Neurology

Novel Insights in the Pathophysiology of A-Synuclein Dysregulation of Dopamine Neurons

Faculty Mentor’s Name: Dr. Habibeh Khoshbouei
Email: Habibeh@ufl.edu 
Phone Number: (352) 273-8115 
Project Category: Clinical
International Component or Travel: No

Research Project Description:
Pathophysiological damages and loss of function of dopamine neurons precedes their demise and contributes to the early phases of Parkinson’s disease. The presence of aberrant intercellular pathological inclusions of the protein α-synuclein within ventral midbrain dopaminergic neurons is one of the cardinal features of Parkinson’s disease. We employed multiple complementary approaches in molecular biology, electrophysiology, and live-cell imaging to investigate how excessive α-synuclein levels alters multiple characteristics of dopaminergic neuronal dynamics and dopamine transmission prior to neuronal demise. These studies demonstrate that α-synuclein dysregulation of D2 receptor autoinhibition contributes to the vulnerability of dopaminergic neurons, and that modulation thereof can ameliorate the resulting pathophysiology. These novel findings provide mechanistic insights in the insidious loss of dopaminergic function and neurons that characterize Parkinson’s disease progression with significant therapeutic implications.

Emergency Management of Acute Neurological Emergencies in a Live High-Fidelity Multidisciplinary Simulation Setting

Faculty Mentor’s Name: Dr. Marc-Alain Babi
Email: m.babi@ufl.edu
Phone Number: (802) 777-2880
Project Category: CQI
International Component or Travel: No

Research Project Description:
This study is IRB APPROVED . Protocol: IRB202000255

The aim of this study is to describe the development of a high-fidelity multidisciplinary simulation program that uses evidence-based medicine and guidelines, focused on the management of acute neurological emergencies in the NeuroICU (live simulation). In this study, we will review the technical, cognitive and effective teamwork skillsets in a controlled multidisciplinary simulation, identify risk factors for non-adherence to treatment guidelines, and identify threats, misses and near-misses.

Management of acute neurological emergencies is often a stressful and emergent situation that requires proper medical knowledge, training, and the ability to quickly function and adapt in a multidisciplinary setting.

The purpose of this study is to develop a high-fidelity multidisciplinary simulation program that uses evidence-based medicine and guidelines, focused on the management of acute neurological emergencies in the Neurology ICU (live simulation). In this study, we will review the technical, cognitive and effective teamwork skill sets in a controlled multidisciplinary simulation, identify risk factors for non-adherence to treatment guidelines, and identify threats, misses and near-misses. Simulation-training programs are an effective method of education for emergency-medical care teams, with the aim to reduce adverse-events related to these non-technical skills, thus improving patient safety. The participants in this study are house staff trainees (residents, fellows), advanced practice providers (APPs-nurse practitioners, physician assistants), and other clinical team members (ie: nursing staff, respiratory therapist) who will be running a mock educational clinical scenario (an acute neurological emergency) in a controlled clinical setting. This involves a mannequin (simulator). The process involves: a developed clinical vignette, a mock paper-based chart containing a clinical (educational) scenario of a patient’s history and physical exam notes, progress notes, nursing kardex, medication orders, physician orders, vital signs record, and simulation mannequin. The simulation leader will be adjusting the mannequin vitals and medical parameters based on the written educational/clinical script and as the clinical scenarios evolve.
During the process, the simulation leader will be reviewing the technical, cognitive and effective teamwork skill sets as well as identify risk factors for non-adherence to treatment guidelines, as well as identify threats, misses and near-misses.
The specific aims of this study are:
1. Provide leadership training and improve communication skills for acute neurological emergencies.
2. Provide participants with experience in simulation, leadership in coordination of care, understanding self-organization principles, tools for delegation and diffusing conflict.
3. Develop situational awareness and critical thinking skills.
The scenarios are conducted in the Neurological ICU (Neurocritical care unit, Neuromedicine tower, unit 47). A room is designed to be the “simulation/education lab”, with an interactive mannequin and actors playing the roles of patients and family members. The simulation room is configured as a trauma/emergency/intensive care room where the team responds to an urgent acute neurological situation. Each team will consist of four to eight healthcare member, and each scenario will be video recorded. A briefing and debriefing will be conducted prior to and following the scenario. The simulation will start with brief introductions, overview of the exercise, and expectations. It will be emphasized that strict confidentiality and professionalism will be upheld among the participants, the simulation staff and investigators. Follow up simulation will be conducted six months and one year after the initial course to evaluate retention of knowledge and skills. The investigators will fill out the Performance Observation Tool, from TeamSTEPPS to assess the study participants for leadership and teamwork skills. Upon completion, the participants will complete a post simulation survey to assess effectiveness of the training (Teamwork Perceptions Questionnaire, from TeamSTEPPS) (See attachment). After undergoing the initial scenario, the participants will be debriefed and coached in the proper teamwork skills like closing the loop, delegation and speaking up. Following the debriefing and coaching, the participants will be provided an opportunity to practice what they just learned and train in established best practices for teamwork such as those developed by AHRQ in the TeamSTEPPS program. These sessions will be recorded and evaluated for cohesiveness of the study participants as a team in the same manner as the first scenario. Participants will be asked to participate in simulation exercises during their rotation in the NeuroICU. The evaluation tools and pre and post training surveys used in the study, will not be linked to an individual nor be used to assess competency for physician in training involved in the scenario.

