This document provides an overview of Paul Crane's involvement with patient-reported outcomes (PROs) and the PROMIS initiative. It describes how he became interested in psychometrics during his fellowship and worked on early PROMIS projects. It also discusses how his wife Heidi integrated PRO assessments into routine HIV care through the CNICS network. Paul's PROMIS 2 project examined the depression domain in clinical practice. He has since served on the PROMIS Clinical Practice Subcommittee and the initiative is expanding with additional domains, populations, and efforts to integrate PROMIS into electronic health records.
Annals of behavioral medicine volume 49 issue 1 supplement april 2015Monique Tsang, BS, CNA
The current study investigated whether a single presentation on sleep hygiene could result in improvement in reported sleep quality and quantity for undergraduate students newly entering university.
Annals of Behavioral Medicine Volume 49-Issue 1 Supplement-April 2015Monique Tsang, BS, CNA
This seminar provides an overview of a pilot bibliotherapy program for survivors of acquired brain injury (ABI) and individuals with chronic pain or disability. The program was started in 2012 at Erie County Medical Center in Buffalo, NY and has shown benefits to quality of life and symptom reduction. The seminar will present qualitative data on the impact of the program and provide details on its development, mission statement, recruitment process, book selection, and collaboration with rehabilitation and behavioral health services. Bibliotherapy shows potential as a cost-effective and sustainable treatment approach to target common deficits after ABI or injury such as reduced empathy, poor perspective taking, and impaired information processing.
The document summarizes two small studies conducted by students to examine the relationship between inadequate sleep and unintentional injuries. A qualitative study using an online focus group of 4 students explored perceptions of sleep and injuries. It found inadequate sleep negatively impacts health and can increase risks. A quantitative survey of 18 students further examined the relationship, finding agreement that inadequate sleep impacts judgment and awareness and may increase injury risks. Both studies had limitations as student exercises but provided insight into how policies could help address the issue.
Methodological Issues and Challenges in eHealth Research Panel [Aud 900 P...Gunther Eysenbach
This document summarizes a panel discussion on methodological issues and ethical challenges in e-health research. The panel discussed key issues like sampling biases in internet studies, ethical concerns around privacy and informed consent in online research, and challenges assessing the reliability and validity of measures administered online. Specific studies on online psychoeducation, a bipolar disorder program, and youth mental health education were also briefly described to illustrate these methodological considerations.
Development of a Novel Pain Management Simulator to Enhance Skills of Medical...Clinical Tools, Inc
Tanner B, Metcalf M, Rossie K. Development of a Novel Pain Management Simulator to Enhance Skills of Medical and other Health Professional Students. Poster presented at the 2015 American Academy of Pain Medicine, May 20, 2015, National Harbor, MD.
A short course in epidemiology for cliniciansSurya Rao
This document provides an overview of a short course in epidemiology for clinicians. The course aims to help clinicians understand how epidemiological concepts can enhance clinical practice by applying principles to decision making, risk assessment, interpreting tests and literature. It covers topics like study designs, statistical analysis, biases and applying evidence-based practices. The 5 modules include sessions on epidemiology applications in clinics, evidence-based medicine, epidemiological methods, statistical concepts and getting started in research. Overall, the course aims to equip clinicians with skills in epidemiology, evidence interpretation and undertaking clinical research.
Negotiating Expertise: PACS and the Challenges to Radiologyatillack
This document summarizes a study examining how the adoption of PACS has impacted professional relationships between radiologists and clinicians and the role of radiologists in patient care teams. Through interviews and observations, the study found that radiologists interact much less with clinicians after PACS, which has marginalized their expertise and role on care teams as clinicians increasingly interpret images themselves. However, some radiologists are taking steps like embedding in clinical areas and conferences to rebuild trust and expertise. Future research will explore how trust can be established through alternate communication modes like telemedicine.
Annals of behavioral medicine volume 49 issue 1 supplement april 2015Monique Tsang, BS, CNA
The current study investigated whether a single presentation on sleep hygiene could result in improvement in reported sleep quality and quantity for undergraduate students newly entering university.
