Winter 2010/2011

Advocacy Update from the Statehouse Chapter S-PAC Needs National Prominence You!

Cutting Edge National Prominence

Chapter News Cancer Liaison Report October Council Meeting Reports

Resident Research Forum Annual Resident Research Forum & Poster Session Winners

Pulse Throughout Ohio District Councilor Reports Cleveland Convention Center and Medical Mart

From the College ACS Foundation: Planned Two Determined Surgeons Serve on Gifts ACS Regents from Ohio Plus Much More…

Be a S-PAC Contributor Ohio Chapter, American College Of Michael D. Sarap, MD, FACS Medical Education/Program Surgeons Southeastern Ohio Physicians Inc [email protected] Alice Ann Dachowski, MD, FACS Executive Committee Holzer Clinic Joseph J. Sferra, MD, FACS [email protected] Joseph J. Sferra, MD, FACS Toledo Surgical Specialists Inc Chair Toledo Surgical Specialists Inc [email protected] [email protected] Steven M. Steinberg, MD, FACS President Ohio Chapter Committees [email protected] Alice Ann Dachowski, MD, FACS Vice-Chair Holzer Clinic Advocacy & Health Policy [email protected] Membership President-Elect Michael E. Stark, MD, FACS Toledo Surgical Specialists Christopher A. Grove, MD, FACS Jay A. Johannigman, MD, FACS [email protected] Upper Valley Professional Corporation University of Chair [email protected] [email protected] Chair Ohio Chapter, Secretary James I. Merlino, MD, FACS Cleveland Clinic Foundation Juan A. Crestanello, MD, FACS American College of Surgeons Steven M. Steinberg, MD, FACS [email protected] The Ohio State University Ohio State University Vice-Chair [email protected] www.ohiofacs.org [email protected] Vice-Chair Treasurer Assn of Women Surgeons Representative Nominating Michael D. Sarap, MD, FACS Southeastern Ohio Physicians Inc Nancy L. Gantt, MD, FACS Michael D. Sarap, MD, FACS Table of Contents [email protected] St Elizabeth Health Center Southeastern Ohio Physicians Inc Immediate Past President [email protected] [email protected] Advocacy Chair Chair Christopher R. McHenry, MD, FACS Update from the Statehouse...... 4 MetroHealth Medical Center Awards Resident Essay Contest Ohio Chapter S-PAC Needs You!...... 6 [email protected] Past President Mark A. Malangoni, MD, FACS Randy J. Woods, MD, FACS S-PAC Contribution Form ...... 7 MetroHealth Medical Center Wright State University [email protected] [email protected] District Councilors Chair Chair Cutting Edge Brent Michael Alan Bogard, MD, FACS Bylaws Walter Cha, MD, FACS National Prominence: Two Determined Cleveland Clinic MetroHealth Surgeons Serve on ACS Regents from Ohio ...... 8 [email protected] Gary B. Williams, MD, FACS [email protected] Northeast Summa Health Systems Vice-Chair [email protected] Bruce Jeffrey Averbook, MD, FACS Resident/Young Surgeons Education Chapter News MetroHealth Medical Center CAC Representative Ohio Chapter Past Presidents...... 10 [email protected] Peter F. Klein, MD, FACS Northeast James I. Merlino, MD, FACS TSSI Member Spotlight: Jeffrey Blatnik, MD ...... 11 Cleveland Clinic Foundation [email protected] Michael Bielefeld, MD, FACS [email protected] Chair October Council Meeting Committee Reports . . . . 13 Surgical Specialist of Bowling Green LLC Commission on Cancer Jeffrey A. Blatnik, MD [email protected] University Hospitals Case Medical Resident Research Forum Northwest Valeriy Moysaenko, MD, FACS Center Legis Inc [email protected] Ethanol Treatment After Traumatic Brain Peter F. Klein, MD, FACS [email protected] Vice-Chair Injury Decreases Cerebral MIP1α And TSSI Chair Serum Neuron Specific Enolase In Mice...... 18 [email protected] Mario Castillo-Sang, MD Northwest Jean T. Stevenson, MD, FACS University of Toledo Medical Center The Presence But Not The Location Of MetroHealth Medical Center [email protected] An Appendicolith Affects The Success Of David M. Hasl, MD, FACS [email protected] Vice-Chair Interval Appendectomy In Children With Lancaster Surgical Associates Chair Ruptured Appendicitis...... 18 [email protected] Ohio Committee on Trauma Southeast Communications Pancreatic Resection In The Ninth Decade Of Charles J. Yowler, MD, FACS Life: Not Always A Safe Option For Malignancy. . . . 19 J. Allen McElroy, MD, FACS Scott Michael Wilhelm, MD, FACS MetroHealth Medical Center Surgical Associates of Marietta University Hospital Cleveland [email protected] [email protected] [email protected] Chair Pulse Throughout Ohio Southeast Chair Jonathan M. Saxe, MD, FACS District Councilor Reports ...... 20 Akpofure Peter Ekeh, MBBS, MPH Community Hospital Wright State University Miami Valley Hospital [email protected] Cleveland Convention Center and Medical Mart . . . 23 [email protected] Mary Carey MacDonald, MD, FACS Vice-Chair Southwest Samaritan Professional Corp [email protected] Executive Office From the College Cari A. Ogg, MD, FACS Chair It Pays To Plan Ahead...... 25 Cincinnati General Surgeons Inc Brad L. Feldman, MPA, CAE, IOM [email protected] Michael D. Sarap, MD, FACS [email protected] Southwest Southeastern Ohio Physicians Inc Executive Director [email protected] Vice-Chair ACS Board of Governors: Ohio Members Pulse is the official publication of the Ohio Chapter, Delegate to OSMA American College of Surgeons. It is published two times a year in Columbus, Ohio as a benefit of membership Linda M. Barney, MD, FACS and circulated free of charge to Ohio Chapter members. Wright State University Dept of Surgery William C. Sternfeld, MD, FACS Information appearing in this publication is obtained [email protected] Toledo Clinic from sources we believe to be reliable. The information may not be a complete statement of all available data [email protected] and is guaranteed as such. Conclusions are based Alice Ann Dachowski, MD, FACS Delegate solely on editorial judgment and analysis of technical factors and surgical/medical industry information Holzer Clinic sources. Pulse is copyrighted and portions may be [email protected] Development reprinted with the permission of the Ohio Chapter. Pulse is not responsible for the contents of its advertisements and advises all members to investigate David N. Linz, MD, FACS Linda M. Barney, MD, FACS claims before making any purchases. Canton General Surgery Associates Wright State University Dept of Surgery Permission requests to reproduce written material should be sent to: [email protected] [email protected] Ohio Chapter, ACS Chair P.O. Box 1715 Columbus, OH 43216-1715 Christopher R. McHenry, MD, FACS (877) 677-3227 MetroHealth Medical Center © Copyright 2010, Ohio Chapter, ACS. [email protected] All rights reserved. President’s Message

I am pleased important to surgeons . Remember, supported me over the years .” If your to report to the your elected leaders don’t know what colleague is not an active member of membership of the you don’t tell them . the Ohio Chapter, please encourage Ohio Chapter of the At the Fall Council Meeting, I was them to join today . American College of pleased to hear how much progress I am constantly reminded of how Surgeons that our Chapter is strong the Program Committee was making blessed the Ohio Chapter is when I and continues to set the benchmark toward planning for the 2011 Annual travel and attend conferences . One for chapters! Meeting that is going to take place such example is that our chapter It was my privilege to accept May 6-7, 2011, in Cincinnati . recently had one of our members the gavel as president of the Ohio President-Elect Dr . Alice Dachowski elected to the ACS Board of Regents . Chapter, ACS at the Annual Meeting is doing an outstanding job planning I join Ohio Chapter members in this past May . I would like to thank this event with the Executive Office, offering my sincere congratulations Past President Dr . Michael Sarap for and I am certain that you will not to Dr . Margaret M . Dunn on her all of the hard work that he did to want to miss this exciting day in election to the board . make sure that my term started off on the life of the Ohio Chapter . I look I would be remiss if I did not such a positive note . Ohio Chapter forward to working with the Program mention the commitment by the Executive Director Brad Feldman and Committee in the coming weeks Board of Governors that represent his staff do a wonderful job of taking to build on the success of past the Ohio Chapter faithfully: Dr . care of the day-to-day responsibilities annual meetings . Linda Barney, Dr . Alice Dachowski, of the Chapter and they are to The Ohio Chapter was well Dr . David Linz, and Dr . Michael be commended . represented at the 2010 ACS Clinical Stark . Each do a tremendous job of The Ohio Chapter continues to Congress in Washington, DC . I was making sure that the best interests of advocate in policy decisions at the impressed and pleased that Ohio has Ohio surgeons is represented to the state and national level . As healthcare a lot of new fellows who are eager College . I would like to pay special reform legislation continues to work to get involved . The Ohio Chapter tribute to Dr . Stark as his term ends . its way to fruition, there are lots of hosted a reception at Clinical His commitment to the Chapter opportunities for surgeons to voice Congress which was financially Activities Committee has positively their opinions on implementation . supported by Cook Medical and well affected chapters and his presence I believe that it is imperative that attended by new and established will be missed . each one of us create and maintain chapter members . The reception I am humbled to be the president of direct contact with our elected proved to be an excellent opportunity the Ohio Chapter, ACS . Partnering officials about the importance for surgeons to network, share ideas, with each and every one of you makes of this undertaking . Medicare and celebrate friendships . this a wonderful experience each and physician payment and tort reform I want to pause and urge you to every day . I believe strongly that the are two issues that continue to need consult with your surgical colleagues general surgeon is the backbone of addressing by our elected officials and and invite them to join the Ohio American medicine . As I examine all we need to make our voice known . Chapter if they are not currently of the issues that surgeons face, I am I hope that you will join with me in a member because the chapter’s proud to exclaim that I love being a advocating on important policy issues strength is its strong commitment surgeon and working with you makes affecting the practice of surgery in to membership . As I said when it even better . our state . assuming the presidency, “I am greatly Joseph Sferra, MD, FACS In that vein, I urge you to mark appreciative of the friendships that I March 23, 2011, on your calendar have developed over the years as an and plan to join fellow surgeons in Ohio Chapter member . Surgeons who Columbus for the Ohio Chapter, approached me nearly 20 years ago ACS Legislative Day . More details about becoming active in the Ohio will follow as we get closer to the Chapter continue to be friends and event, but now is the time to set this offer me sound advice and support . date aside and plan on meeting with They have served as role models Ohio Chapter, legislators to discuss medical issues and have graciously encouraged and American College of Surgeons www.ohiofacs.org

