New milestone for fellowship research training in stroke, neurocritical care

CINCINNATI - Fellowship research training in stroke and neurocritical care at the University of Cincinnati Neuroscience Institute and Mayfield Clinic reached another important milestone with the renewal of a five-year, $1.16 million T32 Institutional Training Award from the National Institute of Neurological Disorders and Stroke (NINDS).

When the Cerebrovascular Fellowship Training Program began five years ago, it was only the second such training program in the United States and the first to include both emergency physicians as well as neurologists as fellowship trainees. The renewal of the NINDS-funded training program, which began July 1, adds neurocritical care training as an option in research training, making this program the only one in the United States with a neurocritical training component.

The T32 training grant each year will fund four fellows who have completed their residencies in neurology or emergency medicine and are seeking advanced research training in the focused, specialized care of patients who have suffered a stroke or other severe neurological injury.

"Our training program has always been among the most innovative and sought-after in the United States," says Joseph P. Broderick, MD, the Albert Barnes Voorheis Professor and Chair of the Department of Neurology and Principal Investigator of the T32 Training Award. "We remain passionate about training future academic leaders in stroke and neurocritical care who will develop new treatments that benefit patients across the world but with the greatest impact in our own community."

A neurocritical care program is one that has dedicated physicians, called neuro-intensivists, who specialize in the care of the neurologic patient and are available to manage the patient in a specialized intensive care unit, a concept that is still relatively new. Patients in a neurocritical care setting typically have suffered massive strokes, intracerebral hemorrhages, subarachnoid hemorrhages, severe brain or spinal cord injuries or continuous seizures. They also may have undergone surgery for brain tumors or other lesions. The UC Neuroscience Institute's Neurocritical Care Program, based at University Hospital, was established in 2003 with the recruitment of Director Lori Shutter, MD, Associate Professor of Neurosurgery & Neurology and a neuro-intensivist with the Mayfield Clinic.

"Our goal is to provide outstanding clinical and research training for future academic neuro-intensivists, and the awarding of our T32 grant maximizes our opportunities for success," Dr. Shutter said. "This grant will provide our fellows with the option of pursuing either a pure cerebrovascular track or a neurocritical care track."

Joining Drs. Shutter and Broderick on the Training Program Steering Committee are Art Pancioli, MD, Professor and Chair of the Department of Emergency Medicine, and Dawn Kleindorfer, MD, Associate Professor of Neurology and Director of the Vascular Neurology Fellowship. Drs. Pancioli and Kleindorfer are also Co-Directors of the Greater Cincinnati-Northern Kentucky Stroke Team, which is based at UC.

In another significant development, the United Council for Neurologic Subspecialties in May re-accredited the Neurocritical Care Fellowship Training Program for five years. Neurocritical care accreditation has been achieved by only 31 institutions nationally.

The neurocritical care program at University Hospital forms a backbone of support for patients of UC Health who are recovering from surgery of the brain or spine, patients who have undergone airway reconstruction, and stroke patients who have been treated by the Stroke Team.

University Hospital's 20-bed neuroscience intensive care unit (NSICU), which is part of the UC Neuroscience Institute, is staffed 24 hours a day by highly trained physicians and nurses. The NSICU's state-of-the-art technology includes:

• A portable CT scanner, which eliminates the risks associated with transporting patients to other parts of the hospital for procedures.
• Advanced monitoring of critical values in the brain, such as brain oxygen levels and brain blood-flow levels.
• An endovascular cooling device to protect the brain in patients who have suffered cardiac arrest. The hypothermia technology enables gradual, controlled cooling of the body and a similarly controlled re-warming 18 to 24 hours later.
• Continuous, 24-hour EEG monitoring for seizures. New data suggests that the incidence of seizures in comatose patients is much higher than what was previously expected and that electrical disturbances that spread through an injured brain have a direct link to poor recovery and can last far longer than previously realized.
  

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The Mayfield Clinic is recognized as one of the nation's leading physician organizations for clinical care, education, and research of the spine and brain. Supported by 20 neurosurgeons, five neuro-intensivists, an interventional radiologist, and a pain specialist, the Clinic treats 25,000 patients from 35 states and 13 countries in a typical year. Mayfield's physicians have pioneered surgical procedures and instrumentation that have revolutionized the medical art of neurosurgery for brain tumors and neurovascular diseases and disorders.

The UC Department of Neurosurgery is one of the leading neurosurgery training programs in the United States. The department, chaired by Mario Zuccarello, MD, provides broad-based education for medical students, residents, and fellows, while offering continuing medical education for neurosurgeons worldwide. The department supports technical, clinical, and basic science research in the neurosciences.

The UC Neuroscience Institute, a regional center of excellence, is dedicated to patient care, research, education, and the development of new treatments for stroke, brain and spinal tumors, epilepsy, traumatic brain and spinal injury, multiple sclerosis, neuromuscular disorders, Alzheimer's disease, Parkinson's disease, disorders of the senses (swallowing, voice, hearing, pain, taste and smell), and psychiatric conditions (bipolar disorder, schizophrenia and depression).