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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 clinical, technologic instrumentation and outcomes research that will directly address questions and needs that are relevant to clinical practice on a daily basis. This research is directed by clinicians within the Department, frequently with collaboration from other Departments within URMC/UR. Equally importantly, we set out to establish an internationally recognized focus of basic science research in an area that was just emerging 3 years ago, and is now one of the hottest areas in biological science, 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 our focus for translational research as knowledge developed in the laboratory is brought to understanding disease in cells, organs, and finally whole organisms, ideally moving to human clinical trials (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 managment, 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 mainly seed partial funding from national groups to help new investigators, we have provided $2.5 M dollars to support clinical research during the past 4 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 the coming year. We are additionally revamping 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 new Chair of the Research Committee along with monetary resources to allow it to move forward. 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, 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 is both an active clinical anesthesiologist in the Department but also had three years of basic science training, to join the RSRB in an innovative role. With the full support of the RSRB, Dr. Zollo will join 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 has been 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 has also been assigned to serve on the Departmental Research Committee, closing that loop and further enhancing a coherent approach to developing our clinical research base. 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 that provides seed money to seek NIH funding in the area of respiratory control in diabetes. In collaboration with the Department of Psychiatry, Dr. Ward is supporting a KO-8 application for Dr. Suzanne Karan, an Assistant Professor in the Department, who has worked with him on respiratory control issues over the past three years. Under Dr. Robert 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. In collaboration with the Department of Community and Preventive Medicine, 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. In collaboration with Dr. Richard Wissler, Director of Obstetric Anesthesiology at URMC, Dr. Glance is also exploring the possibility of using regional obstetric databases to better define outcome and process measures in order to assess quality of care in obstetrical patients. (see Health Outcomes Research). During the past year the Department's Liver Transplant Anesthesiology 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.
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