Lawrence Chu, MD, MS

All Publications

• AnesthesiaChat: An Anesthesia-Specific Large Language Model Built from WikiAnesthesia Goodell, A., Chung, P., Chu, L., Larson, B., Chu, S. N., Rishel, C. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001290723300048

• Perceived Workload Using Separate (Filtering Facepiece Respirator and Face Shield) and Powered Air-Purifying Respirator and Integrated Lightweight Protective Air-Purifying Respirator: Protocol for an International Multisite Human Factors Randomized Crossover Feasibility Study. JMIR research protocols Price, A., Lin, Y. L., Levin, A. S., Tumietto, F., Almeida, R., Almeida, A., Ciofi-Silva, C. L., Fontana, L., Oliveira, N., Parisi, N. F., Mainardi, G. M., Cordeiro, L., Roselli, M., Shepherd, P., Morelli, L., Mehrabi, N., Price, K., Chan, W., Srinivas, S., Harrison, T. K., Chu, M., Padoveze, M. C., Chu, L. 2022; 11 (12): e36549

  Abstract

  The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences.This study will assess whether the L-PAPR improves health care professionals' comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs.This is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user's perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types.We expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time.The design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied.PRR1-10.2196/36549.

  View details for DOI 10.2196/36549

  View details for PubMedID 36454625

• A mixed methods study on effectiveness and appropriateness of face shield use as COVID-19 PPE in middle income countries. American journal of infection control Brainard, J., Hall, S., van der Es, M., Sekoni, A., Price, A., Padoveze, M. C., Ogunsola, F. T., Nichiata, L. Y., Hornsey, E., Crook, B., Cirino, F., Chu, L., Hunter, P. R. 2022; 50 (8): 878-884

  Abstract

  BACKGROUND: Face shields were widely used in 2020-2021 as facial personal protective equipment (PPE). Laboratory evidence about how protective face shields might be and whether real world user priorities and usage habits conflicted with best practice for maximum possible protection was lacking - especially in limited resource settings.METHODS: Relative protective potential of 13 face shield designs were tested in a controlled laboratory setting. Community and health care workers were surveyed in middle income country cities (Brazil and Nigeria) about their preferences and perspectives on face shields as facial PPE. Priorities about facial PPE held by survey participants were compared with the implications of the laboratory-generated test results.RESULTS: No face shield tested totally eliminated exposure. Head orientation and design features influenced the level of protection. Over 600 individuals were interviewed in Brazil and Nigeria (including 240 health care workers) in March-April 2021. Respondents commented on what influenced their preferred forms of facial PPE, how they tended to clean face shields, and their priorities in choosing a face cover product. Surveyed health care workers commonly bought personal protection equipment for use at work.CONCLUSIONS: All face shields provided some protection but none gave high levels of protection against external droplet contamination. Respondents wanted facial PPE that considered good communication, secure fixture, good visibility, comfort, fashion, and has validated protectiveness.

  View details for DOI 10.1016/j.ajic.2022.01.019

  View details for PubMedID 35908826

• Combining Machine Learning, Patient-Reported Outcomes, and Value-Based Health Care: Protocol for Scoping Reviews. JMIR research protocols Raclin, T., Price, A., Stave, C., Lee, E., Reddy, B., Kim, J., Chu, L. 2022; 11 (7): e36395

  Abstract

  BACKGROUND: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are self-reporting tools that can measure important information about patients, such as health priorities, experience, and perception of outcome. The use of traditional objective measures such as vital signs and lab values can be supplemented with these self-reported patient measures to provide a more complete picture of a patient's health status. Machine learning, the use of computer algorithms that improve automatically through experience, is a powerful tool in health care that often does not use subjective information shared by patients. However, machine learning has largely been based on objective measures and has been developed without patient or public input. Algorithms often do not have access to critical information from patients and may be missing priorities and measures that matter to patients. Combining objective measures with patient-reported measures can improve the ability of machine learning algorithms to assess patients' health status and improve the delivery of health care.OBJECTIVE: The objective of this scoping review is to identify gaps and benefits in the way machine learning is integrated with patient-reported outcomes for the development of improved public and patient partnerships in research and health care.METHODS: We reviewed the following 3 questions to learn from existing literature about the reported gaps and best methods for combining machine learning and patient-reported outcomes: (1) How are the public engaged as involved partners in the development of artificial intelligence in medicine? (2) What examples of good practice can we identify for the integration of PROMs into machine learning algorithms? (3) How has value-based health care influenced the development of artificial intelligence in health care? We searched Ovid MEDLINE(R), Embase, PsycINFO, Science Citation Index, Cochrane Library, and Database of Abstracts of Reviews of Effects in addition to PROSPERO and the ClinicalTrials website. The authors will use Covidence to screen titles and abstracts and to conduct the review. We will include systematic reviews and overviews published in any language and may explore additional study types. Quantitative, qualitative, and mixed methods studies are included in the reviews.RESULTS: The search is completed, and Covidence software will be used to work collaboratively. We will report the review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and Critical Appraisal Skills Programme for systematic reviews.CONCLUSIONS: Findings from our review will help us identify examples of good practice for how to involve the public in the development of machine learning systems as well as interventions and outcomes that have used PROMs and PREMs.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36395.

  View details for DOI 10.2196/36395

  View details for PubMedID 35849426

• Coproduction, Coeducation, and Patient Involvement: Everyone Included Framework for Medical Education Across Age Groups and Cultures. JMIR medical education Price, A., Damaraju, A., Kushalnagar, P., Brunoe, S., Srivastava, U., Debidda, M., Chu, L. 2021; 7 (4): e31846

  Abstract

  Medical education, research, and health care practice continue to grow with minimal coproduction guidance. We suggest the Commons Principle approach to medical education as modeled by Ostrom and Williamson, where we share how adapting these models to multiple settings can enhance empathy, increase psychological safety, and provide robust just-in-time learning tools for practice. We here describe patient and public coproduction in diverse areas within health care using the commons philosophy across populations, cultures, and generations with learning examples across age groups and cultures. We further explore descriptive, mixed methods participatory action in medical and research education. We adopt an "Everyone Included" perspective and sought to identify its use in continuing medical education, citizen science, marginalized groups, publishing, and student internships. Overall, we outline coproduction at the point of need, as we report on strategies that improved engagement. This work demonstrates coproduction with the public across multiple settings and cultures, showing that even with minimal resources and experience, this partnership can improve medical education and care.

  View details for DOI 10.2196/31846

  View details for PubMedID 34730539

• PERSONAL PROTECTIVE EQUIPMENT (PPE) SEES THE LIGHT: LOW-COST METHYLENE BLUE PLUS LIGHT INACTIVATES SARS-COV-2 ON PPE INCLUDING MASKS AND RESPIRATORS Lendvay, T. S., Chen, J., Harcourt, B. H., Scholte, F. E., Kilinc-Balci, F., Lin, Y., Lamb, M. M., Chu, L. C., Evans, D., Price, A., Lin, Y., Mores, C. N., Sahni, J., Kabra, K., Haubruge, E., Thiry, E., Heyne, B., Laperre, J., Simmons, S., Cui, Y., Wagner, T., Clark, T., Smit, S., Parker, R., Gallagher, T., Timm, E., Ludwig-Begall, L., Ludwig-Begall, L., Macia, N., Mackie, C., Page, K., Reader, S., Farris, P., Jolois, O., Patel, A., Lemyre, J., Molloy-Simard, V., Homdayjanakul, K., Tritsch, S., Wielick, C., Mayo, M., Malott, R., Willaert, J., Nauwynck, H., Dams, L., De Jaeger, S., Lao, L., Zhao, M., Chu, S., Conly, J. M., Chu, M. C. AMER SOC TROP MED & HYGIENE. 2021: 8

  View details for Web of Science ID 000778105601023

• Effects of a 2-Week Remote Learning Program on Empathy and Clinical and Communication Skills in Premedical Students: Mixed Methods Evaluation Study. JMIR medical education Srivastava, U., Price, A., Chu, L. F. 2021; 7 (4): e33090

  Abstract

  BACKGROUND: Expressing empathy builds trust with patients, increases patient satisfaction, and is associated with better health outcomes. Research shows that expressing empathy to patients improves patient adherence to medications and decreases patient anxiety and the number of malpractice lawsuits. However, there is a dearth of research on teaching empathy to premedical students. The Clinical Science, Technology, and Medicine Summer Internship of Stanford Medicine (also called the Stanford Anesthesia Summer Institute) is a 2-week collaborative medical internship for high school and undergraduate students to inspire learners to be compassionate health care providers. The summer 2020 program was adapted to accomplish these objectives in a fully remote environment because of the COVID-19 global pandemic.OBJECTIVE: This study aims to measure the change in empathy and competencies of participants in clinical and communication skills before and after program participation.METHODS: A total of 41 participants completed only the core track of this program, and 39 participants completed the core + research track of this program. Participants in both tracks received instructions in selected clinical skills and interacted directly with patients to improve their interviewing skills. Research track participants received additional instructions in research methodology. All participants completed web-based pre- and postsurveys containing Knowledge and Skills Assessment (KSA) questions. Participant empathy was assessed using the validated Consultation and Relational Empathy measure. A subset of participants completed optional focus groups to discuss empathy. The pre- and post-KSA and Consultation and Relational Empathy measure scores were compared using paired 2-tailed t tests and a linear regression model. Open-ended focus group answers were then analyzed thematically.RESULTS: Participants in both tracks demonstrated significant improvement in empathy after the 2-week remote learning course (P=.007 in core track; P<.001 in research track). These results remained significant when controlling for gender and age. A lower pretest score was associated with a greater change in empathy. Participants in both tracks demonstrated significant improvement in KSA questions related to surgical skills (P<.001 in core track; P<.001 in research track), epinephrine pen use (P<.001 in core track; P<.001 in research track), x-ray image interpretation (P<.001 in core track; P<.001 in research track), and synthesizing information to solve problems (P<.001 in core track; P=.05 in research track). The core track participants also showed significant improvements in health communication skills (P=.001). Qualitative analysis yielded 3 themes: empathy as action, empathy as a mindset, and empathy in designing health care systems.CONCLUSIONS: Summer internships that introduce high school and undergraduate students to the field of health care through hands-on interaction and patient involvement may be an effective way to develop measurable empathy skills when combined with clinical skills training and mentorship. Notably, increases in empathy were observed in a program administered via a remote learning environment.

  View details for DOI 10.2196/33090

  View details for PubMedID 34704956

• Graduate medical education in anaesthesiology and COVID-19: lessons learned from a global pandemic. Current opinion in anaesthesiology Chu, L. F., Kurup, V. 2021

  Abstract

  PURPOSE OF REVIEW: The recent global pandemic has dramatically altered the anaesthesiology educational landscape in unexpected ways. It is important that we pause to learn from this crisis.RECENT FINDINGS: Most resident trainees actively caring for COVID-19 patients present with probable or subclinical finding of post-traumatic stress disorder. Anaesthesia resident training programmes evolved to continue the mission of anaesthesia education in the face of institutional restrictions and evolving clinical crises.SUMMARY: The recent global COVID-19 pandemic has illustrated how external stressors can cause significant disruption to traditional medical education pathways. Resilience to external disruptive forces in anaesthesia education include a willingness of leadership to understand the problem, flexibility in adapting to the needs of learners and instructors in the face of key challenges, deployment of technology and innovation-minded solution-finding where appropriate, and attention to Maslow's hierarchy of needs.VIDEO ABSTRACT: http://links.lww.com/COAN/A77.

  View details for DOI 10.1097/ACO.0000000000001065

  View details for PubMedID 34608056

• The Burnout Dyad: A Collaborative Approach for Including Patients in a Model of Provider Burnout. The Journal of continuing education in the health professions Martinez-Hollingsworth, A., Hicks, M., Dobrota, S., Chu, L. F. 2021

  Abstract

  ABSTRACT: Both patients and providers in the United States (US) suffer from burnout, which can impact the clinical relationship and quality of care. Among providers, burnout is a state of exhaustion including heightened depersonalization; among patients, burnout can negatively affect clinical outcomes. More than half of clinical providers in the United States suffer from burnout; less is known about the magnitude and prevalence among patients. Understanding patient burnout will improve our recognition of treatment barriers, understanding of patient-provider communication, and perceived quality of care. The purpose of the 2019 Stanford University MedicineX Burnout Workgroup was to use a collaborative approach to expand on the National Academy of Medicine (NAM) Wellness and Resilience Model, which does not currently include the patient as an influential member of the care team potentially experiencing burnout. This collaboration among patients, physicians, students, caregivers, technologists, and researchers used a convenience sample of conference attendees, broken into three focus groups to (1) provide an expanded definition of burnout that includes patients' perspectives, (2) analyze the NAM burnout model for inclusion of the patient experience, and (3) define a care experience that includes both patients and providers. The design of this workgroup was informed by Everyone Included, a model that recognizes and rejects hierarchical traditions in clinical practice. This approach allowed for the creation of a safe space for the exchange of knowledge between the various stakeholders. The resulting inclusive conceptual model, The Burnout Dyad, describes a cocreated care experience informed by both patient and provider characteristics.

  View details for DOI 10.1097/CEH.0000000000000391

  View details for PubMedID 34609356

• Patient and Public Involvement in research: A journey to co-production. Patient education and counseling Price, A., Clarke, M., Staniszewska, S., Chu, L., Tembo, D., Kirkpatrick, M., Nelken, Y. 2021

  Abstract

  The public and patients can be powerful sensors for shaping and powering healthcare research. They are joining research teams as investigators and collaborators to co-produce evidence for the practical use of interventions in clinical practice. While clinicians and researchers are encouraged by funders and policymakers to involve the public and patients as partners in research, knowledge on what involvement consists of is limited, and the continuum between consultation, collaboration and co-production are not clearly defined. In this article, we explore Patient and Public Involvement (PPI) and introduce greater involvement through research co-production. Co-production describes ways that research partnership can work through public and patient involvement and we outline the similarities of co-production to "The Commons", a strategy utilized by economists to increase effective use of resources. We share examples of how public and patient involvement have used co-production, to demonstrate financial and health benefits. We then outline practical challenges at system, social and cultural levels and consider how others have worked to resolve them.