Annals of Behavioral Medicine Volume 49-Issue 1 Supplement-April 2015Monique Tsang, BS, CNA
This seminar provides an overview of a pilot bibliotherapy program for survivors of acquired brain injury (ABI) and individuals with chronic pain or disability. The program was started in 2012 at Erie County Medical Center in Buffalo, NY and has shown benefits to quality of life and symptom reduction. The seminar will present qualitative data on the impact of the program and provide details on its development, mission statement, recruitment process, book selection, and collaboration with rehabilitation and behavioral health services. Bibliotherapy shows potential as a cost-effective and sustainable treatment approach to target common deficits after ABI or injury such as reduced empathy, poor perspective taking, and impaired information processing.
The document summarizes two small studies conducted by students to examine the relationship between inadequate sleep and unintentional injuries. A qualitative study using an online focus group of 4 students explored perceptions of sleep and injuries. It found inadequate sleep negatively impacts health and can increase risks. A quantitative survey of 18 students further examined the relationship, finding agreement that inadequate sleep impacts judgment and awareness and may increase injury risks. Both studies had limitations as student exercises but provided insight into how policies could help address the issue.
Methodological Issues and Challenges in eHealth Research Panel [Aud 900 P...Gunther Eysenbach
This document summarizes a panel discussion on methodological issues and ethical challenges in e-health research. The panel discussed key issues like sampling biases in internet studies, ethical concerns around privacy and informed consent in online research, and challenges assessing the reliability and validity of measures administered online. Specific studies on online psychoeducation, a bipolar disorder program, and youth mental health education were also briefly described to illustrate these methodological considerations.
Development of a Novel Pain Management Simulator to Enhance Skills of Medical...Clinical Tools, Inc
Tanner B, Metcalf M, Rossie K. Development of a Novel Pain Management Simulator to Enhance Skills of Medical and other Health Professional Students. Poster presented at the 2015 American Academy of Pain Medicine, May 20, 2015, National Harbor, MD.
A short course in epidemiology for cliniciansSurya Rao
This document provides an overview of a short course in epidemiology for clinicians. The course aims to help clinicians understand how epidemiological concepts can enhance clinical practice by applying principles to decision making, risk assessment, interpreting tests and literature. It covers topics like study designs, statistical analysis, biases and applying evidence-based practices. The 5 modules include sessions on epidemiology applications in clinics, evidence-based medicine, epidemiological methods, statistical concepts and getting started in research. Overall, the course aims to equip clinicians with skills in epidemiology, evidence interpretation and undertaking clinical research.
Negotiating Expertise: PACS and the Challenges to Radiologyatillack
This document summarizes a study examining how the adoption of PACS has impacted professional relationships between radiologists and clinicians and the role of radiologists in patient care teams. Through interviews and observations, the study found that radiologists interact much less with clinicians after PACS, which has marginalized their expertise and role on care teams as clinicians increasingly interpret images themselves. However, some radiologists are taking steps like embedding in clinical areas and conferences to rebuild trust and expertise. Future research will explore how trust can be established through alternate communication modes like telemedicine.
Ncbi bookshelf. a service of the national library of medicine,MARRY7
The document describes the experience of Ms. Martinez as she navigated the healthcare system while dealing with breast cancer. Her experience highlighted significant problems with safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity of care. She experienced long wait times for appointments, lack of coordination between providers, missing records and test results, anxiety due to delays in diagnosis and treatment, and discomfort during her many procedures.
This article provides nurses with a guide for taking a comprehensive patient health history. It discusses creating a private environment and using open-ended questions to make the patient comfortable. The guide outlines systematically assessing the patient's chief complaint, past medical history, medications, family history, social history, and reviewing other body systems. Following this structured process helps nurses obtain thorough information to inform care.
Information interventions for injury recovery: a reviewAlex Collie
This presentation reports the results of a systematic review of information based interventions for injury recovery. It was presented at the Canadian Association for Research on Work and Health (CARWH) conference in 2012. The study has since been published in the Journal of Rehabilitation Medicine. A link to the study is here:
http://www.ncbi.nlm.nih.gov/pubmed/22674232
The document outlines an evaluation plan to assess the usability of a hospital's new electronic health record (EHR) system from the nurses' perspective. The evaluation will use qualitative methods, including interviews and observations of nurses, to identify any areas where the EHR's documentation screens are inconsistent with nursing workflow and clinical practice. The goals are to understand usability issues and offer solutions to better align the EHR with nursing work. Ethical considerations around participant consent and data confidentiality will be addressed. The analysis will provide a narrative to illustrate nurses' experiences using the EHR and how it impacts their work.
