A. Develop an understanding of the scientific principles of clinical or laboratory research as they apply to anesthesiology or critical care.
B. Learn to read, analyze, and discuss peer-reviewed literature in a specific research area of interest.
C. Develop an in-depth understanding of a specific area of anesthesiology or critical care beyond that expected of a general anesthesia practitioner.
D. Learn to prepare, submit, and follow research proposals based upon institutional guidelines and policies for human or animal experimentation.
E. Complete a focused research project including developing specific aims and hypotheses, acquiring necessary technical skills, generating and collecting data, analyzing data, and writing an abstract (as a minimum) or paper based upon study.
F. Prepare and deliver an in-depth slide presentation pertaining to an area of scientific research to a group of physician peers.
1. A project will be designed that can be completed in a six month period.
2. All studies must conform to the standards of human research (as outlined by the Institutional Review Board of UTMB) or animal research (Animal Care and Use Committee) with current, approved protocols.
3. A written outline of the study including scientific justification for the propose of the study and appropriate bibliography must be prepared. The outline will conform to the general criteria for preparing grant
proposals for submission to the National Institutes of Health. Specific sections will include:
► Hypotheses and Specific Aims,
► Background and Significance
► Preliminary Studies (if applicable)
► Experimental Design and Methods
4. The proposal should be no longer than 10 double spaced, typed pages.
5. In order to prepare an adequate proposal, the resident should choose and meet with a faculty mentor at least six months prior to beginning the research rotation. The research proposal must be submitted to the Education Committee by December of the CA-2 year and approved prior to beginning the research rotation.
6. The resident must have a satisfactory rating from the Clinical Competency Committee for the six-month clinical period preceding the Research Track.
The research will be conducted under the direct supervision of the research mentor, who will provide the education committee and residency director a written overview of the research progress at three-month intervals. Within each written review, the mentor will assign a grade of satisfactory or unsatisfactory.
For grades of unsatisfactory, a review by the mentor, residency director, and education committee will be held to determine the appropriateness of the project and whether or not the rotation should continue.
Residents receiving an unsatisfactory grade will also have an interview with the residency director and education committee as part of the review process. A high level of achievement is expected. Standards that are applicable to persons pursuing graduate or postdoctoral research training will be applied.
Residents and research mentors will spend a minimum of 1 hour per week discussing peer-reviewed literature in the area of research being examined. At the completion of the research rotation, the resident and mentor will summit an abstract of the work to the education committee and residency director as minimum. The resident will be strongly encouraged to write up the research and submit it to a peer-reviewed journal for publication. The resident will be expected to complete the bulk of the research, statistical analysis, and writing of any paper or abstract submitted for publication. The resident will provide a minimum of a 30-minute oral presentation to the anesthesia residents and faculty about the scientific background, research protocol, results, and conclusions of the research after its completion.
Research Fellowships (PGY-5 level):1. A project will be designed that can be completed within the proposed duration of the research fellowship.
2. All studies must conform to the standards of human research (as outlined by the Institutional Review Board of UTMB) or animal research (Animal Care and Use Committee) with current, approved protocols.
3. A written outline of the study including scientific justification for the proposed study and appropriate bibliography must be prepared. The outline will conform to the general criteria for preparing grant proposals for submission to the National Institutes of Health. Specific sections will include:
a. Hypotheses and Specific Aims
b. Background and Significance
c. Preliminary Studies (if applicable)
d. Experimental Design and Methods.
4. The proposal should be no longer than 10 double spaced, typed pages. In order to prepare an adequate proposal, the fellow should choose and meet with a faculty mentor at least 3 months prior to beginning the research rotation. Although not absolutely required, fellows are strongly encouraged to identify a faculty research mentor as early as possible in order to investigate the possibility of submitting a proposal for extramural funding.
Facilities
The Department of Anesthesiology has research laboratories located in the Old Shriners Burns Hospital and the Shriners Hospital for Children. The entire first floor and much of the second and fourth floors of the Old Shriners Burns Hospital are dedicated to the Department of Anesthesiology for basic science research; the laboratories occupy 5,000 square feet (sf) of actual floor space. The intensive care research laboratory consists of 3,300 sf of laboratory space. It has 900 sf contained in three laboratories dedicated to the housing and care of chronically instrumented large animals; currently there are 12 sheep under study. These laboratories also have infusion pumps, physiologic monitors, and cardiac output computers available at each animal station. Two of these laboratories have a blood gas analyzer and one has a co-oximeter.
