This K01 details a career development training and research plan for Dr. Joseph Singapogu, Research Assistant Professor at Clemson University. Dr. Singapogu has a background in using simulation technology for training clinical skills. The research plan of this proposal focuses on the development of a novel, state-of-the- art training simulator for training cannulation skills of dialysis clinic personnel (Patient Care Technicians and nurses). Dr. Singapogu's mentoring team consists of key leaders in nephrology, vascular access, cannulation training, computer scientists, bioengineers and statisticians. The goals of his training plan are: (1) Coursework in Clinical and Translational Research methods, (2) Practical clinical exposure along the continuum of care in ESRD, (3) Biologically-based understanding of processes that affect vascular mechanics, and (4) Computational and virtual modeling with cyberinfrastructure training. The survival of a patient with ESRD depends on a functioning vascular access through which blood is drawn for dialysis. Of the currently available three options for vascular accesses, the arteriovenous fistula (AVF) is the most preferred due to better patient outcomes. The Tunneled Dialysis Catheter (TDC) is the least preferred vascular access due to increased likelihood of infections, complications and hospitalizations. Due to the overwhelming evidence for the benefits of AVFs, the national Fistula First Breakthrough Initiative was launched in 2004 with the goal of achieving a 66% fistula rate nationwide. As a result, the rates of incident and prevalent AVFs have continued to rise. Though the widespread creation and use of AVFs are a welcome development, there has arisen the serious challenge of AVF-related complications as a consequence. AVFs need to remain patent and usable for hemodialysis, a condition fraught with vascular complications including non-maturation, thrombosis, stenosis and hematoma formation. Thus, vascular access complications are called the ?Achilles heel? of hemodialysis, contributing to about 20% of hospitalizations in ESRD patients. AVF non-use due to any of these conditions, in turn, results in TDC use, which only greatly increases the risk of infection and death. Consequently, the ESRD medical community has collectively called for reduced TDC usage and the need to facilitate prolonged AVF patency. One of the main contributing factors related to AVF complications, prolonged TDC use and lack of AVF use is the lack of cannulation skills. 99% of patients on hemodialysis receive dialysis treatments multiple times a week from Patient Care Technicians (PCTs) and nurses. Through these clinical personnel spend a significant time delivering dialysis treatments, there is currently no standard to test or train PCTs and nurses to safely and effectively cannulate AVFs. In this project, I propose to develop and test a novel simulator for teaching cannulation skills (called the ?CanSim?) to PCTs and nurses. I will conduct three experiments to test the central hypothesis that objective feedback provided through novel sensors in a simulator-based test environment will improve cannulation outcomes by enhancing the technical skill of healthcare professionals. This novel study will potentially significantly impact patient care by providing a state-of-the-art simulator for cannulation skills training which, in turn, will have positive impact on patient outcomes and attitudes toward cannulation.
In 2012, there were more than 630,000 patients in the U.S. with End Stage Renal Disease (ESRD), the majority of whom rely on hemodialysis for survival. Though ESRD patients account for just 1.3% of Medicare population, they account for more than 7.5% of Medicare spending ($25.7 billion annually). Further, the incidence of ESRD in African-Americans is four times that of Caucasians, and South Carolina ranks 4th in the U.S. in ESRD prevalence (cases/population). This proposal will enable better patient outcomes through skills training of dialysis clinic personell.