Pediatric Neurology

PEDIATRIC NEUROLO

GY

O B S E R V E R S H I P A

N D RE S E A R C H P

R O G R A M

Mahima Venkatesh

ABOUT ME • Second year Biology- Premed student studying at the

University of Cincinnati• Connections Dual Admissions Medical Program with the

School of Medicine. • Spend more time exploring the field of medicine and see

which specialties interest me• Interest in pediatrics came from my shadowing experiences

with Pediatric Intensive Care Unit Doctor, Dr. Appachi, at the Cleveland Clinic

• Realized the importance of addressing the patients' and their families wants, needs, and fears

• Understood that a doctor's work is multi-faceted and combined the science of medicine with the art of compassion

• Research needs to be done to develop treatment methods for these patients. Treating patients is impactful on a community level, but research can be impactful on a global level.

PREVIOUS EXPERIENCES • Pediatrics research University Hospitals and Case Western-

Summer 2011 (pediatric oncology/hematology lab)• I learned all the basic lab techniques such as Western blot, PCR, and

mouse handling. • Interacted with researchers all around the world, whether it was

sharing breeding techniques of mice, emailing them about information on articles or papers, or reviewing research developed from around the world. I found that research is evolving everyday and it is very rewarding and exciting.

• Spring Quarter 2012- Biomedical Mentorship Research program at the Atweh lab under the post-doc, Dr. Charmaine Ramlogan-Steel (Oncology-Hematology)• This project helped me develop my basic skills and go even further

with learning analytical skills and independence in my research• use my own initiative and creativity and contribute to the structuring

and designing of experiments.

PEDIATRIC NEUROLOGY SUMMER 2012• Cleveland Clinic Child Neurology Research & Observer

Program• 8 weeks starting June 6, 2011 from 8:00 am to 5:00 pm• Worked with Dr. Debabrata Ghosh at the Pediatric

Neurology Department in the Cleveland Clinic Main Campus Children’s Hospital

• The Pediatric Neurology Department at the Cleveland Clinic Children’s Hospital is ranked #3 in the nation and #1 in Ohio.

• Dr. Ghosh is specialized in movement disorders relating to spasticity and dystonia.

CITI TRAINING

COMET TRAINING

GOAL #1• Frame and develop the research project question

or problem and identify and apply appropriate methodologies to design research study, and collect and analyze data

• Accomplished this goal by working closely with my mentor to learn a variety of clinical research procedures and methods.

• Skills learned:• Statistically analyze data and compile patient records and charts into excel spreadsheets• How to write a report and paper for a clinical research journal.

MY PROJECT My specific project was on the Effects of Botulinum Toxin

(Botox) Injections on Spasticity in Children. Botulinum toxin is a protein and neurotoxin produced by

bacterium Clostridium botulinum There are 7 different types of Botulinum toxin, of which 2

can be used to treat dystonia and spasticity disorders including muscular atrophy.

Spasticity is referred to as unusual muscle tightness or stiffness

Dystonia is sustained muscle contractions cause twisting and repetitive movements or abnormal postures.

CLINICAL RESEARCH SPREADSHEET My spreadsheet compiled data from the charts and records of over

300 patients who have received Botox injections to relieve spasticity and dystonia and compare the effects of the treatment.

I learned about the methodologies required to evaluate the effects of Botox on spasticity, including Spasm frequency, resting angle, MRC, Modified Ashworth Scale, Adductor Tone Rating, Global pain, and Range of Motion.

These factors were compiled in the spreadsheet and used to analyze the effectiveness of the botox injections.

During the 8 weeks, I compiled the information and sorted the patients by the reasons they received injections (drooling, spasticity, dystonia, or sweating).

I also started analyzing the data to compare results to put into paper. I will continue working on the analysis during the school year and July and August of 2013.

BLANK SPREADSHEET

GOAL#1- LESSONS LEARNED• related to my academic development• relevant to the statistics class I had taken in high school • relevant to my interest in pursuing a Master’s in Public Health

since many statistical methods are used in Public health. • realized that I like clinical research better than lab research

because it is more patient involved and seemed more interactive to me. • Clinical research is also a lot more desk work• During the initial phase, the doctor has to survey patients for

information and keep in contact with them to collect results at certain intervals• interpret the huge amount of data collected• sort what was relevant and how analyze data in categories.

GOAL #2• Think beyond the just completed research and articulate

how my world view has been impacted by the experience• Accomplished by the time I spent shadowing Dr. Ghosh and

other staff members, residents and fellows on hospital rounds and other patient visits

• helped me gain significant knowledge about how a hospital runs and how each person functions in the system.

• Related to my Success in Health Professions Class• learned about how different medical professionals work together to

provide healthcare. • clerks, nurses, PT/OT, neurosurgeons, radiology team, neurology

team, and orthopedic surgeon during the interdisciplinary grand rounds and well as the multidisciplinary spasticity clinic every week.

GOAL #2- LESSONS LEARNED• By working with various undergraduate and graduate

students, residents, fellows, and staff physicians I built my network of connections and gain more teamwork and collaboration skills

• More than the actual academic and medical knowledge, I gained a lot of insight about how to run appointments, the method of running of a physical exam, and how to deal with patients and families of all types

• Most of the time is taken up by paperwork and talking to the patients.

• This is why a lot of doctors get involved with clinical research so that they can be more efficient and also accomplish more with the time they do have with the patients.

RECOMMENDATIONS/FUTURE PLANS• I would recommend this program to anyone who

wants to get experience with clinical research as well as shadowing.

• It was a good balance of getting research and shadowing experience.

• If I repeat this experience, which I probably will next summer, I would probably do the program for a longer period of time than 8 weeks.

• This experience has made me realize that I would like to some kind of research while practicing. Specifically I think I would like to do clinical research that is public health related.