Becker's Hospital Review

21 CEO / STRATEGY A trait of the best leaders: Contagious positive energy By Georgina Gonzalez H aving a positive relational energy that helps upli and inspire workers is the most powerful predictor of or- ganizational success, according to an April 18 Harvard Business Review article. e authors of the article, Emma Seppälä, PhD, of Yale and Stanford universities, and Kim Cameron, PhD, of the University of Michigan, used their research, interviews and experience to show why energizing leaders are so important. To understand which leaders have such pos- itive energy, Dr. Seppälä and Dr. Cameron asked all employees to rate what happens to their energy levels aer interacting with other team members. Leaders with high positive re- lational energy were identified by other team members stating their energy levels increased aer interacting with them. e researchers found that leaders with positive relational energy consistently pro- duce more engaged workforces, lower em- ployee turnover and increased feelings of employee well-being. ey also found there was a higher concentration of such leaders at high-performing companies as opposed to average-performing companies. Innova- tion, teamwork, financial performance and team cohesion all improved when led by positive energizers. n CEO pay approaches record amid workforce shortages By Kelly Gooch A nnual compensation for CEOs in the U.S. is heading for a record amid worker shortages and inflation, The Wall Street Journal reported April 3. The newspaper examined pay data for more than half the S&P 500 index from MyLogIQ, a provider of U.S. Securities and Exchange Commission compliance and disclosure intelligence products. Based on the analysis, median pay reached $14.2 million last year for CEOs of S&P 500 companies, compared to a record $13.4 million for the same compa- nies in 2020. Pay increases for most CEOs climbed at least 11 percent. The Journal said its analysis showed CEOs saw pay increases overall in 2020, but nearly one-third of the CEOs saw their total compensation decline from 2019, and many gave up some pay during the COVID-19 pandemic. Half the companies also reported that pay for their median worker climbed by as much as 3.1 percent last year, and one-third of companies reported that their median employee pay declined between 2020 and 2021, the newspa- per's analysis showed. The analysis comes as workers across various industries leave their jobs as part of the "Great Resignation." In February, 4.4 million Americans left their jobs, The Washington Post reported March 29. Within healthcare, hospital CEOs are joining the Great Resignation, with some retiring and others stepping down to take roles at other organizations. At the same time, hospitals continue to grapple with staffing strain and pan- demic-related challenges. n • In patients undergoing hemorrhoidectomy, a total of 266 mg (20 mL ) of EXPAREL was diluted with 10 mL of saline, for a total of 30 mL, divided into six 5 mL aliquots, injected by visualizing the anal sphincter as a clock face and slowly infiltrating one aliquot to each of the even numbers to produce a field block. Local Analgesia via Infiltration Dosing in Pediatric Patients The recommended dose of EXPAREL for single-dose infiltration in pediatric patients, aged 6 to less than 17 years, is 4 mg/kg (up to a maximum of 266 mg), and is based upon two studies of pediatric patients undergoing either spine surgery or cardiac surgery. Regional Analgesia via Interscalene Brachial Plexus Nerve Block Dosing in Adults The recommended dose of EXPAREL for interscalene brachial plexus nerve block in adults is 133 mg (10 mL), and is based upon one study of patients undergoing either total shoulder arthroplasty or rotator cuff repair. Compatibility Considerations Admixing EXPAREL with drugs other than bupivacaine HCl prior to administration is not recommended. • Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. • Bupivacaine HCl administered together with EXPAREL may impact the pharmacokinetic and/or physicochemical properties of EXPAREL, and this effect is concentration dependent. Therefore, bupivacaine HCl and EXPAREL may be administered simultaneously in the same syringe, and bupivacaine HCl may be injected immediately before EXPAREL as long as the ratio of the milligram dose of bupivacaine HCl solution to EXPAREL does not exceed 1:2. The toxic effects of these drugs are additive and their administration should be used with caution including monitoring for neurologic and cardiovascular effects related to local anesthetic systemic toxicity. • When a topical antiseptic such as povidone iodine (e.g., Betadine ® ) is applied, the site should be allowed to dry before EXPAREL is administered into the surgical site. EXPAREL should not be allowed to come into contact with antiseptics such as povidone iodine in solution. Studies conducted with EXPAREL demonstrated that the most common implantable materials (polypropylene, PTFE, silicone, stainless steel, and titanium) are not affected by the presence of EXPAREL any more than they are by saline. None of the materials studied had an adverse effect on EXPAREL. Non-Interchangeability with Other Formulations of Bupivacaine Different formulations of bupivacaine are not bioequivalent even if the milligram dosage is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL and vice versa. Liposomal encapsulation or incorporation in a lipid complex can substantially affect a drug's functional properties relative to those of the unencapsulated or nonlipid-associated drug. In addition, different liposomal or lipid-complexed products with a common active ingredient may vary from one another in the chemical composition and physical form of the lipid component. Such differences may affect functional properties of these drug products. Do not substitute. CLINICAL PHARMACOLOGY Pharmacokinetics Administration of EXPAREL results in significant systemic plasma levels of bupivacaine which can persist for 96 hours after local infiltration and 120 hours after interscalene brachial plexus nerve block. In general, peripheral nerve blocks have shown systemic plasma levels of bupivacaine for extended duration when compared to local infiltration. Systemic plasma levels of bupivacaine following administration of EXPAREL are not correlated with local efficacy. PATIENT COUNSELING Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue. Pacira Pharmaceuticals, Inc. San Diego, CA 92121 USA Patent Numbers: 6,132,766 5,891,467 5,766,627 8,182,835 Trademark of Pacira Pharmaceuticals, Inc. For additional information call 1-855-RX-EXPAREL (1-855-793-9727) Rx only March 2021

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