WINTER 2010/2011 3 Advocacy Update from the Statehouse By Tracy Intihar, Ohio Chapter Legislative Agent

Republicans Sweep • District 6 (Eastern and Southeastern (D-Licking Township); Rep . Steve Key Races in Ohio Ohio) – Johnson Dyer (D-Green); and Rep . Brian After months of Democrat U .S . Rep . Charlie Williams (D-Akron) . hard-hitting politics, the 2010 election Wilson of St . Clairsville lost to Bill • HD 18 – Republican Mike is over . Voters sent a clear message Johnson, a U .S . Air Force veteran Dovilla was successful in his to elected officials that it is time for a after earning 51 percent of efforts to unseat Rep . Matt Patten change in state and federal policies . A the vote . (D-Strongsville) . recap of the key races follows . • District 15 (Columbus) – Stivers • HD 19 – Republican Ann Ohio Governor – John Kasich In this election, Gonzales, mayor of Westerville, In the contentious battle for the also fell victim to anti-incumbent won this seat currently held by Governor’s office that ran close during sentiment . Former State Senator Rep . Marian Harris (D-Columbus) . won by 54-41 margin . the many months of campaigning, • HD 20 – Incumbent Democrat former Republican U .S . Congressman • District 17 (Northeast Ohio) – Renacci Rep . Nancy Garland faced a John Kasich beat incumbent Democrat Democrat also was in challenge by Republican Matt Governor 49 to a targeted race with a challenge by Carle, an attorney and campaign 47 percent . businessman . Renacci staff veteran . She held tough with a U.S. Senate – Rob Portman won the race with 52 percent 52-48 percent victory . of the vote . Former Republican U .S . • HD 21 – In a seat vacated by Congressman Rob Portman held a • District 18 (Eastern part of Ohio) – Rep . Kevin Bacon’s successful run solid lead over Democratic Lieutenant Gibbs for the , Republican Governor Lee Fisher throughout most Incumbent Democrat Mike Duffey beat Democrat David of the election season . The final tally: lost his seat in Congress after a Robinson . Portman 57 percent; Fisher 39 percent . challenge from State Senator Bob Despite turnover in this and a few other Gibbs . Final vote percentage: • HD 42 – Republican challenger key races, Democrats continue to hold Gibbs 54 percent and Space Kristina Roeger, an engineer with a majority in the U .S . Senate . 40 percent . an MBA serving on Hudson City Council, edged Rep . Mike Moran U.S. House of Representatives Ohio House (D-Hudson) . Of the 18 Ohio members of the U .S . The Ohio House also faces a swing House, currently 10 are Democrats in power as Republicans win a majority • HD 63 – Rep . Mark Scheider and 8 are Republicans . With five key of the 99 races across the state . The (D-Mentor) lost his election to Republican victories in Ohio, the current House tally for the new General former state representative Ron majority in our state’s congressional Assembly in January is 58 Republicans, Young, from Leroy Township, in team shifts to 13-5 in the Republicans 41 Democrats . the November election . favor . With similar surges across the Recounts were necessary in two very • HD 85 – In a district that almost country, the U .S . House has shifted close elections: always has a heated race, Rep . to a Republican majority . At time of Ray Pryor (D-Chillicothe) lost this report, Republicans won at least • HD 28 – Rep . Connie Pillich the election to Republican Bob 61 of the mid-term election races to (D-Montgomery) faced a recount Peterson, a family farmer from gain a solid majority . Also important to in this close election . On election Fayette County . Ohio, U .S . Congressman day she won by only five votes (R-West Chester) has been elected which was upheld after a recount . • HD 89 – Dr . Terry Johnson, a Republican physician and colonel by his colleagues as the next Speaker • HD 99 – Incumbent Democrat of the House in the new Congress . A in the Ohio National Guard, Debbie Newcomb (D-Conneaut) beat Democrat Ron Hadsell, a summary of the important Ohio U .S . trailed her opponent Casey House races follow: Portsmouth construction executive Kozlowski by only 51 votes . A in this open seat . • District 1 (Cincinnati) – Chabot recount declared Kozlowski the U .S . Rep . unseated eventual winner . • HD 93 – In this seat currently held Republican U .S . Rep . by outgoing Rep . Jennifer Garrison A recap of other key House (D-Marietta), Republican Andy in 2008 . In this election, Chabot races follows: returned and bested Driehaus, Thompson won a majority of the earning 52 percent of the vote . • Four multi-term incumbent vote over Democrat Linda Secrest . Democrats lost their elections: Rep . Linda Bolon (D-East (continued on page 5) Palestine); Rep . Dan Dodd

4 WINTER 2010/2011 Advocacy Update from the Statehouse (continued)

Ohio Senate Key Leadership Posts Announced for What Lies Ahead for the Republicans grew their majority in House and Senate Ohio Chapter the Ohio Senate by two seats after By early December, Republicans and Traditionally, the period following a victory in Lorain County and the Democrats picked their leaders for the an election at the end of the two-year Dayton area . North Ridgeville City 129th General Assembly: session can be a legislative madhouse Councilman Gayle Manning beat House Leadership: with last minute efforts to pass incumbent Democrat Sue Morano and policy reforms both large and small . Sen . lost in a targeted Rep. William Batchelder (R-Medina), However, with the shift of power from challenge by Bill Beagle of Tipp City . speaker Democrat to Republican in both the Republicans now hold a 23-10 majority Rep. Lou Blessing (R-Cincinnati), Governor’s office and the Ohio House in this chamber . speaker pro tem of Representatives, a light lame duck Ohio’s Statewide Offices session is expected as Republicans in Rep. Matt Huffman (R-Lima), majority the Senate wait for January when the Ohio Attorney General – DeWine floor leader Former Republican new majorities take their seats . senator and former lieutenant governor Rep. Barbara Sears (R-Sylvania), For this new session beginning in Mike DeWine challenged current assistant majority floor leader January 2011, Ohio Chapter will Democrat Attorney General Richard Rep. John Adams (R-Sydney), majority be meeting and getting to know Cordray to serve as Ohio’s lead whip new legislators and preparing for an attorney . DeWine won with 48 percent Rep. Cheryl Grossman (R-Grove important budget debate . With a of the vote . City), assistant majority whip strong Republican state government, Ohio Auditor – Yost policymakers will likely be ready to Rep. Armond Budish (D-Beachwood), take on issues such as additional tort Republican Delaware County minority leader Prosecutor Dave Yost and Democrat reforms, but less likely to take on issues David Pepper battled for this seat in the Rep. Matt Szollosi (D-Toledo), that reform or mandate insurance . fall election . Many insiders predicted assistant minority leader Additionally, this Republican majority this race would fall to Pepper, however, is less likely to look at increasing taxes Rep. Tracy Heard (D-Columbus), to balance the state budget . Additional Yost bested Pepper with a solid 51-44 minority whip percent victory . cuts in Medicaid and throughout state Rep. Debbie Philips (D-Athens), government are expected . – Husted assistant minority whip State Senator Jon Husted Although many challenges lie ahead, (R-Kettering) beat Democrat Franklin Senate Leadership: Ohio Chapter and our consultants at Capitol Consulting Group will be County Commissioner Maryellen Sen. Tom Niehaus (R-New Richmond), working to make sure the voices of O’Shaughnessy for Ohio’s secretary of president state seat – 54-41 percent of the vote . Ohio’s surgeons and the people you Sen. Keith Faber (R-Celina), president care for every day are heard loud Ohio Treasurer – Mandel pro tempore and clear . Incumbent Democrat Kevin Sen. Jimmy Stewart (R-albany), Boyce faced a strong challenge by Capitol Consulting Group, Ohio majority floor leader State Representative Josh Mandel Chapter’s lobbying team, continues (R-Lyndhurst) . Representative Mandel, Sen. Shannon Jones (R-Springboro), to work diligently to ensure that although criticized for an early negative majority whip the voices of Ohio’s surgeons are ad, won the seat 55-40 . heard in policy debates taking place Sen. Capri Cafaro (D-Hubbard), in Columbus . Ohio Supreme Court – Lanzinger, minority leader O’Connor and Pfeifer Sen. Shirley Smith (D-Cleveland), Justice Maureen O’Connor assistant minority leader (Republican) won the Supreme Court’s Chief Justice position, easily beating Sen. Edna Brown (D-Toledo), minority Strickland appointee Justice Eric Brown . whip O’Connor will become Ohio’s first Sen. Jason Wilson (D-Columbiana), female Chief Justice . Republican Justice assistant minority whip Judith Lanzinger beat back a challenge from Democrat Mary Jane Trapp . Justice Paul Pfeifer was also elected to the court as he ran unopposed for his third term on Ohio’s highest court .