  View details for DOI 10.1016/j.pec.2021.07.021

  View details for PubMedID 34334264

• Addressing Personal Protective Equipment (PPE) Decontamination: Methylene Blue and Light Inactivates SARS-CoV-2 on N95 Respirators and Medical Masks with Maintenance of Integrity and Fit. Infection control and hospital epidemiology Lendvay, T. S., Chen, J., Harcourt, B. H., Scholte, F. E., Lin, Y. L., Kilinc-Balci, F. S., Lamb, M. M., Homdayjanakul, K., Cui, Y., Price, A., Heyne, B., Sahni, J., Kabra, K. B., Lin, Y., Evans, D., Mores, C. N., Page, K., Chu, L. F., Haubruge, E., Thiry, E., Ludwig-Begall, L. F., Wielick, C., Clark, T., Wagner, T., Timm, E., Gallagher, T., Faris, P., Macia, N., Mackie, C. J., Simmons, S. M., Reader, S., Malott, R., Hope, K., Davies, J. M., Tritsch, S. R., Dams, L., Nauwynck, H., Willaert, J., De Jaeger, S., Liao, L., Zhao, M., Laperre, J., Jolois, O., Smit, S. J., Patel, A. N., Mayo, M., Parker, R., Molloy-Simard, V., Lemyre, J., Chu, S., Conly, J. M., Chu, M. C. 2021: 1-83

  Abstract

  OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in shortages of personal protective equipment (PPE) underscoring the urgent need for simple, efficient, and inexpensive methods to decontaminate SARS-CoV-2-exposed masks and respirators. We hypothesized that methylene blue (MB) photochemical treatment, which has various clinical applications, could decontaminate PPE contaminated with coronavirus.DESIGN: The two arms of the study included: 1) PPE inoculation with coronaviruses followed by MB with light (MBL) decontamination treatment, and 2) PPE treatment with MBL for 5 cycles of decontamination (5CD) to determine maintenance of PPE performance.METHODS: MBL treatment was used to inactivate coronaviruses on three N95 filtering facepiece respirator (FFR) and two medical mask (MM) models. We inoculated FFR and MM materials with three coronaviruses, including SARS-CoV-2, and treated with 10 M MB and exposed to 50,000 lux of white light or 12,500 lux of red light for 30 minutes. In parallel, integrity was assessed after 5CD using multiple US and international test methods and compared to the FDA-authorized vaporized hydrogen peroxide plus ozone (VHP+O3) decontamination method.RESULTS: Overall, MBL robustly and consistently inactivated all three coronaviruses with 99.8 - to >99.9% virus inactivation across all FFRs and MMs tested. FFR and MM integrity was maintained after 5 cycles of MBL treatment, whereas one FFR model failed after 5 cycles of VHP+O3.CONCLUSIONS: MBL treatment decontaminated respirators and masks by inactivating three tested coronaviruses without compromising integrity through 5CD. MBL decontamination is effective, low-cost and does not require specialized equipment, making it applicable in all-resource settings.

  View details for DOI 10.1017/ice.2021.230

  View details for PubMedID 34016200

• An evidence review of face masks against COVID-19. Proceedings of the National Academy of Sciences of the United States of America Howard, J., Huang, A., Li, Z., Tufekci, Z., Zdimal, V., van der Westhuizen, H., von Delft, A., Price, A., Fridman, L., Tang, L., Tang, V., Watson, G. L., Bax, C. E., Shaikh, R., Questier, F., Hernandez, D., Chu, L. F., Ramirez, C. M., Rimoin, A. W. 2021; 118 (4)

  Abstract

  The science around the use of masks by the public to impede COVID-19 transmission is advancing rapidly. In this narrative review, we develop an analytical framework to examine mask usage, synthesizing the relevant literature to inform multiple areas: population impact, transmission characteristics, source control, wearer protection, sociological considerations, and implementation considerations. A primary route of transmission of COVID-19 is via respiratory particles, and it is known to be transmissible from presymptomatic, paucisymptomatic, and asymptomatic individuals. Reducing disease spread requires two things: limiting contacts of infected individuals via physical distancing and other measures and reducing the transmission probability per contact. The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high. Given the current shortages of medical masks, we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. Because many respiratory particles become smaller due to evaporation, we recommend increasing focus on a previously overlooked aspect of mask usage: mask wearing by infectious people ("source control") with benefits at the population level, rather than only mask wearing by susceptible people, such as health care workers, with focus on individual outcomes. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.

  View details for DOI 10.1073/pnas.2014564118

  View details for PubMedID 33431650

• Household Materials Selection for Homemade Cloth Face Coverings and Their Filtration Efficiency Enhancement with Triboelectric Charging. Nano letters Zhao, M., Liao, L., Xiao, W., Yu, X., Wang, H., Wang, Q., Lin, Y. L., Kilinc-Balci, F. S., Price, A., Chu, L., Chu, M. C., Chu, S., Cui, Y. 2020

  Abstract

  The COVID-19 pandemic is currently causing a severe disruption and shortage in the global supply chain of necessary personal protective equipment (e.g., N95 respirators). The U.S. CDC has recommended use of household cloth by the general public to make cloth face coverings as a method of source control. We evaluated the filtration properties of natural and synthetic materials using a modified procedure for N95 respirator approval. Common fabrics of cotton, polyester, nylon, and silk had filtration efficiency of 5-25%, polypropylene spunbond had filtration efficiency 6-10%, and paper-based products had filtration efficiency of 10-20%. An advantage of polypropylene spunbond is that it can be simply triboelectrically charged to enhance the filtration efficiency (from 6 to >10%) without any increase in pressure (stable overnight and in humid environments). Using the filtration quality factor, fabric microstructure, and charging ability, we are able to provide an assessment of suggested fabric materials for homemade facial coverings.

  View details for DOI 10.1021/acs.nanolett.0c02211

  View details for PubMedID 32484683

• Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive care medicine Aziz, S., Arabi, Y. M., Alhazzani, W., Evans, L., Citerio, G., Fischkoff, K., Salluh, J., Meyfroidt, G., Alshamsi, F., Oczkowski, S., Azoulay, E., Price, A., Burry, L., Dzierba, A., Benintende, A., Morgan, J., Grasselli, G., Rhodes, A., Moller, M. H., Chu, L., Schwedhelm, S., Lowe, J. J., Bin, D., Christian, M. D. 2020

  Abstract

  Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.

  View details for DOI 10.1007/s00134-020-06092-5

  View details for PubMedID 32514598

• Inflammatory Response to Chronic Opioid Exposure in Humans Mathi, K., Dobrota, S. D., Lee, T. J., Sayyid, Z. N., Rouholiman, D., Gamble, J. G., Encisco, E. M., Rico, T., Maecker, H. T., Chu, L. F. AMER ASSOC IMMUNOLOGISTS. 2020

  View details for Web of Science ID 000589972401216

• Bridging the implementation gap of machine learning in healthcare BMJ INNOVATIONS Seneviratne, M. G., Shah, N. H., Chu, L. 2020; 6 (2): 45-47

  View details for DOI 10.1136/bmjinnov-2019-000359

  View details for Web of Science ID 000850799300001

• Critical patient insights from the same-day feedback programme at Stanford Health Care. BMJ open quality Luna, A. n., Price, A. n., Srivastava, U. n., Chu, L. F. 2020; 9 (3)

  Abstract

  Healthcare organisations now integrate patient feedback into value-based compensation formulas. This research considered Stanford Healthcare's same-day feedback, a programme designed to evaluate the patient experience. Specifically, how did patients with cancer interviewed in the programme assess their physicians? Furthermore, how did assessments differ across emotional, physical, practical and informational needs when interviewed by volunteer patient and family partners (PAFPs) versus hospital staff?Integral to this research was Communication Accommodation Theory (CAT), which suggests individuals adjust interactions based on conversational roles, needs and understanding. Previous influential research was conducted by Frosch et al (2012) and Di Bartolo et al (2017), who revealed barriers to patient-physician communication, and Baker et al (2011) who associated CAT with these interactions. However, we still did not know if patients alter physician assessments between interviewers.This mixed methods study worked with 190 oncology unit patient interviews from 2009 to 2017. Open-ended interview responses underwent thematic analysis. When compared with hospital staff, PAFPs collected more practical and informational needs from patients. PAFPs also collected more verbose responses that resembled detailed narratives of the patients' hospital experiences. This study contributed insightful patient perspectives of physician care in a novel hospital programme.

  View details for DOI 10.1136/bmjoq-2019-000773

  View details for PubMedID 32816863

• I Tweet, Therefore I Learn: An Analysis of Twitter Use Across Anesthesiology Conferences. Anesthesia and analgesia Schwenk, E. S., Jaremko, K. M., Park, B. H., Stiegler, M. A., Gamble, J. G., Chu, L. F., Utengen, A. n., Mariano, E. R. 2019

  Abstract

  Twitter in anesthesiology conferences promotes rapid science dissemination, global audience participation, and real-time updates of simultaneous sessions. We designed this study to determine if an association exists between conference attendance/registration and 4 defined Twitter metrics.Using publicly available data through the Symplur Healthcare Hashtags Project and the Symplur Signals, we collected data on total tweets, impressions, retweets, and replies as 4 primary outcome metrics for all registered anesthesiology conferences occurring from May 1, 2016 to April 30, 2017. The number of Twitter participants, defined as users who contributed a tweet, retweet, or reply 3 days before through 3 days after the conference, was collected. We also collected influencer data as determined by mentions (number of times a user is referenced). Two authors independently verified the categories for influencers assigned by Symplur. Conference demographic data were obtained by e-mail inquiries. Associations between meeting attendees/registrants and Twitter metrics, between Twitter participants and the metrics, and between physician influencers and Twitter participants were tested using Spearman rho.Fourteen conferences with 63,180 tweets were included. With the American Society of Anesthesiologists annual meeting included, the correlations between meeting attendance/registration and total tweets (rs = 0.588; P = .074), impressions (rs = 0.527; P = .117), and retweets (rs = 0.539; P = .108) were not statistically significant; for replies, it was moderately positive (rs = 0.648; P = .043). Without the American Society of Anesthesiologists annual meeting, total tweets (rs = 0.433; P = .244), impressions (rs = 0.350; P = .356), retweets (rs = 0.367; P = .332), and replies (rs = 0.517; P = .154) were not statistically significant. Secondary outcomes include a highly positive correlation between Twitter participation and total tweets (rs = 0.855; P < .001), very highly positive correlations between Twitter participation and impressions (rs = 0.938; P < .001), retweets (rs = 0.925; P < .001), and a moderately positive correlation between Twitter participation and replies (rs = 0.652; P = .044). Doctors were top influencers in 8 of 14 conferences, and the number of physician influencers in the top 10 influencers list at each conference had a moderately positive correlation with Twitter participation (rs = 0.602; P = .023).We observed that the number of Twitter participants for a conference is positively associated with Twitter activity metrics. No relationship between conference size and Twitter metrics was observed. Physician influencers may be an important driver of participants.

  View details for DOI 10.1213/ANE.0000000000004036

  View details for PubMedID 31124801

• Peripheral Nerve Blocks for Hand Procedures REPLY NEW ENGLAND JOURNAL OF MEDICINE Chandrasoma, J., Harrison, T., Chu, L. F. 2018; 379 (22): 2182

  View details for PubMedID 30485784

• Peripheral Nerve Blocks for Hand Procedures. The New England journal of medicine Chandrasoma, J., Harrison, T. K., Ching, H., Vokach-Brodsky, L., Chu, L. F. 2018; 379 (10): e15

  View details for PubMedID 30184448

• Peripheral Nerve Blocks for Hand Procedures NEW ENGLAND JOURNAL OF MEDICINE Chandrasoma, J., Harrison, T., Ching, H., Vokach-Brodsky, L., Chu, L. F. 2018; 379 (10)

  View details for DOI 10.1056/NEJMvcm1400191

  View details for Web of Science ID 000443748200011

• Internet searches for opioids predict future emergency department heroin admissions. Drug and alcohol dependence Young, S. D., Zheng, K., Chu, L. F., Humphreys, K. 2018; 190: 166-169

  Abstract

  For a number of fiscal and practical reasons, data on heroin use have been of poor quality, which has hampered the ability to halt the growing epidemic. Internet search data, such as those made available by Google Trends, have been used as a low-cost, real-time data source for monitoring and predicting a variety of public health outcomes. We aimed to determine whether data on opioid-related internet searches might predict future heroin-related admissions to emergency departments (ED).Across nine metropolitan statistical areas (MSAs) in the United States, we obtained data on Google searches for prescription and non-prescription opioids, as well as Substance Abuse and Mental Health Services Administration (SAMHSA) data on heroin-related ED visits from 2004 to 2011. A linear mixed model assessed the relationship between opioid-related Internet searches and following year heroin-related visits, controlling for MSA GINI index and total number of ED visits.The best-fitting model explained 72% of the variance in heroin-related ED visits. The final model included the search keywords "Avinza," "Brown Sugar," "China White," "Codeine," "Kadian," "Methadone," and "Oxymorphone." We found regional differences in where and how people searched for opioid-related information.Internet search-based modeling should be explored as a new source of insights for predicting heroin-related admissions. In geographic regions where no current heroin-related data exist, Internet search modeling might be a particularly valuable and inexpensive tool for estimating changing heroin use trends. We discuss the immediate implications for using this approach to assist in managing opioid-related morbidity and mortality in the United States.

  View details for DOI 10.1016/j.drugalcdep.2018.05.009

  View details for PubMedID 30036853

• A Flawed Design Produces Flawed Results Reply JOURNAL OF ADDICTION MEDICINE Chu, L. F., Sun, J., Clemenson, A., Erlendson, M. J., Rico, T., Cornell, E., Obasi, H., Sayyid, Z. N., Encisco, E. M., Yu, J., Gamble, J. G., Clark, J. 2018; 12 (3): 252–53

  View details for DOI 10.1097/ADM.0000000000000393

  View details for Web of Science ID 000441391100014

• Reply to Dr Peltz. Journal of addiction medicine Chu, L. F., Sun, J., Clemenson, A., Erlendson, M. J., Rico, T., Cornell, E., Obasi, H., Sayyid, Z. N., Encisco, E. M., Yu, J., Gamble, J. G., Clark, J. D. 2018; 12 (3): 252–53

  View details for PubMedID 29794619

• Ondansetron does not prevent physical dependence in patients taking opioid medications chronically for pain control. Drug and alcohol dependence Chu, L. F., Rico, T. n., Cornell, E. n., Obasi, H. n., Encisco, E. M., Vertelney, H. n., Gamble, J. G., Crawford, C. W., Sun, J. n., Clemenson, A. n., Erlendson, M. J., Okada, R. n., Carroll, I. n., Clark, J. D. 2018; 183: 176–83

  Abstract

  In this study, we investigated the co-administration of ondansetron with morphine, and whether it could prevent the development of physical dependence in patients taking opioids for the treatment of chronic pain.A total of 48 chronic back pain patients (N = 48) participated in this double-blinded, placebo-controlled, randomized study. Patients were titrated onto sustained-release oral morphine and randomized to take 8 mg ondansetron or placebo three times daily concurrently with morphine during the 30-day titration. Following titration, patients underwent Naloxone induced opioid withdrawal. Opioid withdrawal signs and symptoms were then assessed by a blinded research assistant (objective opioid withdrawal score: OOWS) and by the research participant (subjective opioid withdrawal score: SOWS).We observed clinically significant signs of naloxone-precipitated opioid withdrawal in all participants (ΔOOWS = 4.3 ± 2.4, p < 0.0001; ΔSOWS = 14.1 ± 11.7, p < 0.0001), however no significant differences in withdrawal scores were detected between treatment groups.We hypothesized that ondansetron would prevent the development of physical dependence in human subjects when co-administered with opioids, but found no difference in naloxone-precipitated opioid withdrawal scores between ondansetron and placebo treatment groups. These results suggest that further studies are needed to determine if 5HT3 receptor antagonists are useful in preventing opioid physical dependence.

  View details for PubMedID 29278818

• Patient-Centric Strategies in Digital Health DIGITAL HEALTH: SCALING HEALTHCARE TO THE WORLD Chu, L. F., Shah, A. G., Rouholiman, D., Riggare, S., Gamble, J. G., Rivas, H., Wac, K. 2018: 43–54

  View details for DOI 10.1007/978-3-319-61446-5_4

  View details for Web of Science ID 000431892700005

• Internet searches for opioids predict future emergency department heroin admissions. Drug and alcohol dependence Young, S. D., Zheng, K., Chu, L. F., Humphreys, K. 2018; 190: 166–69

  Abstract

  For a number of fiscal and practical reasons, data on heroin use have been of poor quality, which has hampered the ability to halt the growing epidemic. Internet search data, such as those made available by Google Trends, have been used as a low-cost, real-time data source for monitoring and predicting a variety of public health outcomes. We aimed to determine whether data on opioid-related internet searches might predict future heroin-related admissions to emergency departments (ED).Across nine metropolitan statistical areas (MSAs) in the United States, we obtained data on Google searches for prescription and non-prescription opioids, as well as Substance Abuse and Mental Health Services Administration (SAMHSA) data on heroin-related ED visits from 2004 to 2011. A linear mixed model assessed the relationship between opioid-related Internet searches and following year heroin-related visits, controlling for MSA GINI index and total number of ED visits.The best-fitting model explained 72% of the variance in heroin-related ED visits. The final model included the search keywords "Avinza," "Brown Sugar," "China White," "Codeine," "Kadian," "Methadone," and "Oxymorphone." We found regional differences in where and how people searched for opioid-related information.Internet search-based modeling should be explored as a new source of insights for predicting heroin-related admissions. In geographic regions where no current heroin-related data exist, Internet search modeling might be a particularly valuable and inexpensive tool for estimating changing heroin use trends. We discuss the immediate implications for using this approach to assist in managing opioid-related morbidity and mortality in the United States.

