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232747_NCS Currents_December_2_eMag

Q&A with Inaugural NCS Research Training Fellowship Recipient Dave Hwang By J. Claude Hemphill III, MD, MAS, FNCS and David Hwang, MD, FNCS CH: Why did you decide to apply for the Have you participated in any of the other prior NCS research NCS Research Training Fellowship award? efforts, including mentoring, Annual Meeting workshops, or DH: My research interest is in optimizing Neurocritical Care Research Network? how we work with the families of our sickest I have! The year before I applied for the NCS Research Training patients, particularly when making goals- Fellowship, I participated in the Research Career Development of-care decisions. A big part of applying for Session that happens every year right before the NCS Annual grants is simply fi nding foundations that are Meeting. I also attended the last Neurocritical Care Research interested in your topic! The fi eld that I’m Network (NCRN) Meeting in Houston and was able to give an interested in is important but isn’t really the oral presentation of my proposal to attendees. I think some of J. Claude best “fi t” for training grants explicitly geared Bill Coplin’s comments after my presentation are permanently Hemphill III, MD, towards translational science or “traditional” seared into my memory! But in all seriousness, that opportunity MAS, FNCS patient-oriented research. When I heard was incredibly useful for helping me put the actual grant proposal that the NCSwas starting its own career together. development award program, I knew I had to try to apply—goals-of-care decision making What advice do you have for fellows who want an academic is undeniably a big part of neurocritical care career including independent research? practice, and the “fi t” seemed promising. Claude, I’ve clearly got a ways to go before becoming independent! But perhaps one piece of advice I’d give is for Tell us briefl y about your project. fellows to try seeking mentorship outside of one’s own department My project addresses the following question: and even institution if it makes sense for your interests. My can the groups of surrogates in the U.S. primary mentor for this project is Dr. Liana Fraenkel, a Professor at who are making goals-of-care decisions Yale whose clinical expertise is rheumatology, but whose research David Hwang, for incapacitated intracerebral hemorrhage expertise is scientifi c approaches to shared decision-making. My MD, FNCS (ICH) patients with an uncertain prognosis co-mentor for this project is the chief of my division here at Yale, be reliably divided into distinct groups based on their decision- Dr. Kevin Sheth. Liana and Kevin helped put me in touch with a making priorities? If we can characterize specifi c like-minded couple of key advisors for my research who, despite not being at groups of ICH surrogate decision makers based on their decisional Yale, have been totally indispensible—Dr. Robert Holloway, who priorities, we will have specifi c target groups for which to design chaired the writing committee for the recent AHA/ASA Guidelines high-yield future interventions aimed at improving goals-of-care for Palliative Care and Stroke, and Dr. Doug White, who has built decision making. an independently funded academic career studying ICU surrogate decision-making. To do this, we will be interviewing surrogate decision makers in the Yale Neuro ICU as well as national experts in ICU shared Any thoughts on what the NCS can do to further prepare decision-making to come up with a comprehensive list of trainees for research careers? decision-making factors that surrogates consider in such situations Honestly, I would just say—please keep funding these early career for ICH patients. We will create a survey that puts the respondent opportunities! At the end of the day, the money itself for trainees in the hypothetical scenario of making a decision regarding and junior faculty is simply critical. It is awesome that the NCS tracheostomy and feeding tube placement versus comfort care community has such a focus on research career development for for an intubated ICH patient with an uncertain prognosis. The junior members. As someone who is just starting out, I have felt survey will present lists of possible decision-making factors that incredibly supported. respondents will be asked to prioritize. We will administer the survey to a very large sample representative of the general U.S. population and analyze the data using a technique known as latent class analysis to discover like- minded groups, which we can target for future decision support development. The NCS Research Training Fellowship award is only for one year. How is this going to make a difference in your future decision support tools. & Hemphill, MD at the NCS Annual Meeting.David Hwang, MD accepting the Research Training Fellowship award from Clauderesearch career?I am currently fortunate to be in the midst of a two-yearresearch career development award from the AmericanBrain Foundation for a similar project—looking at howsurrogates prioritize decision-making factors when facedwith goals-of-care decisions for ICH patients who are feltto have certain long-term poor prognosis (i.e., prolongedunconsciousness). As we all know though, it’s verycommon in the Neuro ICU for prognosis for ICH patientsto be murkier—for example, possible long-term functionaldependence, but unclear degree of cognitive recovery. Theyear of the project funded by the NCS will allow me tostudy how prognosis affects surrogate priorities and willhopefully put me in a better position to create and test 8


232747_NCS Currents_December_2_eMag
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