WINTER 2010/2011 5 Advocacy Ohio Chapter S-PAC Needs You! By Brad L. Feldman, MPA, CAE, IOM

In order to advance the goals of Bruce Averbook, MD, FACS Steven Steinberg, MD, FACS the profession through political Michael Bielefeld, MD, FACS Charles Yowler, MD, FACS involvement, the Ohio Chapter has a Political Action Committee (PAC) . Walter Cha, MD, FACS Again, we thank these individuals Alice Ann Dachowski, MD, FACS for their support and contribution Having a strong PAC fund assists to S-PAC . Together, we will fight the Ohio Chapter in forming Brad Feldman, MPA, CAE, IOM the legislative battles for the Ohio relationships with legislators who Nancy Gantt, MD, FACS surgical profession . To contribute are in-tune with the problems and Christopher Grove, MD, FACS to S-PAC, you can complete the needs of our profession and patients . accompanying form or you can Engaging in the legislative process Mark Malangoni, MD, FACS contribute online at www.ohiofacs.org. will help the Ohio Chapter to Christopher McHenry, MD, FACS For more information on the Ohio remain proactive and will enable Chapter’s legislative agenda or how Peter Muscarella, MD, FACS our association to support the key you can participate, contact the legislators who sustain our profession . Michael Sarap, MD, FACS Ohio Chapter Executive Office On behalf of the Ohio Chapter, Jonathan Saxe, MD, FACS at (877) 677-3227 or email thank you to all members who have [email protected]. Joseph Sferra, MD, FACS contributed to S-PAC in 2010 (As of October 29, 2010): Michael Stark, MD, FACS

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6 WINTER 2010/2011

Cutting Edge National Prominence: Two Determined Surgeons Serve on ACS Regents from Ohio By Pattie Stechschulte, Communications Director The great state of Ohio is home to Dr . Margaret Dunn, a general “I like helping our chairs and faculty many sources of eminence – home of surgeon, received her medical degree members accomplish what they want eight U .S . Presidents, the first man in 1977 from Jefferson Medical to do for the school and students . I to walk on the moon, and, of course, College of Thomas Jefferson love it when people bring in good Ohio State Buckeye football and the University in Philadelphia . She ideas and I can help make Rock and Roll Hall of Fame . went on to complete an internship them happen .” At the Ohio Chapter, American and a surgery residency at Einstein It was about 1990 when she first College of Surgeons, there are two Montefiore, Bronx, NY . became involved with the Ohio stellar examples of outstanding “I decided to be a surgeon during my Chapter, ACS . “I first got contacted buckeyes – Dr . Margaret Dunn and clerkship . I started out wanting to be about 20 years ago to help out by Dr . Mark Malangoni . an anesthesiologist, but realized all testifying about some legislation . The Last October, Dr . Dunn joined Dr . the action was happening at the other leaders kept me involved as a district Malangoni as an elected member end of the table,” said Dr . Dunn . “As counselor and my involvement grew of the select American College of is typical of women my age, I never from there,” said Dr . Dunn . Surgeon’s Board of Regents which met a woman surgeon in “The Ohio Chapter is one of the includes the ACS president . As a medical school .” oldest and largest in the country, and member of the Board of Regents, they During her residency, she met a it has wonderful culture . It has always have a role in formulating policy and woman surgeon named Dr . Sylvia been a very supportive group for me directing the affairs of the College, Ramos who became a role model and other colleagues across the state . which currently has more than and who she remains close to even That culture has continued with new 77,000 members . now serving together on the ACS people,” said Dr . Dunn, who has The regents have the ultimate Committee on Diversity . served the chapter in many capacities responsibility for managing the In 1982, Dr . Dunn moved to Ohio including chapter president . affairs of the College, and the when she was appointed instructor in In 1997, she started serving on board’s diversity and the variety of surgery at Wright State University . the ACS Board of Governors and experiences and interests among Over the years, she steadily moved has been a member of the ACS its members enable the regents to up the ranks becoming an assistant Committee on Diversity and represent views related to myriad professor of surgery in 1984; associate Association of Women issues in contemporary surgery . professor of surgery in 1989; Surgeons (AWS) . Made of up of only 22 surgeons professor of surgery in 1997; then At a recent AWS meeting, Dr . Dunn representing doctors from across the eventually becoming the executive said that someone made a comment country, Ohio has the distinct honor associate dean . She also went on to why other chapters can’t be more of having two doctors serving from earn a master’s degree in business like Ohio with their outreach efforts, our noble state . administration from Wright State support, and getting women involved . in 2005 . Margaret Dunn, “I felt very proud,” she said . MD, FACS, MBA Last year, she decided to restrict At the October ACS meeting, Dr . Chief Executive her practice to breast surgery which Dunn was elected to the ACS Board Officer and President allows her to spend more time on of Regents . “The scope of issues Wright State the administrative demands from her that the Board of Regents is dealing Physicians current professional role – managing with is very broad from the safety Professor of Surgery about 175 physicians . of patients to the support of fellows Executive Associate “My job is to help and support the to the fiduciary responsibilities of Dean Wright State University doctors and students who work hard keeping the organization healthy . I Boonshoft School of Medicine caring for patients,” said Dr . Dunn . am looking forward to the challenge,”

(continued on page 9)

8 WINTER 2010/2011 Cutting Edge National Prominence: Two Determined Surgeons Serve on ACS Regents from Ohio (continued) said Dr . Dunn, who has been department of surgery in 1993 and represents the collective voice of assigned to serve on the Member surgeon-in-chief in 2003 . Ohio surgeons . It is the most collegial Services Committee . “I spend most of my time providing professional organization that I “I served on the Board of Governor’s direct patient care and operating,” belong to,” he said . Member Services Committee, so feel said Dr . Malangoni . “Nothing is more His dedication to the College was I can make a contribution . I will stay satisfying than caring for a patient or recognized when he was elected by informed of what the Ohio Chapter doing an operation and knowing that the Board of Governors to serve on is doing because it will serve as an you have made a difference in that the ACS Board of Regents in 2009 . excellent example for me,” said person’s life .” “At every meeting of the Board of Dr . Dunn . Dr . Malangoni has made the Regents, I discover more activities Mark Malangoni, most of his career belonging to of the College that I was unaware MD, FACS 26 professional societies and 18 of previously . The spectrum of Chair, Department of professional groups centered on activity at the ACS and the quality Surgery surgery, trauma, emergency medicine, and dedication of the staff are Surgeon-in-Chief critical care, and infection – usually unsurpassed,” said Dr . Malangoni . MetroHealth Medical serving in a leadership position . His Unfortunately, Dr . Malangoni Center travels have taken him across the will be leaving Ohio in 2011 as he Professor of Surgery country, even as far as Hong Kong, has accepted a job as the associate Case Western Reserve University as an invited lecturer and a visiting executive director of the American School of Medicine professor . He has written 149 peer- Board of Surgery in Philadelphia It was during his fourth year of reviewed published works, two books, starting February 1 . medical school at Indiana University 41 book chapters, 20 abstracts, and “This is an exciting opportunity School of Medicine when Dr . 47 other published works aside from to have an impact on the education Malangoni thought about becoming serving on ten editorial boards and of surgeons and surgical care . My a surgeon . “The decision began in as an ad hoc editorial reviewer for responsibilities at the American the 4th year of medical school but twelve medical journals including the Board of Surgery will include the wasn’t finalized until the second Lancet and Mayo Clinic Proceedings . development of practice-based year of my residency,” he said . During this time, he has faithfully assessment tools and self-assessment “Fortunately, I had wonderful faculty served the Ohio Chapter, ACS in resources for maintenance of role models that showed me the many capacities including a term certification . In addition, I will benefits and satisfaction of surgery as as chapter president . “The Ohio have oversight responsibility for a profession .” Chapter provided me with an the oral examination process,” He left Indiana in 1980 to take an opportunity to get involved in the said Dr . Malangoni . appointment as an assistant professor surgical community in Ohio and also Please join us in wishing of surgery at Medical College of served as a vehicle to meet other Dr . Malangoni success with his Wisconsin being named the associate surgeons from across the state . This new position . Ohio will miss program director only a year later . In was particularly important for me him greatly . 1984, he moved on to the University since I moved from out of state and of Louisville where he served as the did not train in Ohio,” said chief of surgery until 1990 before Dr . Malangoni . moving to the Buckeye State . Serving as Chapter president and He joined the teaching staff at Case receiving the Chapter’s Distinguished Western Reserve University School of Service Award is one of his greatest Medicine as a professor of surgery in professional achievements . 1990, then was named chair of the “There is no competing state surgical society, so the Ohio Chapter