  View details for DOI 10.1016/j.drugalcdep.2018.05.009

• Improving Health-Related Quality of Life of Patients With an Ostomy Using a Novel Digital Wearable Device: Protocol for a Pilot Study. JMIR research protocols Rouholiman, D. n., Gamble, J. G., Dobrota, S. D., Encisco, E. M., Shah, A. G., Grajales Iii, F. J., Chu, L. F. 2018; 7 (3): e82

  Abstract

  Ostomy surgeries involving the placement of an ostomy bag (eg, colostomy, ileostomy, urostomy, etc) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on the health-related quality of life of ostomy patients.In the present study, we plan to assess the quality of life of ostomy patients using the Ostom-i alert sensor, a portable, wearable, Bluetooth-linked biosensor that facilitates easier ostomy bag output measurements. We hypothesize that using the Ostom-i alert sensor will result in an improved, ostomy-specific, health-related quality of life as compared to baseline measurement before the use of the sensor.A total of 20 ostomy patients will be screened and recruited to participate in this prospective, observational, cross-over pilot study using an Ostom-i alert sensor for one month. The primary outcome of this study will compare ostomy-specific, health-related quality of life at baseline (prior to Ostom-i alert sensor use) to ostomy-specific, health-related quality of life after 2 and 4 weeks of Ostom-i use by utilizing the City of Hope Quality of Life Questionnaire for Patients with an Ostomy. Secondary outcomes of general health-related quality of life and adjustment to ostomy will be evaluated using the Medical Outcomes Study 36-item short form health survey and the Olbrisch Ostomy Adjustment Scale Short Form 2.The project was funded by the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. Enrollment is currently underway and data analysis is expected to be completed in 2018.Proposed benefits of mobile, internet-linked personal health monitors, such as the Ostom-i, include a reduction in the cost of care by reducing resource utilization and infection rates, improving patient-provider communication, reducing time spent as an inpatient as well as improved quality of life. Prior studies have demonstrated decreased health-related quality of life in patients with an ostomy bag. We aim to examine the extent to which the Ostom-i alert sensor affects the health-related quality of life of its users. The Ostom-i alert sensor has the potential to improve quality of life of users by giving them the freedom and confidence to partake in daily activities with the knowledge that they can check how full their ostomy bag is in a private, discrete manner.ClinicalTrials.gov NCT02319434; https://clinicaltrials.gov/ct2/show/NCT02319434 (Archived at WebCite at http://www.webcitation.org/6xhFDThmq).

  View details for PubMedID 29581087

• Ondansetron Does Not Reduce Withdrawal in Patients With Physical Dependence on Chronic Opioid Therapy. Journal of addiction medicine Chu, L. F., Sun, J., Clemenson, A., Erlendson, M. J., Rico, T., Cornell, E., Obasi, H., Sayyid, Z. N., Encisco, E. M., Yu, J., Gamble, J. G., Carroll, I., Clark, J. D. 2017

  Abstract

  Individuals taking opioids for an extended period of time may become physically dependent, and will therefore experience opioid withdrawal should they stop taking the medication. Previous work in animal and human models has shown that the serotonin (5-HT3) receptor may be implicated in opioid withdrawal. In this study, we investigated if ondansetron, a 5-HT3-receptor antagonist, could reduce the symptoms of opioid withdrawal after chronic opioid exposure in humans.In this double-blinded, randomized, crossover study, 33 chronic back pain patients (N = 33) were titrated onto sustained-release oral morphine for 30 days. After titration, participants attended 2 study sessions, 1 week apart, in which opioid withdrawal was induced with intravenous naloxone, with or without 8 mg intravenous ondansetron pretreatment. Opioid withdrawal symptoms were assessed by a blinded research assistant (objective opioid withdrawal score [OOWS]) and by the research participant (subjective opioid withdrawal score [SOWS]).Clinically significant signs of withdrawal were observed during both the ondansetron (ΔOOWS = 3.58 ± 2.22, P < 0.0001; ΔSOWS = 12.48 ± 11.18, P < 0.0001) and placebo sessions (ΔOOWS = 3.55 ± 2.39, P < 0.0001; ΔSOWS = 12.21 ± 10.72, P < 0.0001), but no significant differences were seen between the treatment sessions in either the OOWS or SOWS scores.We hypothesized that ondansetron would reduce opioid withdrawal symptoms in human subjects, but found no difference in withdrawal severity between ondansetron and placebo sessions. These findings suggest that more investigation may be necessary to determine if 5-HT3-receptor antagonists are suitable treatment options for opioid withdrawal.

  View details for DOI 10.1097/ADM.0000000000000321

  View details for PubMedID 28514235

• Factors Contributing to Anesthesia Residents' Learner Engagement and Learning Experience in a Mobile App: A Mixed-Method Design Study Traynor, A., Wang, K., Ngai, L., Chu, L. LIPPINCOTT WILLIAMS & WILKINS. 2017: 102–3

  View details for Web of Science ID 000404667000044

• Cytokine signature associated with disease severity in chronic fatigue syndrome patients. Proceedings of the National Academy of Sciences of the United States of America Montoya, J. G., Holmes, T. H., Anderson, J. N., Maecker, H. T., Rosenberg-Hasson, Y. n., Valencia, I. J., Chu, L. n., Younger, J. W., Tato, C. M., Davis, M. M. 2017; 114 (34): E7150–E7158

  Abstract

  Although some signs of inflammation have been reported previously in patients with myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), the data are limited and contradictory. High-throughput methods now allow us to interrogate the human immune system for multiple markers of inflammation at a scale that was not previously possible. To determine whether a signature of serum cytokines could be associated with ME/CFS and correlated with disease severity and fatigue duration, cytokines of 192 ME/CFS patients and 392 healthy controls were measured using a 51-multiplex array on a Luminex system. Each cytokine's preprocessed data were regressed on ME/CFS severity plus covariates for age, sex, race, and an assay property of newly discovered importance: nonspecific binding. On average, TGF-β was elevated (P = 0.0052) and resistin was lower (P = 0.0052) in patients compared with controls. Seventeen cytokines had a statistically significant upward linear trend that correlated with ME/CFS severity: CCL11 (Eotaxin-1), CXCL1 (GROα), CXCL10 (IP-10), IFN-γ, IL-4, IL-5, IL-7, IL-12p70, IL-13, IL-17F, leptin, G-CSF, GM-CSF, LIF, NGF, SCF, and TGF-α. Of the 17 cytokines that correlated with severity, 13 are proinflammatory, likely contributing to many of the symptoms experienced by patients and establishing a strong immune system component of the disease. Only CXCL9 (MIG) inversely correlated with fatigue duration.

  View details for PubMedID 28760971

• How Social Media is Changing the Practice of Regional Anesthesiology. Current anesthesiology reports Schwenk, E. S., Chu, L. F., Gupta, R. K., Mariano, E. R. 2017; 7 (2): 238–45

  Abstract

  This review summarizes the current applications of social media in regional anesthesiology, describes ways that specific platforms may promote growth, and briefly discusses limitations and future directions.Although Facebook users outnumber Twitter users, the latter has been better studied in regional anesthesiology and may have the advantages of speed and expansion of reach. Highly tweeted publications are more likely to be cited in the medical literature, and twitter-enhanced journal clubs facilitate communication regarding important articles with international colleagues. In both the United States and internationally, Twitter has been shown to enhance the anesthesiology conference experience, changing communication among attendees and non-attendees. YouTube and podcasts are quickly finding a niche in regional anesthesiology for just-in-time training and continuing professional development.Social media use is rapidly growing in regional anesthesiology, and benefits include global interaction and knowledge translation within the specialty and with the general public.

  View details for PubMedID 29422779

• Patient Participation at Health Care Conferences: Engaged Patients Increase Information Flow, Expand Propagation, and Deepen Engagement in the Conversation of Tweets Compared to Physicians or Researchers. Journal of medical Internet research Utengen, A. n., Rouholiman, D. n., Gamble, J. G., Grajales Iii, F. J., Pradhan, N. n., Staley, A. C., Bernstein, L. n., Young, S. D., Clauson, K. A., Chu, L. F. 2017; 19 (8): e280

  Abstract

  Health care conferences present a unique opportunity to network, spark innovation, and disseminate novel information to a large audience, but the dissemination of information typically stays within very specific networks. Social network analysis can be adopted to understand the flow of information between virtual social communities and the role of patients within the network.The purpose of this study is to examine the impact engaged patients bring to health care conference social media information flow and how they expand dissemination and distribution of tweets compared to other health care conference stakeholders such as physicians and researchers.From January 2014 through December 2016, 7,644,549 tweets were analyzed from 1672 health care conferences with at least 1000 tweets who had registered in Symplur's Health Care Hashtag Project from 2014 to 2016. The tweet content was analyzed to create a list of the top 100 influencers by mention from each conference, who were then subsequently categorized by stakeholder group. Multivariate linear regression models were created using stepwise function building to identify factors explaining variability as predictor variables for the model in which conference tweets were taken as the dependent variable.Inclusion of engaged patients in health care conference social media was low compared to that of physicians and has not significantly changed over the last 3 years. When engaged patient voices are included in health care conferences, they greatly increase information flow as measured by total tweet volume (beta=301.6) compared to physicians (beta=137.3, P<.001), expand propagation of information tweeted during a conference as measured by social media impressions created (beta=1,700,000) compared to physicians (beta=270,000, P<.001), and deepen engagement in the tweet conversation as measured by replies to their tweets (beta=24.4) compared to physicians (beta=5.5, P<.001). Social network analysis of hubs and authorities revealed that patients had statistically significant higher hub scores (mean 8.26×10-4, SD 2.96×10-4) compared to other stakeholder groups' Twitter accounts (mean 7.19×10-4, SD 3.81×10-4; t273.84=4.302, P<.001).Although engaged patients are powerful accelerators of information flow, expanders of tweet propagation, and greatly deepen engagement in conversation of tweets on social media of health care conferences compared to physicians, they represent only 1.4% of the stakeholder mix of the top 100 influencers in the conversation. Health care conferences that fail to engage patients in their proceedings may risk limiting their engagement with the public, disseminating scientific information to a narrow community and slowing flow of information across social media channels.

  View details for PubMedID 28818821

• Palonosetron and hydroxyzine pre-treatment reduces the objective signs of experimentally-induced acute opioid withdrawal in humans: a double-blinded, randomized, placebo-controlled crossover study. American journal of drug and alcohol abuse Erlendson, M. J., D'Arcy, N., Encisco, E. M., Yu, J. J., Rincon-Cruz, L., Peltz, G., Clark, J. D., Chu, L. F. 2016: 1-9

  Abstract

  Treatments for reducing opioid withdrawal are limited and prone to problematic side effects. Laboratory studies, clinical observations, and limited human trial data suggest 5-HT3-receptor antagonists and antihistamines may be effective.This double-blind, crossover, placebo-controlled study employing an acute physical dependence model evaluated whether (i) treatment with a 5-HT3-receptor antagonist (palonosetron) would reduce opioid withdrawal symptoms, and (ii) co-administration of an antihistamine (hydroxyzine) would enhance any treatment effect.At timepoint T = 0, healthy (non-opioid dependent, non-substance abuser) male volunteers (N = 10) were pre-treated with either a) placebo, b) palonosetron IV (0.75 mg), or c) palonosetron IV (0.75 mg) and hydroxyzine PO (100 mg) in a crossover study design. This was followed at T = 30 by intravenous morphine (10 mg/70kg). At T = 165, 10 mg/70kg naloxone IV was given to precipitate opioid withdrawal. The objective opioid withdrawal score (OOWS) and subjective opioid withdrawal score (SOWS) were determined 5 and 15 minutes after naloxone administration (T = 170, 180, respectively). Baseline measurements were recorded at T = -30 and T = -15.Comparison of average baseline OOWS scores with OOWS scores obtained 15 minutes after naloxone was significant (p = 0.0001). Scores from 15 minutes post-naloxone infusion showed significant differences in OOWS scores between treatment groups: placebo, 3.7 ± 2.4; palonosetron, 1.5 ± 0.97; and palonosetron with hydroxyzine, 0.2 ± 0.1333.Pretreatment with palonosetron significantly reduced many signs of experimentally-induced opioid withdrawal. Co-administration with hydroxyzine further reduced opioid withdrawal severity. These results suggest that 5-HT3 receptor antagonists, alone or in combination with an antihistamine, may be useful in the treatment of opioid withdrawal.

  View details for PubMedID 27712113

• One Month of Oral Morphine Decreases Gray Matter Volume in the Right Amygdala of Individuals with Low Back Pain: Confirmation of Previously Reported Magnetic Resonance Imaging Results. Pain medicine Lin, J. C., Chu, L. F., Stringer, E. A., Baker, K. S., Sayyid, Z. N., Sun, J., Campbell, K. A., Younger, J. W. 2016; 17 (8): 1497-1504

  Abstract

  Prolonged exposure to opioids is known to produce neuroplastic changes in animals; however, few studies have investigated the effects of short-term prescription opioid use in humans. A previous study from our laboratory demonstrated a dosage-correlated volumetric decrease in the right amygdala of participants administered oral morphine daily for 1 month. The purpose of this current study was to replicate and extend the initial findings.Twenty-one participants with chronic low back pain were enrolled in this double-blind, placebo-controlled study. Participants were randomized to receive daily morphine (n = 11) or a matched placebo (n = 10) for 1 month. High-resolution anatomical images were acquired immediately before and after the treatment administration period. Morphological gray matter changes were investigated using tensor-based morphometry, and significant regions were subsequently tested for correlation with morphine dosage.Decreased gray matter volume was observed in several reward- and pain-related regions in the morphine group, including the bilateral amygdala, left inferior orbitofrontal cortex, and bilateral pre-supplementary motor areas. Morphine administration was also associated with significant gray matter increases in cingulate regions, including the mid cingulate, dorsal anterior cingulate, and ventral posterior cingulate.Many of the volumetric increases and decreases overlapped spatially with the previously reported changes. Individuals taking placebo for 1 month showed neither gray matter increases nor decreases. The results corroborate previous reports that rapid alterations occur in reward-related networks following short-term prescription opioid use.

