By Shraddha Mainali (left), Sara Hocker (center), Andrew Naidech (right), NCS Research Operations Sub-CommitteeWe recently asked the NCS Research Training Fellowship Grant recipients Dr. David Hwang (2015) and Dr. Edilberto Amorim De Cerqueira Filho (2016) to share their experience regarding the fellowship grant.
How did you learn about the grant?
Dr. David Hwang (DH)
: NCS did a great job advertising this grant via emails.Dr. Edilberto Amorim De Cerqueira Filho (EA)
: I found out about the grant when Dr. David Hwang received the award in 2015. I have participated in the annual NCS meeting every year since I was a PGY-2 resident, and I encourage all trainees to attend the pre-meeting career development and research mentoring talks. Bring your specific aims page with you if you can!
Please provide a brief description of your project.
: Discussing the options of trach/PEG versus comfort care with families of severely brain injured patients is routine in the neuroICU, yet evidence suggests that families are not satisfied with current decision-making practices and are at risk of developing PTSD, complicated grief etc. One of my goals is to develop decision aids that can help families through difficult decisions in the hopes of improving their long-term psychological outcomes. The goal of my funded study was to characterize the general U.S. population into various groups of decision makers when placed in this neuro-ICU goals-of-care situation based on how they prioritize their concerns. The idea was to use this data regarding key decision making archetypes as high-yield targets for future decision aid development.
Our team worked with a professional survey company to recruit a large sample of adult respondents whose demographics mirrored that of the U.S. population. We presented them with a hypothetical situation of an elderly relative hospitalized with severe ICH and needing trach/PEG to survive, although likely with a severe functional deficit. In asking respondents whether they would prefer a trach/PEG versus comfort measures for the patient, we also used a survey technique known as “best-worst scaling” to get at what each respondent’s top concerns were in making their decision. We then used the data we collected to divide our respondents into key groups with like-minded concerns.EA
: My goal is to develop quantitative neurophysiology methods that can help us understand why some patients recover from coma after hypoxic-ischemic brain injury while others don’t. Our first steps were to build algorithms that could efficiently process and analyze large amounts of continuous EEG data, and then use machine learning methods to generate early and accurate outcome predictions. We have since started a prospective observational study using continuous EEG and evoked potentials in comatose cardiac arrest subjects. We hope to identify which specific neurophysiology signatures are necessary for awakening from coma and how temperature and sedation may affect these biomarkers.
How did this grant help you move forward in your research career?
: The grant made all aspects of this project possible: facilitating mentorship, working with the survey company, hiring a research assistant to help with survey development and validation, and working with a statistical team to perform the subsequent analysis. We’ve presented the results of our study at several conferences, including oral presentation at AAN this year. We are in the process of using the data to draft an actual decision aid for pilot testing among families of patients hospitalized with severe ICH.EA
: Getting protected time for research during the fellow to faculty transition time is one of the most important goals for anyone invested in research career. The NCS Fellowship Grant allowed me to spend more time in the lab working with my mentors and many other people with skill sets complementary to mine. We have since been able to secure grants from other foundations and industry, I got a part-time appointment at MIT, and we are starting to draft an NIH K23 award proposal that I hope to submit next year.
Did you experience any roadblocks during the grant period? If so, how did you overcome it?
: The actual process of gathering and analyzing the data has taken longer than projected, but in between phases of this project, I have tried my best to move forward other research projects that are thematically related. Having the time that this grant has afforded me has allowed me to conduct research on topics such as how physicians and nurses prognosticate ICH outcomes, how satisfied families are with shared decisionmaking practices in ICUs, and how variable decisions to place PEGs in ICH patients are across different U.S. hospitals. I hope these projects will be helpful in designing interventions to help families of critically ill patients. EA
: 1) Recruiting for a small pilot study is not easy, so having people who can help you enroll is very important, or you risk under-powering your study. 2) My IRB inclusion criteria were too strict, so making it a little broader was helpful, but it can take a while to get reviews back, so starting broad would be my advice. 3) Having buy-in from nurses, residents, fellows and faculty (from your division and others) is often how you are going to get a “heads-up” about potential study candidates early on, and also avoid any potential misunderstandings. Making sure I had a one-minute pitch, a flyer and a short video about our study was helpful as well. The key has been to talk to as many people as possible about our study.#NCSRoundup #Research #ShraddhaMainali #SaraHocker #AndrewNaidech #June2018