This document summarizes a PCORI pilot project that aimed to develop methods for identifying health outcomes that are important to children and their parents. The project had three main aims: 1) Develop a typology of health outcomes from various sources including patients and clinicians; 2) Ensure the typology is comprehensible to patients and clinicians; 3) Develop and test methods for prioritizing outcomes based on patient input, using autism as a test condition. Challenges included effectively engaging patients and researchers in the process. The project produced an outcomes typology in both clinical and lay terms and methods for identifying patient-centered outcomes priorities.
Evidence based practice (EBP) in physiotherapy Saurab Sharma
This presentation is the classroom lecture for undergraduate physiotherapy students whom I teach at Kathmandu University School of Medical Sciences in Nepal. This is an introductory lecture. Students carry on with steps of EBP in the years to come during the student life and use it for their presentations and clinical learning placement.
Other students too may benefit. I highly encourage other students, especially in some parts of India where EBP is not taught, and is reserved for Master's degree program. I completely disagree with this concept, as EBP is the pillar of a responsible physiotherapy practice. Early it starts, better it is.
Closing the Loop on Clinical Competency Based AssessmentsExamSoft
Presented by Karen Bobak, DC, EdD, Dean of Chiropractic, and Wendy Maneri, MS, DC, Associate Dean of Chiropractic Clinical Education and Health Centers, of New York Chiropractic College, discussed ways to effectively assessing student competency in a clinical setting is an essential element in professional healthcare education.
Effectively assessing student competency in a clinical setting is an essential element in professional healthcare education. Moreover, the use of assessment data to improve student learning is essential in order to meet program goals, professional standards, and provide quality patient care. Examples of strategies used to develop and implement a process of assessment / analysis / communication and change will be shared. Participants will be encouraged to develop a process framework while considering the challenges and opportunities that exist within their programs.
Evidence based practice (EBP) in physiotherapy Saurab Sharma
This presentation is the classroom lecture for undergraduate physiotherapy students whom I teach at Kathmandu University School of Medical Sciences in Nepal. This is an introductory lecture. Students carry on with steps of EBP in the years to come during the student life and use it for their presentations and clinical learning placement.
Other students too may benefit. I highly encourage other students, especially in some parts of India where EBP is not taught, and is reserved for Master's degree program. I completely disagree with this concept, as EBP is the pillar of a responsible physiotherapy practice. Early it starts, better it is.
Closing the Loop on Clinical Competency Based AssessmentsExamSoft
Presented by Karen Bobak, DC, EdD, Dean of Chiropractic, and Wendy Maneri, MS, DC, Associate Dean of Chiropractic Clinical Education and Health Centers, of New York Chiropractic College, discussed ways to effectively assessing student competency in a clinical setting is an essential element in professional healthcare education.
Effectively assessing student competency in a clinical setting is an essential element in professional healthcare education. Moreover, the use of assessment data to improve student learning is essential in order to meet program goals, professional standards, and provide quality patient care. Examples of strategies used to develop and implement a process of assessment / analysis / communication and change will be shared. Participants will be encouraged to develop a process framework while considering the challenges and opportunities that exist within their programs.
Decide treatment - a new approach to better healthØystein Eiring
Better treatment, better health! People often experience suboptimal health because treatment is not optimal. A new approach is being developed - enabling patients and doctors to improve treatment and improve health.
What is implementation science and why should you careLisa Muldrew
This seminar will discuss the emerging field of implementation science with a focus on its application within clinical settings. Topics will include an overview of implementation science, how implementation science is positioned within the translation continuum, common conceptual models and analytic frameworks used in implementation science and a study example.
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.
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
Clinical research is quite vital in the field of physiotherapy. Physiotherapists depends on information from researches to enhance the knowledge they have already gained through their university education and with continuous education courses.
The lecture presents skills and requirements of the initial interview in dental clinic, how could dentist gain patient rapport and patient's required information to reach diagnosis also identifying pits and errors of initial interview
Decide treatment - a new approach to better healthØystein Eiring
Better treatment, better health! People often experience suboptimal health because treatment is not optimal. A new approach is being developed - enabling patients and doctors to improve treatment and improve health.
What is implementation science and why should you careLisa Muldrew
This seminar will discuss the emerging field of implementation science with a focus on its application within clinical settings. Topics will include an overview of implementation science, how implementation science is positioned within the translation continuum, common conceptual models and analytic frameworks used in implementation science and a study example.
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.
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
Clinical research is quite vital in the field of physiotherapy. Physiotherapists depends on information from researches to enhance the knowledge they have already gained through their university education and with continuous education courses.
The lecture presents skills and requirements of the initial interview in dental clinic, how could dentist gain patient rapport and patient's required information to reach diagnosis also identifying pits and errors of initial interview
Selection of the Problem pg 13One of the most difficult tasks co.docxbagotjesusa
Selection of the Problem pg 13
One of the most difficult tasks confronting the beginner is to select a researchable problem. More often than not, the newcomer has a proclivity to tackle an exotic issue, thus making the problem either too broad or too narrow in scope. Some factors that should be involved in the ultimate selection are listed here (Bailey, 1994):
1. Interest: The researcher should be interested in pursuing the problem area. The problem should be related to the background and career interests of the student, and in pursuing the problem the student should develop useful skills for the future.
2. Operability: The nature of the problem should be such that the researcher has both the resources and the time available to complete the subject.
3. Scope: While the research problem should not attempt to solve all the health dilemmas of the world, neither should it be so small as to negate the variables necessary for adequate results.
4. Theoretical and practical values: The research should contribute to the health field, perhaps through publication, and be of benefit to health practitioners.
5. Health paradigm: This is the school of thought or model employed by the researcher as discussed in an earlier chapter (Chapter 1).
