The document summarizes the process undertaken by the Patient-Centered Outcomes Research Institute (PCORI) Pilot Projects Selection Committee to review applications and select a slate of awards to recommend to the PCORI Board of Governors for funding. The committee applied a multi-step selection process that involved determining an initial pool of applications, developing potential selection options, analyzing the options for balance across key criteria, and selecting a final recommendation. The committee's recommendation will be put forth for a vote by the PCORI Board of Governors.
An overview on priorities in health research was a part of a course for research methodology delivered in King Saud University College of Medicine August 2015
An evaluation of the Route to Success resources, related tools and frameworks covering disease specific areas: heart failure; advanced kidney disease; dementia; and long term neurological conditions
13 December 2012 - Institute of Healthcare Management / National End of Life Care Programme
This project set out to review how the series of publications and supporting tools, resource guides and frameworks developed and supported by the National End of Life Care Programme (NEoLCP) have been utilised across four disease specific pathways.
The disease specific pathways to be included in the review are:
Heart Failure
Advanced Kidney Disease
Dementia
Long term neurological conditions
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
An overview on priorities in health research was a part of a course for research methodology delivered in King Saud University College of Medicine August 2015
An evaluation of the Route to Success resources, related tools and frameworks covering disease specific areas: heart failure; advanced kidney disease; dementia; and long term neurological conditions
13 December 2012 - Institute of Healthcare Management / National End of Life Care Programme
This project set out to review how the series of publications and supporting tools, resource guides and frameworks developed and supported by the National End of Life Care Programme (NEoLCP) have been utilised across four disease specific pathways.
The disease specific pathways to be included in the review are:
Heart Failure
Advanced Kidney Disease
Dementia
Long term neurological conditions
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Involving patients in research what have we done and how did we do it? Jean R. Slutsky, Patient-Centered Outcomes Research Institute (PCORI) Foredrag, Brukermedvirkning i helseforskning, fra ord til handling. Diakonhjemmet Sykehus 4. november 2014.
The slide presentation from the combined meeting of PCORI'S Advisory Panels on Patient Engagement and Addressing Disparities April 28, 2014 meeting in Alexandria, VA.
The slide presentation that preceded of the annual Health Datapalooza in Washington DC, PCORI was pleased to participate in the latest installment in the Health Data Consortium and PricewaterhouseCoopers (PwC) Innovators in Health Data Series, a webinar featuring PCORI Executive Director Joe Selby, MD, MPH; NIH Director and PCORI Board of Governors member Francis Collins, MD, PhD; and Philip Bourne, PhD, NIH’s Associate Director for Data Science.
Policy and Funding for CER: Making Sense of a Confusing Landscape CTSI at UCSF
UCSF researcher, Michael Steinman, MD, Director of CTSI's Comparative Effectiveness Research initiative presents. View more related presentations and resources at http://accelerate.ucsf.edu/research/cer
Developing comprehensive health promotion - MedCrave Online PublishingMedCrave
As the global prevalence of obesity and chronic diseases continues to rise, the need for effective health promotion programs is imperative. Whilst research into effectiveness of health promotion programs is needed to improve population health outcomes, translation of these research findings into policy and practice is crucial. Translation requires not only efficacy data around what to implement, but also information on how to implement it.
http://medcraveonline.com/MOJPH/MOJPH-02-00007.pdf
Involving patients in research what have we done and how did we do it? Jean R. Slutsky, Patient-Centered Outcomes Research Institute (PCORI) Foredrag, Brukermedvirkning i helseforskning, fra ord til handling. Diakonhjemmet Sykehus 4. november 2014.
The slide presentation from the combined meeting of PCORI'S Advisory Panels on Patient Engagement and Addressing Disparities April 28, 2014 meeting in Alexandria, VA.
The slide presentation that preceded of the annual Health Datapalooza in Washington DC, PCORI was pleased to participate in the latest installment in the Health Data Consortium and PricewaterhouseCoopers (PwC) Innovators in Health Data Series, a webinar featuring PCORI Executive Director Joe Selby, MD, MPH; NIH Director and PCORI Board of Governors member Francis Collins, MD, PhD; and Philip Bourne, PhD, NIH’s Associate Director for Data Science.
