The UT-Stroke Program has a rich and longstanding history of developing the careers of clinicianscientists in cerebrovascular disease. Dr. Grotta has mentored dozens of clinicians involved in the care of stroke patients, many of whom are now leaders themselves in clinical and basic stroke research. Dr. Grotta has recruited Dr. Savitz to lead our fellowship program. An important priority of this Program Project is to continue to train the next generation of clinicians to devise and carry out clinical research in acute stroke therapy, and to provide cutting edge, effective treatments to acute stroke patients. Through the establishment of this Training and Career Development Program, we seek to reach this goal by building on past accomplishments of our successful fellowship training program.
Our specific aims are to 1)develop clinician-scientists who will dedicate their careers to investigating the pathophysiology of cerebrovascular disease and the application of this knowledge to new therapeutic advances;2)provide training to non-stroke specialists and paramedics, who take care of acute stroke patients, especially in pre-hospital and Emergency Department settings;and 3)to collaborate with other SPOTRIAS centers by exchange of fellows and other personnel for training purposes.
Aim 1 will be accomplished by continuing our educational mission to provide our fellows with training in laboratory investigation into the biology of stroke. Fellows will spend focused periods of time in the laboratory , attend lectures on the pathophysiology of cerebrovascular disease, and participate in journal clubs devoted to basic science articles. Our fellows take leading roles in our clinical research protocols and have didactic sessions devoted to the teaching of biostatistics from our statistical colleagues in the data core and also from the medical school's Center for Clinical and Translational Sciences. Early in the fellowship, the trainees are required to identify a general program of intensive research focus that incorporates the equivalent of 1 full year of training. Recent fellows have pursued a structured schedule of courses leading to a Master's degree. It is expected that within the context of these areas of concentrated focus that the fellows complete one or more independent research projects during their fellowship leading to a first-authored publication. All of the proposed SPOTRIAS projects will give the fellows ample opportunity to learn the nuts and bolts of clinical trial design, conduct translational research within a well-established infrastructure for clinical investigation in acute stroke therapeutics, and gather data for publication under the mentorship of our clinical faculty.
Aim 2 will be accomplished by continuing to provide lectures to our emergency department residents. These educational sessions includes the NIH Stroke Scale certification video training as well as lectures on acute stroke, medical management of ischemic and hemorrhagic stroke, and head CT evaluation. Interns receive the UT Stroke Team Acute Stroke Care handbook, which has recently been published and describes the paradigms used at our center for treating acute stroke patients, including appendices with standing orders, pathways and algorithms that are useful for all clinical personnel involved in treating these patients. We have played a pivotal role in the 2005 Texas State Legislation that has established 3 levels of stroke centers statewide, as well as a statewide plan for triage of stroke patients to those centers. Dr. Grotta chairs the State-mandated committee to help community hospitals become stroke centers. We are now in the implementation phase on the division of the state into regional trauma networks. At the heart of this initiative will be the training of emergency medicine staff and paramedics.
Aim 3 is will be accomplished through an exchange program with other SPOTRIAS centers. In fact, we have already hosted a visiting fellow from the Columbia SPOTRIAS center, and we propose to send our fellows to UCSD to broaden their experience by working at another first-class academic stroke center with which we are closely collaborating with in Project #1.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Specialized Center (P50)
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Special Emphasis Panel (ZNS1)
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University of Texas Health Science Center Houston
United States
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Berekashvili, Ketevan; Soomro, Jazba; Shen, Loren et al. (2018) Safety and Feasibility of Argatroban, Recombinant Tissue Plasminogen Activator, and Intra-Arterial Therapy in Stroke (ARTSS-IA Study). J Stroke Cerebrovasc Dis 27:3647-3651
Cai, Chunyan; Rahbar, Mohammad H; Hossain, Md Monir et al. (2017) A placebo-controlled Bayesian dose finding design based on continuous reassessment method with application to stroke research. Contemp Clin Trials Commun 7:11-17
Barreto, Andrew D; Ford, Gary A; Shen, Loren et al. (2017) Randomized, Multicenter Trial of ARTSS-2 (Argatroban With Recombinant Tissue Plasminogen Activator for Acute Stroke). Stroke 48:1608-1616
Ifejika, Nneka Lotea; Noser, Elizabeth Anne; Grotta, James C et al. (2016) Swipe out Stroke: Feasibility and efficacy of using a smart-phone based mobile application to improve compliance with weight loss in obese minority stroke patients and their carers. Int J Stroke 11:593-603
Lyden, Patrick; Hemmen, Thomas; Grotta, James et al. (2016) Results of the ICTuS 2 Trial (Intravascular Cooling in the Treatment of Stroke 2). Stroke 47:2888-2895
McDonald, Mark M; Wetzel, Jeremy; Fraser, Stuart et al. (2016) Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke. J Thromb Thrombolysis 41:505-10
Ifejika, Nneka L; Vahidy, Farhaan; Aramburo-Maldonado, Linda A et al. (2015) Acute Intravenous Tissue Plasminogen Activator Therapy does not Impact Community Discharge after Inpatient Rehabilitation. Int J Neurorehabil 2:
Huang, Richard S P; McDonald, Mark M; Wetzel, Jeremy S et al. (2015) Clot Strength as Measured by Thrombelastography Correlates with Platelet Reactivity in Stroke Patients. Ann Clin Lab Sci 45:301-7
Elliott, Andrea; Wetzel, Jeremy; Roper, Tiffany et al. (2015) Thromboelastography in patients with acute ischemic stroke. Int J Stroke 10:194-201
Vahidy, F S; Rahbar, M H; Lal, A P et al. (2015) Patient refusal of thrombolytic therapy for suspected acute ischemic stroke. Int J Stroke 10:882-6

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