N of 1 Trials, Self Tracking and Personal Experiments

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A talk given by Paul Abramson MD on 8/25/12 at the Medicine of Cycling Conference at the Olympic Training Center, Colorado Springs. …

A talk given by Paul Abramson MD on 8/25/12 at the Medicine of Cycling Conference at the Olympic Training Center, Colorado Springs.

Discusses N of 1 experimental design, the Quantified Self movement, and a paradigm for implementing self tracking and the Quant Coach in medical care in order to empower patients.

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  • 1. N OF 1 TRIALS Self Tracking and Personal Experiments Paul Abramson MD My Doctor Medical Group - San Francisco @paulabramsonmdSaturday, August 25, 12
  • 2. DISCLOSURES no conflicts of interest to discloseSaturday, August 25, 12
  • 3. THE QUANTIFIED SELF self-tracking geeks uniteSaturday, August 25, 12
  • 4. QS CONFERENCE #3 Stanford University, September 2012Saturday, August 25, 12
  • 5. QUANTIFIED MANIA self-tracking goes mainstreamSaturday, August 25, 12
  • 6. Saturday, August 25, 12
  • 7. WHY SELF TRACK?Saturday, August 25, 12
  • 8. DO YOU HAVE A PROBLEM? that’s hard to solveSaturday, August 25, 12
  • 9. OR A QUESTION? that matters to youSaturday, August 25, 12
  • 10. OR A DESIRED CHANGE? how can I improve my sleep?Saturday, August 25, 12
  • 11. FEEDBACK gathering data can facilitate insight and changeSaturday, August 25, 12
  • 12. RANDOMIZED TRIAL large numbers are betterSaturday, August 25, 12
  • 13. N OF 1 TRIAL just youSaturday, August 25, 12
  • 14. N OF 1 TRIALS an opportunity to tailor treatment to the individualSaturday, August 25, 12
  • 15. STUDY OF N OF 1 TRIALS • 70 trials begun, 57 finished • 50 trials resulted in definitive answer • 39% of trials with enough data resulted in a change in plan Arch Int Med 1990- PMID 2297206Saturday, August 25, 12
  • 16. QUININE AND LEG CRAMPS • 13 primary care patients already on quinine for leg cramps •2 week washout • Three 4-week treatment blocks: quinine vs. placebo • Outcome measures: • patient diaries of cramp occurance, duration, severity • capsule counts Br J Gen Pract 2005- • blood quinine levels PMID 15808032Saturday, August 25, 12
  • 17. QUININE AND LEG CRAMPS • 10 patients completed the trial •3 patients showed significant benefit of quinine (p < 0.05) •6 showed non-significant benefit • One showed no benefitSaturday, August 25, 12
  • 18. N OF 1 TRIAL DESIGNSaturday, August 25, 12
  • 19. PASSIVE SENSORS biometric - environmentalSaturday, August 25, 12
  • 20. ZEPHYR BIOHARNESSSaturday, August 25, 12
  • 21. quantified-mind.com mymee.com ACTIVE TRACKING APPS mindfulness requiredSaturday, August 25, 12
  • 22. OTHER DATA SOURCES calendar - e-mail - GPS data - government agencies - etc.Saturday, August 25, 12
  • 23. VISUALIZATION TOOLS bodytrack - fluxtreamSaturday, August 25, 12
  • 24. VISUALIZATION TOOLSSaturday, August 25, 12
  • 25. VISUALIZATION TOOLSSaturday, August 25, 12
  • 26. DEFINE THE PROBLEM specific - simpleSaturday, August 25, 12
  • 27. DESIGN THE EXPERIMENT achievable - time-limitedSaturday, August 25, 12
  • 28. IMPLEMENTATION pick tools - assemble teamSaturday, August 25, 12
  • 29. FEEDBACK AND ADJUSTMENT data - process - story - coachingSaturday, August 25, 12
  • 30. END THE EXPERIMENT assess the results - tell the storySaturday, August 25, 12
  • 31. Quant Coach Doctor Team Coach Self Tracker Other PractitionersSaturday, August 25, 12
  • 32. WHERE TO LEARN MORE •quantifiedself.com •quantdoctor.com •bodytrack.org •quantified-mind.com •mainstream mediaSaturday, August 25, 12
  • 33. CONTACT INFO: PAUL ABRAMSON MD mydoctorsf.com @paulabramsonmd office@mydoctorsf.com 415-963-4431Saturday, August 25, 12