6. Values of the researcher: The myth of value-free research is just that, a myth. The student of research should be aware that in addition to being unstable, values may prejudice the research effort to the degree that all objectivity is lost. Note that even the selection of a problem is value-laden.
7. Research methodology: Every researcher has a philosophy of research that affects procedure. Thus, the student must be certain that hypotheses are well written and that appropriate criteria are used to interpret the data to reach conclusions.
8. Reactivity: The method of data collection should be scrutinized for reactivity. That is, a reactive technique brings about a reaction on the part of those being studied in a way that affects that data. The reactive effect is commonly labeled the “Hawthorne effect” from the study of the Hawthorne Plant of the Western Electric Company in Chicago, where it was found that worker productivity increased simply because the personnel were being observed.
9. Unit of analysis: In health research, the unit of analysis may be an individual (such as the health habits of a single anorexic patient) or an entire population (patterns among the hospital anorexic population). The researcher must ascertain which is most appropriate and whether resources are available to collect data.
10. Time frame: This is particularly important to the student because only a limited amount of time is usually available. In a cross-sectional study aparticular population is involved at a single point in time; in a longitudinal time frame, data are gathered over an extended period of time (such as months or years).
11. Budget: To ensure that your proposal is feasible, write up a budget for expensive items. These items m.
EVIDENCE-BASED PRACTICE IN NURSING.docxHaraLakambini
-Evidence-based Practice in Nursing
-Steps of Evidence-Based Practice
-Hierarchy of Evidence | Quantitative Questions
-Elements of Evidence-Based Practice
-Nursing Research
-Types of Research
-Rights of Human Subject
-Comparison of Nursing Process with Research Process Table
-Performance Improvement in Nursing
-Examples of Performance Improvement Models
-Relationship between Evidence-Based Practice, Research, and Performance Improvement
-Similarities and Differences among Evidence-Based Practice, Research, and Performance Improvement
evidence based practice that hlps in you reasarch and ease you in reaseach practice. in this presentation many things are given which you learn n your research article.
. Evidence-based dentistry (EBD) is the integration and interpretation of the available current research evidence, combined with personal experience. It allows dentists, as well as academics researchers, to keep update of the new developments and to make decisions that should improve their clinical practice.
Chnaging trends in Medical Education Oct 23.pptxRajan Duda
Teaching : Latest concepts in medical education
how best to optimize medical education
new trends in undergraduate and post graduate teaching in pediatrics
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.
The slide presentation from PCORI'S Advisory Panel on Assessment of Prevention, Diagnosis, and Treatment Options April 28-29, 2014 meeting in Alexandria, VA.
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.
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.
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
- 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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. K ATHE RI NE B . B E VAN S
AMY K RATC HMAN
C HRI STOP HE R B . FORRE ST
C HI LDRE N’S HOSP I TAL OF P HI LADE LP HI A
UN I VE RSI TY OF P E N N SY LVAN I A
SUCCESSES AND CHALLENGES IN ENHANCING
PATIENT ENGAGEMENT
DEVELOPMENT OF METHODS FOR IDENTIFYING CHILD
AND PARENT HEALTH OUTCOME PRIORITIES
2. ADVANCES IN PATIENT-REPORTED OUTCOME
MEASUREMENT AND ADOPTION
• NIH Initiatives: Patient-Reported Outcome (PRO)
Measurement Information System® (PROMIS), Neuro-
QoL, NIH Toolbox
• Provides qualitative and quantitative standards for
demonstrating the reliability, validity, sensitivity, and efficiency
of PRO measurement tools.
• Food and Drug Administration guidance
• Integration into EPIC
• Increasing adoption in clinical research and practice
3. A MISSING PIECE…
• Usually, outcomes are selected without sufficient
patient input
• Precludes assessment of the full spectrum of patient concerns
• May lead to identification of “best practice” interventions that
have little or no effect on the outcomes that matter most to
children and parents
• Core sets = the “minimal standards” for the
assessment and reporting of outcomes in clinical
studies and encounters
• Usually comprised of outcomes identified by researchers and
clinicians
• Some attempts to obtain patient input through qualitative
means (e.g., focus groups)
4. CHILDREN WITH AUTISM SPECTRUM DISORDERS:
COMMONLY EVALUATED PRO’S VS. PARENT-
IDENTIFIED OUTCOME PRIORITIES
Behavioral and
emotional inhibition
and control
Sensory regulation
Restricted interests,
flexibility, and
adaptation
Stereotyped
behavior
Energy level
Externalizing
behavior
problems
Interpersonal
communication
Anxiety
PRO Parent-Identified
5. PURPOSE OF PCORI PILOT PROJECT
• To develop and evaluate novel methods for eliciting
and prioritizing children’s health outcomes that are:
• Comprehensible to both patients and clinicians
• Measureable
• Ready for integration into comparative effectiveness research
• Focused on six of the most common childhood
conditions: ASD, ADHD, epilepsy, JIA, asthma, obesity
6. OUR TEAM
Patient Advisors (6)
Scientific Advisors (3)
Researchers
Bevans +3
Patient-Scientists
Kratchman +3
Harmonization
Concept
Validation
Patient
Understanding
Prioritization
CORES: Co-directed by a researcher
and a patient-scientist
Patient Advocacy
and Support Groups
7. CHALLENGES AND LESSONS LEARNED:
DEVELOPING THE TEAM
• Inclusion of “representative” patients
• Recognize and respect varying levels of patient
engagement
• Related to patients’ readiness to engage as a patient-scientist
• Reasons for readiness = personal journey, experience,
confidence…
• Researchers’ readiness to adopt the PCOR model
• Power and team structure