WINTER 2010/2011 9 Chapter News Ohio Chapter, ACS Past Presidents Edwin Ellison, MD...... 1957 I Want My Pulse NOW! Robert T. Allison, MD ...... 1958 Byron G. Shaffer, MD ...... 1959 Jack W. Cole, MD ...... 1960 Attention members! Berton M. Hogle, MD...... 1961 Franklin L. Shively, Jr, MD, FACS. . . . . 1962 Pulse NOW!, features all the news you need to know in a clear, Stanley O. Hoerr, MD...... 1963 concise, two-to-three-page fax bulletin. Each edition of Pulse Tom E. Lewis, MD, FACS...... 1964 NOW! is released on a monthly basis and is packed with the Walter A. Hoyt, Jr, MD, FACS...... 1965 latest Ohio Chapter news and hot legislative updates. Warren Wendell Green, MD...... 1966 Please ensure that the Executive Office has your correct fax Stephen Ondash, MD...... 1967 Richard Zollinger, MD...... 1968 number to be sure you don’t miss out on this valuable member Tom Morgan, MD...... 1969 resource. Please call us at (877) 677-3227 or email us at C. William Loughry, MD ...... 1970 [email protected] to let us know if you need to update your Miles Flickenger, MD...... 1971 contact information. Mary M. Martin, MD, FACS ...... 1972 Charles Lovingood, MD...... 1973 P.J. Robechek, MD...... 1974 Byers Shaw, MD...... 1975 William J. Flynn, MD...... 1976 Tom Kelly, MD...... 1977 Robert P. Hummel, MD, FACS...... 1978 Robert E. Hermann, MD, FACS ...... 1979 Roland A. Gandy, Jr, MD, FACS...... 1980 Robert K. Finley, Jr, MD, FACS...... 1981 Larry C. Carey, MD...... 1982 Robert M. Zollinger, Jr, MD, FACS. . . . 1983 William V. Sharp, MD...... 1983-1984 Sterling W. Obenour, MD, FACS...... 1984 Submit an Article for the Next Edition Rex K. Whiteman, MD...... 1985-1986 Richard B. Reiling, MD, FACS...... 1987 of Pulse – Deadline is May 1st John Peter Minton, MD, FACS, PhD. . . 1988 Richard B. Fratianne, MD, FACS. . . . . 1989 The next issue of Pulse is in need of your article or news item Lawrence H. Linder, MD, FACS ...... 1990 relevant to the Ohio Chapter members. If you have a story Sidney F. Miller, MD, FACS...... 1991 relevant to surgery in Ohio, but no time to write it, contact the Josef E. Fischer, MD...... 1992 Juan R. LaCerda, MD...... 1993 Executive Office and we’ll do the follow-up. Keep in mind that Dennis Ross Irons, MD, FACS...... 1994 this issue of Pulse will be printed and mailed to every Ohio Jeffrey L. Ponsky, MD, FACS ...... 1995 Chapter member. This is your opportunity to be heard! Ezra Steiger, MD, FACS...... 1996 Michael A. Flynn, MD, FACS ...... 1997 Contact the Ohio Chapter, ACS Executive Office by email G. William Parker, MD, FACS...... 1998 [email protected] or by telephone at (877) 677-3227. Mark A. Malangoni, MD, FACS ...... 1999 Margaret M. Dunn, MD, FACS...... 2000 Michael S. Nussbaum, MD, FACS. . . . 2001 Joseph P. Crowe, Jr, MD, FACS...... 2002 Robert E. Falcone, MD, FACS ...... 2003 E. Christopher Ellison, MD, FACS. . . . 2004 Michael E. Stark, MD, FACS ...... 2005 Gary B. Williams, MD, FACS...... 2006 William C. Sternfeld, MD, FACS . . . . . 2007 Linda M. Barney, MD, FACS...... 2008 Christopher R. McHenry, MD, FACS. . . 2009 Michael D. Sarap, MD, FACS...... 2010 WINTER 2010/2011 10 Chapter News Member Spotlight By Jeffrey Alan Blatnik, MD

Dr. Blatnik currently solver, I love to work with my hands, came in with shortness of breath serves the Ohio Chapter and I enjoy a challenge . and back pain . Imaging revealed a as the vice-chair of Who were your professional moderate size hemo-pneumothorax . the Resident/Young Surgeons Education mentors? What did you learn The patient was extremely Committee. from them? apprehensive about needing a chest What is your educational Being that I am still in training, I am tube, and despite it being 3 a .m ., I background and experience? sure that I will develop more mentors spent an hour with the patient and I earned my undergraduate degree as my time goes on, but there are a her husband going over everything in Zoology from in few that have impacted my career involved . The patient tolerated the Oxford, Ohio in 2003 . From Miami, already . First is my research advisor procedure terrifically, and both she I continued my education at Case Dr . Michael Rosen . I first worked and her husband were extremely Western Reserve University School of with Dr . Rosen as a medical student, appreciative . It is moments like Medicine, and graduated in the spring and was attracted to his enthusiasm this that make up for all the of 2007 . I was involved in numerous and hard work . I went on to help other challenges . research projects throughout my with a research project as a medical My greatest frustration is with the education studying everything from student . Looking at things now, I medical system, which I don’t know the role of nerve growth factor in would have to say that his ability how to improve upon . Too often peripheral nerve ingrowth, acute renal to have a very complicated clinical physicians and patients are required failure, infections in trauma patients, practice, lead a busy research lab, and to jump through hoops for what and hernias . always put his family and kids first in seems like simple, routine medical Where did you start your career? his life is something I will strive for as care . I just don’t think it should be I am about to finish my third post- I continue my training . so complicated, but I certainly don’t graduate year in general surgery at In addition to Dr . Rosen, I would have the solution . University Hospitals Case Medical have to say that Dr . Jeffrey Ponsky What do you feel separates Center in Cleveland, OH . I spent my and Dr . Mark Malangoni are two you from “the rest of the pack” of first two years in clinical activity, and members of our program who have physicians or surgeons? In other I am currently completing my first of been able to serve as leaders in the words, what make you unique? two years in research investigating surgical community . Since my goal This is a tough question as I believe incisional hernias and biologic mesh . is to one day also serve a leader in that every surgeon brings unique After my time in the lab, I will return surgery, their wisdom and experience characteristics to their practice . I feel to clinical training for my final both in surgery and in life are that my ability to solve problems sets three years . extremely valuable . me apart from others . How did you become interested in How did you decide to join/start If you were not a surgeon, what your profession? your practice? other career path(s) would you If one were to ask me during my Haven’t yet, but will most likely have taken? first two years of medical school if I look for an academic setting where I This may sound weird, but I would would ever see myself as a surgeon, can continue to perform research, and be an underwater photographer . It is a the answer would be no . My first some day train residents . career that mixes two of my interests . medical school clerkship was What has been your greatest joy First, prior to beginning residency, internal medicine, which I thought in your career? Greatest frustration? I used to be a professional sports was interesting, and involved a lot Being young in my training, I have photographer, and spent numerous of critical thinking . My second to say my greatest joy is still helping nights per week at local and national clerkship was surgery, and after my the patient . For example, one night sporting events taking pictures . I first day in the operating room at recently while covering the thoracic would mix this with my most recent MetroHealth Medical Center, I was surgery service, a woman who was hobby, which is scuba diving . The hooked . Surgery is a natural fit for traveling from Missouri to underwater world is so unique and me, I consider myself to be a problem (continued on page 12)

WINTER 2010/2011 11 Chapter News Member Spotlight (continued)

cannot be replicated on dry land . It How have you applied your Do you have any unique hobbies is amazing how animals are just as roles with the Ohio Chapter to or interests? curious about you as you are community involvement? I used to be a professional about them . I have been able to take some of my sports photographer during my In your opinion, what are the experiences with the Ohio Chapter undergraduate education and medical biggest issues facing the surgical/ and pass them on to medical students school . I have been lucky enough to medical industry in the next and other residents who I work with . travel the country taking pictures, five years? The Chapter is a great way for people and I have had my work published I feel that cost will be one of the early in their career to get involved . with national media including ESPN biggest issues for everyone involved What can the Ohio Chapter do Magazine and USA Today . This was a in medical care over the next five for young surgeons? Any advice for great experience for me, and although years . For the physician, the time surgeons just getting started? I do not have the time currently to necessary to obtain a medical degree take pictures professionally, I still The Ohio Chapter can serve continue to enjoy it . followed by a surgical residency is as a great stepping stone for nine years or more . When combining getting involved in other national What are your upcoming this with decreased reimbursement for organizations . By volunteering to major goals, both professionally physicians it will be harder to recruit serve on various committees you and personally? people to medicine and surgery . For can setup the connections needed to For me the next year in the lab will the patient, more medical expenses continue to grow your surgical career . go by faster than I can even imagine . are being passed on to the individual, I hope to be twice as productive as I and as costs increase, this puts more Why should other surgeons join the Ohio Chapter? was during my first year, and I look stress on the patient . forward to returning to complete my Why did you join the Surgeons frequently look to clinical training . Ohio Chapter? large national meetings as places to gain experience and continue their My wife of more than three years Being a young surgeon in training, I education . However, I have already will be completing her pediatric saw the Ohio Chapter as a great way seen in my limited experience that residency from Rainbow Babies and to begin my career . It has provided local and regional meetings provide Children’s Hospital in Cleveland in me with a chance to get involved in a more personal environment for June of this year and she will follow the organization, meet leaders in the surgeons . The meetings are often this up with their fellowship in sports field of surgery from around Ohio focused on being a surgeon just as medicine . She keeps me sane and and around the country . much as the science behind surgery, without her I wouldn’t be where I which is typically the primary focus am today . of national meetings .

