Support for our endeavors
comes primarily from the
National Institutes of Health

Custer Lab- Research Opportunities 

Resident Initiated PSQI projects

The ACGME requires that residents actively participate in interdisciplinary clinical quality improvement and patient safety programs. Some of these projects include:

1)      Assessing resident and program director opinions regarding required PSQI projects during residency, including utility, priority and barriers to implementation.

2)      An inter-departmental evaluation of the management of pre-septal and orbital cellulitis at SLCH. Different services approach the treatment of these conditions differently resulting in “re-inventing the wheel” every time a new patient is admitted with orbital disease. The goal of this project is to develop pathways of care that will standardize the diagnostic interventions and treatment of pediatric patients with presumed orbital cellulitis to reduce unnecessary radiation exposure due to CT scanning, streamline consultant input, and improve time to improvement by using the best evidence-based therapeutic interventions available.

3)      A little known complication of hemodialysis is an optic neuropathy that is reminiscent of glaucoma. Some data suggests that fluid shifts during dialysis can cause spikes in intraocular pressure immediately post-dialysis. If this is true, chronic dialysis patients could be at increased risk of vision loss. Acute use of aqueous suppressants could abrogate this effect in patients who are susceptible. We will conduct a prospective observational study to measure intraocular pressure in hemodialysis patients before, during and after dialysis to assess the occurrence of this phenomenon in a typical dialysis unit. We will evaluate dialysis parameters as secondary (hypothesis generating) analyses. If the hypothesis that hemodialysis produces acute elevations in IOP bears true, a second phase study would include an intervention arm that consisted of acute administration of aqueous suppressants to determine whether that intervention alters the degree of IOP fluctuation in the setting of dialysis.

4)     Consultation to the ICU for patients with exposure keratopathy is common. Some ICUs have routine protocols for ocular lubrication for their patients. Other units do not. We will assess the frequency of consultation for exposure keratopathy in units with and without standing protocols to determine whether there should be a universal prophylaxis protocol.

Dr. Phil Custer:

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The Vision Research Community at Washington University in St. Louis
Washington University School of Medicine
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