Research

The RCHSD PICU is an active research center for issues pertinent to pediatric critical care.  Fellows spend approximately 40% of their time doing research under the supervision of the Director of Critical Care Research, Dr. Brock Fisher. Furthermore, the RCHSD PICU has a dedicated research nurse, Jennifer Foley.

Fellows receive formal research didactics through the Clinical Research Enhancement through Supplemental Training (CREST) program, which is a UCSD program that provides comprehensive multidisciplinary clinical research training for future leaders in clinical investigation. It is designed specifically for doctoral candidates, postdoctoral fellows, and junior faculty pursuing a career in clinical or translational research. First-year fellows begin the course several months into the academic year.


Guidelines for Completion of Required Fellowship Research at RCHSD

Alexander Rodarte, M.D., FCCM

In general, it is best to try to maintain a timeline for completion of research at RCHSD.  Once fellows have left the institution, support for completion of projects is very difficult.  Seemingly simple things, like IRB extensions (for review of medical records for instance) cannot be granted unless the PI (The fellow is usually the principle investigator on the submission) is a current RCHSD staff member.

During the first 6 months, fellows should be searching for interesting areas of potential research.  Remember that this is your research; you will be the one spending the hours doing the reading, data collection, writing, etc., so you should have a personal interest in the topic.  Topics that are handed to a fellow who has no particular interest in the subject tend to whither and die.  We have a list of some potential topics listed on this website, but don’t be afraid to follow up a question that comes up on rounds with some literature searching to see if anyone has satisfactorily answered the question.

In January, the first in a year long series of CREST (Clinical Research Enhancement through Supplemental Training) lectures begin which allows you to get a better idea of how to structure a study, epidemiology, the principles of analysis and finishes with some basic statistics (actually rather advanced for most).  These classes are mandatory, involve homework, and require attendance at 70% of the classes.  Your attendings may use your grades for evaluation when letters of recommendation are requested. 

By the one year point in your fellowship, you should have finalized your protocol and be in the process of applying for IRB approval.  The IRB meets two times a month, on the 1st Thursday and the 3rd Thursday of each month.  All documents must be submitted 2 weeks prior to the meeting.  Assuming that you can get on the calendar for that month, and if there are no problems, the IRB usually issues a letter of approval within a couple of weeks of the review.  If the research involves the use of the Trauma Department database, you must get approval from the Trauma Research Advisory Committee, which meets a maximum of once a month, and will often skip a month or two before considering new research requests.  In general, you cannot submit to the IRB until you have approval of the Trauma Department.  Lack of planning on your part does not constitute an emergency.  I can assist in some of the more practical problems like smoothing things out with various departments that will be impacted by some study protocols or attendings that will pay more attention to a request from another attending than from a fellow.  I am available in my office on most Thursdays and am always on my pager (I2, or 619-580-0077).  Jennifer Foley, RN can assist in getting through the maze of IRB forms and deadlines.  She is also a good resource if you want to know how much cooperation you can expect from the nurses for a particular study.  A year to a year and half is an appropriate window of time to collect data.  You should spend the last year to six months analyzing the data and presenting it in a form worthy of publication.  Depending on the publication, submission to first revision (There is always some revision) or rejection is usually within a month or two.  Realize that from date of submission to final publication can be a year or more depending on many factors.  I will be happy to read over any submission.  Good luck.

Timeline for Research during Fellowship:

1st  year

2nd  year

3rd  year

Orientation to PICU and CHSD

 

CREST

Optional 2nd year of CREST.  Abstract submission of prelim data.

Interviews

Develop interest in research topic, brainstorm with attendings.

Lit search of topic with consultation of attending mentor. Begin writing protocol.

Submit project to IRB (Consider Trauma Dept. requirements)

Begin enrollment (preferably earlier in 2nd year.)

Finish enrollment and begin analyzing data and finalizing paper.

Submit paper and be ready for revisions or re submission to another journal.

 


Current Fellows' Research Studies:

• Kourosh Parsapour, MD/Karim Rafaat MD –3% hypertonic saline in pediatric concussion.  A prospective, randomized trial comparing 3% hypertonic saline to NS for the treatment of headache in trauma patients
• Didima Mon – Continuous glucose monitoring in the PICU
• Michael Sokoloff, MD – Comparison of peripherally transduced venous pressure to central venous pressure in critically ill pediatric patients
• Theresa Murdock-Vlautin, MD – Heliox study.  Prospective trial comparing the effects of heliox to FiO2 50% in patients with ARDS
• Karim Rafaat , MD – Retrospective review of cerebral edema in pediatric submersion victims 
• Valerie Kalinowski, MD – undeclared
• Izabel Belem –Undeclared

Recent Research Studies in the CHSD PICU:  

    Attending Research Studies

• Brad Peterson, MD – Hyperosmolar Therapy for Refractory Cerebral Edema and Intracranial Hypertension in Pediatric Trauma Patients (Rescue Study)
• Brad Peterson, MD/Lawrence Marshall, MD – Hypertonic Saline for Increased ICP Following Head Injury (NIH Pilot Study)
• Susan Duthie, MD - Drotrecogin Alfa and pediatric sepsis (closed)
• Susan Duthie, MD – Retrospective review:  Characterization of Code Blue Team Response in Non-critical Care Areas of a Children’s Hospital

    Fellow Research Studies

• Alireza Fathi , MD – A prospective, randomized, cross-over trial to compare the efficacy of inhaled prostacylin to that of inhaled Nirtric Oxide in the treatment of intrapulmonary hypertension secondary to ARDS.
• Matthew Niedner, MD - B-Type Natriuretic Peptide in the Repair of Congenital Heart Lesions
• John Doung-Tran, MD – A retrospective review of ICP Monitoring in children with severe meningitis.
• Tanya Drews, MD – Using Near Infrared Spectroscopy (NIRS) to detect changes in cerebral hemodynamics and oxygenation during and after bi-directional glenn surgery – a retrospective review.
• Michelle Halley, MD – A prospective descriptive study - Loss of Consciousness:  When to CT?
• Eric Peters, MD, - Blunt Bowel and Mesenteric Injuries in Children:  The Significance of Nonspecific CT Findings
• Javed Akhtar, M.D. - Detection of Traumatic Brain Injury with MRI and S-100 protein in Children Despite a Normal CT Scan.
• Susan Diaz, M.D. - The Pharmacokinetics of Dexmedetomidine in Post-surgical Pediatric Intensive Care Unit Patients: A Preliminary Study.
• Sam Lehman, M.D. - A Simple Method to Correctly Position Central Venous Catheters in Infants and Children.
• Deborah Franzon, MD - Comparing Calf Blood Pressure Measurements with Direct Arterial Measurements in Pediatric Intensive Care Unit.

Comprehensive Listing of Research, Abstracts, and Awards:

• CHSD PICU Curriculum Vitae


Research Resources:

• CREST: Clinical Research Enhancement through Supplemental Training
          http://www.ucsdmedres.com/crest/index.htm
• American Board of Pediatrics: What constitutes meaningful accomplishment in research for critical care fellows:
          http://www.abp.org/certinfo/subspec/princip.htm
•
Poster production for conferences or presentations:
          UCSD OLR: http://cybermed.ucsd.edu/olr/

          Navy-Balboa: Ed Sanford at (619) 532-7909
• NIH Web-training site for Human Research - certification:
          http://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp
• HIPAA certification (use login/password of HIPAA/READY):
          http://sdhipaa.org/
•
Download IRB Proposal Forms in MS Word Format:
          http://www.chsd.org/body.cfm?id=548