What will it take for patients and clinicians to use data from mobile health apps and sensors in routine care? Watch how Linq, a new product from Open mHealth, offers a new "bring your own app" approach that puts the focus back on patients and clinicians rather than on technology.
- Melissa Wieland has over 15 years of experience managing research projects and clinical studies in areas such as mental health, substance abuse, and traumatic brain injury. She has strong skills in qualitative and quantitative data analysis, clinical assessments, and overseeing all aspects of research projects from design to reporting.
- She has held positions at universities such as University of Pittsburgh and Yale where she coordinated multiple studies, oversaw staff, analyzed data, and published findings. She is proficient in statistical software like SAS.
- Her background includes epidemiology research, program evaluation, and clinical work in both inpatient and outpatient settings. She has experience leading teams and mentoring junior staff.
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
Knowledge questionnaire on home care of schizophrenics (kqhs) validity and r...Alexander Decker
The document describes the development and validation of the Knowledge Questionnaire on Home Care of Schizophrenics (KQHS). The KQHS is a 32-item multiple choice questionnaire that assesses caregivers' knowledge of schizophrenia, including its meaning, causes, signs/symptoms, and home care. The development process involved literature review, blueprint creation, item writing, content validation, pretesting, and reliability testing. Content validity and internal consistency were established. The KQHS was found to be a brief, valid, and reliable tool for assessing caregivers' knowledge of caring for schizophrenic patients at home.
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
The first quasiexperiemental study of the ORS/SRS in a telephonic EAP company. Doubled outcomes and improved retension. Set the stage for the RCTs that followed
This document provides an overview of evidence-based medicine (EBM). It defines EBM as integrating the best research evidence with clinical expertise and patient values. The history and obstacles of EBM are discussed. The document outlines how to practice EBM using the 5 A's framework: Ask, Acquire, Appraise, Apply, and Assess. A case example is provided to demonstrate how to formulate a focused clinical question using the PICO format.
This article, "Casting a Wider Net in Behavioral Health Screening in Primary Care" found that the ORS identified more clients for behavioral healthcare consultation than the PHQ-9. A first step toward the upcoming RCT with PCOMS in an integrated setting.
The document discusses Cleveland Clinic, an academic medical center with 1300 bed main hospital and 9 regional hospitals. It sees over 54,000 admissions and 2 million outpatient visits annually. The clinic has a group practice of 2700 physicians and scientists, and is involved in over 3000 research projects. It operates an innovative medical school and has spun off 30 companies. The document then discusses how electronic medical records and clinical decision support systems can help reduce the 17 year lag time for implementing clinical research results into practice. It provides examples of how EMRs and CDS tools such as order sets, alerts and clinical guidelines can improve patient care, outcomes and efficiency. Registries created from EMR data are also discussed as a way to study conditions, treatments
The document summarizes a student's summer research project studying patient perspectives on teamwork in the emergency department. The student administered exit surveys to emergency department patients to assess how perceptions of provider teamwork related to patient satisfaction, confidence in providers, and likelihood of following treatment recommendations. The student hypothesized that patients would be less likely to endorse clear team roles but more likely to perceive providers as enjoying their work and sharing treatment goals. The student also hypothesized that more positive perceptions of teamwork would correlate with higher patient ratings in the areas studied. Preliminary results did not support the first hypothesis but supported associations between teamwork perceptions and patient outcomes as outlined in the second hypothesis.
The document summarizes the work of the RTI-UNC Evidence-based Practice Center (EPC) in conducting evidence syntheses (systematic reviews) to inform clinical practice, policy, and research. Key points:
- EPC evidence syntheses have helped shape guidelines and recommendations from organizations like the US Preventive Services Task Force.
- Examples are cited where EPC reviews uncovered gaps in evidence and influenced changes to clinical guidelines and practices, as well as new areas of research.