A 250 sf fully equipped operating suite is available to prepare large animals for study. The surgery suite has an anesthesia machine, electrocautery unit, physiologic monitor, and adjustable operating room table. A study area of approximately 400 sf is used for non-sterile experiments and postmortem examinations. The area contains a large stainless steel table in a “cold room”. A 50 sf walk-in cooler is available for cadaver storage.
The analytical laboratories consist of 1,200 sf dedicated to the analysis of samples generated during animal experiments. These five laboratories contain two ultra-cold freezers, normal freezers, two centrifuges, refrigerated ultra-centrifuge, Coulter Counter, two fume hoods, gamma counter, colloid osmometer, drying oven, analytical balance, oxygen evaporator, speedovac concentrator, and light spectrophotometer. One laboratory (450 sf) is used entirely for radioimmunoassay preparation. Another labora-tory is dedicated to gravimetric determination of tissue water content. A third laboratory is used for microsphere analysis. The fourth and fifth laboratories are used for cell counts and cell preparations.
The cerebrovascular research laboratories consist of two laboratories totaling 500 sf. The experimental laboratory has a fluid coupled trauma device for producing brain injury in rodents, anesthesia machine, pial arteriolar diameter measurement system, microcapnometer, two stereo microscopes, water bath, two precision balances, fume hood, and a computerized data acquisition system with sixteen-channel analog to digital converter. An adjacent equipment room is shared with the cardiopulmonary bypass research laboratories and has a blood gas analyzer, blood gas co-oximeter, gamma counter (microsphere blood flow determinations), precision balance, icemaker, and an ultracold freezer.
The cardiopulmonary bypass research laboratory is used to study gas emboli during cardiopulmonary bypass. The lab has 700 sf of floor space in two laboratories. One laboratory has cardiopulmonary bypass pumps with flow meter, color scan ultrasonic bubble detector, saturation/hematocrit monitor, physiologic monitor, cardiac output computer, sonomocrometer, electrocautery unit, defibrillator, surgery lights and table infusion pumps, vapor pressure osometer, and a computerized data acquisition system.
The anesthesia equipment laboratory (500sf) contains both a museum for demonstrating historical yet functional, anesthesia equipment for educational purposes and a laboratory for evaluation and testing new anesthetic equipment. The isolated heart research laboratories are 300 sf each. These laboratories are for studying isolated, perfused hearts (Langendorf Preparation) and have a four-channel strip chart recorder with pressure transducers, and cardiac output computers.
The inflammation and immunology laboratories are housed on the 8th floor of the Shriners Hospital for Children. The mission of this research group is to study the mechanisms of injury and immune dysfunction caused by sepsis, tissue ischemia and burn trauma. The laboratory is involved in both basic science and clinical research. A well equipped cell and molecular biology laboratory has been established and is housed in two laboratories with a combined area of approximately 1000 sf.
Facilities include a tissue culture laboratory containing incubators, microscopes and laminar flow hoods. The laboratories are fully equipped to perform, and investigators are actively utilizing, molecular techniques including reverse transcription polymerase-chain reaction (RT-PCR), RNAse protection assays, Western blotting, immunoprecipitation, flow cytometry, immunohistochemistry, electrophoretic mobility shift assays, gene microarrays and immunoassays such as ELISA. Most molecular studies are being performed in mouse models of sepsis and trauma. This laboratory is also actively involved in several local and national clinical studies aimed at understanding the effects of burn trauma on the immune system.
In addition to the formal research laboratories, several investigators in the department are conducting research in the General Clinical Research Center (GCRC). The GCRC has a long history of NIH support and provides an excellent setting for conducting clinical investigations. Currently departmental researchers are performing research aimed at understanding fluid kinetics in patients and volunteers. All monitoring and analytical equipment as well as research nursing support is provided by the GCRC in conjunction with the principal investigators.