• Communication: Learning the language vs. using a
translator
• Consider researchers’ and stakeholders’ unique and
complementary expertise in assigning roles and
responsibilities
8. AIM 1: DEVELOP A TYPOLOGY OF HEALTH
OUTCOMES
ICF-CY,
PRO
concepts,
NCS
Intervention Research
Outcomes (Systematic
Literature Review)
Clinician-Identified
Outcomes
Child- and Parent-
Identified Outcomes
Focus on six common childhood conditions: ASD, ADHD,
epilepsy, asthma, JIA, obesity
9. AIM 1: DEVELOP A TYPOLOGY OF HEALTH
OUTCOMES
ICF-CY,
PRO
concepts,
NCS
Intervention Research
Outcomes (Systematic
Literature Review)
Clinician-Identified
Outcomes
Child- and Parent-
Identified Outcomes
Focus on six common childhood conditions: ASD, ADHD,
epilepsy, asthma, JIA, obesity
Researcher-
Driven
10. Develop Controlled
Vocabulary
Condition-Specific AND
Measurement AND Self/Proxy-
Report
Limited to Children
Execute Search
PubMed
3189 articles
Identify Unique Article
Remove Duplicates
2865 articles
Abstraction of Articles
In-Scope
201 ASD articles (19%)
309 ADHD articles (39%)
292 epilepsy articles (29%)
Identification of Tools
40 ASD tools
36 ADHD tools
28 epilepsy tools
Obtain Tools
32 ASD tools
31 ADHD tools
24 epilepsy tools
Examine and Classify Items until
Concept Saturation is Achieved
1592 ASD items
698 ADHD items
Epilepsy items (TBD)
IDENTIFYING COMMONLY ASSESSED OUTCOMES
SYSTEMATIC LITERATURE REVIEW
11. TYPOLOGY MAPPING:
VINELAND SOCIALIZATION
SCALE
Most commonly assessed ICF-CY categories:
b126: temperament and personality functions
d125: disposition and interpersonal functions
b125: emotional functions
d710: basic interpersonal interactions
d720: complex interpersonal interactions
d750: informal social relationships
d330: speaking
d880: engagement in play
d920: recreation and leisure
12. AIM 1: DEVELOP A TYPOLOGY OF
HEALTH OUTCOMES
ICF-CY,
PRO
concepts,
NCS
Intervention Research
Outcomes (Systematic
Literature Review)
Clinician-Identified
Outcomes
Child- and Parent-
Identified Outcomes
Focus on six common childhood conditions: ASD, ADHD,
epilepsy, asthma, JIA, obesity
Patient-Scientist
Driven
13. ASSESSING CHILD AND PARENT
PERSPECTIVES
What problems
would you like
your child’s
treatment to
address?
How would you
like your child’s
treatment to
improve his/her
life?
A lot of research
involving children with
asthma focus on
symptoms like difficulty
breathing, but asthma
impacts kids in other
ways too. How does
your child’s asthma
impact his/her life?
How would you like
that to change?
(Probe specific life
domains: at school, with
friends, how he/she
communicates, etc.)
• Preference for
positive focus
• “Treatment”
facilitates focus
on symptomatic
outcomes
• Need to be
specific about
condition
• Consider impact
on family, not just
the child
Participants: Youth aged 12+ with six conditions and their parents;
two in-person and two online data-collection modalities
14. AIM 1 PRODUCT
Outcome typology derived from patients (parents
and youth), clinicians, and a review of the
intervention research
15. CHALLENGES AND LESSONS LEARNED: AIM 1
• Empower patient-scientists to lead development of
methodology
• Methods for accessing
and engaging patient
partners to elicit patient-
centered outcome
priorities
Data Quality
Access Feasibility
Acceptability
Network
Barriers:
Geography
Sample Bias Cost
16. AIM 2: ENSURE THE COMPREHENSIBILITY AND
CONTENT VALIDITY OF THE TYPOLOGY
e-Delphi with clinicians
Round 1: Open-ended elicitation
of outcome concept definitions
for clinicians and patients
Rounds 2 and 3:
Rate each outcome definition:
• Clinician understanding
• Patient understanding
Suggest revisions
2x
Cognitive Interviews with
youth and parents
Development of clinician
and patient outcome
definitions
Revisions
Test patient-centered outcome
definitions using a cognitive
interview approach
Iteratively refine
and re-test until
definitions are well-
understood
Outcomes defined in BOTH clinician-
oriented and lay language
17. AIM 2 PRODUCT
Typology with outcomes defined in clinician-oriented
and lay language.
Uses:
• To translate and standardize the dialects that health professionals
and patients use to describe health experiences
• As a substrate for the outcome prioritization process
18. CHALLENGES AND LESSONS LEARNED: AIM 2
• Communication: Learning the language vs. using a
translator
• Use the expertise of patient-scientists
• Capitalize on clinicians’ experience in communicating with
patients
• Commitment to developing a replicable and
scalable approach to identifying patient-centered
outcomes (rather than a product)
19. AIM 3: DEVELOP AND TEST METHODS FOR
OBTAINING PATIENT-OUTCOME PRIORITIES
• Test two technology-enabled methods for prioritizing
patient outcomes
• Method 1: Individually administered
• Participants (youth with ASD and parents of children with ASD)
are asked to choose between two outcomes (with patient
definitions).
• Outcome ratings are determined by analyzing results of the
pair-wise comparisons using analytic hierarchy processes.
• Method 2: Administered in groups of similar
participants
• Participants rate the importance of each outcome using an
audience response system.
• After each question, response frequencies are shown in real-
time to the group to facilitate discussion.
20. AIM 3 PRODUCT
A scalable approach to identifying patient-prioritized
outcomes
Uses:
• To establish “patient-centered” core sets for use in clinical
research involving specific sub-groups (e.g., diagnostic,
capacity, age)
• For further testing in clinical settings as a means for identifying
individual patient’s outcome priorities
21. AIM 3: ANTICIPATED CHALLENGES AND
FUTURE DIRECTIONS
• Selecting an outcome prioritization approach that is
understandable, is feasible, and yields meaningful
results
• Promote approaches for developing “patient-
centered core sets”
• Patient prioritization of outcomes included in PRO
development recommendations/standards
• Sustain the patient-scientist network
• Involve patient-scientists in interpretation of results and
dissemination efforts
• Strengthen and deepen engagement
23. PCORI PILOT PROJECTS
Aims
1. To develop a typology of health outcomes that is
relevant to the experiences and preferences of
children.