Policy and Funding for CER: Making Sense of a Confusing Landscape CTSI at UCSF
UCSF researcher, Michael Steinman, MD, Director of CTSI's Comparative Effectiveness Research initiative presents. View more related presentations and resources at http://accelerate.ucsf.edu/research/cer
Developing comprehensive health promotion - MedCrave Online PublishingMedCrave
As the global prevalence of obesity and chronic diseases continues to rise, the need for effective health promotion programs is imperative. Whilst research into effectiveness of health promotion programs is needed to improve population health outcomes, translation of these research findings into policy and practice is crucial. Translation requires not only efficacy data around what to implement, but also information on how to implement it.
http://medcraveonline.com/MOJPH/MOJPH-02-00007.pdf
A piece of propaganda issued by the far-left, virulent anti-drilling Earthworks titled "Blackout in the Gas Patch: How Pennsylvania Residents are Left in the Dark on Health and Enforcement". The "study" supposedly offers evidence of regulatory mismanagement at the state's Dept. of Environmental Protection with respect to the miracle of Marcellus Shale drilling. The report is DOA because it's not independent and misrepresents the data. One more anti-drilling tirade by a fossil fuel-hating organization.
Project management final report ENG3004 Griffith University Guri Dam & Chunne...peter747
3004ENG: Project Management Principles
Griffith School of Engineering
Griffith University Gold Coast
guri dam venezuela
chunnel project case study
The Chunnel Tunnel Project
project management report engineering
Agenda SettingA key aspect of the policy process is agendacheryllwashburn
Agenda Setting
A key aspect of the policy process is agenda setting. How do topics get on that agenda? Agenda setting requires the support of stakeholders to move the issue forward. In this week's media presentation, Dr. Kathleen White outlines the policy process and discusses how to move issues into the policy arena through agenda setting. The ultimate goal is to gain the attention of leadership whether at the organizational, local, state, national, or international level.
To prepare:
Review this week’s media presentation, focusing on the insights shared by Dr. White and Dr. Stanley on agenda setting and identification of stakeholders.
Brainstorm clinical practice issues that you believe are worthy of being on your organization’s systematic agenda.
Who are the stakeholders who would be interested in this clinical practice issue?
By tomorrow 03/14/2018 3pm, write a minimum of 550 words in APA format with at least 3 scholarly references from the list of required readings below. Include the level one headings as numbered below”
Post
a cohesive response that addresses the following:
1) In the first line of your posting, identify the clinical practice issue you would like to see on your organization’s systematic agenda.
2) What strategies would you use to inform stakeholders and persuade them of the importance of your identified clinical practice issue?
Required Readings
Hyder, A., Syed, S., Puvanachandra, P., Bloom, G., Sundaram, S., Mahmood, S., ... Peters, D. (2010). Stakeholder analysis for health research: case studies from low- and middle-income countries. Public Health, 124(3), 159–166.
This study demonstrates how the engagement of stakeholders in research and policy making can assist in the successful implementation of policy proposals. The authors propose that by engaging stakeholders, researchers and policy makers are provided with multiple perspectives on proposed policies, which can lead to greater success with policy adoption and implementation.
Lavis, J. N., Permanand, G., Oxman, A. D., Lewin, S., & Fretheim, A. (2009). SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking. Health Research Policy & Systems, 71–79. doi: 10.1186/1478-4505-7-S1-S13
The purpose of a policy brief is to communicate an issue clearly and definitively to policy makers. The authors of this article propose an outline for policy briefs and also stress the importance of using research when creating a policy brief.
Lowery, B. (2009). Obesity, bariatric nursing, and the policy process: The connecting points for patient advocacy. Bariatric Nursing & Surgical Patient Care, 4(2), 133–138.
This article provides an example of nurse involvement in policy making by examining a bariatric nursing issue. The author stresses that nurses, in their patient-advocacy role, have a responsibility to be involved in the health care ...
