Medical Student Research Fellowship for Summer 2011
Mentor: Philip E. Greilich, MD
Department: Department of Anesthesiology, Division of Cardiothoracic Anesthesia
Room number: HQ3.320B
Mail Code: 8894
Phone number: 58018
E-mail: Philip.Greilich@utsouthwestern.edu
Project title #1: FOCUS Initiative - Use of human factor engineering and system analysis to improve teamwork and reduce complications and resource utilization following cardiac surgery.
FOCUS = Flawless Operative Cardiovascular Unified Systems
Human subjects IRB approved project number (where applicable): Although this is a quality improvement project, a minimal risk IRB submission is being submitted in order to collect de-identified patient information for this project.
Animal subjects IRB approved project number (where applicable): N/A
Project Type: Patient-based research
Brief Description of Project:
Human error in health care delivery leads to 44,000-98,000 avoidable deaths per year in the United States alone. The World Health Organization (WHO) sees human error in the delivery of medical care as a major problem for industrialized and emerging nations alike.
The FOCUS Initiative is a multidisciplinary learning collaborative that uses a variety of novel tools to improve and measure the culture of safety and outcomes of cardiac surgical teams. This study is led by, Peter Pronovost, MD, PhD and the Quality and Safety Research Group at The Johns Hopkins Medical Institute. (see link:...http://www.safercare.net/OTCSBSI/Home.html for more details)
Role of the Student:
The role of the student will be to conduct a survey to assess the culture of safety at the onst of this project. They will then assist in the implementation and data collection for the central line associated blood stream infection (CLABSI) module for this study. The student will be exposed to several novel tools that are being use in health care to reduce avoidable errors and create more effective surgical teams.
Students will be exposed to the perioperative care the cardiac surgical patient. Authorship on any presentation and/or publication will be based on the level of contribution to the project.
Project Support:
This project is being funded by the Agency for Healthcare Research and Quality (AHRQ), Society of Cardiovascular Anesthesiologist Foundation (SCAF) and the UT Southwestern Office of Quality Improvement and Safety.
Project title #2: Creation and institution of a clinical pathway for the active management of perioperative anemia in cardiac surgery patients with erythrocyte stimulating agents and iron.
Human subjects IRB approved project number (where applicable): This is a quality improvement project and should not require an IRB submission.
Animal subjects IRB approved project number (where applicable): N/A
Project Type: Patient-based research
Brief Description of Project:
Nationally, up to 50% of patients undergoing cardiac surgery are anemic (defined by the World Health organization as 12.5gm/dL for females and 13.5gm/dL for males). UT Southwestern University Hospitals spends over $20, 000,000.00 a year for the procurement, management, administration and treatment of complications associated with blood transfusion. A growing literature suggests red blood cell (RBC) transfusions increase morbidity, mortality and resource utilization in surgical patients. Given these facts, a quality and safety initiative is being undertaken to promote the recognition and resolution of preoperative anemia.
The objectives of this project are to: (1) trial an clinical pathway for actively managing anemia in cardiac surgery patients, (2) measure the effectiveness and value of this clinical pathway in improving the quality and safety of the care received by these patients and 3) prepare an abstract for presentation/publication at a national meeting.
The primary measurements for analysis will include: 1) percent of patients with anemia on the day of surgery (DOS), 2) incidence of perioperative RBC transfusions with and without anemia on the DOS; 3) incidence of postoperative complications and extended length of stay in patients with and without preoperative anemia.
Role of the Student:
The role of the student will be to collect data and assist in refining the clinical pathway during the implementation phase of this quality improvement project.
The student will be involved with creation of a database, data management, statistical analysis (SPSS) and preparation of an abstract. Training in SPSS and use of a reference manager will be provided, if needed.
Students will be exposed to the perioperative care the cardiac surgical patient. Authorship on any presentation and/or publication will be based on the level of contribution to the project.
Project Support:
This project will be funded, in part, by the UT Southwestern Office of Quality Improvement and Safety.
Previous Research Activities or Publications with Medical Students:
1) Lindsey Rutland, BS (Summer 2010) - Medical Student (II) at UT Southwestern - Dallas
Lindsey worked on a feasibility trial in patients with uncontrollable bleeding following cardiac surgery.
Greilich, PE, Jessen ME, Rutland L, Key NS, Levy JH, Faraday N, Steiner ME
Can High-Quality Trials be Performed in Cardiac Surgery patients with Uncontrollable Bleeding?
A Feasibility Pilot Study. 2011 Submitted
Rutland L, Jessen ME, Steiner ME, Greilich PE. Can High-Quality Trials be Performed in Cardiac Surgery patients with Uncontrollable Bleeding? A Feasibility Pilot Study. Presented at the 49th Annual UT Southwestern Medical Student Research Forum, January 18th, 2011, Dallas, Tx.
