RAPM Focus

Episode 33: Use of natural language processing method to identify regional anesthesia from clinical notes

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.

Episode 32: “IDEA Lab—creative ways to promote scholastic endeavors in the contemporary health system”

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.

Episode 31: Anesthesia Start Time Documentation Accuracy where Peripheral Nerve Block is the Primary Anesthetic

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.

Episode 30: Methodological and statistical characteristics of meta-analyses on spinal cord stimulation for chronic pain: a systematic review

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.

Article Reads Episode 1

In RAPM Focus’s latest podcast series, Article Reads, Alopi Patel, MD, narrates “Artificial intelligence and regional anesthesiology education curriculum development: navigating the digital noise” by Kristopher M Schroeder and Nabil Elkassabany. Originally published in Regional Anesthesia & Pain Medicine in June 2024, this daring discourse is now available in podcast format for an all new RAPM experience.
Artificial intelligence (AI) has demonstrated a disruptive ability to enhance and transform clinical medicine. While the dexterous nature of anesthesiology work offers some protections from AI clinical assimilation, this technology will ultimately impact the practice and augment the ability to provide an enhanced level of safe and data-driven care. An essential mission of academia is education, and challenges are frequently encountered when working to develop and implement comprehensive and effectively targeted curriculum appropriate for the diverse set of learners assigned to teaching faculty. Large language models offer the promise of targeted curriculum and content development that can be individualized to a variety of learners at various stages of training. 
https://pubmed.ncbi.nlm.nih.gov/38876802

Episode 29: Best Practice Advisories and Policies with Systematic Reviews

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, sits down with Michael Barrington, MD, to discuss best practice advisories and policies with systematic reviews.
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. As part of a RAPM initiative to establish education and standards for researchers interested in submitting a systematic review or meta-analysis we participate in a joint publication with the journal, Anesthesia and Analgesia. 
Dr. Barrington is well known in the regional anesthesia community as he is currently the section editor for Regional Anesthesia for the journal, Anesthesia and Analgesia. He has had a recent appointment as professor of anesthesiology at OHSU and is transitioning to the University of Washington. 
Some topics covered by Dr. Sites and Dr. Barrington in this podcast are: 
How having a broad team with a broad scope of expertise as part of the authorship team reflects some of the important components of a systematic review.
How many review authors are unable to articulate a clear rationale for performing the reviews which often is associated with a lack of a very a clear research question.
The basic resources and expertise needed to perform a systematic review at a high level.
What protocol is in a systematic review and why it is an important first step.
PICO (Participant/ Population, Intervention, Compareta, 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.

Episode 28: Challenges within the Scientific Publishing Landscape

In this episode of RAPM Focus, Associate Editor Ed Mariano, MD, MAS, FASA substitutes for Editor-in-Chief Brian Sites, MD, to discuss the diverse publishing landscapes in the scientific field with Executive Editor Ruth Landau, MD.
Dr. Mariano is a professor at Stanford University School of Medicine.
Dr. Landau is the Virginia Apgar professor and the Chief of Obstetric Anesthesiology at Columbia University. She is also the director of the Center of Precision Medicine within the department and a past president for the Society for Obstetric Anesthesia and Perinatology (SOAP). Dr. Launda is known globally for her expertise and leadership with Obstetric Anesthesia, Labor Analgesia, and Maternal Health and Outcomes. In addition to her extensive work with Obstetrics, she also serves on the RAPM editorial board. 
Dr. Mariano and Dr. Landau discuss the publishing approach RAPM has taken. RAPM is dedicated to publishing research that has the potential to have a real clinical impact and better-informed decision making. There is a huge responsibility in publishing to inform clinicians, to give back to researchers, and selecting the right reviewers. 
*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.

Episode 27: Crystallization of mixtures of local anesthetics with and without select adjuvants: a semiquantitative light microscopy analysis

In this episode of RAPM Focus, Dr. Brian Sites is delighted to support the work of Dr. Ottokar Stundner, MD, and colleagues by discussing the use of liposomal bupivacaine trends following the March 2024 publication of “Crystallization of mixtures of local anesthetics with and without select adjuvants: a semiquantitative light microscopy analysis.”
Dr. Studener completed his anesthesia residency in Salzburg, Austria, as well as a research fellowship in regional anesthesia and perioperative outcomes at the Hospital for Special Surgery in New York. After his training, he joined the faculty at Innsbruck Medical University, also in Austria, where he currently is co -chair of pediatric anesthesia. He holds an MBA in Master of Public Health degrees. from the Imperial College of London and is an editorial fellow at the BJA.
With its high expense and questionable benefit over conventional forms of local analgesia, it is possible that the use of liposomal bupivacaine is declining—especially in the United States.
*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.

Episode 26: Perioperative considerations for patients exposed to hallucinogens

In this episode of RAPM Focus, Dr. Brian Sites discusses the perioperative use of hallucinogens with Trent Emerick, MD, MBA, following the February 2023 publication of Dr. Emerick’s paper, “Perioperative considerations for patients exposed to hallucinogens.”
Dr. Trent Emerick is currently an associate professor in the departments of anesthesiology and perioperative medicine and bioengineering at the University of Pittsburgh Medical Center and School of Medicine. He was a fellowship director for the chronic pain fellowship, and associate chief in the medical director of the UPMC chronic pain division. He is also the designated pain specialist for the NLF Pittsburgh Steelers.
Medicine is always changing, providing a career steeped in creativity. Hallucinogen use in the general population is growing, becoming more and more common. There is a renewed interest in the therapeutic benefits of drugs commonly classified as hallucinogens. These drugs are complicated and alter the sensorium. Psychedelics, a type of hallucinogen, are mediated by serotonin to a receptor and can help to soothe pain.
*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 Twitter @RAPMOnline.

Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial

In this episode of RAPM Focus, Dr. Brian Sites sits down with Daryl Henshaw, MD, and Christopher Edwards, MD, to discuss “Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial,” first published in June 2023.
Dr. Daryl Henshaw completed his medical school residency in regional anesthesia and acute pain fellowship training at Wake Forest. He is the associate vice chair of clinical operations at Atrium Health Wake Forest Baptist, the section head of regional anesthesia and acute pain management, and the medical director of acute pain services.
Dr. Christopher Edwards is a graduate of Louisiana State University Health Sciences at Wake Forest for both anesthesia and fellowship training in RAPM. He is the medical director for regional anesthesia and acute pain.
Dr. Henshaw and colleagues performed a prospective observational trial, where they asked the question if current guidelines to hold full anti-coagulation dose of Lovenox for 24 hours before surgery resulted in adequate anti-Xa level activity to support the performance of neuraxial or deep anesthetic type nerve block procedures. Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU/mL.
*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 Twitter @RAPMOnline.