2. To ensure the comprehensibility of the health
outcome typology for children and their parents.
3. To develop and test the feasibility and
practicality of methods that use the typology to
prioritize health outcomes from the perspectives
of children and their families, using Autism
Spectrum Disorder as a proof-of-principle
condition.
24.
25. Patient and Clinician
Perceptions of Engagement in
Research
1
Laura Forsythe, PhD, MPH
AcademyHealth Annual Research Meeting
June 25, 2013
26. Improved research recruitment and retention rates
(Edwards et al. 2011)
Enhanced trust between researchers and participants
(Decker et al. 2010; Edwards et al. 2011; Staniszewska et al . 2007)
Improved content and construct validity of measures
(Cashman et al. 2008; Cotterell 2008)
Improved patient understanding of results
(Chalmers 1995; McCauley et al. 2001; Doyle 2010)
Increased relevance of research results to patients
(summarized in Nass et al. 2012)
Patient Engagement in Research
27. Objectives
Describe and compare patient and clinician
attitudes about engagement in research
Identify perceived barriers to and facilitators of
engagement in research
3
29. Methods: Survey Development
5
Identify Existing
Survey Items
Develop New
Survey Items
• Perceived value of
engagement
• Interest in engagement
• Barriers and facilitators
for engagement
Partner with Patients
and Clinicians for
Feedback
• Survey concepts
• Item wording
• Survey layout
• Dissemination
30. Methods: Crowdsourced Survey
Recruitment from existing opt-in panels based on
pre-supplied profile information
Web based survey
Rapid data collection
Limited generalizability
6
33. Respondents: Primary Care Clinicians
(N=750)
9
53%
27%
12%
8%
Type of Provider
Physicians
Nurse Practitioners
Nurses
Physician Assistants
7%
23%
35%
25%
10%
Years in Practice
< 3 Years
3 to 9 Years
10 to 19 Years
20 to 29 Years
>30 Years
35. Perceived Value of Research that Measures
Things Patients Care About
11
87% 87%
0%
20%
40%
60%
80%
100%
Patients Clinicians
%Very/ModeratelyImportant
Survey Group
p>0.05
37. Perceived Value of Engaging Patients in
Research
13
86%
72%
83%
0%
20%
40%
60%
80%
100%
CliniciansCliniciansPatients
%Strongly/SomewhatAgree
Survey Group
*p<0.001
“Patients working directly with
researchers can improve the
value of medical research”
38. Perceived Value of Engaging Clinicians in
Research
14
86%
72%
83%
0%
20%
40%
60%
80%
100%
CliniciansCliniciansPatients
%Strongly/SomewhatAgree
Survey Group
*p<0.001
“Patients working directly with
researchers can improve the
value of medical research”
“Providers working directly with
researchers can improve the
value of medical research”
39. Interest in Engaging in Research
15
66%
55%
0%
20%
40%
60%
80%
100%
Patients Clinicians
%Strongly/SomewhatAgree
Survey Group
*p<0.001
40. Barriers and Facilitators of Engagement
16
Barriers Facilitators
Patients
• Lack of time (43%)
• Concerns about privacy
(36%)
• Work, school or caregiving
commitments (33%)
• Helping others with their medical condition
(68%)
• Learning about their health (63%)
• Helping the next generation (57%)
• Getting paid (56%)
• Making research more meaningful to
patients (49%)
Clinicians
• Lack of time (79%)
• Lack of payment (47%)
• Lack of research training
(35%)
• Helping patients receive better care (79%)
• Getting paid (78%)
• Contributing to scientific knowledge (61%)
• Making research more meaningful for
patients (61%)
• Improving professional satisfaction (52%)
• Helping researchers decide what to study
(43%)
41. Strengths and Limitations
Strengths
Exploration of understudied topic areas
Inclusiveness of understudied populations: Spanish
speakers, rare-disease patients
Limitations
Generalizability
Self-reported data
New survey items testing complex constructs
17
42. Conclusions
Most patients and clinicians agreed that
engagement can improve the value of health
research.
Many patients and clinicians reported interest in
engaging in research themselves.
Strategies to facilitate both patient and clinician
engagement:
Establish link between engagement and patient care.
Provide financial compensation.
Minimize time burden.
18
43. Implications
Find ways to help those who are interested in
engaging in research to be involved in meaningful
ways.
Develop evidence on the value of engagement in
research, particularly for improving patient
outcomes.
Address barriers to engaging patients and primary
care clinicians in research.
19
44. Next Steps
20
Foundational Elements
• Awareness of methods for PCOR
• Valuing patient perspective
• Interest in PCOR
• Ways for patients and researchers to partner
• Resources and infrastructure
• Policies/governance
45. Thank you!
Acknowledgements
Patient, caregiver, and clinician partners
Collaborators: Lori Frank, Kara Odom Walker, Diane
Hayes, Sue Levine, Ayodola Anise, Natalie Wegener,
Gail Hunt, Anne Beal, Harlan Weisman, Freda Lewis Hall
Laura Forsythe, PhD, MPH
lforsythe@pcori.org
www.pcori.org
21
47. Understanding
the choices
patients face
Aligning research questions
and methods with
patient needs
Providing patients and
providers with information
for better decisions
Patient Engagement
Patient-Driven
Research Dissemination
Taking Patient-Centeredness Seriously
48. Research engagement
Who determines
The research questions?
The database to use?
The variables to examine outcomes,
comparators, and covariates?