Slide presentation for the June 4, 2014 joint PCORI/ National Institute on Aging (NIA) of the National Institutes of Health webinar. This webinar announced the selection of the research team that will carry out a major, five-year, $30 million patient-centered study of the effectiveness of individually tailored care plans to help older individuals avoid falls and related injuries.
The slide presentation from PCORI'S Advisory Panel on Assessment of Prevention, Diagnosis, and Treatment Options April 28-29, 2014 meeting in Alexandria, VA.
Slide presentation from Day Two of the PCORnet Partners meeting. The January 21-2, 2014 meeting took place at the Brookings Institute. This event launched the development of the nation’s most ambitious and promising clinical research network aimed at delivering high quality care through patient-centered outcomes research.
Slide presentation from Day One of the PCORnet Partners meeting. The January 21-2, 2014 meeting took place at the Brookings Institute. This event launched the development of the nation’s most ambitious and promising clinical research network aimed at delivering high quality care through patient-centered outcomes research.
Slide presentation from the October 30, 2013 webinar which described the process and rationale for PCORI’s unique approach to reviewing research proposals for funding.
Slide presentation from the November 13, 2013 webinar. This webinar was an opportunity to learn more about the Tier 1 Pipeline Awards, what type of projects PCORI is looking to fund, and how to apply.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Special Board of Governors Teleconference/Webinar
1. PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE
April 25, 2012
Patient-Centered Outcomes Research Institute
National Priorities and Research
Agenda
2. Review Genesis of National Priorities and Research Agenda
Review Public Comment Process
Share Public Comment Findings
Recommend PCORI Response
Board Vote on Recommended Changes
Objectives for Today
2
3. 3
The What and Why of National Priorities and Research
Agenda
Mandated in the legislation (including
Public Comment period)
Pre-requisite for releasing funding
announcements
Preliminary roadmap for PCORI research
activities
Envisioned as a living document
4. Developed
Framework to be
used for refining
priorities and for
determining
Research Agenda
and funding
announcements
Reviewed initial
stakeholder input
advising us to not
“reinvent the wheel”
Development of Draft National Priorities and
Research Agenda
4
Initial Stakeholder
feedback
Reviewed prior CER
frameworks (e.g.,
IOM, FCCCER,
National Priorities
Partnership, and
NQF)
Environmental
scan of existing
priorities and
criteria
Identified broad
priorities from prior
frameworks and the
statutory criteria for
PCORI
Candidate
priorities and
criteria identified
Framework to
inter-relate
Priorities and
Criteria
5. Establishing PCORI’s First National Priorities
for Research and Initial Research Agenda
9
Criteria outlined
by law
5
Draft priorities
proposed
Corresponding
agenda drafted
Public input
received and
evaluated
Priorities and
agenda revised
and approved
First primary
funding
announcements
issued
Aug-Dec 2011 Jan-Apr 2012 May 2012
5
6. Patient and Caregiver Focus Groups
6
Columbus, OH (Dec. 7)
• Parents of children with ADD/ADHD
(caregivers)
• Patients with Mental Health
conditions
• Patients who survived Cancer
• Insured and uninsured
• Age: 30-70+
Phoenix, AZ (Dec. 8)
• Patients with Respiratory Disease
(chronic bronchitis, emphysema)
• Hispanic patients with mix of
chronic conditions
• Patients with Heart Disease
• Insured and uninsured
• Age: 21-69
Atlanta, GA (Nov. 21)
• Patients with Diabetes
• Caregivers to Alzheimer’s patients
• Patients with Chronic Pain
• Insured and uninsured
• Age: 21-75+
Baltimore, MD (Nov. 9)
• Patients with Arthritis
• Parents of children with Pediatric
Asthma (caregivers)
• Patients with mix of chronic
conditions
• Insured and uninsured
• Age: 21-69
7. Receiving Public Feedback on the National
Priorities and Research Agenda
7
• Clinician Focus Groups
o Clinician focus groups took place in cities across the US
o Philadelphia
o Birmingham
o California
o Chicago
o Four groups of physicians and four groups of nurses
o Behavioral Health Professionals
o Physician Assistants
8. A commitment to public engagement
8
Formal 53-day Public Comment Period
• Nearly 500 comments received through
website, e-mail or postal mail
• All comments will be posted at pcori.org
Additional Forums
• National Patient and Stakeholder Dialogue
• Patient, caregiver and clinician focus groups
• Individual meetings with diverse mix of
stakeholders
9. Public Comment Yielded Diverse Array of Input
and Feedback
Broad range of comment sources
301 Web survey (64%) 116 Email/ letter (24%)
57 Stakeholder event (12%)
474TotalComments
9
10. Those Who Commented Said They Understand
the National Priorities…
Addressing Disparities Accelerating PCOR and Methodological Research
Assessment of Options Improving Healthcare Systems Communications and Dissemination Research
“How well do you understand
the National Priorities?”
