Clin-STAR Journey Story

Physician-Scientist Finds Supportive Mentors and Broader Interests in the Geriatrics Community

Dr. Mike Devinney’s original training in neuroscience led him down the path of becoming a physician-scientist, studying neural control of breathing and how the brain adapts with age. His interest in the interaction between complex physiologic systems to maintain normal functioning in disease took him to Duke University, where he is currently an anesthesiologist and a critical care specialist.

Noting the number of ICU patients who experienced an acute change in awareness of their surroundings, Dr. Devinney quickly saw the opportunity to blend his training in basic sciences with clinical practice. “Working in critical care and the ICU, I see a patient with delirium on almost every shift. Delirium is so distressing to patients and their families, not to mention that it contributes to longer hospital stays and worse outcomes. It’s important for us to find ways to combat it.”

Dr. Devinney began to focus on the mechanisms of neurocognitive dysfunction and development of delirium after surgery and during critical illness. His specific area of research centers on the breakdown in the blood-brain barrier, a phenomenon that can be seen with Alzheimer’s disease but can also be the result of disrupted sleep. In fact, Dr. Devinney says, “The sleep component is how I first became interested in the aging population, especially patients in the ICU, where it seems nobody can get much sleep. The first few nights in the hospital are the most disruptive.”

With the objective of investigating the aging-related mechanism of delirium and its relationship to interrupted sleep and sleep apnea, Dr. Devinney applied for a GEMSSTAR award. His application generated much interest, and while he wasn’t initially funded, he was invited to participate in the 2020 Rising Star Program, through which he received a great deal of helpful feedback. Particularly valuable was advice from Dr. Ed Marcantonio, Section Chief for Research in the Division of General Medicine at Beth Israel Deaconess Medical Center, and Professor of Medicine at Harvard Medical School. With their matching interests in delirium, Drs. Marcantonio and Devinney collaborated on development (and publication) of a delirium severity score, useful not only in objective evaluation of delirium but also for potential in biomarker-related research. Per Dr. Devinney, “We lack good markers or measurements to define the risk of delirium after surgery. If someone has really poor sleep, we can look at markers for breakdown in the blood-brain barrier. But are there other markers that could predict risk? We have some multicomponent interventions to reduce risk, but they require a lot of nursing intervention, so being able to identify those who are most at risk would be very useful.”

After working with Dr. Marcantonio and other mentors, and subsequently improving his research design, Dr. Devinney resubmitted an application to GEMSSTAR and was awarded a grant. He was also able to attend the Clin-STAR annual meeting. “The 2021 Clin-STAR annual meeting was fantastic! Virtual rooms were set up for people to talk and exchange ideas in smaller groups. This year’s meeting, coming up in the fall, will be in person and promises to be even better.”

As a result of the 2021 Clin-STAR meeting, Dr. Devinney, along with some other GEMSSTAR awardees, created a Clin-STAR special interest group of transdisciplinary clinician scientists interested in inflammation research, and he encourages others to join. Dr. Devinney is particularly interested in how the brain is affected by neuroinflammation, as well as by inflammation elsewhere in the body, such as in the gastrointestinal tract or even the skin. He believes that cross-pollination of ideas among those in different specialty areas can lead to innovative work and solve some major clinical problems. “The aging research community has a unique perspective into disease pathophysiology, looking to understand comprehensively why a patient would have a functional decline. It’s a wonderful transdisciplinary community with many supportive mentors, and I’m grateful to be a part of it.”