The analytic methods?
Who is on the research team?
Patients or patient advocates?
Other stakeholders?
What will the research team do with the information?
How will results apply to health decisions?
Is there a plan for interaction between researchers and the
community?
49. Frameworks for PCOR
Identify PCOR concepts and relationships between
them
Identify key components of PCOR and role of
engagement
Theoretical and evaluative frameworks:
One conceptual model for PCOR
A distinct measurement model
50. PCORI Conceptual Model of PCOR
Process for development informed by:
Evaluative framework of research engagement
(AcademyHealth)
Review of PCOR literature
Refined and vetted through:
Discussion with AcademyHealth
Input from PCORI’s Patient Engagement Advisory Panel
51. PCOR conceptual model
The following key changes were made based on
discussion with the patient engagement advisory
panel:
TBD
TBD
Final structure: PCOR conceptual model
Use as basis for deriving testable measurement models.
52. Foundational Elements
• Awareness of methods for PCOR
• Valuing of the patient perspective
• Interest in PCOR
• Ways for patients and researchers to partner
• Resources and infrastructure
• Policies/governance
Actions
• Initiate and maintain partnerships
between researchers and stakeholders
• Facilitate cross-communication among
research stakeholders
• Capture, use, and optimize patient
perspective across phases of research
• Ensure meaningful influence on
research
• Train for partnering
• Share and use learnings
Outcomes
PCOR Principles
Trust, Co-learning, Transparency, Respect
• Culture of patient-centeredness
in research
• Meaningful & effective
partnerships
• Optimal health outcomes
• Research relevant to
patients/other stakeholders
• Use of research results in
health decisions
• Quality health decisions
• Satisfaction with health care
experiences
Conceptual Model for PCOR
Outcomes
Near-term
Long-term
Intermedia
53. AcademyHealth and PCORI Partnership
Contract awarded in 2012 to:
Conduct literature scan on stakeholder engagement in
research (manuscript in progress)
Develop framework for patient engagement in research
Establish learning network for 50 PCORI pilot projects
Monitor progress and experiences of PCORI pilot
projects in key areas
8www.pcori.org
54. PCORI Pilot Projects Program
50 projects in 24 states and Washington, DC
$31 million (over two years)
www.pcori.org 9
55. AcademyHealth Approach
Framework for patient and consumer engagement
in research:
Literature scan
Initial framework draft (input from PCORI staff)
Three iterations of input from Consumer Patient
Researcher Roundtable
Revision and augmentation ongoing
56. Evaluative Framework for Patient
Engagement in Research
Key Attributes
Intended for use as evaluative tool
Based on Donabedian model
Agnostic with respect to entity “sponsoring” research
effort
Inclusive definition of the term “patient”
Acknowledges how much remains to be learned about
how to conduct PCOR
57. Evaluative Framework for Patient
Engagement in Research
Key Components:
Structure: refers to existence of assets, policies, and
other infrastructure deemed necessary for conduct of
PCOR
Process: examines how patient engagement is
incorporated or integrated into research process
Outcomes: near and longer-term end points of patient
engagement in research (such as improvement in
research design, health outcomes)
59. Increased quality
and/or relevance of
research
More informed
decision making and
uptake of research
Improvements to
dissemination and
access to research
Policy
deliberations/changes
Improvements in
patient activation and
empowerment
Improvements in
health outcomes and
health status
Outcomes
Attitudes,
perceptions, and
activation
Modifications to
research process
Interim
Outcomes
Longer-term
Outcomes
60. Next Steps
Anticipated:
Still a work in progress, so welcome questions,
suggestions, and other feedback
Developing manuscript for peer review
Hoped:
Would like the framework to be used as a guidance tool
for those engaged in PCOR
• Not a prescriptive “how to”
61. Thank You!
Consumer Patient Researcher Roundtable
Contributors: Bryan Dowd, Jason Goldwater,
Mark Gorman, Alice Leiter, Musa Mayer, Eva
Powell, John Santa, Shoshanna Sofaer, and Mike
Stoto
AcademyHealth and PCORI Staff: Rochelle Bent,
Laura Esmail, Laura Forsythe, Lori Frank, Emily
Moore, Raj Sabharwal, Veronica Thomas, Rachel
Witsaman, and Natalie Wegener
62. Improving the Impact of Patient-Engaged
Research: Recommendations for
Evaluation
Lori Frank, PhD and Sue Sheridan, MIM, MBA
AcademyHealth Annual Research Meeting
June 25, 2013
63. October 2012
Transforming Patient-Centered Research:
Building Partnerships and Promising Models
Workshop purpose: Begin a dialogue on how to conduct
patient-centered research.
Input received was used by PCORI staff to develop policy
and programmatic recommendations.
2
64. Workshop Structure
The two-day event included 142 representatives from a
range of communities.
75% of participants were patient representatives.
Other participants: clinicians, providers, researchers
Small group brainstorming sessions
3
65. Breakout Session Topics
4
Identifying and Selecting
Research Questions
How should PCORI identify and select specific research
questions that are patient-centered for funding ?
Reviewing Research Proposals
for Funding
How can PCORI effectively engage and use the real-world
experience of patients to help evaluate research
proposals we receive?
Matching Patients and
Stakeholders with Researchers
How can PCORI connect patients and stakeholders with
researchers for collaborative work that ensures studies
reflect patient perspectives?
Disseminating Research to the
Community
How do we ensure that patients and those who care for
them can access and use PCORI’s research to make more-
informed decisions?
Evaluating PCORI’s Patient and
Stakeholder Engagement
Programs
How can PCORI measure the effectiveness of its programs
to involve patients and stakeholders throughout its work?
66. Evaluating Engagement Session:
Questions for Consideration
Participants were asked to consider:
How can PCORI best measure the effectiveness of
patient and stakeholder engagement in research?