10
11. Rigorous, Systematic Review and Analysis
of Comments
Computer algorithm to identify key terminology
Each narrative comment reviewed and analyzed by
3 people
Stakeholder comments aggregated to 15 key
themes
Themes compared to National Priorities and
Research Agenda to identify gaps
Gaps reviewed to determine options for PCORI
response to themes
11
12. Options for Response
Change Language Within the Research Agenda
Embed in PCORI Operations and Processes
Address in Summary Document
Future Consideration
12
13. Recommends that PCORI choose a specific condition, disease
area, or other issues in the Research Agenda and National
Priorities
PCORI has proposed a condition-neutral Research Agenda and has introduced
specificity through its comparative nature and emphasis on patient centeredness.
While future funding announcements may specify conditions, the overall mission of
PCORI is not served by excluding any conditions if there is compelling reason for a
patient centered, comparative clinical effectiveness study. We added language to
elaborate on our position.
Recommends that PCORI partner with organizations and
stakeholders to carry out its mission
PCORI is committed to efficient use of its research investments. Where appropriate,
PCORI will partner with other organizations after a transparent decision-making
process and consideration of conflicts of interest. This theme impacts PCORI
processes, rather than funding subjects, so no specific language changes were made
to the document.
Recommends greater focus on the patient, with particular
attention to methods of engagement
PCORI has fully endorsed and appreciates the centrality of patient engagement to its
mission. The National Priorities and Research Agenda reflect the patient centered
focus of PCORI and include many of the themes from the public comments.
Language has been added to the Agenda to specifically reflect the need for study of
self care and to more clearly define personalized medicine.
Recommends a greater focus on care coordination PCORI appreciates the need to study care coordination and has expanded the
language in the Research Agenda to reflect its importance.
Recommends funding towards improving patient and provider
health literacy and education
Improving communication between patient and provider is one of the five PCORI
National Priorities for Research. Language has been added to the Research Agenda
to reflect the importance of health literacy to achieving this goal.
PCORI Response to Key Themes-1
13
14. Recommends funding for and use of health IT infrastructure,
networks, tools and patient data acquisition efforts in and outside
the practice setting
The foundation for performing comparative clinical effectiveness requires substantial
health IT and data infrastructure. The National Priorities and Research Agenda
contain substantial language about this infrastructure. Therefore, no additional
language was added to the document. PCORI will support reusable infrastructure for
comparative clinical effectiveness research.
Recommends that PCORI pay greater attention to the role of
caregivers and other stakeholders in the patient decision making
process
PCORI appreciates the role of caregivers in patient centered care and has mentioned
them in the document and included studies of caregiving in the Research Agenda.
Therefore, no additional language was added to the document.
Recommends that PCORI pay greater attention to access to
care, including the social and environmental determinants that
determine access and use of care
Access to care is a key issue for patients. Language has been added in both the
comparative assessment and the healthcare systems Research Agenda topics to
include the comparative study of access as a determinant of health.