  View details for DOI 10.1093/pm/pnv047

  View details for PubMedID 26814280

• Teaching the 21st Century Learner: Innovative Strategies and Practical Implementation. International anesthesiology clinics Chandrasoma, J., Chu, L. F. 2016; 54 (3): 35-53

  View details for DOI 10.1097/AIA.0000000000000108

  View details for PubMedID 27285071

• Palonosetron and hydroxyzine pre-treatment reduces the objective signs of experimentally-induced acute opioid withdrawal in humans: a double-blinded, randomized, placebo-controlled crossover study The American Journal of Drug and Alcohol Abuse Erlendson, M., D'Arcy, N., Encisco, E., Yu, J., Rincon-Cruz, L., Peltz, G., Clark, D. J., Chu, L. F. 2016: 1-9

  Abstract

  Treatments for reducing opioid withdrawal are limited and prone to problematic side effects. Laboratory studies, clinical observations, and limited human trial data suggest 5-HT3-receptor antagonists and antihistamines may be effective.This double-blind, crossover, placebo-controlled study employing an acute physical dependence model evaluated whether (i) treatment with a 5-HT3-receptor antagonist (palonosetron) would reduce opioid withdrawal symptoms, and (ii) co-administration of an antihistamine (hydroxyzine) would enhance any treatment effect.At timepoint T = 0, healthy (non-opioid dependent, non-substance abuser) male volunteers (N = 10) were pre-treated with either a) placebo, b) palonosetron IV (0.75 mg), or c) palonosetron IV (0.75 mg) and hydroxyzine PO (100 mg) in a crossover study design. This was followed at T = 30 by intravenous morphine (10 mg/70kg). At T = 165, 10 mg/70kg naloxone IV was given to precipitate opioid withdrawal. The objective opioid withdrawal score (OOWS) and subjective opioid withdrawal score (SOWS) were determined 5 and 15 minutes after naloxone administration (T = 170, 180, respectively). Baseline measurements were recorded at T = -30 and T = -15.Comparison of average baseline OOWS scores with OOWS scores obtained 15 minutes after naloxone was significant (p = 0.0001). Scores from 15 minutes post-naloxone infusion showed significant differences in OOWS scores between treatment groups: placebo, 3.7 ± 2.4; palonosetron, 1.5 ± 0.97; and palonosetron with hydroxyzine, 0.2 ± 0.1333.Pretreatment with palonosetron significantly reduced many signs of experimentally-induced opioid withdrawal. Co-administration with hydroxyzine further reduced opioid withdrawal severity. These results suggest that 5-HT3 receptor antagonists, alone or in combination with an antihistamine, may be useful in the treatment of opioid withdrawal.

  View details for DOI 10.1080/00952990.2016.1210614

• "Nothing about us without us"-patient partnership in medical conferences. BMJ (Clinical research ed.) Chu, L. F., Utengen, A., Kadry, B., Kucharski, S. E., Campos, H., Crockett, J., Dawson, N., Clauson, K. A. 2016; 354: i3883-?

  View details for DOI 10.1136/bmj.i3883

  View details for PubMedID 27628427

• Acute opioid withdrawal is associated with increased neural activity in reward-processing centers in healthy men: A functional magnetic resonance imaging study. Drug and alcohol dependence Chu, L. F., Lin, J. C., Clemenson, A., Encisco, E., Sun, J., Hoang, D., Alva, H., Erlendson, M., Clark, J. D., Younger, J. W. 2015; 153: 314-322

  Abstract

  Opioid analgesics are frequently prescribed for chronic pain. One expected consequence of long-term opioid use is the development of physical dependence. Although previous resting state functional magnetic resonance imaging (fMRI) studies have demonstrated signal changes in reward-associated areas following morphine administration, the effects of acute withdrawal on the human brain have been less well-investigated. In an earlier study by our laboratory, ondansetron was shown to be effective in preventing symptoms associated with opioid withdrawal. The purpose of this current study was to characterize neural activity associated with acute opioid withdrawal and examine whether these changes are modified by ondansetron.Ten participants were enrolled in this placebo-controlled, randomized, double-blind, crossover study and attended three acute opioid withdrawal sessions. Participants received either placebo or ondansetron (8Ymg IV) before morphine administration (10Ymg/70Ykg IV). Participants then underwent acute naloxone-precipitated withdrawal during a resting state fMRI scan. Objective and subjective opioid withdrawal symptoms were assessed.Imaging results showed that naloxone-precipitated opioid withdrawal was associated with increased neural activity in several reward processing regions, including the right pregenual cingulate, putamen, and bilateral caudate, and decreased neural activity in networks involved in sensorimotor integration. Ondansetron pretreatment did not have a significant effect on the imaging correlates of opioid withdrawal.This study presents a preliminary investigation of the regional changes in neural activity during acute opioid withdrawal. The fMRI acute opioid withdrawal model may serve as a tool for studying opioid dependence and withdrawal in human participants.

  View details for DOI 10.1016/j.drugalcdep.2015.04.019

  View details for PubMedID 26059463

• A Survey of Resident Educational Technology Preferences from 374 Anesthesiology Residents Ngai, L. K., Eng, R. L., Erlendson, M. J., Chu, L. F. LIPPINCOTT WILLIAMS & WILKINS. 2014

  View details for Web of Science ID 000209827700013

• A Pilot Study to Measure the Impact of Blended Learning on Intern Wellness and Burnout Wen, L., Ratner, E., Harrison, T., Chu, L., Mariano, E., Roberts, S., Wang, T., Udani, A. LIPPINCOTT WILLIAMS & WILKINS. 2014

  View details for Web of Science ID 000209827700053

• STARTPrep: A 12-Month Multi-Institutional Online Preparatory Course for the American Board of Anesthesiology Part1 Basic Examination Eng, R., Roberts, S. E., Grove, W., Ngai, L., Bartsch, J., Fuller, A. J., Chu, L. F. LIPPINCOTT WILLIAMS & WILKINS. 2014

  View details for Web of Science ID 000209827700034

• THE IMPACT OF A FLIPPED CLASSROOM ON INTERN WELLNESS AND BURNOUT: A PILOT STUDY Wen, L., Ratner, E., Harrison, K., Chu, L., Mariano, E., Roberts, S., Udani, A. LIPPINCOTT WILLIAMS & WILKINS. 2014: S101

  View details for Web of Science ID 000209827600091

• Laryngeal Mask Airway in Medical Emergencies NEW ENGLAND JOURNAL OF MEDICINE Golzari, S. J., Mahmoodpoor, A. 2014; 370 (9): 883

  View details for Web of Science ID 000332013000024

• Laryngeal Mask Airway in Medical Emergencies REPLY NEW ENGLAND JOURNAL OF MEDICINE Lighthall, G., Harrison, T., Chu, L. F. 2014; 370 (9): 883–84

  View details for Web of Science ID 000332013000025

  View details for PubMedID 24571772

• Laryngeal Mask Airway in Medical Emergencies NEW ENGLAND JOURNAL OF MEDICINE Wang, H. E., Callaway, C. W., Soar, J. 2014; 370 (9): 882–83

  View details for DOI 10.1056/NEJMc1315505

  View details for Web of Science ID 000332013000022

  View details for PubMedID 24571770

• The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. 'Fritz' Berry PEDIATRIC ANESTHESIA Mai, C. L., Yaster, M., Chu, L., Ahmed, Z., Firth, P. G. 2014; 24 (2): 217-223

  Abstract

  Dr. Frederic A. 'Fritz' Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians-in-training while advancing the field of pediatric anesthesiology.

  View details for DOI 10.1111/pan.12309

  View details for Web of Science ID 000329300800014

  View details for PubMedID 24251450

• RapidRead: step-at-a-glance crisis checklists Pervasive Health Cirimele, J., Wu, L., Leach, K., Card, S., Harrison, T., Chu, L., Klemmer, S. R. 2014: 25–32

  View details for DOI 10.4108/icst.pervasivehealth.2014.254954

• Supporting crisis response with dynamic procedure aids Proceedings of the 2014 conference on Designing interactive systems Wu, L., Cirimele, J., Leach, K., Card, S., Chu, L., Harrison, T., Klemmer, S. R. 2014: 315–24

  View details for DOI 10.1145/2598510.2598565

• The MOOClet Framework: Improving Online Education through Experimentation and Personalization of Modules Social Science Research Network Williams, J. J., Li, N., Kim, J., Whitehill, J., Maldonado, S., Pechenizkiy, M., Chu, L., Heffernan, N. 2014

  View details for DOI 10.2139/ssrn.2523265

• Videos in clinical medicine: Laryngeal mask airway in medical emergencies. New England journal of medicine Lighthall, G., Harrison, T. K., Chu, L. F. 2013; 369 (20)

  Abstract

  This video demonstrates the placement of a laryngeal mask airway, an alternative airway device that is both efficacious and easy to place. The laryngeal mask airway is routinely used for patients receiving general anesthesia and, increasingly, in patient resuscitation.

  View details for DOI 10.1056/NEJMvcm0909669

  View details for PubMedID 24224639

• Laryngeal Mask Airway in Medical Emergencies NEW ENGLAND JOURNAL OF MEDICINE Lighthall, G., Harrison, T. K., Chu, L. F. 2013; 369 (20)

  Abstract

  This video demonstrates the placement of a laryngeal mask airway, an alternative airway device that is both efficacious and easy to place. The laryngeal mask airway is routinely used for patients receiving general anesthesia and, increasingly, in patient resuscitation.

  View details for DOI 10.1056/NEJMvcm0909669

  View details for Web of Science ID 000330468300001

• SUCCESSFUL TRANSITION TO ANESTHESIA RESIDENCY TRAINING: A MULTICENTER STUDY OF AN ONLINE DISTANCE-LEARNING PROGRAM DESIGNED TO PREPARE INTERNS FOR ANESTHESIA RESIDENCY TRAINING Erlendson, M. J., Ngai, L., Garbin, M., Chu, L. F. LIPPINCOTT WILLIAMS & WILKINS. 2013: 17–18

  View details for Web of Science ID 000330443300009

• IMPRINT: A BLENDED-LEARNING ONLINE AND SIMULATION-BASED CURRICULUM TO PROMOTE INTERN WELLNESS AND INCREASE MEDICAL KNOWLEDGE DURING THE CB-1 YEAR Udani, A., Clemenson, A., Harrison, K., Garbin, M., Chu, L. LIPPINCOTT WILLIAMS & WILKINS. 2013: 70–71

  View details for Web of Science ID 000330443300036

• INTERACTIVE COGNITIVE AIDS FOR CRITICAL EVENTS IN ANESTHESIA Cirimele, J., Cirimele, J., Wu, L., Chu, L., Harrison, K., Card, S., Klemmer, S. LIPPINCOTT WILLIAMS & WILKINS. 2013: 13–14

  View details for Web of Science ID 000330443300007

• SOCIAL MEDIA-BASED DISTRIBUTION OF ANESTHESIA EDUCATIONAL CONTENT: UTILIZATION OF THE ANESTHESIA ILLUSTRATED EDUCATIONAL WEBSITE Clemenson, A., Sun, J., Erlendson, M., Chu, L. F. LIPPINCOTT WILLIAMS & WILKINS. 2013: 15–16

  View details for Web of Science ID 000330443300008

• THE USE OF MOBILE COMPUTING DEVICES IN ANESTHESIA RESIDENT EDUCATION: A CROSS-SECTIONAL SURVEY STUDY Sun, J. S., Clemenson, A. M., Garbin, M. C., Chu, L. F. LIPPINCOTT WILLIAMS & WILKINS. 2013: 68–69

  View details for Web of Science ID 000330443300035

• Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology JOURNAL OF TRANSLATIONAL MEDICINE Stringer, E. A., Baker, K. S., Carroll, I. R., Montoya, J. G., Chu, L., Maecker, H. T., Younger, J. W. 2013; 11

  Abstract

  Chronic fatigue syndrome (CFS) is a debilitating disorder characterized by persistent fatigue that is not alleviated by rest. The lack of a clearly identified underlying mechanism has hindered the development of effective treatments. Studies have demonstrated elevated levels of inflammatory factors in patients with CFS, but findings are contradictory across studies and no biomarkers have been consistently supported. Single time-point approaches potentially overlook important features of CFS, such as fluctuations in fatigue severity. We have observed that individuals with CFS demonstrate significant day-to-day variability in their fatigue severity.Therefore, to complement previous studies, we implemented a novel longitudinal study design to investigate the role of cytokines in CFS pathophysiology. Ten women meeting the Fukuda diagnostic criteria for CFS and ten healthy age- and body mass index (BMI)-matched women underwent 25 consecutive days of blood draws and self-reporting of symptom severity. A 51-plex cytokine panel via Luminex was performed for each of the 500 serum samples collected. Our primary hypothesis was that daily fatigue severity would be significantly correlated with the inflammatory adipokine leptin, in the women with CFS and not in the healthy control women. As a post-hoc analysis, a machine learning algorithm using all 51 cytokines was implemented to determine whether immune factors could distinguish high from low fatigue days.Self-reported fatigue severity was significantly correlated with leptin levels in six of the participants with CFS and one healthy control, supporting our primary hypothesis. The machine learning algorithm distinguished high from low fatigue days in the CFS group with 78.3% accuracy.Our results support the role of cytokines in the pathophysiology of CFS.

  View details for DOI 10.1186/1479-5876-11-93

  View details for Web of Science ID 000318117400001

  View details for PubMedID 23570606

  View details for PubMedCentralID PMC3637529

• Preparing Interns for Anesthesiology Residency Training: Development and Assessment of the Successful Transition to Anesthesia Residency Training (START) E-Learning Curriculum. Journal of graduate medical education Chu, L. F., Ngai, L. K., Young, C. A., Pearl, R. G., Macario, A., Harrison, T. K. 2013; 5 (1): 125-129

  Abstract

  The transition from internship to residency training may be a stressful time for interns, particularly if it involves a change among programs or institutions after completing a preliminary year.We explored whether an e-learning curriculum would increase interns' preparedness for the transition to the first year of clinical anesthesiology training and reduce stress by improving confidence and perceived competence in performing professional responsibilities.We tested a 10-month e-learning program, Successful Transition to Anesthesia Residency Training (START), as a longitudinal intervention to increase interns' self-perceived preparedness to begin anesthesiology residency training in a prospective, observational study and assessed acceptance and sustainability. After a needs assessment, we administered the START modules to 22 interns, once a month, using an integrated learning management and lecture-capture system. We surveyed interns' self-assessed preparedness to begin anesthesiology residency before and after completing the START modules. Interns from the prior year's class, who did not participate in the online curriculum, served as controls.After participation in the START intervention, self-assessed preparedness to begin residency improved by 72% (P  =  .02). Interns also felt more connected to, and had improved positive feelings toward, their new residency program and institution.Participation in our novel 10-month e-learning curriculum and virtual mentorship program improved interns' impression of their residency program and significantly increased interns' subjective assessment of their preparedness to begin anesthesiology residency. This e-learning concept could be more broadly applied and useful to other residency programs.

  View details for DOI 10.4300/JGME-D-12-00121.1

  View details for PubMedID 24404239

  View details for PubMedCentralID PMC3613296

• Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology. Journal of translational medicine Stringer, E. A., Baker, K. S., Carroll, I. R., Montoya, J. G., Chu, L., Maecker, H. T., Younger, J. W. 2013; 11: 93-?

  Abstract

  Chronic fatigue syndrome (CFS) is a debilitating disorder characterized by persistent fatigue that is not alleviated by rest. The lack of a clearly identified underlying mechanism has hindered the development of effective treatments. Studies have demonstrated elevated levels of inflammatory factors in patients with CFS, but findings are contradictory across studies and no biomarkers have been consistently supported. Single time-point approaches potentially overlook important features of CFS, such as fluctuations in fatigue severity. We have observed that individuals with CFS demonstrate significant day-to-day variability in their fatigue severity.Therefore, to complement previous studies, we implemented a novel longitudinal study design to investigate the role of cytokines in CFS pathophysiology. Ten women meeting the Fukuda diagnostic criteria for CFS and ten healthy age- and body mass index (BMI)-matched women underwent 25 consecutive days of blood draws and self-reporting of symptom severity. A 51-plex cytokine panel via Luminex was performed for each of the 500 serum samples collected. Our primary hypothesis was that daily fatigue severity would be significantly correlated with the inflammatory adipokine leptin, in the women with CFS and not in the healthy control women. As a post-hoc analysis, a machine learning algorithm using all 51 cytokines was implemented to determine whether immune factors could distinguish high from low fatigue days.Self-reported fatigue severity was significantly correlated with leptin levels in six of the participants with CFS and one healthy control, supporting our primary hypothesis. The machine learning algorithm distinguished high from low fatigue days in the CFS group with 78.3% accuracy.Our results support the role of cytokines in the pathophysiology of CFS.