What novel methods can patients and patient advocates
propose for evaluation of research engagement that
would capitalize on the growing networks of patients
engaged in research?
5
68. Nominations for
Principles of Engagement
Transparency Empathy
Infrastructure
change to achieve
parity between
researchers and
patients
Incorporating
learning in an
ongoing way
Aiming for
excellence in
engagement
Evaluating the
meaningfulness,
quality, and impact
of the engagement
69. Recommendations for Evaluating
Engagement in Research
• The objective for engaging patients and researchers as partners in research may be study-
specific, but must be pre-defined to permit adequate evaluation of the partnership.
Define Success
• Topic generation will require different forms of engagement than will establishing research
hypotheses or analyzing data and reporting findings.
Determine goals of engagement by research phase
• Use to ensure that all research partners can provide input on the quality and value of the
research engagement, using established metrics based on definitions of success.
Establish feedback channels
• Including compensation for patient time and co-authorship
Address patient and researcher parity
• Assessments should happen before and after engagement.
Assess patient and researcher perceptions of the value and
appropriateness of engagement
8
70. Items for Evaluating
Engagement in Research
Stakeholders: How did engagement in the research change
the project?
Has your PCORI-funded project been used by other research
groups?
Was there a successful outcome for your study? Does it relate
to quality of patient engagement?
Are people voting with their feet?
Was the research idea collaborative?
How quickly are results being used in further research and in
clinical care?
Additional metrics should include both subjective and
objective measures of quality of engagement.
9
71. Process Recommendations for Evaluation
Funding applicants should be asked to build an evaluation
of patient engagement into their proposals for the
conclusion of their studies.
Dissemination metrics: Go beyond peer-review.
Evaluate quality and impact of engagement during and after
the study.
Evaluate diversity of project participants.
Consider linking funding to evaluation results,
10
72. Recommendations for Strengthening
Engagement in Research
Incentivize co-learning between researchers and
patient partners.
Organizational structures of health systems and
research organizations should include patient research
experts.
“Seal of Approval” recognition of optimal research
engagement methods
Require it: Evaluate engagement in all PCORI funded
projects.
11
73. Conclusions
Patients and other stakeholders provided concrete and
feasible recommendations for evaluating quality of
engagement in research.
Metrics for success should be linked to quality of
research and quality of engagement.
Different metrics are needed by research phase.
Organizational structures and funding requirements
can be powerful levers for ensuring engagement
quality.
12
74. Implications for Policy, Delivery, and
Practice
Meaningfulness and impact of the research should be
measured and link to engagement quality made overt.
Research organizational structures can be modified to
support success.
13
75. Thank You!
14
Patient, caregiver, and clinician partners
Contact:
Lori Frank, PhD
lfrank@pcori.org
Sue Sheridan, MIM, MBA
ssheridan@pcori.org
76. Engaging Stakeholders to
Improve Depression
Management in a Tribal
Health System
1
Renee Robinson (PI)
Jennifer Shaw
Vanessa Hiratsuka
Sara Norman
Julia Smith
Denise Dillard
Southcentral Foundation
Helene Starks
University of Washington
77. Presentation Objectives and
PCORI Pilot Project Overview
• Familiarize audience with…
• Organization, population, and stakeholders
• Depression management at our organization
• Decision-support tools
• Stakeholder engagement
• Approval versus engagement
• Impact of engagement on process/project
• Barriers encountered/proposed solutions
2
78. Southcentral Foundation (SCF)
• Mission
– Working together with the
Native Community to
achieve wellness through
health and related services
• Vision
– A Native Community that
enjoys physical, mental,
emotional, and spiritual
wellness
3
79. Population
• SCF provides services to…
– ~60,000 AN/AI people
– Across 107,413 square miles
– 231 federally recognized tribes
– 60 villages
4
81. Depression Management
at SCF
• In 2001, SCF integrated
annual depression
screening into all
primary care clinics due
to:
– High prevalence of
symptoms
– Low utilization of
behavioral health
services
6
82. To make a good healthcare decision,
you need to…
• Clarify the decision…
– What is the decision you
need to make?
– What is your reason for
making this decision?
– Look at timeline for the
decision.
• Explore the decision…
– What healthcare options
are available to you?
– What are positive and
negative effects of
options?
– What is the value of the
positive and negative
effects to you? (Explore
your decision.)
7
83. Decision-Support Tools
• Interactive tool to aid clinical decision-making
• Describe treatment options, risks, benefits, and efficacy
• Help clarify preferences and values for treatment options
• Communication between customer-owners and providers
• Facilitate improved depression management
– Educational
– Interactive
– Selective
8
84. Pilot Project
• Background and Rationale…
– Many people don’t pursue depression treatment
• Negative effects of untreated illness (e.g., absenteeism)
– Many people prematurely discontinue treatment
• Wasted resources of healthcare system (e.g., unused Rx)
– Few people prefer holistic depression treatment
• Under-utilized services
9
85. Project Aims and Overview
10
Aim 1
• Identify stakeholder priorities, preferences,
and needs for depression management
• Key informant interviews with customer-
owners, providers, and leaders
Aim 2
• Develop and evaluate decision-support
tool
• Steering committee guidance and feedback
• Pilot test in one primary-care clinic
Aim 3
• Evaluate health and economic outcomes
• Test refined tool in multiple clinics
• Evaluate disease management, economic, and
health outcomes
86. Stakeholder Engagement:
Aim 1
• Data Collection
– 38 stakeholder interviews conducted Dec to Feb
• 19 Customer-Owners, 9 Leaders, 10 Providers
– Semi-structured interview guide
• Depression screening and treatment resources
• Decision-tool content, design, and deployment
• Analysis
– Transcripts summarized
– Themes identified
– Synthesized information presented to Steering Committee
• Used to guide tool development
11
87. Deciding on Drug Therapy
12
I didn't even realize that I was
depressed for a long time. I thought
everyone felt this way; at least,
everyone in my family seemed to. I
probably would have just gone on
like that if my doctor hadn't asked
one day if I had ever thought about
taking an antidepressant. I was
relieved to find out that it isn't
normal to feel like I do and that a lot
of people are helped by medicines. I
know it might take a while to find
the right one, but I'm in no hurry;
I've spent my whole life feeling sad.