12 WINTER 2010/2011 Chapter News October Council Meeting Committee Reports

The following are excerpts from out what some of the volunteer Executive Office at (877) 677-3227 some of the written committee committees have been, and are or [email protected] and to be put in reports provided at the October, currently, working on . If you are touch with the committee chair . 2010 Ohio Chapter Council Meeting interested in serving on a committee held in Columbus . Read on to find of the Ohio Chapter, contact the

Association of Women Surgeons Liaison Report Submitted by Nancy L. Gantt, MD, FACS

The OCACS, in practice should find the AWS session The ACS, in conjunction with conjunction with enlightening . The opportunity for the AWS, has developed the Early the AWS, will be networking with female surgeons Career Mentorship Program which sponsoring a breakfast from across the state over breakfast pairs women surgeons interested in presentation at the will also be invaluable . an academic career with mentors Ohio Chapter Annual Women surgeons from Ohio who are full professors in academic Meeting in Cincinnati . continue to have a significant surgical practice . Twenty-five The session will focus presence nationally in the ACS . surgeons have been interviewed and on the use of personal technology Dr . Margaret Dunn of Dayton has matched with appropriate mentors by surgeons for research, patient been elected to the ACS Board of from across the country . care, and educational opportunities . Regents, while President-Elect Dr . Nationally, the AWS continues to New technologies for personal and Alice Dachowski of Gallipolis was encourage its members to become professional use will be highlighted, re-elected to a three-year term on the active in their state ACS chapters . and the legal “dos and don’ts” of Board of Governors . Dr . Linda Barney social networking will be discussed . of Dayton continues to represent Surgeons at all levels of training and Ohio on the Board of Governors . ACS Board of Governors Report Submitted by Michael Stark, MD, FACS; Linda Barney, MD, FACS; David Linz, MD, FACS, Christopher McHenry, MD, FACS; Michael Sarap, MD, FACS, Joseph Sferra, MD, FACS and Alice Ann Dachowski, MD, FACS

• Workforce Issues: Title 7 discussed . The American College expanded health service core, of Surgeons responded to the residency position increase ACGME, indicating that “the 80 hour or redistribution and duty week represents the absolute employee surgeons minimum required to provide the The governors raised concern public with well trained surgeons who can provide safe care .” Special Board of Governor’s Response Report and about the implications of the passage of the . The need areas of concern regarding proposed Survey Analysis 2011 ACGME requirements included The results of the annual survey to repeal the Medicare sustainable growth rate formula for physician the additional resources that will be of the Board of Governors were needed to implement the 16 hour summarized . The top five issues reimbursement was emphasized . It is highly unlikely that there will be maximum for PGY-1 residents and the of concern identified by the negative unattended consequences on governors were: malpractice or liability reform at the federal level . However, initiatives at patient care, education, professionalism • Healthcare Reform the state level are continuing . and the impracticality of not allowing the averaging of in house call . • Physician Reimbursement The proposed 2011 Accreditation • Malpractice and Liability Reform Council for Graduate Medical The College is investing resources and seeking expertise in the • Graduate Medical Education Education (ACGME) requirements Duty Hours regarding resident duty hours was (continued on page 14)

WINTER 2010/2011 13 Chapter News May Council Meeting Committee Reports (continued) ACS Board of Governors Report (continued) development of accountable Division of Advocacy and Health Policy: was in 2003 . There was a discussion care organizations and bundling Report from Christian Shalgian, Director about raising dues and the pros and projects . The American College of Surgeons cons of such a decision . It was felt The College is fortunate to have Bob did not support the final version of that the deficit between the dues Zwolak for surgical representation the Patient Protection and Affordable and services being provided by the on the newly formed PCORI-patient Care Act . The final bill does not College would not be sustainable and centered outcomes research institute . fix the flawed Medicare physician that a dues increase was likely . payment plan . It also included plans Principals for Payment Reform NSQIP for an independent payment advisory NSQIP is now offering four A joint session of the Board of board which the American College Governors and Board of Regents was different options with variable pricing of Surgeons opposed and there was for participation of different types held to garner collective input from no liability reform . Currently, there the governors and the regents on of hospitals, the classic option, an is no long term plan for replacement essentials option, the small rural a document entitled Principals for of the sustainable growth rate . On Payment Reform . The purpose of this option, and the targeted option . The December 1st Medicare physician classic option is the same program document was to develop principals payment is scheduled to be reduced to help guide discussion regarding that exists now . The essentials by 24 percent and an additional program tracks only essential alternative payment methodologies 6 percent cut is scheduled for and payment reform for physicians . variables and eliminates many of the January 1st . other variables, but continues with The four guiding principals were that the same sampling and the same Surgeons continue to be disengaged any alternative payment methodology validation . The small rural option politically . Only four percent of or payment reform must be patient would be available to hospitals 200 surgeons have given to the S-PAC centered physician lead, quality and beds or less with an essential data set in 2010 . safety driven, and efficiency based . and sampling that is appropriate for The Fiscal Affairs of the American College The purpose of this document is to smaller rural hospitals . The targeted of Surgeons set the ground work for the guiding option focuses on specific procedures There is a $215 deficit in terms of principles in dealing with the within specialties, specifically the services provided to the members challenges facing Medicare physician targeting more complex cases that of the American College of Surgeons payment reform . are preferentially being performed in and the individual dues that are paid . specialty hospitals . The divergence in dues and expenses is increasing . The last dues increase

Advocacy and Health Policy Committee Submitted by Michael E. Stark, MD, FACS The Ohio Legislative result will be that no additional are up for election this year as well . session will conclude at legislation will pass this year . The Governor position was up for the end of this calendar Capitol Consulting continues to election as well as State Auditor, year . Ohio’s General work for the Ohio Chapter to keep Attorney General, State Treasurer, Assembly session is two us all apprised of the latest legislative and Secretary of State . (See separate years in duration and developments in Columbus . This is story on election results on page 4) therefore, at the end noteworthy because the elections The chapter has made application of the calendar year this year are extremely important for a grant from the College to help the 128th Ohio General Assembly to the medical and business with our advocacy day at the State concludes . It is not clear at this communities . All 99 of the Ohio House . Legislative Day is scheduled time if there will be any additional House of Representative’s seats were for March 23, 2011, and hopefully legislative session dates this year . If up for election and half of the Ohio the chapter will receive part of, or all, no additional session dates are added Senate seats were up for election . of our request and as many surgeons to the legislative calendar, then the Additionally, statewide office holders as possible will participate . (continued on page 15)

14 WINTER 2010/2011 Chapter News May Council Meeting Committee Reports (continued) Advocacy and Health Policy Committee (continued) The College has a new building as a focus of advocacy for The House The Chapter is not 100 percent in Washington, DC, at 20 F Street, of Surgery . committed . and it is strategically located near the Recommendations for current • Stay engaged with local elected U .S . Capitol and the offices should legislative strategy: officials – personally and by prove to be an effective launching phone, email, and/or letter . point for advocacy efforts . The • Contribute and encourage others building is about 40 percent leased to contribute to our S-PAC . It is • Stay engaged with Ohio Chapter with prospects for more tenants . It is difficult to encourage others to positions on bills and contribute planned that this building can serve contribute when the leadership of to policy making . Commission on Cancer Report Submitted by Valeriy Moysaenko, MD, FACS This report is a brief earned AMA, Category I, credit . the proposed changes to summary of the activities The presentations included: the current cancer program standards that will be of the Commission on • Dr . Stevenson describing Cancer of the Ohio how she designed, initiated implemented in 2011, and Chapter of the American and evaluated a breast cancer provided web-based resources College of Surgeons . screening, support and to access and comment on the treatment program at Metro- proposed changes to the CoC • Dr . Jean Stevenson, Health in Cleveland . The Cancer Program Standards . MD, FACS, was recruited to serve program targeted Hispanic as Co-Chair of Ohio’s Cancer woman . Newly Appointed Ohio Cancer Liaison Physicians . Dr . Stevenson Liaison Physicians has been an outstanding Cancer • John Alduino, Health Initiatives Dr . Moysaenko greeted the Liaison Physician for Metro- Director, American Cancer newly appointed cancer liaison Health in Cleveland . She Society, spoke about the physicians with a personal letter designed and implemented an Collaborative Action Plan, of congratulation . The letter also exemplary breast care screening, an agreement between the offered the Commission on Cancer support, and treatment program Commission on Cancer as resources in helping the new CLPs for minority health . She has also accredited cancer programs and in their roles . The letter outlined the been instrumental in monitoring the American Cancer Society role of the cancer liaison physician and assuring the quality of cancer to collaborate in providing and provided access to resources to care at Metro-Health through the support groups, supportive help the CLP evaluate the quality use of National Cancer Data services, screening, prevention, of the cancer care provided by the Base (NCDB) data . and education programs to cancer program . The letter also cancer patients and the local encouraged collaboration with the • In May, the Commission held community . the Annual Meeting of Ohio’s American Cancer Society . John Cancer Liaison Physicians in • Dr . Valeriy Moysaenko Alduino, Health Initiatives Director conjunction with the Ohio presented the work being of the American Cancer Society, and Chapter, American College of done to refine the role of the Dr . Moysaenko has been visiting Surgeon’s Annual Meeting . It was cancer liaison physician in CoC interested newly appointed CLPs well attended by Cancer Liaison accredited cancer programs, with local ACS Health Initiatives staff Physicians, Cancer Registrars, and he also presented the and reviewing the benefits of an ACS Cancer Committee Chairs and NCDB data tools to evaluate Collaborative Action Plan agreement . Cancer Program Administrators the quality of cancer program To date 15 cancer liaison physicians from Ohio’s 98 Commission care: CP3R, NCDB Benchmark have been visited . on Cancer accredited cancer Reports, RQRS, and CP3R . (continued on page 16) programs . The presentations The Commission reviewed