  View details for DOI 10.1186/1479-5876-11-93

  View details for PubMedID 23570606

• Interactive cognitive aids in medicine CHI '13 Extended Abstracts on Human Factors in Computing Systems Wu, L., Cirimele, J., Leach, K., Card, S., Chu, L., Harrison, K., Klemmer, S. 2013: 2887–88

  View details for DOI 10.1145/2468356.2479562

• Head-mounted and multi-surface displays support emergency medical teams Proceedings of the 2013 conference on Computer supported cooperative work companion Wu, L., Cirimele, J., Bassen, J., Leach, K., Card, S., Chu, L., Harrison, K., Klemmer, S. 2013: 279–82

  View details for DOI 10.1145/2441955.2442020

• Clinical Anesthesiology Board Review edited by Chu, L. F. McGraw-Hill. 2013
• Mobile computing in medical education: opportunities and challenges CURRENT OPINION IN ANESTHESIOLOGY Chu, L. F., Erlendson, M. J., Sun, J. S., Alva, H. L., Clemenson, A. M. 2012; 25 (6): 699-718

  Abstract

  There is an increasing importance of incorporating mobile computing into the academic medical environment. A growing majority of physicians, residents and medical students currently use mobile devices for education, access to clinical information and to facilitate bedside care. Therefore, it is important to assess the current opportunities and challenges in the use of mobile computing devices in the academic medical environment.Current research has found that a majority of physicians, residents and medical students either own or use mobile devices. In addition, studies have shown that these devices are effective as educational tools, resource guides and aids in patient care. Although there are opportunities for medical education, issues of deployment must still be addressed, such as privacy, connectivity, standardization and professionalism.Understanding the opportunities and challenges of using mobile computing devices in the academic medical environment can help determine the feasibility and benefits of their use for individuals and institutions.

  View details for DOI 10.1097/ACO.0b013e32835a25f1

  View details for PubMedID 23103844

• Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release morphine for treatment of chronic nonradicular low-back pain PAIN Chu, L. F., D'Arcy, N., Brady, C., Zamora, A. K., Young, C. A., Kim, J. E., Clemenson, A. M., Angst, M. S., Clark, J. D. 2012; 153 (8): 1583-1592

  Abstract

  Although often successful in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dose escalation to attain pain relief. Analgesic tolerance, and more recently opioid-induced hyperalgesia, have been invoked to explain such declines in opioid effectiveness over time. Because both phenomena result in inadequate analgesia, they are difficult to distinguish in a clinical setting. Patients with otherwise uncomplicated low-back pain were titrated to comfort or dose-limiting side effects in a prospective, randomized, double-blind, placebo-controlled clinical trial using sustained-release morphine or weight-matched placebo capsules for 1 month. A total of 103 patients completed the study, with an average end titration dose of 78 mg morphine/d. After 1 month, the morphine-treated patients developed tolerance to the analgesic effects of remifentanil, but did not develop opioid-induced hyperalgesia. On average, these patients experienced a 42% reduction in analgesic potency. The morphine-treated patients experienced clinically relevant improvements in pain relief, as shown by a 44% reduction in average visual analogue scale pain levels and a 31% improvement in functional ability. The differences in visual analogue scale pain levels (P = .003) and self-reported disability (P = .03) between both treatment groups were statistically significant. After 1 month of oral morphine therapy, patients with chronic low-back pain developed tolerance but not opioid-induced hyperalgesia. Improvements in pain and functional ability were observed.

  View details for DOI 10.1016/j.pain.2012.02.028

  View details for PubMedID 22704854

• Modulation of remifentanil-induced postinfusion hyperalgesia by the beta-blocker propranolol in humans PAIN Chu, L. F., Cun, T., Ngai, L. K., Kim, J. E., Zamora, A. K., Young, C. A., Angst, M. S., Clark, D. J. 2012; 153 (5): 974-981

  Abstract

  Acute and chronic exposure to opioids has been associated with hyperalgesia in both animals and humans. A genetic analysis of opioid-induced hyperalgesia in mice linked the β(2)-adrenergic receptor to mechanical sensitization after opioid exposure. In humans, expansion of the area of mechanical hyperalgesia surrounding an experimentally induced lesion after the cessation of remifentanil infusion is a commonly used model of opioid hyperalgesia (remifentanil-induced postinfusion hyperalgesia, RPH). The purpose of our translational study was to test the hypothesis that the β-adrenergic receptor antagonist propranolol modulates the expression of RPH in humans. This double-blinded, randomized, placebo-controlled, crossover study was performed in 10 healthy human volunteers. During test sessions, intracutaneous electrical stimulation was used to generate areas of secondary mechanical hyperalgesia. The area of this sensitization was measured before, during, and after remifentanil infusion. Heat pain sensitivity was also followed. During one test session, subjects received propranolol infusion. We observed an average increase in the areas of secondary mechanical hyperalgesia to 141% of the baseline in subjects infused with remifentanil and placebo (P=0.00040). However, when remifentanil infusion was combined with propranolol, the area of secondary hyperalgesia after terminating remifentanil was not significantly different than the area before beginning the opioid infusion (P=0.13). Thermal hyperalgesia was not observed after remifentanil infusion. Propranolol infusion at the selected dose had minor hemodynamic effects. Concomitant infusion of propranolol with remifentanil prevented the expression of RPH. β-adrenergic receptor blockade may be a useful pharmacological strategy for preventing hyperalgesia in patients exposed to opioids.

  View details for DOI 10.1016/j.pain.2012.01.014

  View details for PubMedID 22365565

• Information technology and its role in anaesthesia training and continuing medical education. Best practice & research. Clinical anaesthesiology Chu, L. F., Erlendson, M. J., Sun, J. S., Clemenson, A. M., Martin, P., Eng, R. L. 2012; 26 (1): 33-53

  Abstract

  Today's educators are faced with substantial challenges in the use of information technology for anaesthesia training and continuing medical education. Millennial learners have uniquely different learning styles than previous generations of students. These preferences distinctly incorporate the use of digital information technologies and social technologies to support learning. To be effective teachers, modern educators must be familiar with these new information technologies and understand how to use them for medical education. Examples of new information technologies include learning management systems, lecture capture, social media (YouTube, Flickr), social networking (Facebook), Web 2.0, multimedia (video learning triggers and point-of-view video) and mobile computing applications. The information technology challenges for educators in the twenty-first century include: (a) understanding how technology shapes the learning preferences of today's anaesthesia residents, (b) distinguishing between the function and properties of new learning technologies and (c) properly using these learning technologies to enhance the anaesthesia curriculum.

  View details for DOI 10.1016/j.bpa.2012.02.002

  View details for PubMedID 22559955

• Analysis of 4999 Online Physician Ratings Indicates That Most Patients Give Physicians a Favorable Rating JOURNAL OF MEDICAL INTERNET RESEARCH Kadry, B., Chu, L. F., Kadry, B., Gammas, D., Macario, A. 2011; 13 (4)

  Abstract

  Many online physician-rating sites provide patients with information about physicians and allow patients to rate physicians. Understanding what information is available is important given that patients may use this information to choose a physician.The goals of this study were to (1) determine the most frequently visited physician-rating websites with user-generated content, (2) evaluate the available information on these websites, and (3) analyze 4999 individual online ratings of physicians.On October 1, 2010, using Google Trends we identified the 10 most frequently visited online physician-rating sites with user-generated content. We then studied each site to evaluate the available information (eg, board certification, years in practice), the types of rating scales (eg, 1-5, 1-4, 1-100), and dimensions of care (eg, recommend to a friend, waiting room time) used to rate physicians. We analyzed data from 4999 selected physician ratings without identifiers to assess how physicians are rated online.The 10 most commonly visited websites with user-generated content were HealthGrades.com, Vitals.com, Yelp.com, YP.com, RevolutionHealth.com, RateMD.com, Angieslist.com, Checkbook.org, Kudzu.com, and ZocDoc.com. A total of 35 different dimensions of care were rated by patients in the websites, with a median of 4.5 (mean 4.9, SD 2.8, range 1-9) questions per site. Depending on the scale used for each physician-rating website, the average rating was 77 out of 100 for sites using a 100-point scale (SD 11, median 76, range 33-100), 3.84 out of 5 (77%) for sites using a 5-point scale (SD 0.98, median 4, range 1-5), and 3.1 out of 4 (78%) for sites using a 4-point scale (SD 0.72, median 3, range 1-4). The percentage of reviews rated ≥75 on a 100-point scale was 61.5% (246/400), ≥4 on a 5-point scale was 57.74% (2078/3599), and ≥3 on a 4-point scale was 74.0% (740/1000). The patient's single overall rating of the physician correlated with the other dimensions of care that were rated by patients for the same physician (Pearson correlation, r = .73, P < .001).Most patients give physicians a favorable rating on online physician-rating sites. A single overall rating to evaluate physicians may be sufficient to assess a patient's opinion of the physician. The optimal content and rating method that is useful to patients when visiting online physician-rating sites deserves further study. Conducting a qualitative analysis to compare the quantitative ratings would help validate the rating instruments used to evaluate physicians.

  View details for DOI 10.2196/jmir.1960

  View details for PubMedID 22088924

• Prescription opioid analgesics rapidly change the human brain PAIN Younger, J. W., Chu, L. F., D'Arcy, N. T., Trott, K. E., Jastrzab, L. E., Mackey, S. C. 2011; 152 (8): 1803-1810

  Abstract

  Chronic opioid exposure is known to produce neuroplastic changes in animals; however, it is not known if opioids used over short periods of time and at analgesic dosages can similarly change brain structure in humans. In this longitudinal, magnetic resonance imaging study, 10 individuals with chronic low back pain were administered oral morphine daily for 1 month. High-resolution anatomical images of the brain were acquired immediately before and after the morphine administration period. Regional changes in gray matter volume were assessed on the whole brain using tensor-based morphometry, and those significant regional changes were then independently tested for correlation with morphine dosage. Thirteen regions evidenced significant volumetric change, and degree of change in several of the regions was correlated with morphine dosage. Dosage-correlated volumetric decrease was observed primarily in the right amygdala. Dosage-correlated volumetric increase was seen in the right hypothalamus, left inferior frontal gyrus, right ventral posterior cingulate, and right caudal pons. Follow-up scans that were conducted an average of 4.7 months after cessation of opioids demonstrated many of the morphine-induced changes to be persistent. In a separate study, 9 individuals consuming blinded placebo capsules for 6 weeks evidenced no significant morphologic changes over time. The results add to a growing body of literature showing that opioid exposure causes structural and functional changes in reward- and affect-processing circuitry. Morphologic changes occur rapidly in humans during new exposure to prescription opioid analgesics. Further research is needed to determine the clinical impact of those opioid-induced gray matter changes.

  View details for DOI 10.1016/j.pain.2011.03.028

  View details for PubMedID 21531077

• A sensitive assay for the quantification of morphine and its active metabolites in human plasma and dried blood spots using high-performance liquid chromatography-tandem mass spectrometry ANALYTICAL AND BIOANALYTICAL CHEMISTRY Clavijo, C. F., Hoffman, K. L., Thomas, J. J., Carvalho, B., Chu, L. F., Drover, D. R., Hammer, G. B., Christians, U., Galinkin, J. L. 2011; 400 (3): 715-728

  Abstract

  Opioids such as morphine are the cornerstone of pain treatment. The challenge of measuring the concentrations of morphine and its active metabolites in order to assess human pharmacokinetics and monitor therapeutic drugs in children requires assays with high sensitivity in small blood volumes. We developed and validated a semi-automated LC-MS/MS assay for the simultaneous quantification of morphine and its active metabolites morphine 3β-glucuronide (M3G) and morphine 6β-glucuronide (M6G) in human plasma and in dried blood spots (DBS). Reconstitution in water (DBS only) and addition of a protein precipitation solution containing the internal standards were the only manual steps. Morphine and its metabolites were separated on a Kinetex 2.6-μm PFP analytical column using an acetonitrile/0.1% formic acid gradient. The analytes were detected in the positive multiple reaction mode. In plasma, the assay had the following performance characteristics: range of reliable response of 0.25-1000 ng/mL (r(2) > 0.99) for morphine, 1-1,000 ng/mL (r(2) > 0.99) for M3G, and 2.5-1,000 ng/mL for M6G. In DBS, the assay had a range of reliable response of 1-1,000 ng/mL (r(2) > 0.99) for morphine and M3G, and of 2.5-1,000 ng/mL for M6G. For inter-day accuracy and precision for morphine, M3G and M6G were within 15% of the nominal values in both plasma and DBS. There was no carryover, ion suppression, or matrix interferences. The assay fulfilled all predefined acceptance criteria, and its sensitivity using DBS samples was adequate for the measurement of pediatric pharmacokinetic samples using a small blood of only 20-50 μL.

  View details for DOI 10.1007/s00216-011-4775-z

  View details for Web of Science ID 000289297000015

  View details for PubMedID 21400080

• Self-Reported Information Needs of Anesthesia Residency Applicants and Analysis of Applicant-Related Web Sites Resources at 131 United States Training Programs ANESTHESIA AND ANALGESIA Chu, L. F., Young, C. A., Zamora, A. K., Lowe, D., Hoang, D. B., Pearl, R. G., Macario, A. 2011; 112 (2): 430-439

  Abstract

  Despite the use of web-based information resources by both anesthesia departments and applicants, little research has been done to assess these resources and determine whether they are meeting applicant needs. Evidence is needed to guide anesthesia informatics research in developing high-quality anesthesia residency program Web sites (ARPWs).We used an anonymous web-based program (SurveyMonkey, Portland, OR) to distribute a survey investigating the information needs and perceived usefulness of ARPWs to all 572 Stanford anesthesia residency program applicants. A quantitative scoring system was then created to assess the quality of ARPWs in meeting the information needs of these applicants. Two researchers independently analyzed all 131 ARPWs in the United States to determine whether the ARPWs met the needs of applicants based on the scoring system. Finally, a qualitative assessment of the overall user experience of ARPWs was developed to account for the subjective elements of the Web site's presentation.Ninety-eight percent of respondents reported having used ARPWs during the application process. Fifty-six percent reported first visiting the Stanford ARPW when deciding whether to apply to Stanford's anesthesia residency program. Multimedia and Web 2.0 technologies were "very" or "most" useful in "learning intangible aspects of a program, like how happy people are" (42% multimedia and Web 2.0 versus 14% text and photos). ARPWs, on average, contained only 46% of the content items identified as important by applicants. The average (SD) quality scores among all ARPWs was 2.06 (0.59) of 4.0 maximum points. The mean overall qualitative score for all 131 ARPWs was 4.97 (1.92) of 10 points. Only 2% of applicants indicated that the majority (75%-100%) of Web sites they visited provided a complete experience.Anesthesia residency applicants rely heavily on ARPWs to research programs, prepare for interviews, and formulate a rank list. Anesthesia departments can improve their ARPWs by including information such as total hours worked and work hours by rotation (missing in 96% and 97% of ARPWs) and providing a valid web address on the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) (missing in 28% of ARPWs).