I guess I'm just not comfortable with
taking medicine for my depression. I feel
like I ought to be able to manage this on
my own without needing medicine. It
seems too much like taking the easy route.
But maybe I just don't feel bad enough yet.
I recently began going to counseling. I
know that if I took an antidepressant, I
might feel better sooner, but I don't like
the sound of the side effects I could
have. My therapist and I have set some
goals for me to work on, and we agreed
to revisit my decision in three months. I
want to wait and see how the counseling
goes before I take medicine.
88. Example Screens of First Draft of
Decision-Support Tool
Approval versus Engagement
13
89. Get the facts
• What is depression?
– A very common, highly treatable,
medical illness that involves the
body, mood, and thoughts. Physical, mental,
emotional, and spiritual well-being.
– It affects how people think about things, feel about
themselves, the way a person functions socially, at
work and in relationships, as well as everyday
activities like eating and sleeping.
– It is more than feeling blue, down in the dumps or sad
about a particular issue or situation.(Link to Table with
Symptoms of Depression, See next slide)
Link to Video about learn more about depression
http://www.youtube.com/watch?v=IeZCmqePLzM&playnext=1&list=PL3E95B34CC364B7D0&feature=results_main
14
90. What healthcare options are available
to you to manage your depression…
• Lifestyle Changes (Link to page expanding each)
– Healthy eating
– Exercise
– Relationship building
– Stress management
• Behavioral Health Services - Therapy
– Screening
– Psychotherapy
• Medications
• Traditional Healing
• Other
92. Stakeholder Recommendations:
Decision Tool Content
• Provide context for the tool
– Who will see the information and how will it be used
• Give people information about depression
– De-stigmatize/normalize (common life experience)
– High level of depression in Alaska due to multiple factors
(seasonal, trauma, situational)
– Different types (situational versus chronic/organic)
• Assess/offer resources
– SCF and non-SCF resources, including Customer-Owner
personal resources (social support)
– Include non-medication resources (dietician, traditional
healing, individual counseling, and groups)
– Explain potential benefits and burdens (side effects, wait
times)
– Follow-up/make multiple contacts
• Use story/culturally consonant communication
– Include Native faces/voices; include testimonials of success
Context
Information
Resources
Story
17
93. • Adapt for multiple audiences
– iPad generally endorsed for providing screener and general
information, especially with younger people
– Elders and others may prefer personal or written option
• Strategize location and timing
– Could deploy screen in waiting area or provide general info on
closed-circuit TV in waiting area and use iPad for screen in
examination or talking room
• Maximize customer choice
– Make tool voluntary, not mandatory
– Provide staff assistance with tool (e.g., RN or BHC)
– Allow time for customers to explore options, including time in
examination room and in follow-up appointments
• Align with other initiatives
– Minimize duplication and multiple requests for information
Stakeholder Recommendations:
Decision Tool Design and Deployment
Alignment
Audience
Strategy
Choice
18
94. Factors Related to Workflow
• Administration of tool
– BHC
– PCP
• Role of tool
– Facilitate discussion
– Provide information
– Support Decision
• Time
19
95. Example Screens of Resultant
Decision-Support Tool
Impact of Engagement on Process
20
96. The Signs and Symptoms that Bother
Me Most Are …
Feel Hopeless
Loss of Interest in
Daily Activities
Weight and/or
Appetite Changes
Sleep
Changes
Anger or
Irritability
Decreased
Energy
Self Loathing
Trouble
Concentrating
Pain
Exit
97. What can I do about my depression?
Healthy Eating
Exercise
Stress Reduction
Support Groups
Clergy
Counseling
Traditional
Healing
Drugs
Herbal
Remedies
Exit
98. Engagement Barriers and
Proposed Solutions
• Barriers
– Cultural
– Time
– Communication
– Information
• Solution
– Cultural-adaptation
– Technology/resources
– Decision-support tool
– Decision-support tool
and extended tool
23
100. Every day people face complex
health decisions…
However, most healthcare decisions
have no clear best choice.
0%
10%
20%
30%
40%
50%
Beneficial
Outcomes
Probably
Beneficial
Need to
Weigh
Benefits
versus Risk
Probably Not
Beneficial
Insufficient
Evidence of
Usefulness
Healthcare Intervention
Classifications
25
102. What causes depression?
Life Experiences Biology
Exit
Money problems/
unemployment
Grief and loss
Violence Drugs/ Alcohol
Abuse
Genetics Neurotransmitters
(brain chemicals)
Hormones Other Medical
Conditions
105. This Presentation Will:
1. Describe the process of engaging stakeholders in our pilot project
2. Identify lessons about engaging stakeholders
3. Briefly describe the current status of the project
106. The setting: Arkansas Delta
• Primarily rural with agriculture-
based economy
• Characterized by:
• Poor economic conditions
• Higher prevalence of chronic health
conditions
• Increased risk of early mortality
• Poor access to quality health services
• Highest percentage of cities with
predominately African-American
populations
107. Mental Health in the Delta
• Poorer self-reported mental
health
• Increased levels of frequent mental
distress (BFRSS)
• Poorer mental health outcomes
• Increased burden of disability
• Increased mortality
• Poorer management of chronic physical
health
• Underuse of mental health
services
• Limited access
• Stigma
108. UAMS Psychiatric Research Institute
• Division of Health Services
Research
• Improve the lives of individuals with
mental health or substance use disorders
• Focus on rural areas
• Focus on partnership with key
stakeholders
What can we do to improve mental
health service use in rural
Arkansas?
