is often overlooked. Physicians struggle to extract meaningful data from electronic medical records, despite their great potential. This is often due to the prioritization of funding for billing and compliance, which leads to challenges in accessing meaningful data. Additionally, barriers such as data license agreements and institutional review board considerations further complicate matters. This is why Dr. Sites is excited about new technologies, such as artificial intelligence that can assist physicians in the practice in the science of medicine. Dr. Laura Graham is an epidemiologist with VA’s Health Economics Resource Center at the VA Palo Alto Health Care System and an associate faculty with the Stanford-Surgery, Policy, Improvement Research, and Education Center at the Stanford University School of Medicine. Her research interests include causal inference methods and improving clinical processes of care for surgery.Dr. Sesh Mudumbai is an associate professor in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine and a staff anesthesiologist at the VA Palo Alto Health Care System. His research interests include using and developing informatics tools to improve opioid management and perioperative outcomes. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this special episode, RAPM Focus takes a break from its usual format of discussing specific research projects to discuss instead how research in health care is increasingly vital yet often hindered by escalating costs and time constraints. Editor-in-Chief Brian Sites, MD, discusses these challenges with Alexander (Xan) Abess, MD, and Jonathan Weed, MD. Traditional, large scale, randomized controlled trials are resource intensive, making them challenging for clinicians to conduct. As a result, innovative approaches to engage in knowledge acquisition are becoming paramount. Creating a scholastic environment within the anesthesia department not only fosters a culture of continuous learning, but also becomes essential for attracting and retaining talent. Dr. Abess is an anesthesiologist at Dartmouth Hitchcock Medical Center and assistant professor of anesthesiology and perioperative medicine at Geisel School of Medicine at Dartmouth. He has previously served as the vice chair of quality and safety, department of anesthesiology and perioperative medicine, and is actively involved with the Multi-Center Perioperative Outcomes Group (MPOG). He is the founder and Director of IDEA Lab (Innovation, Development, and Entrepreneurship in Anesthesiology). Xan has a wide range of clinical experience (private practice, academic medicine, military medicine) and medical device development experience, having previously started his own medical device company. He understands well the challenges of medical innovation and truly enjoys helping others achieve their development goals while also attempting to improve the quality of health care delivery and simultaneously addressing our broader economic and workforce challenges. Dr. Weed is a clinical assistant professor of anesthesiology at Dartmouth Hitchcock Medical Center. He is a graduate of Tulane Medical School and completed his anesthesiology residency at Beth Israel Deaconess Medical Center, followed by a fellowship at Dartmouth Hitchcock Medical Center in regional anesthesia. He spent several years as a residency program director at Tulane Medical Center before returning to Tulane Medical Center in 2021. His most recent interests relate to the use of the electronic health record to improve clinical workflow in research within the department. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a health care practitioner’s judgment, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is delighted to be joined by Alexander Stone, MD, and Kamen Vlassakov, MD, following the April 2024 publication of their original research paper, “Anesthesia Start Time Documentation Accuracy where Peripheral Nerve Block is the Primary Anesthetic.” Understanding the intricacies of billing is crucial for anesthesiologists in all practice settings, not just in private practice. Proper billing practices not only ensure fair compensation for services rendered, but also impact patient care, hospital finances, and overall health care delivery. Anesthesiologists who engage with billing gain a better understanding of health care economics, which is essential for navigating the complex landscape of modern health care. Dr. Stone is a regional anesthesiologist at Brigham and Women’s Hospital. He is an assistant professor of anesthesia at Harvard Medical School and Associate Editor of RAPM. Dr. Vlassakov is the chief of the division of regional and orthopedic anesthesiology, as well as the program director of the regional anesthesiology and acute pain medicine fellowship at Brigham and Women’s Hospital. He is an associate professor of anesthesia at Harvard Medical School and also an Associate Editor of RAPM. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is delighted to be joined by Ryan D’Souza, MD, and Nasir Hussain, MD, following the February 2024 publication of their review, “Methodological and Statistical Characteristics of Meta-Analyses on Spinal Cord Stimulation for Chronic Pain: A Systematic Review.” Both of these anesthesiologists are prolific in their research and contributions to the regional anesthesia and pain medicine community. Best practice advisories and policies tend to stem from the results of systematic reviews and metanalysis, thus the stakes are very high for a journal to ensure that the results are meaningful and valid. The mathematical principles and assumptions of systematic reviews and meta-analyses are quite complex, which often exceeds the capacity of many journals to truly adjudicate. To further complicate matters, there are emerging techniques that include network meta-analyses that take even more expertise to review. Therefore, better understanding content areas where there are strengths and weaknesses around systematic reviews is critical to best informing clinical practice. Dr. D’Souza is a pain medicine physician and anesthesiologist at the Mayo Clinic. He is an associate professor, director of neuromodulation, and director of the in-patient pain service. He is an associate editor and social media editor for RAPM. Dr. Hussain is a pain medicine physician and anesthesiologist at the Ohio State University Wexner Medical Center. He is an assistant professor, associate program director for anesthesiology residency, and assistant program director of the chronic pain fellowship. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.