Academic Interview Flashcards
What is DTI
DTI characterises tissue microstructure and provides reproducible proxy measures of nerve health which are sensitive to myelination, axon diameter, fibre density and organisation.
Determines white matter pathways , important information prior to surgery so surgeons can avoid these areas and reduce chance of deficit
DTI summary
- DTI reconstructs the brachial plexus in 3D through tractography
When creating DTI tractograms, the change in angle (‘step angle’) between line segments must be prescribed; however, the literature is lacking detailed geometry of brachial plexus which is needed to inform clinical imaging. - My main role was to dissect The spinal cord and brachial plexus bilaterally via a posterior approach, with osteotomies through the pedicles of C4‐T1.
- We took photos and analysed the images with MATLAB. Data was analysed with STATAcorp
- The geometry of the roots of the brachial plexus increases in complexity from C5 to T1. When reconstructing the roots of the brachial plexus using diffusion tensor imaging tractography, a step angle of 70° is likely to plot 99% of tracts representing the roots, based on the limited sample size of this study.
DTI Critique
- not recently dead cadaver
- only 10 cadavers
Elderly Patient
Objectives: With an aging population and advances in neuroanesthesia and critical care, an increasing subgroup of elderly patients have been undergoing neurosurgery. Of particular relevance is the cohort aged >80 years. The aim of the present study was to investigate the 30-day mortality and survival in this cohort after emergency and elective neurosurgery.
Methods: We performed a retrospective cohort study of all patients aged ≥70 years who had undergone a neurosurgical procedure from 2015 to 2017. The patient demographic data were identified, and independent predictors were found using logistic regression analysis.
Results: A total of 796 patients were included, of whom 622 were aged <80 years (group A) and 174 were aged >80 years (group B). Overall survival was 86.3% in group A and 79.9% in group B. The 30-day mortality between the elective (0.8%) and emergency (10.1%) patients was significantly different statistically (P < 0.001). Of the patients in groups A and B, 84.7% and 68.9% were discharged back to their usual residence, respectively. Logistic regression found emergency surgery to be an independent predictor of mortality.
Conclusions: The current model for accepting elderly patients has been associated with good overall outcomes. The elderly should not be refused neurosurgery on the basis of their age alone. However, we applied fairly strict criteria, especially for those with subarachnoid hemorrhage, which should be factored into our results.
What would I change DTI
How to hold surgical instruments
Learn more about DTI before
- Camera was difficult, ask for help when I need it
What would I change DTI
How to hold surgical instruments
Learn more about DTI before
- Camera was difficult, ask for help when I need it
- scan cadaver before
What did I learn elderly
- key research skills (how to write a paper)
- witnessed the challenges faced of balancing academia with a clinical career.
What would I change elderly
- ## make a dedicated file (organisation skills have since improved)
How would I improve elderly
- prospective
- national
- out of reach as an F1
- COVID is also something to take into account now
What is clinical governance
a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish
Recent paper (COVID)
https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC7170733/
- postpone non-emergent procedures
- fast evolving neuro-onc classed as
Recent paper (non-covid)
https://pubmed.ncbi.nlm.nih.gov/33162926/
Machine Learning Applications in the Neuro ICU: A Solution to Big Data Mayhem
- lots of data due to more obs, imaging and lab tests
- Machine Learning algorithms (ML), are uniquely capable of interpreting high-dimensional datasets that are too difficult for humans to comprehend.
- major hurdles = lack of awareness and comfort using ML
- Triaging CT Heads
- read EEGs to detect seizures and attain consciousness level
- real time feedback to Neuro-ICU staff
What is EBM?
It’s about integrating individual clinical expertise and the best external evidence
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
What is research governance
Research governance can be defined as the broad range of regulations, principles and standards of good practice that ensure high quality research.
Why is research important
Increases Knowledge and advances in care
What is bias
Factor which causes systematic over or under estimating of a particular result.
Participation bias
particpant in research may differ systematically to the population of interest
Volunteer Bias
??
Chanelling bias
Subconscious selection
interview bias
may already know disease status of the patient
recall bias
can they remember if they have that RF
hawthorne
change how they act because they know they are being watched
publication bias
more likely to publish positive findings
confounding
independent factor associated with outcome and causing factor
e.g. peanuts in pub
do a regression analysis
DTI clinical Impact
Determines white matter pathways , important information prior to surgery so surgeons can avoid these areas and reduce chance of deficit
Diffusion tensor imaging of symptomatic nerve roots in patients with cervical disc herniation
Magnetic resonance imaging of the cervical spinal cord in spinal muscular atrophy
Challenges of an academic career
- Clinical academia is hard
- Expected to be outstanding clinician and academic
- Demands of both worlds will interact often
- Must be proactive and organised
- But… very exciting. They are the change makers
HOW IS research conducted
Question identification • Ethics • Protocol • Methodology • Analysis and bias • Presentation and publication
Latest teaching feedback
online polls
more security
know the subject well
Leadership
• Academic clinicians often influence change in organisations • Discuss your experiences • How you aim to grow as a leader • Influencing change within the organisation allows for research to complete its journey • From idea • To study • To implementation and bedside • Ultimately improving patient care
Teaching
Doctor is Latin for teacher
• Disseminating information effectively is probably
more important than obtaining it
research plans
2 -fold
from day one I want to utilise the excpetional facilities
and participate in longitudinal studies, both retrospective and prospective, national and local
In my 4 month protected research project i would like to carry out an impactful reseacrh project that can be diseeminated to a neurosurgical audience
What challenges have I faced in research
Logistical - dealing with big data
Ethical challenges - STUN and Conference. Is it ethical t put someone in an MRI scanner
Personal - Work-life balance, Challenges that come with working as a team - author order
