Dr. Eglė Palevičiūtė: “The Success of the Dissertation Is a Clear Vision and Consistent Work”
“We read and listen to recommendations on a daily basis that we must exercise regularly and be physically active in order to be healthier, but for some patients with certain conditions, poorly chosen exercise or the intensity of exercise can be unhelpful and even harmful. For a long time, exercise of any kind was not recommended for patients with pulmonary hypertension, but as medical treatment options have improved, exercise was introduced for such patients under the close supervision of healthcare professionals,” Dr. Eglė Palevičiūtė, a cardiologist at Vilnius University (VU) Hospital Santaros Klinikos stated during an interview about her doctoral research.
This year, you defended your thesis on “Accessibility and effectiveness of a specialist exercise/rehabilitation programme for patients with pulmonary hypertension and heart failure” for your PhD in Medicine. Tell us more about your thesis.
Pulmonary hypertension (PH) and chronic heart failure (chronic HF) are severe, progressive cardiovascular conditions that significantly impair exercise capacity, reduce quality of life and shorten life expectancy. Some patients develop PH as a primary condition, others develop PH as a complication of a pre-existing heart or lung disease. Despite the availability of modern medical treatments, most of these patients are still affected by shortness of breath, fatigue and other symptoms, which impair their quality of life. More and more researchers are focusing on non-medicinal treatments. As part of a multicentre randomised routine therapy controlled trial involving a total of 11 PH centres in 10 European countries, my thesis explored the feasibility, safety and efficacy of an exercise programme for these critically ill patients. In addition, I found during a systematic literature review during my PhD studies that there was a lack of research on the effectiveness of rehabilitation training in patients with HF complicated by PH, which led to the initiation of a multicentre study of physical exercise in this particular group of the population.
What were the findings of your study?
The results of the multicentre study showed that a combination of optimal medical treatment and individually tailored physical exercises and other rehabilitation techniques significantly improve both the exercise capacity and the quality of life of the patients. The findings of this study have already been assessed by experts from the European Society of Cardiology, who, based on the results of this study, recommend that PH patients should have supervised physical training as an effective non-medication therapy. By participating in the study, VU researchers and VU Hospital Santaros Klinikos healthcare professionals had the opportunity to learn how to prescribe and apply a specialist rehabilitation programme at the University Hospital of Heidelberg, which is perhaps the most experienced hospital in this field. We are very pleased and proud that we have successfully applied the knowledge and experience gained during the research in our clinical work now we have the opportunity to provide this medical rehabilitation programme to PH patients in Lithuania.
What challenges did you face in writing your thesis?
The first challenge was to organise a specialist PH rehabilitation programme in our healthcare system. Up to now, rehabilitation treatment in Lithuania has been mostly prescribed for patients after an episode of worsening of their disease, trauma or surgery, so the general procedure of rehabilitation treatment in Lithuania has been more adapted to such patients, and our physical medicine and rehabilitation specialists are more experienced in treating such patients. In our case, we aimed to train stable, but seriously ill patients. To ensure maximum safety and to achieve the best outcome, our rehabilitation treatment was carried out exclusively in an inpatient setting. As we did not have any physical medicine and rehabilitation specialists in Lithuania with practical skills in training PH patients, our team travelled several times to a rehabilitation centre in Heidelberg for training. In order to gain a better understanding of the treatment, I also travelled to the training course together with physical medicine and rehabilitation specialists. The great team of enthusiastic professionals overcame many organisational challenges. Furthermore, patients, whose motivation and adherence to the recommendations were crucial for a good treatment outcome willingly joined the study even though they had to continue their daily workouts at home after being discharged from the hospital. We were in constant contact with the scientists and doctors at the University of Heidelberg, who were always available to answer both our scientific and our clinical questions.
Another challenge not foreseen in any PhD plan was the onset of the COVID-19 pandemic, as a result of which enrolment of patients in the study was suspended, and indeed, even outpatient consultations were limited for a while. I used this time to analyse the systematic literature and write publications.
What is a successful dissertation in your opinion?
I think that all the dissertations that have been produced and defended have already been successful. I believe that each dissertation has scientific value for a specific group of the population, addresses important questions, or at least defines more specific tasks for further scientific research. It seems to me that the success of a dissertation is mainly determined by a clear vision of the intended research and consistent work – a specific goal or goals, well-formulated tasks that can be realistically implemented over a period of several years, and detailed planning of the different stages of the work. At the initial stage, an analysis of existing research and a literature review are important. As in most activities, it is essential that the PhD student and their supervisor, as well as other team members, including research subjects, work well together. I believe that multidisciplinarity and internationality allow for a broader perspective on the problem analysed, often contributing to the fulfilment of the objectives, and therefore also contributing to the success of the dissertation.
It is also important to realise that studying for a PhD is unlikely to be easy, this should help you to gauge your motivation, commitment and ability to devote sufficient time to your studies. Although it might not seem so initially, four years of study is a short time for a dissertation, so I would suggest to start working on it right from the very beginning of your studies (possibly even before you start your PhD studies), and if there are difficulties or challenges, not to postpone it to a better time, but instead to try to overcome the obstacles as soon as possible and move on – this is where, I think, your supervisor and other colleagues can help, advise or guide you in the right direction. Everybody comes across obstacles and everybody suffers certain failures, the most important thing is not to give up and to persevere in pursuit of the goal you have set for yourself. I too had my share of difficult moments, setbacks, disappointments, fatigue, and then there was the pandemic that ruined all my plans. I am one of those people motivated by success, and if you fail it can be harder to get going again, it takes even more willpower, but I just always knew that I had a clearly defined timeframe for the duration of my PhD, to complete the work that I had planned.
How has this experience enriched you as a person and as a researcher?
To be honest, I never planned to become a scientist, but in order to provide my patients with the most innovative, science-based healthcare services, I have always been interested in the latest research results and analysed scientific publications. I work in the field of pulmonary hypertension, and some types of PH are very rare, which is why international cooperation and active involvement of the employees of the centre in research and publications are of particular importance here. During my PhD studies, I developed a desire to keep up with research activities and found them extremely interesting, meaningful and enriching. I feel that I have learnt the subtleties of research planning, from an initial idea to the publication of research results. I am very pleased to have had the opportunity to work with an international team of researchers, to have met and still have good contacts with experienced professionals in their field, both in Lithuania and in other European universities.