Recommends that PCORI provide greater rationale and
transparency in the public comment, grants, and research
evaluation processes, as well as the performance measurement
process for PCORI as a whole
PCORI is committed to fully transparent processes as it works towards achieving its
mission. The Research Agenda articulates the ongoing engagement that will occur
continuously as PCORI evolves and funds research. Therefore, no additional
changes were made to the document. PCORI intends to roll out a comprehensive
communications and engagement plan that will clearly define when and how
stakeholders can provide input into PCORI decision making.
Recommends that PCORI's research and funding should impact
the practice setting, with particular attention to patient and
provider behavioral change needed to obtain true shared decision
making
PCORI is fully committed to the idea that its research should improve decision making
and help patients at the point of care. Language has been added to the section
“Establishing the Scope of the Research Agenda” to emphasize the importance of
using the evidence developed through PCORI research to change the way medicine
is practiced.
PCORI Response to Key Themes-2
14
15. Recommends that PCORI place stronger emphasis on patients
with multiple conditions, especially chronic conditions
PCORI understands the difficulty of managing multiple chronic conditions when most
evidence is generated in trials that exclude these patients. Language has been added
to emphasis this in the Research Agenda.
Recommends that PCORI study new and expanded roles for
allied health professionals
PCORI recognizes the diverse health professionals involved in patient centered care.
In the Research Agenda, the description of allied health professionals has been
expanded to be more inclusive of all of potential members of a health care team.
Recommends paying attention to international models PCORI recognizes the significant achievements of many countries in developing the
methods and practices of patient engaged comparative clinical effectiveness research
that may inform investigators as they seek PCORI funding. As this is not central to
PCORI research, no change is proposed to the priorities or agenda.
Recommends exploring novel methods to obtain patient centered
focus
PCORI supports the approach of exploring innovative methods for focusing on the
patient. The fundamental basis of PCOR, however, is the science of evidence-based
medicine. PCORI will support and promote approaches that seek rigorous, scientific
results; therefore no changes were made to the document.
Recommends that PCORI study rare diseases PCORI recognizes the challenges faced in studying rare diseases. In the Research
Agenda, language about rare disease has been expanded.
PCORI Response to Key Themes-3
15
18. PCORI Stakeholders
Thank you for your thoughtful input into the first version
of the PCORI National Priorities for Research and
Research Agenda
PCORI Program Development Committee
Thank you for all your hard work in the development and
refinement of these documents
The detailed Summary Document of changes to the National
Priorities and Research Agenda will be posted on pcori.org
by April 30, 2012
Thanks
18
21. Activities to Date:
Members of a workgroup made up of BOG members met on
a conference call January 25th and arrived at eight potential
balancing criteria
Selection Committee was appointed and met initially on
March 6th at which time they refined the balancing criteria
and proposed options for selecting applications to be funded
Applications in potential fundable range were checked for
accuracy of balancing criteria
The Committee held a conference call on March 19th at which
time they further refined the balancing criteria and decided
on two options for selecting a slate of awards to be funded
The Committee held a conference call on April 2nd and
developed a final recommendation for the Board.
Background and Updates
22. The Process
Step One:
Determine Universe
Step Two: Determine
Approach
Step Three: Develop
Core Slates
Step Four: Analyze
Balance
Step Five: Make Final
Recommendation
Step Six: Approve
The decision was made to eliminate all applications with a score
above 3.0 from consideration for further funding. This yielded a
potential fundable pool of 80 applications.
The criteria to be used for balancing were refined and two
options for selecting a base slate of applications were proposed.
Staff applied the two selection process options to the top 80
applications, yielding two possible sets of fundable applications
(one with 37 selected; the other with 50).
Using the balancing criteria staff analyzed the balance of each of
the two possible sets to determine if balance was achieved or if
additional balancing activities would be required.
The Selection Committee reviewed the two possible sets of
fundable applications to determine if balancing was needed. The
group decided on two options for the Board and selected one for
recommendation.
The Board of Governors will vote on the recommendation.
This process was completed using only generalized information regarding the applicant. No Selection
23. The selection comm. considered all potential options for selecting the slate of
fundable applications and decided to go with an option that would use priority
score first and then ensure the top two applications were selected in each
review group. All selection committee members were blinded as to the names
and affiliations of the applicants.