WINTER 2010/2011 15 Chapter News May Council Meeting Committee Reports (continued) Commission on Cancer Report (continued) The new cancer liaison Cancer Control Organization Meetings second-hand tobacco smoke physicians are: • Ohio Partners for Cancer Control for non-smokers, especially • John Moroney, MD, FACOG, (OPCC): As a member of the children in households with Wright-Patterson AFB, Dayton executive committee of the parental smokers . • Edward Crane, MD, Mercy OPCC, Dr . Moysaenko has • Ohio Colorectal Coalition: Provides Hospital, Fairfield been attending, and actively networking for Ohio’s colorectal • Henry Blair, MD, Euclid participating, in a series of cancer organizations . This Hospital, Cleveland meeting through 2009 and 2010 enhances the exchange of ideas • Michael McKenna, MD, St . to reorganize and revitalize the on improving colorectal cancer John’s Medical Center, Cleveland OPCC . Input was solicited from screening . Dr . Moysaenko serves all executive committee members on the executive committee and • John McDonough III, MD, Marion General Hospital, Marion and general membership . has written articles on colorectal Robert Indian, Director, Ohio cancer screening for Pulse and • Kelly McLean, MD, VA Medical the quarterly CLP newsletter . He Center, Cincinnati Department of Health, has been installed as the executive is also currently participating in Outstanding Ohio Cancer administrative director of the the Athens County Colorectal Liaison Physicians OPCC . The focus of the OPCC Coalition and has helped The Commission provided will continue to be the reduction establish a colonoscopy acknowledgement and of the cancer burden in Ohio . screening program . congratulations on their outstanding The projects will be focused on • American Cancer Society: The Ohio work for their cancer programs and areas of high cancer incidence Division and the Pennsylvania their communities . and late detection . The projects Division of the American Cancer • Henry Blair, MD, Hillcrest will enlist the resources of local Society have merged . The CoC Hospital, Cleveland cancer organizations and will be participated in the transition • Richard Capone, MD, FACG, St . implemented by the local cancer process and Dr . Moysaenko is the Rita’s Medical Center, Lima organizations with the assistance Secretary of the Ohio Division • Michael Sarap, MD, FACS, of the general membership . Board . The new division is called Southeastern Ohio Regional • Medical Advisory Board, Ohio East Central Region . The first Medical Center, Cambridge Department of Health: The CoC has meeting was held October 3, Communication With Ohio Cancer been actively participating in the 2010, and it is expected there Liaison Physicians scheduled meetings that focus will be enhancements in patient Dr . Moysaenko provided articles to on issues identified by the Ohio services and improved financial the PULSE addressing cancer control Department of Health . Physicians strength . The Health Initiative issues and the quality of cancer care provide advice . The most current personnel that members have delivered in Ohio and has provided issues deal with esophageal become accustomed to working a quarterly newsletter to Ohio’s cancer prevention, detection, with will be unchanged . approximately 98 CLPs alerting them and the role of the primary care to CoC initiatives and keeping them physician . The management abreast of cancer control activities of patients in the Breast and in Ohio . Cervical Cancer Early Detection Program . Health issues related to

Save the Date 2011 Annual Meeting - Don’t Miss It!

16 WINTER 2010/2011 17 WINTER 2010/2011 Resident Research Forum Annual Resident Research Forum Winners

Planned as part of the Ohio Chapter Research Forum and Poster Session . the Summer 2010 edition of Pulse Annual Meeting, residents in Ohio Below are the abstracts submitted by which can be found online at surgery and surgery specialty the 2010 second place winners . (The www.ohiofacs.org) . programs enter the Annual Resident first place winners were included in

Basic Science – response to traumatic brain injury in presented as mean + SEM . Statistical Second Place mice and may decrease secondary analysis was performed by ANOVA Ethanol Treatment After Traumatic brain injury . We hypothesized followed by post-hoc testing with Brain Injury Decreases Cerebral that ethanol given after traumatic significance set at p<0 .05 . MIP1-α And Serum Neuron Specific brain injury would attenuate the Results: Neurologic recovery was Enolase In Mice neuroinflammatory response . significantly impaired in the mice EM Campion, MD Goodman, AT Makley, Methods: Mice were subjected to undergoing traumatic brain injury AB Lentsch, TA Pritts. University of a moderately severe blunt TBI by versus sham injury . There was no Cincinnati, Department of Surgery weight drop or sham injury . Righting difference in RRR between groups reflex response (RRR) time was receiving ethanol or water . After Purpose: Traumatic brain injury assessed as an indicator of neurologic TBI, mice that were given ethanol (TBI) is a major cause of morbidity recovery . At 30 min . post injury, had a significantly lower level of the and mortality . Clinical studies have mice were given 5g/kg of ethanol or cerebral pro-inflammatory cytokine suggested that moderate intoxication the equivalent volume of water by MIP1-α at 24 hours as compared to at the time of head injury is gavage . Cortical brain samples were mice receiving water . In addition, correlated with improved outcome . analyzed for inflammatory cytokines serum NSE levels were reduced by Previous studies from our and other by ELISA . Neuron specific enolase ethanol treatment after TBI . laboratories indicate that ethanol (NSE) was measured as a serum attenuates the neuroinflammatory biomarker of TBI severity . Data is

Clinical Science – intent was to treat with initial non- Results: 985 patients had a Second Place operative management and interval diagnosis of ruptured appendicitis . Of The Presence But Not The appendectomy (IA) were selected these, 116 patients met study criteria . Location Of An Appendicolith (n=116) . Children who failed initial Of all patients that met study criteria, Affects The Success Of Interval non-operative management requiring there was an overall 19% failure rate . Appendectomy In Children With appendectomy prior to elective IA Patients with an appendicolith had Ruptured Appendicitis were assigned to the “failure” group a 41 .7% failure rate, and patients (n=22) . Children that improved and without an appendicolith had a IA Otabor, S Druhan, DA Caniano, GE underwent elective IA were assigned 13% failure rate {p= 0 .003; (1 .73, Besner. Nationwide Children’s Hospital and to the “success” group (n=94) . Age, 13 .1 95% CI)} . Patients with an The Ohio State University College gender, duration of symptoms, intraluminal appendicolith had a of Medicine presence of an appendicolith, 41 .7% failure rate and patients with Purpose: To determine whether appendicolith location (intraluminal an extraluminal appendicolith had the presence and/or location of an or extraluminal), presence of a a 41 .7% failure rate (p= 0 .79 and appendicolith can predict failure of drainable abscess on radiographic 0 .76 respectively) . Patients with a initial non-operative management in imaging, and complications were drainable intra-abdominal abscess children with ruptured appendicitis . reviewed . Pathology and operative had a 21 .2% failure rate, and patients Methods: A retrospective reports were reviewed to confirm without a drainable intra-abdominal chart review of pediatric patients the presence or absence of an abscess had a 16% failure rate presenting with ruptured appendicitis appendicolith . Statistical analysis (p=0 .48) . Compared to the success between January 1994 and March was performed using the Student’s group, more children in the failure 2009 was conducted after obtaining t-test and logistic regression, with group presented to the hospital IRB approval . Patients in whom the significance set at p-value≤ 0 .05 . earlier (6 .57 ± 2 .59 vs . 10 .02 ± 7 .21

18 WINTER 2010/2011 Resident Research Forum Annual Resident Research Forum & Poster Session Winners (continued) days; p-value 0 .030) and had higher of an appendicolith increases the of the appendicolith is not a predictor complication rates {(57 .1% vs . 42 .9%; likelihood of failure of initial non- of failure of initial non-operative p-value 0 .02; (0 .03, 0 .72 95% CI)} . operative management of ruptured management in these patients . Conclusions: Our study appendicitis in children, and is the demonstrates that the presence first to demonstrate that the location

ONCOLOGY – HOLZER CLINIC were made by two-tailed Student’s head of the pancreas, hence the most AWARD – SECOND PLACE t-tests and the Wilcoxon rank common procedure performed was Pancreatic Resection In The Ninth sum tests for continuous data and pancreaticoduodenectomy (398, Decade Of Life: Not Always A Safe contingency table analysis (chi- 78%) . There were no differences Option For Malignancy square and Fisher’s exact test) where in the complication rates, length of appropriate . Survival was analyzed stay, or perioperative mortality rates . I Hatzaras, C Schmidt, P Muscarella, WS using the Kaplan-Meier method and While there was a trend towards Melvin, EC Ellison, M Bloomston. Ohio comparisons between groups were shorter overall survival in patients State University, Department of Surgery performed employing the log-rank over 80 (median 10 .2 vs . 15 .5 Purpose: To assess our institution’s test . Statistical significance was months), this was not statistically experience and outcomes with accepted at p-value<0 .05 . significant (p=0 .08, figure) . pancreatic resection in the setting of Results: There were 517 pancreatic Conclusion: Pancreatectomy malignancy, in patients beyond their resections for cancer in our institution for malignancy in octogenarians 9th decade of life . from January 1990 to December is associated with increased Methods: We retrospectively 2007 . Of these, 27 patients were perioperative mortality and decreased reviewed the clinical records of older than 80 . The distribution of overall survival . While these findings all patients undergoing pancreatic clinical characteristics was similar were not statistically significant, resection for malignancy . between the two groups (table) . the trend suggests that appropriate Demographics, laboratory, The majority of patients undergoing patient selection is critical in treatment and outcome data were pancreatic resection harbored a elderly patients . gathered . Comparisons of groups pancreatic adenocarcinoma at the

WINTER 2010/2011 19 Pulse Throughout Ohio District Councilor Reports

Below, please find a summary of the district activity as reported at the Ohio Chapter Council Meeting held in October, 2010 .