  View details for DOI 10.1213/ANE.0b013e3182027a94

  View details for PubMedID 21081766

• The Endogenous Opioid System Is Not Involved in Modulation of Opioid-Induced Hyperalgesia JOURNAL OF PAIN Chu, L. F., Dairmont, J., Zamora, A. K., Young, C. A., Angst, M. S. 2011; 12 (1): 108-115

  Abstract

  Some recent studies suggested a role of the endogenous opioid system in modulating opioid-induced hyperalgesia (OIH). In order to test this hypothesis, we conducted a prospective randomized, placebo-controlled, 2-way crossover study in healthy human volunteers. We utilized a well-established model of inducing OIH after a brief exposure to the μ-opioid agonist remifentanil using intradermal electrical stimulation. Patients were exposed to a randomized 90-minute infusion of remifentanil or saline placebo during 2 separate occasions. Development of OIH was quantified using changes in the average radius of the area of secondary hyperalgesia generated by electrical pain stimulation. A 23.6% (20.2) increase in area of secondary hyperalgesia over baseline was observed in the postinfusion period of the remifentanil session, demonstrating development of OIH (P = .03). In order to test endogenous opioid system modulation of OIH, patients were given a 1-time bolus of naloxone, which had no effect on the size of the hyperalgesic lesion in either the remifentinal or placebo session. These results suggested that the endogenous opioid system did not appear to modulate OIH.Experimental evidence suggested that the endogenous opioid system did not significantly affect opioid-induced hyperalgesia. Consequently, this study suggested that alternative mechanisms such as pronociceptive stimulation and neuroplastic changes might be responsible for expression of OIH.

  View details for DOI 10.1016/j.jpain.2010.05.006

  View details for PubMedID 20864417

• A visual guide to anesthesia procedures Chu, L. F., Fuller, A. J. LWW. 2011
• Coagulopathies Manual of Clinical Anesthesiology Fanning, R., Chu, L. F. Lippincott Williams and Wilkins. 2011
• A visual guide to regional anesthesia Chu, L. F., Fuller, A. J., Mariano, E. LWW. 2011
• Wire Crichothyroidotomy Manual of Clinical Anesthesiology Chu, L. F., Tanaka, P. Lippincott Williams and Wilkins. 2011
• Endotracheal Intubation Manual of Clinical Anesthesiology Chu, L. F., Harrison, T. Lippincott Williams and Wilkins. 2011
• Maintaining shared mental models in anesthesia crisis care with nurse tablet input and large-screen displays Proceedings of the 24th annual ACM symposium adjunct on User interface software and technology Wu, L., Cirimele, J., Card, S., Klemmer, S., Chu, L., Harrison, K. 2011: 71–72

  View details for DOI 10.1145/2046396.2046428

• Mask Ventilation Manual of Clinical Anesthesiology Chu, L. F., Harrison, T. Lippincott Williams and Wilkins. 2011
• Insertion of Peripheral IV Manual of Clinical Anesthesiology Chu, L. F. Lippincott Williams and Wilkins. 2011
• The Anesthetic Plan and Induction of Anesthesia Manual of Clinical Anesthesiology Hairston , J., Ludwin, D., Chu, L. Lippincott Williams and Wilkins. 2011
• Radial Artery Catheterization Manual of Clinical Anesthesiology Chu, L. F., Harrison, T. Lippincott Williams and Wilkins. 2011
• Insertion of Left-Sided DLT Manual of Clinical Anesthesiology Chu, L. F., Kulkarni, V., Harrison, T. Lippincott Williams and Wilkins. 2011
• Awake Fiber Optic Intubation Manual of Clinical Anesthesiology Chu, L. F., Harrison, T. Lippincott Williams and Wilkins. 2011
• Spinal Anesthesia Manual of Clinical Anesthesiology Chu, L. F., Fuller, A., Harrison, T. Lippincott Williams and Wilkins. 2011
• A visual guide to crisis management Chu, L. F., Fuller, A., Goldhaber-Fibert, S., Harrison, K. LWW. 2011
• A visual guide to transesophageal echocardiography Chu, L. F., Fuller, A. J., Weitzel, N. LWW. 2011
• Standard Induction of GA Manual of Clinical Anesthesiology Chu, L. F., Harrison, T. Lippincott Williams and Wilkins. 2011
• Laryngeal Mask Airway Insertion Manual of Clinical Anesthesiology Chu, L. F. Lippincott Williams and Wilkins. 2011
• Lumbar Epidural Placement Manual of Clinical Anesthesiology Chu, L. F., Fuller, A., Harrison, A. Lippincott Williams and Wilkins. 2011
• Central Venous Catheterization Manual of Clinical Anesthesiology Chu, L. F., Harrison, T. Lippincott Williams and Wilkins. 2011
• Manual of Clinical Anesthesiology edited by Chu, L. F., Fuller, A. J. LWW. 2011
• Learning management systems and lecture capture in the medical academic environment. International anesthesiology clinics Chu, L. F., Young, C. A., Ngai, L. K., Cun, T., Pearl, R. G., Macario, A. 2010; 48 (3): 27-51

  Abstract

  As residents work disparate schedules at multiple locations and because of workweek hour limits mandated by the ACGME, residents may be unable to attend lectures, seminars, or other activities that would enhance their skills. Further, the ACGME requires that residency programs document resident learning in six stated core competencies and provide proof of completion for various other requirements. LMS/LC is a promising technology to provide a means by which residency programs may overcome these obstacles. More studies are needed to show under what conditions an LMS/LC program actually enhances learning, and which elements are most useful to the new generation of learners comfortable with Web 2.0 technologies.

  View details for DOI 10.1097/AIA.0b013e3181e5c1d5

  View details for PubMedID 20616636

• The role of social networking applications in the medical academic environment. International anesthesiology clinics Chu, L. F., Zamora, A. K., Young, C. A., Kurup, V., Macario, A. 2010; 48 (3): 61-82

  View details for DOI 10.1097/AIA.0b013e3181e6e7d8

  View details for PubMedID 20616638

• Learning Management Systems and Lecture Capture in the Medical Academic Environment INTERNATIONAL ANESTHESIOLOGY CLINICS Chu, L. F., Young, C. A., Ngai, L. K., Cun, T., Pearl, R. G., Macario, A. 2010; 48 (3): 27–51

  View details for DOI 10.1097/AIA.0b013e3181e5c1d5

  View details for Web of Science ID 000218297800004

• Finite element modeling of subcutaneous implantable defibrillator electrodes in an adult torso HEART RHYTHM Jolley, M., Stinstra, J., Tate, J., Pieper, S., MacLeod, R., Chu, L., Wang, P., Triedman, J. K. 2010; 7 (5): 692-698

  Abstract

  Total subcutaneous implantable subcutaneous defibrillators are in development, but optimal electrode configurations are not known.We used image-based finite element models (FEM) to predict the myocardial electric field generated during defibrillation shocks (pseudo-DFT) in a wide variety of reported and innovative subcutaneous electrode positions to determine factors affecting optimal lead positions for subcutaneous implantable cardioverter-defibrillators (S-ICD).An image-based FEM of an adult man was used to predict pseudo-DFTs across a wide range of technically feasible S-ICD electrode placements. Generator location, lead location, length, geometry and orientation, and spatial relation of electrodes to ventricular mass were systematically varied. Best electrode configurations were determined, and spatial factors contributing to low pseudo-DFTs were identified using regression and general linear models.A total of 122 single-electrode/array configurations and 28 dual-electrode configurations were simulated. Pseudo-DFTs for single-electrode orientations ranged from 0.60 to 16.0 (mean 2.65 +/- 2.48) times that predicted for the base case, an anterior-posterior configuration recently tested clinically. A total of 32 of 150 tested configurations (21%) had pseudo-DFT ratios

  View details for DOI 10.1016/j.hrthm.2010.01.030

  View details for PubMedID 20230927

• Anesthesia 2.0: Internet-based information resources and Web 2.0 applications in anesthesia education CURRENT OPINION IN ANESTHESIOLOGY Chu, L. F., Young, C., Zamora, A., Kurup, V., Macario, A. 2010; 23 (2): 218-227

  Abstract

  Informatics is a broad field encompassing artificial intelligence, cognitive science, computer science, information science, and social science. The goal of this review is to illustrate how Web 2.0 information technologies could be used to improve anesthesia education.Educators in all specialties of medicine are increasingly studying Web 2.0 technologies to maximize postgraduate medical education of housestaff. These technologies include microblogging, blogs, really simple syndication (RSS) feeds, podcasts, wikis, and social bookmarking and networking. 'Anesthesia 2.0' reflects our expectation that these technologies will foster innovation and interactivity in anesthesia-related web resources which embraces the principles of openness, sharing, and interconnectedness that represent the Web 2.0 movement. Although several recent studies have shown benefits of implementing these systems into medical education, much more investigation is needed.Although direct practice and observation in the operating room are essential, Web 2.0 technologies hold great promise to innovate anesthesia education and clinical practice such that the resident learner need not be in a classroom for a didactic talk, or even in the operating room to see how an arterial line is properly placed. Thoughtful research to maximize implementation of these technologies should be a priority for development by academic anesthesiology departments. Web 2.0 and advanced informatics resources will be part of physician lifelong learning and clinical practice.

  View details for DOI 10.1097/ACO.0b013e328337339c

  View details for PubMedID 20090518

• Bilateral infraorbital nerve blocks decrease postoperative pain but do not reduce time to discharge following outpatient nasal surgery Annual Meeting of the American-Society-of-Anesthesiologist Mariano, E. R., Watson, D., Loland, V. J., Chu, L. F., Cheng, G. S., Mehta, S. H., Maldonado, R. C., Ilfeld, B. M. SPRINGER. 2009: 584–89

  Abstract

  While infraorbital nerve blocks have demonstrated analgesic benefits for pediatric nasal and facial plastic surgery, no studies to date have explored the effect of this regional anesthetic technique on adult postoperative recovery. We designed this study to test the hypothesis that infraorbital nerve blocks combined with a standardized general anesthetic decrease the duration of recovery following outpatient nasal surgery.At a tertiary care university hospital, healthy adult subjects scheduled for outpatient nasal surgery were randomly assigned to receive bilateral infraorbital injections with either 0.5% bupivacaine (Group IOB) or normal saline (Group NS) using an intraoral technique immediately following induction of general anesthesia. All subjects underwent a standardized general anesthetic regimen and were transported to the recovery room following tracheal extubation. The primary outcome was the duration of recovery (minutes) from recovery room admission until actual discharge to home. Secondary outcomes included average and worst pain scores, nausea and vomiting, and supplemental opioid requirements.Forty patients were enrolled. A statistically significant difference in mean [SD] recovery room duration was not observed between Groups IOB and NS (131 [61] min vs 133 [58] min, respectively; P = 0.77). Subjects in Group IOB did experience a reduction in average pain on a 0-100 mm scale (mean [95% confidence interval]) compared to Group NS (-11 [-21 to 0], P = 0.047), but no other comparison of secondary outcomes was statistically significant.When added to a standardized general anesthetic, bilateral IOB do not decrease actual time to discharge following outpatient nasal surgery despite a beneficial effect on postoperative pain.

  View details for DOI 10.1007/s12630-009-9119-5

  View details for Web of Science ID 000268294300005

  View details for PubMedID 19475468

  View details for PubMedCentralID PMC2714904

• Anesthesia-controlled time and turnover time for ambulatory upper extremity surgery performed with regional versus general anesthesia 31st Annual Spring Meeting of the American-Society-of-Regional-Anesthesia-and-Pain-Medicine Mariano, E. R., Chu, L. F., Peinado, C. R., Mazzei, W. J. ELSEVIER SCIENCE INC. 2009: 253–57

  Abstract

  To test the hypothesis that regional anesthesia (RA) employing a block room reduces anesthesia-controlled time for ambulatory upper extremity surgery compared with general anesthesia (GA).Retrospective cohort study.Outpatient surgery center of a university hospital.229 adult patients who underwent ambulatory upper extremity surgery over one year.Upper extremity surgery was performed with three different anesthetic techniques: 1) GA, 2) nerve block (NB) performed preoperatively, or 3) local anesthetic (LA), either Bier block or local anesthetic, administered in the operating room (OR).Demographic data, anesthesia-controlled time, and turnover time were recorded. Since the data were not normally distributed, differences in anesthesia-controlled time and turnover time were analyzed using the Kruskal-Wallis test and post-hoc testing using one-way analysis of variance on the ranks of the observations, with Tukey-Kramer correction for multiple comparisons.Anesthesia-controlled time for NB (median 28 min) was significantly shorter than for GA (median 32 min, P = 0.0392). Anesthesia-controlled time for patients who received LA (median 25 min) was also significantly shorter than GA (P < 0.0001). However, turnover time did not differ significantly among the three groups.Peripheral nerve block performed preoperatively in an induction area or LA injected in the OR significantly reduces anesthesia-controlled time for ambulatory upper extremity surgery compared with GA. Turnover time is unaffected by anesthetic technique. These results may increase acceptance of RA in the ambulatory surgery setting.

  View details for DOI 10.1016/j.jclinane.2008.08.019

  View details for Web of Science ID 000267501500004

  View details for PubMedID 19502033

  View details for PubMedCentralID PMC2745934

• No evidence for the development of acute tolerance to analgesic, respiratory depressant and sedative opioid effects in humans PAIN Angst, M. S., Chu, L. F., Tingle, M. S., Shafer, S. L., Clark, J. D., Drover, D. R. 2009; 142 (1-2): 17-26

  Abstract

  It is widely accepted that chronic opioid therapy is associated with the development of pharmacological tolerance. More controversial is the question as to whether acute opioid administration can result in "acute tolerance." The aim of this double-blind, placebo-controlled study in thirty-six healthy human volunteers was to examine whether a 3-h intravenous infusion delivering two different but clinically relevant doses of the mu-opioid receptor agonist remifentanil would result in tolerance to analgesic, respiratory depressant and/or sedative opioid effects. The blood remifentanil concentration versus opioid effect relationship was determined before and after the 3-h infusion. Tolerance was inferred if the potency of remifentanil was significantly lower after the 3-h infusion. Opioid analgesia was assessed with the aid of the cold pressor test and models of electrical and heat pain. Respiratory depression was assessed by measuring arterial pCO2 and minute ventilation. Subjective sedation scores were assessed on a visual analogue scale. Mixed effects modeling was used to relate the steady-state blood remifentanil concentration to each pharmacodynamic assessment. Neither dose of remifentanil produced detectable tolerance to any of the measured opioid effects following a 3-h infusion. The study was adequately powered to detect a decrease in potency of 5-24% for analgesia, 20-48% for respiratory depression, and 32% for sedative effects. These results suggest that short-term administration of clinically useful doses of remifentanil is not associated with the development of significant tolerance to analgesic, respiratory depressant, or sedative opioid effects.