• Percentiles (as noted on the NIH web site) are calculated usually for study
sections that have had at least three meetings – traditionally, the last three
rounds during a year. Thus, percentiles for the Pilot Projects Program do
not have the same meaning as NIH percentiles. They reflect the
application’s ranking within a single study section meeting.
• Priority scoring is likely to be the most reliable measure across all groups
since all reviewers had the same training regarding how to score.
• We don’t know (since there is no history to the review group) if a “poor”
score is due to a review group that just scores “harsher” or the grants they
had were just not very “good”.
Rationale for Selection Method
24. Rationale (cont’d)
• NIH attempted to assign applications to reviewers based on areas
of interest, though it was difficult given the large number of
applicants and PI’s did not necessarily self-assign correctly as well
as listing more than more area.
• However, we did want to take into consideration the potential that
some groups could be harsher and give some weight to ranking
within the review group – so, we decided to also pick up the top
two applications in each review group.
25. Balancing Criteria
Balancing
Criteria
Definition Operationalization Source
Area of Interest*
The eight areas of interest listed in
the PFA
At least 2 unique applications but no
more than 50% in any one area
At least two members of the Selection
Committee read each application
abstract and determined the primary
areas of interest.
Population*
Defined as addressing 1) Specific
ethnic or cultural group, 2)
disabled populations, 3) children,
and 4) elderly populations.
At least 1 application in each of the
four categories
PCORI staff reviewed abstracts to
determine if the application had a clear
focus on one or more of the four
populations.
Condition*
The disease or condition used to
demonstrate the approach
No more than 25% in any major
category within the final slate.
Staff reviewed the abstracts to
categorize conditions addressed, if any
Stakeholder/Patient
Involvement*
The average score given by the
three reviewers for this criterion in
the initial merit review group
Any application added to the core
slate will have a score of 1 or 2 (except
methods focused applications)
The average score from the IRG review
was used.
Geography
Geographic location of institutional
affiliation
Will be reported but not used for
balance.
The state or country on the application
face page for the PI.
Method
The innovation of the research
method
Only to be used if balance is needed
within the area of interest related to
methodologies (8).
The methodology committee would
make the determination, if needed.
PI Discipline
Categorization of PI qualifications
based on primary area of expertise
Insufficient data to use
PI Seniority
Whether the PI has received
Insufficient data to use
Eight potential criteria were discussed and
refined. The top four were proposed as the
most appropriate for balancing.
26. Areas of Interest (summary)
Present recommended slates to BOG in April
Make Grant Award announcements no later than the
May BoG meeting
Incorporate Lessons Learned into 4 PFAs to be
released in May
Create and publish report on selection process to
ensure transparency
Developing, testing, refining, and/or evaluating new or existing methods and approaches
that can inform the PCORI national priorities.
Developing, testing, and/or refining existing methods for bringing together patients,
caregivers, and other stakeholders in all stages of a research process.
Developing, refining, testing, and/or evaluating patient-centered approaches, including
decision-support tools, for translating evidence-based care into health care practice in
ways that account for individual patient preferences for various outcomes.
Developing, refining, testing, and/or evaluating methods to identify gaps in CE knowledge
such as tools collecting and assessing patient- and provider-perceived gaps.
Identifying, testing, and/or evaluating patient-centered outcomes instruments.
Identifying, testing, and evaluating methods that can be used to assess the patient
perspective when researching behaviors, lifestyles, and choices.
Identifying, testing, refining and/or evaluating methods for studying the patient care team
interaction in situations where multiple options exist.
Advancing analytical methods for CER
27. Option 1: Qualities of Proposed Slate
Applications with a priority score of 25 or better and
ensured the inclusion of all applications in the top two
of each review panel. This resulted in 50 applications.
Underserved PopulationsAreas of Interest*
Stakeholder Engagement Scores
68%
Yes
Chronic Condition 7 14%
Mental Health 5 10%
Cardiac 4 8%
Cancer 3 6%
These conditions
and focuses are
those with the
highest
representation.