Northeast Ohio District Submitted by Bruce J. Averbook, MD, FACS

This report summarizes kidney disorders: neurology and hospital in Ohio to be honored by various aspects of neurosurgery, ophthalmology, the Premier Health Care Alliance healthcare information orthopedics, pulmonology, with the 2010 Premier Award for in Northeastern Ohio rheumatology, and urology . Quality (AFQ) for its superior that surgeons may find Lake Health: It was one of only 166 outcomes, outstanding patient care, interesting . hospitals in the nation with patient and consistently setting standards in Akron Children’s outcomes for women that are in clinical excellence nationwide . This Hospital: The Children at Risk the top five percent, according to is the third time in the past four years Evaluation (CARE) Center received the HealthGrades Seventh Annual MetroHealth has received this award . federal stimulus money for same-day, Women’s Health in American Parma Community General mental health counseling for patients Hospitals study . Hospital: The facility’s stroke and families . An $882,550 Edward On August 2, Lake Health began program earned the Gold Seal of Byrne Memorial Competitive Grant posting its ER wait times on Twitter . Approval from the Joint Commission enabled the CARE Center to add four Every two hours Lake Health sends for Primary Stroke Centers after an therapists, two support staff, and a updates with the wait times for unannounced on-site review . part-time research associate . both ERs at West Medical Center in The Phase I of Robinson Memorial Akron General Medical Center: Willoughby and TriPoint Medical Hospital’s surgical services area AGMC broke ground in July for a Center in Concord Township . If renovation is complete with eight Health & Wellness Center in Green a situation occurs to dramatically operating rooms, which are double and started collaboration between change the wait time at either facility, the size of the old rooms, and an in- Akron General and the City of Lake Health will send an update patient endoscopy suite . Green . An additional 42,000-square- immediately . Following Lake Health Southwest General Hospital: It foot medical office building is being on Twitter will give community announced a new Scoliosis Treatment constructed for tenants . members an understanding of the Program through its department of Aultman Hospital: The managed average wait time at each facility; physical medicine and rehabilitation . it will also give consumers an idea care plan, AultCare, was awarded an Summa Health System: Announced a accreditation status of excellent from of the busiest times of day in the emergency departments . new collaboration with Healthagen to the National committee for Quality provide valuable health information Assurance (NCQA) . Marymount Hospital: The facility with the free iTriage smartphone Cleveland Clinic: U.S. News and was awarded a three-year term of application . Through iTriage, mobile World Report ranked the Cleveland accreditation in ultrasound resulting consumers have access to Summa’s Clinic the fourth best hospital in the from a survey by the American door-to-door emergency room wait country along with being ranked College of Radiology . times, hospital locations, urgent care number one in heart care for the 16th Mercy Medical Center: It acquired centers, physician specialties, and year in a row . The Taussig Cancer a BARA-MED XD computerized health information . Center was ranked ninth in the monoplace hyperbaric oxygen Suma Akron City and St. Thomas country . Other specialties ranking in chamber which improved patient Hospitals: Palliative Care and the top ten were diabetes/endocrine comfort and healing, and it can hold Hospice Services recently was named disorders, gastroenterology, ENT, up to a 700-pound patient . a Circle of Life Award honoree for geriatrics, gynecology, heart care, The MetroHealth System: The only innovation in improving the care of (continued on page 21)

20 WINTER 2010/2011 Pulse Throughout Ohio District Councilor Reports (continued)

Northeast Ohio District (continued) patients near the end of life with Chief Medical Officer of Ahuja of Dr . Donald J . Goodman and Ruth life-threatening conditions . Medical Center . Weber Goodman that will support University Hospitals (UH): UH A new UH Cancer Hospital with UH’s cancer care program . In honor was named one of the top ten health a planned opening in May 2011 at of this unparalleled generosity – systems in the United States based a cost of $250 million will be on given in gratitude for the pioneering on clinical performance by Thomson the main Case Western Reserve cancer treatment that saved and Reuters, a leading business and University Medical Center campus in extended Dr . Goodman’s life – UH profession information organization . a single 375,000-squre-foot location has established the Dr . Donald J . and UH was one of only five health and will house 120 beds expandable Ruth Weber Goodman Discovery systems in the United States to to 150 beds . Center for Clinical Research in the new UH Cancer Hospital . receive this recognition over Other expansion includes the two years . Quentin & Elisabeth Alexander UH Rainbow Babies & Children’s UH is finishing up a 1 .2 billion Neonatal Intensive Care Unit ($27 Hospital: The Center for Child dollar expansion with new medical million), The Center for Emergency Health and Policy has become central buildings and linking them with Medicine ($41 million), a parking to public and private partnerships, advanced technology . The new $298 garage ($30 million), The Concord gained several grants, received awards million Ahuja Medical Center will Medical Center ($29 million), The and made substantial contributions open in January 2011 . The first phase Geneva Health Center ($3 .6 Million), to advance children’s health . At the includes 144 beds and a medical The Medina Health Center ($10 federal level, the Center is working office building on a 53-acre site in Million), The Sharon Health Center with U .S . Congresswoman Marcia Beachwood that could accommodated ($3 million), and the Twinsburg Fudge (D-Cleveland) to serve as more hospital buildings with 450 Health Center ($18 Million) . a resource on two bills related to childhood obesity . additional beds and more offices . Alan UH Case Western Medical Center M . Hirsh, MD, has been appointed announces $35 million from the estate

Southeast Ohio District Report Submitted by David Hasl, MD, FACS

Fairfield Medical institution continues the process of of obstetrics and gynecology Center: The facility moving toward electronic medical stopped performing deliveries due to started a Carotid records (EMR) . The hospital has continued lost revenue . The surgery Stenting Program been working with McKesson on the department upgraded equipment in in August 2010, and computerized physician order entry the operating rooms and in surgical to date five patients portion of the EMR with a “go-live” endoscopy and purchased new HD have successfully date scheduled in late 2011 . monitoring systems . undergone the stenting procedure . Hocking Valley Community Diley Ridge Medical Center: This is currently an interdisciplinary Hospital: This 25-bed acute care Opening in March 2010, this teamwork between the interventional facility in Hocking County has had Fairfield County facility has radiology, cardiology, and vascular a major change . The departments more than doubled the projected surgery departments . The entire (continued on page 22)

WINTER 2010/2011 21 Pulse Throughout Ohio Southeast Ohio District Report (continued)

numbers of patients seen in the currently a free-standing emergency There are plans to develop a full- emergency department . This facility, department with full lab and service community hospital in the a partnership between Mt . Carmel radiology services, as-well-as a fully near future . East and Fairfield Medical Center, is occupied medical office building .

Southwest Ohio District Report Submitted by Peter Ekeh, MBBS, MPH, FACS

Dr . Mary McCarthy The Kettering Medical Center in be providing multiple services – has been appointed the Dayton, opened the Benjamin and including expansions to the cardiac Elizabeth Berry Gray Marian Schuster Heart Hospital on and orthopedic programs . Professor and Chair October 3 . This 120,000-square-foot Dr . Margaret Dunn, executive of the Department addition was built at a cost of $77 associate dean of the Boonshoft of Surgery at Wright million and is designed primarily for School of Medicine at Wright State State University in the hospital’s cardiac services . University and a member of the Ohio Dayton . This department oversees The Miami Valley Hospital is on Chapter, ACS, was appointed to the the integrated surgical residency schedule to complete its “Southeast ACS Board of Regents at the last program, which graduates seven to Addition .” This 484,000-square- College meeting . eight chief residents per year and a foot structure is being completed surgical faculty in a consortium of at a cost of $135 million . It was to six hospitals . open in December 2010 and will

22 WINTER 2010/2011 Pulse Throughout Ohio The Cleveland Medical Mart and Convention Center: Where Innovation and Education Meets Commerce Submitted by Bruce J. Averbook, MD, FACS

In the very near future, host simultaneous events which is ideal - Cuyahoga County employs doctors will be able to for events that need to be paired with more than 120,000 healthcare attend an educational conferencing capabilities . professionals seminar then simply travel down the hall Why Cleveland? According to the Cleveland MMCC to see the latest medical equipment and It is not a surprise to Ohio Chapter website, conventions incorporating technology in action, all within in the members that Northeast Ohio is the temporary exhibit space with permanent confines of the same state-of-art facility, center of leading medical treatment, showrooms enjoy increased booth and in Ohio – the Cleveland Medical education, and innovation in the sales . While traffic to the Medical Mart Mart and Convention Center (MMCC) . healthcare industry, giving it the name increases, conventions and conferences Ground will be broken on the new “The Medical Capital .” It is surrounded also generate greater attendance because Cleveland MMCC on January 14, by an extensive network of the world’s visitors will want to visit the flagship 2011, which is designed to be a unique most advanced healthcare institutions, showrooms of the major manufacturers convention center that specifically targets physicians, and research programs . and industry pioneers during their the healthcare and medical industries . Northeast Ohio is the home to many visit . With the ability to conduct business Designed to bring healthcare buyers innovations taking place in the medical more efficiently, Cleveland MMCC and sellers together, Cleveland MMCC community in cities such as Cleveland, developers are hoping that this is the new will feature an integrated market center Canton, Akron, and Youngstown, and home for healthcare clinicians, suppliers, combining permanent showrooms, provides strong evidence that Northeast purchasers, service providers, and exhibition halls, and conference facilities . Ohio truly serves as the nation’s administrators worldwide . It has worked for other markets and is Medical Capital . It does appear as if interest is growing creating a critical mass of innovation, in the planned medical merchandise mart education, and commerce . and convention center in Cleveland . According to the plans, the Cleveland MMPI said it has 16 letters of intent MMCC will house approximately for conferences, conventions, and trade 120,000 square feet of permanent shows at the complex as of late showrooms for major medical October 2010 . manufacturers and service providers . “The Medical Mart concept is Over 30 vendors have signed letters of resonating strongly with medical intent to fill the planned showrooms manufacturers and suppliers,” Mark focused on cardiology, surgery, OB/ Falanga, MMPI senior vice president, GYN, imaging, orthopedics, sterilization, said in a statement recently to The healthcare furnishings, patient care, Cleveland Plain Dealer . “Knowledgeable healthcare IT, and medical devices . industry leaders have also responded At the same time, the Cleveland The developers, MMPI out of Chicago, enthusiastically about displaying their MMCC will feature approximately know the area is a center of excellence in products in Cleveland and Northeast 100,000 square feet of high-tech, flexible healthcare, and that vendors will want to Ohio, the nation’s medical capital and a meeting rooms of varying sizes to tap into Cleveland’s global leadership in globally recognized center for medical accommodate keynote sessions, seminars, the medical field . The strong attraction to innovation and technology .” the area also included: and panel discussions, which are the core A Few Bumps in the Road offering of many medical conferences, - University Circle is a 15-minute The Cleveland MMCC is funded by meetings, and conventions, and it will drive from Cleveland MMCC Cuyahoga County taxes collected from be designed with approximately 300,000 - Health Line, a new transit corridor, a 20-year, quarter-cent sales tax hike square feet of high-quality exhibit space, conveniently connects downtown approved in 2007 to finance the complex . featuring high ceilings, and industry- Cleveland to the medical district However, the cost of the Cleveland standard column spacing . MMCC is going up beyond the - Cleveland’s healthcare institutions According to designers, the Cleveland are one of the largest customers of original plans and that has created MMCC was designed and suited to medical products in the world some opposition . meet the needs of medical trade shows and conventions and the facility can - More than 400 bioscience companies (continued on page 24) are located in Northeast Ohio