2) Jonathan Boyd, BS (2008-09) - Medical Student at UT Southwestern- Dallas
Jonathan worked as a research assistant in the Division of Cardiothoracic Anesthesiology for a year prior to starting his 4th year of medical school to gain experience in clinical research.
Wyrick C, Adesanya AO, Greilich PE, Boyd J, Sarode J. Body Mass Index Does Not Influence Platelet Responsiveness to Clopidogrel in Patients Undergoing Percutaneous Vascular Intervention. Chest 2010;138 (supp 4):852A
Greilich PE, Jessen ME, Boyd JD, Key NS, Levy JH, Faraday N, Steiner ME. Can High-Quality Interventional Trials be Performed in Cardiac Surgery Patients with Excessive Bleeding Despite Conventional Blood Transfusion Therapy. Circulation 2010;122:A124
John A, Yeh C, Boyd J, Greilich PE, Treatment of Refractory Hypotension with Vasopressin in a Patient Receiving High-Dose Clozapine. Journal of Cardiothoracic and Vascular Anesthesia 2010;24:467-8.
John A, Yeh C, Boyd J, Greilich PE. Refractory Hypotension with Vasopressin in a Patient Receiving High-Dose Clozapine. Presented at the International Anesthesia Research Society Meeting. March 14th -17th, 2009, San Diego, CA.
Greilich PE, Leonard D, Boyd J, Brilakis E, Jessen ME. High-dose epsilion-aminocaproic acid increases cardiac enzyme levels in patients following CABG surgery. Presented at the 9th UT Southwestern Cardiovascular Research Symposium, October 26-27, 2009, Dallas, TX.
3) Neeraj Satyanarayana, BS (2007-08) Medical Student at UT San Antonio
Neeraj worked as a research assistant in the Division of Cardiothoracic Anesthesiology for a year prior to starting medical school at UT San Antonio.
Greilich PE, Jessen ME, Satyanarayana N, Whitten CW, Nuttall G, Beckham JM, Wall MH. Effect of epsilon-aminocaproic acid and aprotinin on fibrinolysis and blood loss in patients undergoing primary, isolated coronary artery bypasses grafting: A Placebo-controlled non-inferiority trial. Anesthesia and Analgesia 2009;109:15-24.
May T, Douning LK, Satyanarayana N, Sarode R, Gaza J, Davis M, Jenevein E, Buck B, Jessen M, Greilich PE. Cost: benefit analysis of thromboelastography in cardiac surgery. Transfusion 2007;47 (11):A123.
Greilich PE, Taneja R, Satyanarayana N, Whitten CW, Sarode R. Thrombin generation is attenuated with aprotinin, but not with epsilon-aminocaproic acid, in patients undergoing cardiopulmonary bypass surgery. Anesth Analg 2008;106 (SCA suppl):A80.
Greilich PE, Satyanarayana N, Brilakis E, Leonard D, Jessen ME. Epsilon-aminocaproic acid, but not aprotinin increases cardiac enzyme levels following CABG surgery. Anesthesiology 2008;109:A1620.
Cost: Benefit Analysis of Thromboelastography in Cardiac Surgery: A Process Improvement Approach. Presented at the 7th UT Southwestern Cardiovascular Symposium, October 22-23, 2007, Dallas, TX
May T, Jessen ME, Satyanarayana N, Whitten CW, Greilich PE. Epsilon-aminocaproic acid, but not aprotinin increases myocardial ischemic injury in patients undergoing primary coronary artery bypass surgery. Presented at the 13th Annual Society of Cardiovascular Anesthesiologists Update on Cardiopulmonary Bypass, March 9-14, 2008, Whistler, BC, Canada.
4) Chad Brouse, MS (2001-2004) Chad worked in our lab as a Biomedical Engineering student and Research Assistant before starting medical school at the University of Nebraska.
Greilich PE, Brouse CF, Rinder CS, Smith BR, Jessen ME. Antifibrinolytic therapy during cardiopulmonary bypass reduces leukocyte-platelet adhesion. Anesthesiology 2004;100:225-233.
Greilich PE, Brouse CF, Whitten CW, Chi L, DiMaio JM, Jessen ME. Antifibrinolytic Therapy During Cardiopulmonary Bypass Reduces Proinflammatory Cytokine Levels: A Randomized, Double-Blind, Placebo-Controlled Study of e-Aminocaproic Acid and Aprotinin. Journal Thoracic and Cardiovascular Surgery 2003;1498-1503.
Nguyen KT, Su1 SH, Sheng1 A, Wawro D, Schwade ND, Brouse CF, Greilich PE, Tang L, Eberhart RC. In vitro hemocompatibility studies of drug-loaded poly (L-lactic acid) fibers. Biomaterials 2003;24:5191-5201.
Greilich PE, Brouse C, Beckham J, Estrera A, Carr ME: Reductions in platelet contractile force correlates with duration of cardiopulmonary bypass and blood loss in patients undergoing cardiac surgery. Thrombosis Research 2002;105:523-529.