Emergency Endotracheal Intubation by Non-Anesthesiologists in a Neuroscience ICU in a Large Academic University Hospital – Airway Outcomes and Complications

Faculty Mentor’s Name: Dr. Marc-Alain Babi
Email: m.babi@ufl.edu
Phone Number: (802) 777-2880
Project Category: Clinical
International Component or Travel: No

Research Project Description:
This study is IRB APPROVED. PROTOCOL: IRB202000687
There are limited outcome data regarding emergency non-operative intubation by non-anesthesiologists in intensive care units, and no data that address airway outcomes in Neuro-intensive care units when performed by non-anesthesiologists. The aim of this study is to retrospectively (observational study) evaluate the factors associated with endotracheal intubation in the NeuroICU, evaluate the complication rates and predictors of complication in this setting.
The primary aims of this study:
1. To determine the factors associated with endotracheal intubation (emergency) in a neuroscience ICU at a large single academic center by non-anesthesiologists
1a. Determine the incidence and complications in acute airway management by non-anesthesiologists in a neuroscience ICU
1b. Determine the predictors of complications in this setting compared to emergency management of airway by anesthesiologists (based on published large studies)
This study is of retrospective design. The database will be queried to identify patients who required endotracheal intubation by non-anesthesiologist in the neuroscience ICU (by CPT code 31500) by one of the non-anesthesiology providers. We will be retrospectively collecting data only on patients treated at the University of Florida, Neurosciences (Neurocritical care unit) Shands hospital. Inclusion criteria include admission to UF Health Shands Neurosciences ICU in the period between January 2017 and August 01, 2020, Age>18, admission, endotracheal intubation in the neurosciences ICU. Exclusion criteria will be: age<18 yr, pre-existing endotracheal tube or location other than the neurosciences ICU. Patients in the emergency department (ED) in whom induction/intubation was performed prior to the arrival to the Neurosciences ICU will also be excluded. The study will use previously recorded retrospective defined data points listed on the data collection page. Medico-legal documentation of emergent airway management using this system is an institutional standard of care, consistent with accepted national guidelines. The clinical information system is available at bedside workstations throughout the institution. The emergent intubation documentation is typically completed by the performing clinician (ie: housestaff/trainee/mid-level provider) and is by the supervising attending physician for review and final co-sign. The attending physician reviews the documentation, modifies it as necessary, and cosigns the note, locking it from further editing. Within each airway management record, required fields are designed with a drop-down menu without default settings. Each element is required and allows selection of one or more options and a comment section for free text if the options provided are not adequately descriptive.
ur primary outcome will be a composite variable that includes:
1. Factors associated with emergency endotracheal intubation in a neuroscience ICU at a large single academic center by non-anesthesiologists
1a. The incidence and complications in acute airway management by non-anesthesiologists in the neuroscience ICU
1b. The predictors of complications in this setting compared to emergency management of airway by anesthesiologists (the latter, based on previously published studies)

Statistical analysis will be performed in house using SPSS (R).