WINTER 2010/2011 23 Pulse Throughout Ohio The Cleveland Medical Mart and Convention Center: Where Innovation and Education Meets Commerce (continued)

Cleveland MMCC Specifics Medical Mart Permanent Showrooms • Approximately 100,000 square feet • Four floors

Convention Center Exhibition Halls • Approximately 240,000 square feet • 90’ column spacing • 30’ clear ceiling height

Conference Facility & Ballroom • Approximately 100,000 square feet • More than 50 meeting rooms

Cuyahoga County’s medical mart and facility MMPI proposed to build for $425 continuing medical education programs, convention center will cost an extra $40 million . In that plan, the ballroom – the conferences, and conventions alongside million, going against commissioners’ most important space for marketing permanent showrooms starting in 2013 . long-standing pledge to cap the project a center – had a low ceiling and was The new facility is poised to attract a at $425 million . Cuyahoga County interrupted by columns . Its design also great percentage of the 570 medical Commissioners Tim Hagan and Peter would have forced the delivery of food trade shows and 2,000 medical Lawson Jones defended the spending through the same doorways convention conferences that are held annually in increase recently in an article appearing attendees used . The latest design pushes the United States . in The Cleveland Plain Dealer . the ceiling up without raising the mall At the October Council Meeting, it “We have to spend this additional and removes the columns from the was suggested that the Ohio Chapter, money so we have a top-quality facility,” ballroom, giving unobstructed views . It ACS look at possibly having an annual Jones said . “It was always my thought also creates service entries for meeting at the Cleveland Medial Mart that we’d be able to bring this in at $425 food delivery . and Convention Center in the future so million . That was my hope . We can bring Many love the idea of the Cleveland that Ohio surgeons can take advantage of it in at $425 million, but it won’t be as MMCC or hate it, but it will bring the state-of-the-art facility when it opens . enticing or inviting as we need it to be .” physicians, nurses, technicians, and Commissioner Hagen added, “What’s the other medical professionals to a single fall-out? There’s no tax increase, and location with facilities designed to host we’re moving forward with the project . I look forward to the day it’s done .” Attorney Jeff Appelbaum, the county’s point man on the project, explained during a commissioners meeting how the extra $40 million will ensure that taxpayers get a state-of-the-art complex with first-class amenities convention planners want . Appelbaum said he recognized the need for extra spending after he and consultants took a close look at the

24 WINTER 2010/2011 From the College It Pays To Plan Ahead By Martin H. Wojck, CFRE

When Earl planned giving, which so often links Promoting and Recognizing Mayne, MD, FACS, philanthropic vision and financial Planned Gifts concluded his goals . Planned giving offers the The ACS Foundation has built a surgical practice in greatest opportunity for individuals comprehensive system to encourage 1948, many current Fellows of the to make their largest gift to a not-for- gift planning . They promote the American College of Surgeons were profit organization . idea through the website and Annual not born – much less active . Yet, The major planned giving Report as well as through the Leave years after his passing, Dr . Mayne, instruments include: a Legacy print newsletter and a once a Governor of the College, companion electronic quarterly continues to have a profound impact • Bequests publication . Good news: the on the College’s constituents and • Gifts of assets and property American tax code favors charitable on best practices . As part of his (insurance, securities, real estate) giving, especially planned gifts . estate plan in 1944, Dr . Mayne • Life income agreements (gift The Mayne Heritage Society, the established a trust that supported annuities, remainder trusts, recognition circle for planned gift medical education scholarships for revocable trusts) donors, honors the Fellow mentioned hundreds of individuals over many Bequests are easy – and by far the above . Dr . Mayne knew that future years . In 1994, proceeds from the investment in education and research Mayne Educational Fund reverted to most common – and the language is as simple as: programs would ensure the vitality the American College of Surgeons of the profession and optimal to support its scholarly programs for I, [name], of [city, tate, care of the surgical patient . His years into the future . ZIP], give, devise and philanthropy continues to serve What is a Planned Gift? bequeath to the American as a remarkable example . A planned gift is one that is College of Surgeons Foundation [written Martin Wojcik, CFRE, is interim executive legally consummated during the director for the ACS Foundation. donor’s lifetime, with the principal amount or percentage of benefits generally not accruing to the estate or description the benefiting institution until some of property] for its future date . Truly transformative unrestricted use and philanthropy always includes purpose .

WINTER 2010/2011 25 Plan to Attend!

2011 Annual Meeting - Don’t Miss It!

Each spring, the Ohio Chapter of the American Along with the in-depth learning sessions that all College of Surgeons hosts their Annual Meeting to participants will benefit from, students enrolled in promote the learning and development of statewide residency programs in Ohio are invited to submit doctors, fellows, and residents in surgery programs . their research to the Poster Abstract Contest This two-day event has grown over the years into sponsored by the Ohio Chapter of American an interactive experience for all learning levels to College of Surgeons . This contest allows members promote various fields of surgery including plastics, of the Ohio Chapter to see cutting edge research cardiac, wounds, orthopedic, and vascular to gain that is taking place in the schools, but also promotes knowledge and insight about procedures that are relationships between members and residents that happening around the state . With the variety of can last for years to come . While attending the surgeons that join the speaking panel each year, Annual Meeting, be sure to stop and see the resident participants are guaranteed to leave the Annual posters … you may find your next bright idea there! Meeting with insight and tools to use in their everyday work .

Reserve Your Hotel Room Now Ohio Chapter has a block of rooms at a discounted Hyatt Regency Cincinnati group rate of $139 plus tax for single occupancy, and 151 West 5th Street double rate of $164 plus tax for double occupancy . Cincinnati, OH 45202 Sleeping rooms are assigned on a first-come, first- (513) 579-1234 served basis and reservations must be made by Fax: (513) 354-4299 April 14, 2011 to receive the Ohio Chapter www .Cincinnati .Hyatt .com discounted room rate . Hotel Room Block Name: Check Online for Additional Details Ohio Chapter, American College of Surgeons For information on the 2011 speakers, topics, and Reservations Deadline: optional events, check out the Chapter website at April 14, 2011 www.ohiofacs.org/Events . Reservations: (800) 233-1234 2011 Legislative Advocacy Day Is March 23, 2011

March 23, 2011 • Ohio Statehouse

OHIO CHAPTER, ACS & OHIO COMMITTEE ON TRAUMA

This is one of the Ohio Chapter’s most Issues 2011 session, surgeons will be able to important events of the year, and our goal is to attend their scheduled one-on-one meetings have a large presence in Columbus to advocate on with their legislators in the afternoon. Then, issues important to the practice of surgery to the surgeons will join with legislators for a legislative Ohio General Assembly. reception in the Statehouse Crypt Area before This year, the Ohio Chapter is joining with the heading home. Ohio Committee on Trauma to host a one-day This will be a great networking event to be able Legislative Advocacy Day. It is widely reported to speak with others from the healthcare industry, that Ohio is facing tough budget and filling newly elected legislators, legislative liaisons, and large deficits means that legislators face difficult others. Remember, legislators need to hear from decisions moving forward. These unprecedented you – the medical experts – in order to make difficult spending decisions mean that there is informed decisions on issues facing Ohioans. If no better time for surgeons to advocate for surgeons don’t proactively advocate for items and priority items. issues important to them – then who will? Surgeons will have the opportunity to start their To see the complete schedule of events and to day with a discussion of key issues to the health register to attend this year’s Legislative Advocacy care industry with light lunch will be served at Day, visit www.ohiofacs.org today! 12:00 pm during registration. Following the Key PRSRT STD US POSTAGE PAID PEORIA, IL PERMIT #618

OHIO CHAPTER, AMERICAN COLLEGE OF SURGEONS

P.O. BOX 1715 COLUMBUS OH 43216-1715