2
2
19
0
12
4
6
7
A1
A2
A3
A4
A5
A6
A7
A8
Conditions Categories
4 4
2
9
0
2
4
6
8
10
Pediatric Aging Disabled Racial/Ethnic
Group
Score = 1 11 22%
Score = 2 32 64%
Score = 3+ 7 14%
Balance
Balance
Balance
Balance
Costs: Year 1--$15,843,724; Year 2--$15,005,483
The highest representation is Area 3 at 38%
28. Option 1: Balancing
Option 1 takes the applications with a priority score of 25 or better and ensures
at least the top two applications from each panel are included. This option
yields 50 applications and has only one balancing issue:
Issue: Area of Interest 4--There are no applications within this slate with that
designation as a primary area of interest.
Developing, refining, testing, and/or evaluating methods to identify gaps in CE knowledge such as
tools for the ongoing collection and assessment of gaps as perceived by patients and providers. Of
special interest are gaps that are particularly relevant to vulnerable populations, including but not
limited to, low-income populations; underserved minorities; children; the elderly; women; and
people with disabilities, chronic, rare, and/or multiple medical conditions.
Balancing Recommendation: There are no applications within the top 80
that have this designation as a primary area of interest. The committee
recommends we not balance on this area and propose it be a focus in one of
the new PFA’s or use a contract mechanism to address.
29. Option 2: Qualities of Proposed Slate
Underserved populationsAreas of Interest*
Stakeholder Engagement Scores
These conditions
and focuses are
those with the
highest
representation.
1
2
16
0
7
3
4
6
A1
A2
A3
A4
A5
A6
A7
A8
Mental Health 5 13.51%
Chronic Condition 4 10.81%
Cancer 3 8.11%
Conditions and Focus Categories
3 3
2
7
0
2
4
6
8
Pediatric Aging Disabled Racial/Ethnic
Group
Score 1 9 24%
Score 2 24 65%
Score 3+ 4 11%
Balance
Balance
Balance
Balance
Costs: Year 1--$11,803,263; Year 2--$10,944,425
The highest representation is Area 3 at 43%
To remain as close to 40 grants (the number approved
by the BoG), applications with a priority score of 24 or
better were selected and ensured the inclusion of the
top application in each review panel. This resulted in
37 applications.
30. Option 2: Balancing
To remain as close to 40 grants (number approved by the BoG), option 2 takes applications
with a priority score of 24 or better and ensured the inclusion of the top application in each
review panel. This resulted in 37 applications.
1. Issue: Area of interest 4— This is the same issue encountered under Option 1.
Recommendation: This issue should be handled in the same way as in Option 1.
2. Issue: Area of interest 1—There is only 1 application within the slate that addresses this
area.
Developing, testing, refining, and/or evaluating new or existing methods (qualitative and quantitative) and
approaches that can inform the process of establishing and updating national priorities for the conduct of
patient-centered outcomes research (PCOR). This may include research prioritization approaches (such as Value
of Information (VOI), burden of illness, peer review/expert opinion/Delphi approaches) or methods for
incorporating the perspectives of patients or other stakeholders into the development of national priorities.
Recommendation: To add an additional application with a primary area of interest of 1,
the committee looked within those applications with a priority score of 25. Within that
group there is one application with a primary area of interest of 1.
31. Geographic Distribution
AK 1
AR 1
AZ 1
CA 6
CO 2
CT 1
DC 1
FL 1
IA 1
IL 1
MA 5
MD 1
MD 1
MI 1
MN 1
MO 1
NC 3
OH 2
PA 3
RI 1
TN 1
VA 1
WA 1
AK 1
AR 1
AZ 1
CA 8
CO 3
CT 1
DC 1
FL 1
GA 1
IA 1
IL 1
MA 8
MD 3
MI 2
MN 1
MO 1
NC 3
NY 1
OH 2
PA 4
RI 1
SC 1
TN 1
VA 1
WA 1
Option 1 Option 2
32. Discussion and Voting
Selection Committee
Recommendation
• The committee recommends the Board vote for Option 1 and that
we not try to balance on Area 4.