  View details for DOI 10.1016/j.pain.2008.11.001

  View details for PubMedID 19135798

• From mouse to man: the 5-HT3 receptor modulates physical dependence on opioid narcotics PHARMACOGENETICS AND GENOMICS Chu, L. F., Liang, D., Li, X., Sahbaie, P., D'Arcy, N., Liao, G., Peltz, G., Clark, J. D. 2009; 19 (3): 193-205

  Abstract

  Addiction to opioid narcotics represents a major public health challenge. Animal models of one component of addiction, physical dependence, show this trait to be highly heritable. The analysis of opioid dependence using contemporary in-silico techniques offers an approach to discover novel treatments for dependence and addiction.In these experiments, opioid withdrawal behavior in 18 inbred strains of mice was assessed. Mice were treated for 4 days with escalating doses of morphine before the administration of naloxone allowing the quantification of opioid dependence. After haplotypic analysis, experiments were designed to evaluate the top gene candidate as a modulator of physical dependence. Behavioral studies as well as measurements of gene expression on the mRNA and protein levels were completed. Finally, a human model of opioid dependence was used to quantify the effects of the 5-HT3 antagonist ondansetron on signs and symptoms of withdrawal.The Htr3a gene corresponding to the 5-HT3 receptor emerged as the leading candidate. Pharmacological studies using the selective 5-HT3 antagonist ondansetron supported the link in mice. Morphine strongly regulated the expression of the Htr3a gene in various central nervous system regions including the amygdala, dorsal raphe, and periaqueductal gray nuclei, which have been linked to opioid dependence in previous studies. Using an acute morphine administration model, the role of 5-HT3 in controlling the objective signs of withdrawal in humans was confirmed.These studies show the power of in-silico genetic mapping, and reveal a novel target for treating an important component of opioid addiction.

  View details for DOI 10.1097/FPC.0b013e328322e73d

  View details for PubMedID 19214139

• Overview on Clinical Features of Opioid-Induced Hyperalgesia. Opioid-Induced Hyperalgesia. Angst M, Chu L, Clark J. 2009: 21-37
• Molecular Basis and Clinical Implications of Opioid Tolerance and Opioid-Induced Hyperalgesia ACUTE PAIN MANAGEMENT Chu, L. F., Clark, D., Angst, M. S., Sinatra, R. S., DeLeonCasasola, O. A., Ginsberg, B., Viscusi, E. R. 2009: 114–43

  View details for DOI 10.1017/CBO9780511576706.012

  View details for Web of Science ID 000312035100011

• Molecular basis and clinical implications of opioid tolerance and opioid-induced hyperalgesia Acute Pain Management Chu, L. F., Angst, M. S., Clark, J. Cambridge University Press. 2009; 1: 114–146
• Ondansetron: an effective treatment for the withdrawal symptoms of opioids? Therapy Chu LF, Clark DJ 2009; 6 (5): 637-640
• Molecular Basis and Clinical Implications of Opioid Tolerance and Opioid-induced Hyperalgesia Acute Pain Management, Cambridge University Press, New York, New York Chu LF, Angst MS, Clark DJ 2009
• Reduced Cold Pain Tolerance in Chronic Pain Patients Following Opioid Detoxification PAIN MEDICINE Younger, J., Barelka, P., Carroll, I., Kaplan, K., Chu, L., Prasad, R., Gaeta, R., Mackey, S. 2008; 9 (8): 1158-1163

  Abstract

  One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients.Twelve chronic pain patients on long-term opioid analgesic treatment were observed in a 7- to 14-day inpatient pain rehabilitation program, with cold pain tolerance assessed at admission and discharge. The majority of participants were completely withdrawn from their opioids during their stay.We hypothesized that those patients with the greatest reduction in daily opioid use would show the greatest increases in pain tolerance, as assessed by a cold pressor task.A linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized. Greater opioid reduction was associated with decreased pain tolerance. This reduction of pain tolerance was not associated with opioid withdrawal symptoms or changes in general pain.These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity.

  View details for DOI 10.1111/j.1526-4637.2008.00475.x

  View details for PubMedID 18564998

• Opioid-induced hyperalgesia in humans - Molecular mechanisms and clinical considerations CLINICAL JOURNAL OF PAIN Chu, L. F., Angst, M. S., Clark, D. 2008; 24 (6): 479-496

  Abstract

  Opioid-induced hyperalgesia (OIH) is most broadly defined as a state of nociceptive sensitization caused by exposure to opioids. The state is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain may actually become more sensitive to certain painful stimuli. The type of pain experienced may or may not be different from the original underlying painful condition. Although the precise molecular mechanism is not yet understood, it is generally thought to result from neuroplastic changes in the peripheral and central nervous systems that lead to sensitization of pronociceptive pathways. OIH seems to be a distinct, definable, and characteristic phenomenon that may explain loss of opioid efficacy in some cases. Clinicians should suspect expression of OIH when opioid treatment effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the pain as previously observed. This review highlights the important mechanistic underpinnings and clinical ramifications of OIH and discusses future research directions and the latest clinical evidence for modulation of this potentially troublesome clinical phenomenon.

  View details for PubMedID 18574358

• Comparative evaluation of noninvasive compression adjuncts for hemostasis in percutaneous arterial, venous, and arteriovenous dialysis access procedures JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Wang, D. S., Chu, L. F., Olson, S. E., Miller, F. J., Valji, K., Wong, W. H., Rose, S. C., Austin, M., Kuo, M. D. 2008; 19 (1): 72-79

  Abstract

  To assess the relative efficacy of three compression adjuncts -- D-Stat Dry (D-Stat), QR Powder (QR), and XS Powder (XS) -- for reducing time to hemostasis in patients who underwent diagnostic and interventional percutaneous procedures.D-Stat, QR, or XS was applied in 176 percutaneous diagnostic arterial, therapeutic arterial, venous, and arteriovenous dialysis access (AVDA) procedures in 138 patients. The mean time to hemostasis and application-related complications were retrospectively assessed.Mean time to hemostasis was significantly reduced in all applications of QR (3.1 minutes +/- 1.1) and XS (3.7 minutes +/- 1.1) relative to D-Stat (6.2 minutes +/- 1.1, P < .001 vs both). For therapeutic arterial procedures, mean time to hemostasis for QR and XS was 3.6 minutes +/- 1.1 and 4.8 minutes +/- 1.1, respectively, and this was significantly less than that of D-Stat (10.0 minutes +/- 1.2; P < .001 vs QR, P < .01 vs XS). Mean times to hemostasis for QR and XS were also shorter than that with D-Stat in diagnostic arterial and AVDA procedures (P < .05). For venous procedures, mean time to hemostasis for QR (1.9 minutes +/- 1.2) was significantly shorter than that with both D-Stat (4.0 minutes +/- 1.2, P < .05) and XS (3.7 minutes +/- 1.2, P < .05). Minor immediate complications (hematoma <5 cm) occurred in 2.8% of applications. No access site infections were observed.All three agents effectively reduced time to hemostasis with minimal associated complications. QR was found to be more effective than D-Stat in all four procedure types.

  View details for DOI 10.1016/j.jvir.2007.08.028

  View details for Web of Science ID 000252853200012

  View details for PubMedID 18192470

• Comparison of supplementation rates for perivascular axillary and coracoid infraclavicular blocks in ambulatory upper extremity surgery. Ambulatory Surgery Mariano ER, Cheng GS, Loland VJ, Chu LF. 2008; 14 (2): 95-109
• Ketamine does not increase pulmonary vascular resistance in children with pulmonary hypertension undergoing sevoflurane anesthesia and spontaneous ventilation ANESTHESIA AND ANALGESIA Williams, G. D., Philip, B. M., Chu, L. F., Boltz, M. G., Kamra, K., Terwey, H., Hammer, G. B., Perry, S. B., Feinstein, J. A., Ramamoorthy, C. 2007; 105 (6): 1578-1584

  Abstract

  The use of ketamine in children with increased pulmonary vascular resistance is controversial. In this prospective, open label study, we evaluated the hemodynamic responses to ketamine in children with pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg).Children aged 3 mo to 18 yr with pulmonary hypertension, who were scheduled for cardiac catheterization with general anesthesia, were studied. Patients were anesthetized with sevoflurane (1 minimum alveolar anesthetic concentration [MAC]) in air while breathing spontaneously via a facemask. After baseline catheterization measurements, sevoflurane was reduced (0.5 MAC) and ketamine (2 mg/kg IV over 5 min) was administered, followed by a ketamine infusion (10 microg x kg(-1) x min(-1)). Catheterization measurements were repeated at 5, 10, and 15 min after completion of ketamine load. Data at various time points were compared (ANOVA, P < 0.05).Fifteen patients (age 147, 108 mo; median, interquartile range) were studied. Diagnoses included idiopathic pulmonary arterial hypertension (5), congenital heart disease (9), and diaphragmatic hernia (1). At baseline, median (interquartile range) baseline pulmonary vascular resistance index was 11.3 (8.2) Wood units; 33% of patients had suprasystemic mean pulmonary artery pressures. Heart rate (99, 94 bpm; P = 0.016) and Pao2 (95, 104 mm Hg; P = 007) changed after ketamine administration (baseline, 15 min after ketamine; P value). There were no significant differences in mean systemic arterial blood pressure, mean pulmonary artery pressure, systemic or pulmonary vascular resistance index, cardiac index, arterial pH, or Paco2.In the presence of sevoflurane, ketamine did not increase pulmonary vascular resistance in spontaneously breathing children with severe pulmonary hypertension.

  View details for DOI 10.1213/01.ane.0000287656.29064.89

  View details for PubMedID 18042853

• Single-dose, extended-release epidural morphine (DepoDur (TM)) compared to conventional epidural morphine for post-cesarean pain ANESTHESIA AND ANALGESIA Carvalho, B., Roland, L. M., Chu, L. F., Campitelli, V. A., Riley, E. T. 2007; 105 (1): 176-183

  Abstract

  A single-dose of neuraxial morphine sulfate provides good post-Cesarean analgesia; however, its efficacy is limited to the first postoperative day. In a recent phase III study, extended-release epidural morphine (EREM) formulation provided more effective, prolonged analgesia after Cesarean delivery, compared to conventional epidural morphine. However, the study protocol did not allow for the use of nonsteroidal antiinflammatory drugs, used various postoperative analgesics, and monitoring and treatment of respiratory depression were not standardized. Our aims in this study were to compare postoperative analgesic consumption, pain scores and side effects of EREM with conventional morphine for the management of post-Cesarean pain in a setting more reflective of current obstetric practice.Seventy healthy parturients undergoing elective Cesarean delivery were enrolled in this randomized, double-blind study. Using a combined spinal epidural technique, patients received an intrathecal injection of bupivacaine 12 mg and fentanyl 10 mcg. After closure of the fascia, a single-dose of either conventional morphine 4 mg or EREM 10 mg was administered epidurally. Postoperatively, all patients received ibuprofen 600 mg orally every 6 h. Oral oxycodone and IV morphine were available for breakthrough pain. All patients received pulse oximetry and respiratory monitoring for 48 h post-Cesarean delivery.Single-dose EREM significantly improved pain scores at rest and during activity. The median (interquartile range) of supplemental opioid medication usage for 48 h post-Cesarean (in milligram-morphine equivalents) decreased from 17 (22) to 10 (17) mg with EREM compared to conventional epidural morphine (P = 0.037). Both drugs were well tolerated with no significant difference in adverse event profiles.EREM provides superior and prolonged post-Cesarean analgesia compared to conventional epidural morphine with no significant increases in adverse events.

  View details for DOI 10.1213/01.ane.0000265533.13477.26

  View details for PubMedID 17578973

• Modified and conventional ultrafiltration during pediatric cardiac surgery: Clinical outcomes compared JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Williams, G. D., Ramamoorthy, C., Chu, L., Hammer, G. B., Kamra, K., Boltz, M. G., Pentcheva, K., McCarthy, J. P., Reddy, V. M. 2006; 132 (6): 1291-1298

  Abstract

  This prospective study compared clinical outcomes after heart surgery between three groups of infants with congenital heart disease. One group received dilutional conventional ultrafiltration (group D), another received modified ultrafiltration (group M), and a third group received both dilutional conventional and modified ultrafiltration (group B). We hypothesized that group B patients would have the best clinical outcome.Children younger than 1 year undergoing heart surgery for biventricular repair by the same surgeon were randomly allocated to one of the three study groups. Patient management was standardized, and intensive care staff were blinded to group allocation. Primary outcome measure was duration of postoperative mechanical ventilation. Other outcome measures recorded included total blood products transfused, duration of chest tube in situ, chest tube output, and stays in intensive care and in the hospital.Sixty infants completed study protocol. Mean age and weight were as follows: group D (n = 19), 61 days, 4.3 kg; group M (n = 20), 64 days, 4.5 kg; and group B (n = 21), 86 days, 4.4 kg. Preoperative and intraoperative characteristics were similar between groups. Ultrafiltrate volumes obtained were 196 +/- 93 mL/kg in group D, 105 +/- 33 mL/kg in group M, and 261 +/- 113 mL/kg in group B. There were no significant differences between groups for any outcome variable. Technical difficulties prevented completion of modified ultrafiltration in 2 of 41 infants.There was no clinical advantage in combining conventional and modified ultrafiltration. Because clinical outcomes were similar across groups, relative risks of the ultrafiltration strategies may influence choice.

  View details for DOI 10.1016/j.jtcvs.2006.05.059

  View details for PubMedID 17140945

• Scheduling elective pediatric procedures that require anesthesia: The perspective of parents ANESTHESIA AND ANALGESIA Mariano, E. R., Chu, L. F., Ramamoorthy, C., Macario, A. 2006; 103 (6): 1426-1431

  Abstract

  Daily variability in volume of elective pediatric procedures that require anesthesia may lead to an imbalance between available operating room resources and case load. Longer intervals between scheduling and the surgical date generally result in higher operating room utilization. In this study, we sought to determine which factors influence when parents schedule their children for procedures. We also aimed to identify parents' ideal and longest acceptable waiting intervals and determine whether type of procedure, for example, affects scheduling. From a convenience sample of 250 randomly selected parents of children presenting for elective surgery, 236 completed surveys were analyzed. The remaining 14 surveys were not returned. Overall, parents scheduled their child's procedure a median of 4.3 wk (interquartile range 2.0-8.6) in advance and reported an ideal waiting interval of 3 wk (interquartile range 2-4), and longest acceptable interval of 6 wk (interquartile range 4-10). Parents were willing to wait longer to schedule cardiac (4 wk, P = 0.004) and plastic (3.5 wk, P = 0.024) surgery when compared with general surgical procedures. Overall, parents ranked severity of the child's illness, earliest available time, and surgeon's suggested date as the three most important factors influencing when their child's surgery is scheduled. The timetable for scheduling procedures was highly correlated with both mother and father having available time off work (tau(b) = 0.72, P < 0.0001). Surprisingly, parents did not show a preference for scheduling cases during vacation or summer months.

  View details for DOI 10.1213/01.ane.0000244596.03605.3e

  View details for Web of Science ID 000242289100019

  View details for PubMedID 17122217

• Valdecoxib for postoperative pain management after cesarean delivery: A randomized, double-blind, placebo-controlled study 37th Annual Meeting of the Society-for-Obstetric-Anesthesia-and-Perinatology Carvalho, B., Chu, L., Fuller, A., Cohen, S. E., Riley, E. T. LIPPINCOTT WILLIAMS & WILKINS. 2006: 664–70

  Abstract

  Although nonsteroidal antiinflammatory drugs (NSAIDs) improve postoperative pain relief after cesarean delivery, they carry potential side effects (e.g., bleeding). Perioperative cyclooxygenase (COX)-2 inhibitors show similar analgesic efficacy to nonsteroidal antiinflammatory drugs in many surgical models but have not been studied after cesarean delivery. We designed this randomized double-blind study to determine the analgesic efficacy and opioid-sparing effects of valdecoxib after cesarean delivery. Healthy patients undergoing elective cesarean delivery under spinal anesthesia were randomized to receive oral valdecoxib 20 mg or placebo every 12 h for 72 h postoperatively. As a result of cyclooxygenase-2 inhibitors safety concerns that became apparent during this study, the study was terminated early after evaluating 48 patients. We found no differences in total analgesic consumption between the valdecoxib and placebo groups (121 +/- 70 versus 143 +/- 77 morphine mg-equivalents, respectively; P = 0.26). Pain at rest and during activity were similar between the groups despite adequate post hoc power to have detected a clinically significant difference. There were also no differences in IV morphine requirements, time to first analgesic request, patient satisfaction, side effects, breast-feeding success, or functional activity. Postoperative pain was generally well controlled. Adding valdecoxib after cesarean delivery under spinal anesthesia with intrathecal morphine is not supported at this time.