109. LESSONS
FROM
ENGAGEMENT
Decide who you need to partner with:
• What type of expertise do you need to answer your
question?
• Ground
• People affected by the condition
• Grassroots
• People and organizations who are near the ground
• Caregivers, support system, and service
organization
• Grass tops
• Policymakers
110. The Partners: Tri County Rural Health Network
• Improves the health of individuals
in the Delta
• Uses community health worker model
• Connects community members to health
resources in rural counties
• Works with UAMS College of
Public Health to create “research
friendly communities”
• Connects with community
members and policymakers
111. Mental Health in the Delta
I’m worried about our minds. About our ability to
cope with life. Especially with our young people. I
used to didn’t hear about depression or suicide.
That was never something you heard about with
our people. Now, I have had to sit with several
families of young Blacks who’ve taken their own
lives. I have people who are depressed in my
congregation. Something has to be done.
- A pastor from the Arkansas Delta
112. LESSONS
FROM
ENGAGEMENT
Determine if you are ready to engage:
1. Do you have similar values/missions?
• Both focused on improving health in rural areas
2. Do you have the capacity to work
together?
• Tri County experience with research
• DHSR experience with community engagement
3. Will this partnership be mutually
beneficial?
113. What’s the Solution?
• Focus on improving access to and
use of mental health services
• Adapt community-connector program
• Build on both partners’ expertise
• Start with identifying the mental
health needs of rural African
Americans
• Important to hear the voice of the
community
DHSR’s Idea Tri County’s Idea
Tri County was originally created to provide job
training in the Delta. But the people said, ‘We ain’t
got no jobs here, so we don’t need no job training.
What we do need is better healthcare.’ Let’s hear
the community before deciding where to start.
114. Our Idea
• Conduct formative research to:
• Better understand the mental health needs of rural African Americans
• Inform the development of culturally appropriate interventions to improve
mental health in rural African American communities
115. Writing the Application
• Focus Groups
• Researcher identifies stakeholders
• Researcher creates interview guide
• More traditional research method
• Deliberative Democracy
• Allows community to self-identify as
stakeholders
• Community creates the frame
DHSR Methods Tri County’s Methods
The energy is important. Forums create energy
around an idea. What would happen if we
implemented an intervention in an area that has
this energy already buzzing?
116. Writing the Application
• New Questions:
• What is the best way to gather stakeholder input?
• Does one method lead to more activation?
• Is activation important in intervention implementation?
117. Specific Aims
• Compare two ways of gathering stakeholder input: deliberative
democracy and focus groups
• Themes
• Empowerment
• Gather information to inform the development of an intervention to
improve mental health in rural African American communities
118. LESSONS
FROM
ENGAGEMENT
Engagement before Funding
1. Helps decide what are the most
relevant research questions
• Whole idea changed as a result of partner input
2. More responsive questions= Better
applications
119. Starting the Research
• Community Advisory Board
• One provider
• Two mental health consumers
• One connector
• One college student
• One clergy
• One lay community member
• Advises on consent procedures, measurement tools, recruitment, and
data analysis
120. Mental Health versus Emotional Wellness
No one is going to talk to you about mental
health. When people hear mental health they
think of crazy. Ain’t nobody going to talk to you
about being crazy. I ain’t crazy. I don’t know how
to help you help crazy people
If you want my expertise, you have to ask me
about things I know about.
CAB member
121. Mental Health versus Emotional Wellness
• Based on CAB feedback:
• Application written using the medical frame
• Wellness framework is more culturally acceptable
• Interview guides and framing sessions used term “emotional wellness”
instead of “mental health”
122. LESSONS
FROM
ENGAGEMENT
Respect your partner’s expertise
1. Partner is a part of the research team
• Not just approval
2. Listen and incorporate ideas when
possible
• Using wellness frame versus illness frame
• Changing wording of measurement tools
• Not paying unless they finish
3. Respect builds trust
• Trust builds better partnerships
123. LESSONS
FROM
ENGAGEMENT
Prepare for some differences of opinions
• Audio recording versus note taking
But remember:
• Your core values; what are you working towards
• Respect each other’s point of view and expertise
124. Where are we now?
• Completed six focus groups (n=50)
• Faith community
• College students and administrators
• Patients
• Providers
• Currently completing community forums (n=86)
• Four forums completed (two more planned)
• Lay community members
• Service organization leaders
• Political leaders
125. Where are we now?
• Preliminary analysis
• Stigma and low mental health literacy major barriers to care
• Importance of “reaching people where they are”
• Community-based services versus clinic-based services
• Importance of community support in prevention, treatment, and recovery
• Provide education and support
• Address contextual causes that affect emotional wellness
126. Conclusions
Engagement can lead to:
1. More culturally acceptable research questions
2. Applications that are more responsive to community needs
When engaging stakeholders in research:
1. Make sure you are ready to engage in research
2. Engage stakeholders before funding
3. Respect your partners’ expertise
4. Prepare for differences of opinions
127. Any real attempt to address the problems that are plaguing our
community will take everyone coming to the table; the grassroots, the
grass-tops, and all the grass in between. Everyone talks about how
difficult it is to bring everyone together, but if you focus on solving the
problem, the mountains become just bumps in the road.
Mary Olson, Tri County Rural Health
128. Academic Team
Greer Sullivan, MD MSPH (PI) Mary Olson, D. Min (Community PI)
Geoff Curran, PhD Ann Cheney, PhD
Keneshia Bryant, PhD FNP Christina Reaves, MPH
Naomi Cottoms Elise Allee
Faye Smith
129. Community Advisory Board
Rev. George Barnes Linda Cole
Melva Trask Gloria Scott
Edlun Marshall Pamela Barnes Earnest
Virgil Ward