Faculty Participants
Donald S. Prough, M.D., Rebecca Terry White Distinguished Professor and Chairman. Dr. Prough and colleagues are actively investigating several factors and their role in the pathogenesis of traumatic brain injury. His studies include determination of the roles of zinc and vascular function in the pathogenesis of brain injury in rats. Dr. Prough is also active in studies aimed at determining the effect of aging on the host response to head trauma. In addition, he is active in fluid kinetics research. Specifically, he is studying volume kinetic and mass balance analysis of responses to fluid infusion. Dr. Prough also serves as co-investigator on studies designed to assess noninvasive optoacoustic monitoring of blood oxygenation and hemoglobin concentration.
Daneshvari R. Solanki, M.D., Professor. Dr. Solanki is studying ischemia reperfusion injury. Specifically, she is involved in studies designed to evaluate the effects of restoration of blood flow on muscle tissue and blood following a period of infrarenal or suprarenal aortic cross clamping. They are enrolling patients undergoing total knee arthroplasty and vascular surgery. In addition, she is studying the efficacy and safety of encapsulated long acting morphine administered as a single dose in the epidural space for postoperative pain control.
George C. Kramer, Ph.D., Professor and Director, Resuscitation Research Laboratory. The research performed in the Resuscitation Research Laboratory primarily involves the study of perioperative fluid therapy and their application to the resuscitation of critically injured patients. Specifically, we are studying the use of hypertonic crystalloids and colloids, novel solutions with metabolic substrates and new blood substitutes for treatment of trauma and hypovolemia using a sheep model. In addition, we are involved in ICU and OR clinical trials of an automated resuscitation system and new blood pressure monitors. Student researchers with a computer science or engineering background are a plus, but not a requirement.
Douglas S. DeWitt, Ph.D., Professor and Director, Charles R. Allen Research Laboratories. The research in my laboratories focuses on the study of the effects of traumatic brain injury on the brain and its blood supply and on the effects of secondary insults such as hemorrhagic hypotension on brain function. We are studying the mechanisms that cause cerebral vascular dysfunction after brain injury. In addition, we are working to develop and test resuscitation drugs and solutions to improve brain perfusion and survival after brain trauma and hemorrhage. We primarily utilize a rat model of traumatic brain injury to study a variety of parameters including neurological function and behavior, brain inflammation and apoptosis in order to assess the effectiveness of low volume resuscitation with hypertonic fluids in our model.
Joachin Cortiella, M.D., Associate Professor. My research interests center around tissue engineering and tissue/organ development. Both of these disciplines involve engineering, cell biology and material science principles. Currently my research focus has been on tissue engineered trachea and stem cell research in lung development (regeneration). Future research will focus on organ development using synthetic polymers for the pancreas, liver, heart, kidney, skin and brain.
Helen Hellmich, Ph.D., Assistant Professor. I am currently investigating the temporal patterns of gene expression in the brains of rats that have been subject to fluid percussion brain injury. I am using cDNA microarrays containing over a thousand genes to monitor the gene expression profiles. I have chosen a few of the genes that change following brain injury and am examining their expression in the brain using in situ hybridization techniques. The transcriptional profile of the brain undergoes rapid and dramatic changes in response to trauma. These gene expression changes can lead to apoptosis and neurodegeneration. Understanding the secondary injury cascades at the molecular level will ultimately aid in development of therapeutic interventions for traumatic brain injured patients. I am presently studying the effects of TBI in three age groups, young, adult and aged rats to determine what is the molecular basis of the difference in outcome for the age groups. As a molecular neurobiologist, I also have an interest in how the developing and aging brains respond to trauma. In addition to these lines of investigation, I am developing a series of retroviral vectors to deliver neurotrophic factor genes to the rat CNS as a means of gene therapy. Neurotrophic factors have been shown by several investigators to ameliorate the secondary damage in ischemic and traumatic brain injury.
Ronald S. Levy, M.D., Professor. My main research interest is the development of simulator technology as a teaching tool for medical students and postgraduate physicians. Our department has recently obtained a pediatric and adult simulator. I will be developing protocols for recreating routine and emergency scenarios. These protocols will be used to train personnel in critical incident management. Studies will be performed to determine whether simulator training will improve emergency management skills. Revised 7/2004