  View details for DOI 10.1213/01.ane.0000229702.42426.a6

  View details for PubMedID 16931678

• Communication in critical care environments: Mobile telephones improve patient care ANESTHESIA AND ANALGESIA Soto, R. G., Chu, L. F., Goldman, J. M., Rampil, I. J., Ruskin, K. J. 2006; 102 (2): 535-541

  Abstract

  Most hospital policies prohibiting the use of wireless devices cite reports of disruption of medical equipment by cellular telephones. There have been no studies to determine whether mobile telephones may have a beneficial impact on safety. At the 2003 meeting of the American Society of Anesthesiologists 7878 surveys were distributed to attendees. The five-question survey polled anesthesiologists regarding modes of communication used in the operating room/intensive care unit and experience with communications delays and medical errors. Survey reliability was verified using test-retest analysis and proportion agreement in a convenience sample of 17 anesthesiologists. Four-thousand-eighteen responses were received. The test-retest reliability of the survey instrument was excellent (Kappa = 0.75; 95% confidence interval, 0.56-0.94). Sixty-five percent of surveyed anesthesiologists reported using pagers as their primary mode of communications, whereas only 17% used cellular telephones. Forty-five percent of respondents who use pagers reported delays in communications compared with 31% of cellular telephone users. Cellular telephone use by anesthesiologists is associated with a reduction in the risk of medical error or injury resulting from communication delay (relative risk = 0.78; 95% confidence interval, 0.6234-0.9649). The small risks of electromagnetic interference between mobile telephones and medical devices should be weighed against the potential benefits of improved communication.

  View details for DOI 10.1213/01.ane.0000194506.79408.79

  View details for Web of Science ID 000234912900040

  View details for PubMedID 16428557

• Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: A preliminary prospective study JOURNAL OF PAIN Chu, L. F., Clark, D. J., Angst, M. S. 2006; 7 (1): 43-48

  Abstract

  There is accumulating evidence that opioid therapy might not only be associated with the development of tolerance but also with an increased sensitivity to pain, a condition referred to as opioid-induced hyperalgesia (OIH). However, there are no prospective studies documenting the development of opioid tolerance or OIH in patients with chronic pain. This preliminary study in 6 patients with chronic low back pain prospectively evaluated the development of tolerance and OIH. Patients were assessed before and 1 month after initiating oral morphine therapy. The cold pressor test and experimental heat pain were used to measure pain sensitivity before and during a target-controlled infusion with the short-acting mu opioid agonist remifentanil. In the cold pressor test, all patients became hyperalgesic as well as tolerant after 1 month of oral morphine therapy. In a model of heat pain, patients exhibited no hyperalgesia, although tolerance could not be evaluated. These results provide the first prospective evidence for the development of analgesic tolerance and OIH by using experimental pain in patients with chronic back pain. This study also validated methodology for prospectively studying these phenomena in larger populations of pain patients.Experimental evidence suggests that opioid tolerance and opioid-induced hyperalgesia might limit the clinical utility of opioids in controlling chronic pain. This study validates a pharmacologic approach to study these phenomena prospectively in chronic pain patients and suggests that both conditions do occur within 1 month of initiating opioid therapy.

  View details for DOI 10.1016/j.jpain.2005.08.001

  View details for PubMedID 16414554

• Successful thoracoscopic repair of esophageal atresia with tracheoesophageal fistula in a newborn with single ventricle physiology ANESTHESIA AND ANALGESIA Mariano, E. R., Chu, L. F., Albanese, C. T., Ramamoorthy, C. 2005; 101 (4): 1000-1002

  Abstract

  A neonate with VACTERL association including tricuspid atresia was scheduled for thoracoscopic esophageal atresia with tracheoesophageal fistula (EA/TEF) repair and laparoscopic gastrostomy tube placement. In addition to standard noninvasive monitoring, arterial blood pressure, central venous pressure, and cerebral oxygen saturation were monitored. Gastric distension resulting from positive pressure ventilation prevented laparoscopic gastrostomy tube placement. Thoracoscopy with a CO2 insufflation pressure of 6 mm Hg at low flow (1 L/min) was well tolerated hemodynamically despite hypercarbia and cerebral oxygen saturation was maintained. Careful monitoring and good communication were critical to the safe management of this single ventricle patient during thoracoscopic EA/TEF repair.Esophageal and tracheoesophageal fistula in conjunction with single ventricle physiology carries a significant risk of mortality. We present the anesthetic management of a neonate with unpalliated tricuspid atresia who underwent thoracoscopic tracheoesophageal fistula repair.

  View details for DOI 10.1213/01.ANE.0000175778.96374.4F

  View details for Web of Science ID 000232115400011

  View details for PubMedID 16192508

• A comparison of three methods for estimating appropriate tracheal tube depth in children PEDIATRIC ANESTHESIA Mariano, E. R., Ramamoorthy, C., Chu, L. F., Chen, M., Hammer, G. B. 2005; 15 (10): 846-851

  Abstract

  Estimating appropriate tracheal tube (TT) depth following tracheal intubation in infants and children presents a challenge to anesthesia practitioners. We evaluated three methods commonly used by anesthesiologists to determine which one most reliably results in appropriate positioning.After IRB approval, 60 infants and children scheduled for fluoroscopic procedures requiring general anesthesia were enrolled. Patients were randomly assigned to one of three groups: (1) deliberate mainstem intubation with subsequent withdrawal of the TT 2 cm above the carina ('mainstem' method); (2) alignment of the double black line marker near the TT tip at the vocal cords ('marker' method); or (3) placement of the TT at a depth determined by the formula: TT depth (cm) = 3 x TT size (mmID) ('formula' method). TT tip position was determined to be 'appropriate' if located between the sternoclavicular junction (SCJ) and 0.5 cm above the carina as determined by fluoroscopy. Risk ratios were calculated, and data were analysed by the chi-square test accepting statistical significance at P < 0.05.The mainstem method was associated with the highest rate of appropriate TT placement (73%) compared with both the marker method (53%, P = 0.03, RR = 1.56) and the formula method (42%, P = 0.006, RR = 2.016). There was no difference between the marker and formula methods overall (P = 0.2, RR = 1.27). Analysis of age-stratified data demonstrated higher success with the marker method compared with the formula method for patients 3-12 months (P = 0.0056, RR = 4.0).Deliberate mainstem intubation most reliably results in appropriate TT depth in infants and children.

  View details for DOI 10.1111/j.1460-9592.2005.01577.x

  View details for Web of Science ID 000232471900005

  View details for PubMedID 16176312

• Valdecoxib for postoperative pain management after cesarean section: A randomized, double-blinded, placebo controlled study 37th Annual Meeting of the Society-for-Obstetric-Anesthesia-and-Perinatology Fuller, A. J., Brummel, C., Saxena, A., Chu, L., Riley, E. T., Cohen, S. E., Carvalho, B. LIPPINCOTT WILLIAMS & WILKINS. 2005: A15–A15

  View details for Web of Science ID 000228673000053

• Clinical Anesthesiology Board Review McGraw-Hill Medical Publishing Chu, L. 2005
• Different molecular forms of uncomplexed prostate specific antigen (PSA) show similar immunoreactivities JOURNAL OF UROLOGY Chu, L. F., Chen, Z. X., Stamey, T. A. 1999; 161 (6): 2009-2012

  Abstract

  PSA exists in multiple molecular forms in serum, with the majority complexed to proteinase inhibitors such as alpha 1-antichymotrypsin and alpha 2-macroglobulin. The uncomplexed, or "free" forms of PSA represent a very heterogenous distribution of molecular isoforms. It has been suggested that these variations in uncomplexed PSA may cause differences in their immunologic characteristics which may lead to analytical differences between various PSA assays. We report that various isoforms of uncomplexed PSA purified from seminal fluid as previously described show no differences in relative immunoreactivity and demonstrate equimolar behavior as measured by the TOSOH AIA-600 assay, which is a PSA assay based upon monoclonal PSA and monoclonal detecting antibodies (mono-mono). Furthermore, we show that carbohydrate side-chain modification does not change the equimolar immunoreactivity of these isoforms.

  View details for PubMedID 10332491

• Evolution of web site design: implications for medical education on the Internet COMPUTERS IN BIOLOGY AND MEDICINE Chu, L. F., Chan, B. K. 1998; 28 (5): 459-472

  Abstract

  Since its inception, the world wide web (WWW) has possessed the potential for becoming a 'watershed' medium for conveying complex, structured information across vast temporal and geographical barriers. In 1995, the MedWorld project (http:(/)/medworld.stanford.edu) was created at the Stanford University School of Medicine in an effort to innovate and explore the design process of creating WWW applications specifically for medical education. Until recently, the evolution of WWW applications has been mainly driven by technological advances in client-server technology, enabling or translating traditional modes of collaborative medical education (e.g. voice, presence, print, motion) into WWW devices and applications. Many of these applications, while technologically advanced, lack focused development of interface and interactivity design, which may enhance learning experiences. WWW applications which incorporate design innovation in parity with advances in client-server technology have been termed, 'third generation' web sites and have the potential to improve the quality of WWW applications designed for medical education. This work describes how the MedWorld project has created a 'third generation' WWW application by utilizing innovation in information, interface and interactivity design to create innovative WWW technology for the medical education arena.

  View details for PubMedID 9861505

• Adherence of mononuclear cells to endothelium in vitro is increased in patients with NIDDM DIABETES CARE Carantoni, M., Abbasi, F., Chu, L., CHEN, Y. D., Reaven, G. M., Tsao, P. S., Varasteh, B., Cooke, J. P. 1997; 20 (9): 1462-1465

  Abstract

  To compare the binding to cultured endothelial cells of mononuclear cells isolated from healthy volunteers and patients with NIDDM.Mononuclear cells were isolated from healthy volunteers (n = 11) and patients with NIDDM (n = 14) and incubated with ECV 304 cells, a human umbilical endothelial cell-derived transformed cell line. Following a period of incubation, the adherence of mononuclear cells to endothelial cells was determined.Adherence of mononuclear cells from patients with NIDDM was significantly greater (P < 0.05) than that of cells isolated from the healthy volunteers, and this difference persisted when adjusted for age, sex, and degree of obesity. Mononuclear cell binding to ECV 304 cells correlated significantly with fasting plasma glucose (r = 0.52, P < 0.01), insulin (r = 0.51, P < 0.01), triglyceride (r = 0.54, P < 0.01), and VLDL (r = 0.54, P < 0.01) and HDL cholesterol (r = -0.45, P < 0.05) levels, but not with either total or LDL cholesterol levels or blood pressure.Since the adherence of mononuclear cells to the endothelium represents the earliest step in atherogenesis, the observation that mononuclear cells from patients with NIDDM bind more avidly to cultured endothelial cells may help explain why accelerated atherosclerosis occurs in patients with NIDDM. The metabolic abnormality, or abnormalities, present in patients with NIDDM that is responsible for the enhanced adhesiveness of mononuclear cells requires further examination.

  View details for PubMedID 9283798

• One-step HPLC purification procedure for porcine brain 90-kDa heat shock protein PROTEIN EXPRESSION AND PURIFICATION Chu, L. F., Lee, W. C., Yang, P. C., Chu, R., Huang, T. Y., Mao, S. J. 1997; 10 (2): 180-184

  Abstract

  The 90-kDa heat shock protein (HSP90) was purified from porcine brain by a novel single-step purification procedure using diethylaminoethyl high-performance liquid chromatography (HPLC). About 4.8 mg of HSP90 was isolated from 25 g wet wt porcine brain tissue. The purified protein possessed a single moiety on one- and two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by silver staining. Western blotting using monoclonal antibody prepared against human HSP90 confirmed its identity as HSP90. These results indicate that small-scale HPLC purification of HSP90 from porcine brain tissue can be readily accomplished, with high yield, using a convenient one-step purification method. The procedure described in this paper represents a significant improvement in current purification methods for the isolation of HSP90 from porcine brain.

  View details for Web of Science ID A1997XH85600003

  View details for PubMedID 9226713

• MICROTUBULE MOVEMENT BY A BIOTINATED KINESIN BOUND TO A STREPTAVIDIN COATED SURFACE (VOL 269, PG 8610, 1994) JOURNAL OF BIOLOGICAL CHEMISTRY BERLINER, E., MAHTANI, H. K., KARKI, S., CHU, L. F., CRONAN, J. E., GELLES, J. 1994; 269 (37): 23382

  View details for Web of Science ID A1994PQ16400072

• MICROTUBULE MOVEMENT BY A BIOTINATED KINESIN BOUND TO A STREPTAVIDIN-COATED SURFACE JOURNAL OF BIOLOGICAL CHEMISTRY Berliner, E., Mahtani, H. K., Karki, S., Chu, L. F., Cronan, J. E., Gelles, J. 1994; 269 (11): 8610-8615

  Abstract

  Kinesin, an ATP-dependent microtubule motor, can be studied in vitro in motility assays where the kinesin is nonspecifically adsorbed to a surface. However, adsorption can inactivate kinesin and may alter its reaction kinetics. We therefore prepared a biotinated kinesin derivative, K612-BIO, and characterized its activity in solution and when bound to streptavidin-coated surfaces. K612-BIO consists of the N-terminal 612 amino acids of the Drosophila kinesin alpha subunit linked to the 87-amino acid C-terminal domain of the biotin carboxyl carrier protein subunit of Escherichia coli acetyl-CoA carboxylase. The C-terminal domain directs the efficient post-translational biotination of the protein. We expressed K612-BIO at high levels using the baculovirus expression vector system and purified it to near-homogeneity. The expressed protein is completely soluble, and > 90% is bound by streptavidin. K612-BIO steady-state ATPase kinetics (KM,ATP = 24 microM, K0.5, microtubule = 0.61 mg ml-1, Vmax = approximately 25 s-1 head-1, 25 degrees C) are similar to those reported for intact kinesin. ATPase kinetics are not affected by the addition of streptavidin. Enzyme bound to a surface coated with streptavidin drove microtubule gliding in the presence of 2 mM ATP at 750 +/- 130 nm s-1 (26 degrees C). Activity was abolished by pretreatment of the surface with biotin, indicating that the microtubule movements are due to specifically bound enzyme. Motility assays based on specific attachment of biotinated enzyme to streptavidin-coated surfaces will be useful for quantitative analysis of kinesin motility and may provide a way to detect activity in kinesin derivatives or kinesin-like proteins that have not yet been shown to move microtubules.

  View details for Web of Science ID A1994NB40900116

  View details for PubMedID 8132586

• MICROTUBULE MOVEMENT BY A BIOTINATED KINESIN BOUND TO A STREPTAVIDIN COATED SURFACE BERLINER, E., MAHTANI, H. K., KARKI, S., CHU, L. F., CRONAN, J. E., GELLES, J. BIOPHYSICAL SOCIETY. 1994: A312

  View details for Web of Science ID A1994MU46201813

• Daily opioid analgesic use reduces blood insulin levels. Journal of opioid management Mueller, C. n., Chu, L. F., Lin, J. C., Ovalle, F. n., Younger, J. W. ; 14 (3): 165–70

  View details for PubMedID 30044481