- EPC follows rigorous processes to ensure the quality, accuracy, and reliability of their evidence syntheses, which are used widely to support decision-making by patients, clinicians, and policymakers.
Clearing the Error: Patient Participation in Reducing Diagnostic ErrorJefferson Center
To generate new, patient-centered insights into diagnostic error, we convened diverse groups in public deliberation to recommend and evaluate actions that patients and/or their advocates would be willing and able to perform to improve diagnostic quality.
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)Karin Verspoor
A 68-year-old female presented to the emergency department with shortness of breath that had progressively worsened over 4-5 days. She was admitted and experienced intermittent severe shortness of breath. Testing found a positive D-dimer and chest imaging could not be done, so a nuclear scan was ordered but the patient was too unstable. Given the positive D-dimer and severity of symptoms, the patient was treated with anticoagulants due to concerns for a possible pulmonary embolism. She was admitted under a doctor for further care.
Comorbidity of Depression and Insomnia ProposalJennifer Ocasio
This document discusses the comorbidity of insomnia and depression and proposes studying their link using fMRI brain imaging. It notes commonalities in how these disorders affect the HPA axis and cerebral cortex. The author aims to determine if a relationship exists between insomnia and depression by comparing fMRI scans of healthy individuals and those with only one disorder or both. Finding this link could help develop more targeted treatments for the comorbidity.
Managing Stress - Time Urgency Perfectionism stressAntonio Rodrigues
This document discusses the relationship between stress and fertility. It finds that higher levels of stress, as measured by salivary alpha amylase, are associated with increased time to pregnancy and a 29% reduction in fecundity. A 10-week stress management program was found to significantly reduce symptoms of stress and improve pregnancy rates for women undergoing in vitro fertilization. The program teaches skills to recognize and manage stress over its 10 weeks.
Ncbi bookshelf. a service of the national library of medicine,MARRY7
The document describes the experience of Ms. Martinez as she navigated the healthcare system while dealing with breast cancer. Her experience highlighted significant problems with safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity of care. She experienced long wait times for appointments, lack of coordination between providers, missing records and test results, anxiety due to delays in diagnosis and treatment, and discomfort during her many procedures.
This article provides nurses with a guide for taking a comprehensive patient health history. It discusses creating a private environment and using open-ended questions to make the patient comfortable. The guide outlines systematically assessing the patient's chief complaint, past medical history, medications, family history, social history, and reviewing other body systems. Following this structured process helps nurses obtain thorough information to inform care.
Information interventions for injury recovery: a reviewAlex Collie
This presentation reports the results of a systematic review of information based interventions for injury recovery. It was presented at the Canadian Association for Research on Work and Health (CARWH) conference in 2012. The study has since been published in the Journal of Rehabilitation Medicine. A link to the study is here:
http://www.ncbi.nlm.nih.gov/pubmed/22674232
The document outlines an evaluation plan to assess the usability of a hospital's new electronic health record (EHR) system from the nurses' perspective. The evaluation will use qualitative methods, including interviews and observations of nurses, to identify any areas where the EHR's documentation screens are inconsistent with nursing workflow and clinical practice. The goals are to understand usability issues and offer solutions to better align the EHR with nursing work. Ethical considerations around participant consent and data confidentiality will be addressed. The analysis will provide a narrative to illustrate nurses' experiences using the EHR and how it impacts their work.
What will it take for patients and clinicians to use data from mobile health apps and sensors in routine care? Watch how Linq, a new product from Open mHealth, offers a new "bring your own app" approach that puts the focus back on patients and clinicians rather than on technology.
- Melissa Wieland has over 15 years of experience managing research projects and clinical studies in areas such as mental health, substance abuse, and traumatic brain injury. She has strong skills in qualitative and quantitative data analysis, clinical assessments, and overseeing all aspects of research projects from design to reporting.
- She has held positions at universities such as University of Pittsburgh and Yale where she coordinated multiple studies, oversaw staff, analyzed data, and published findings. She is proficient in statistical software like SAS.
- Her background includes epidemiology research, program evaluation, and clinical work in both inpatient and outpatient settings. She has experience leading teams and mentoring junior staff.
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
Knowledge questionnaire on home care of schizophrenics (kqhs) validity and r...Alexander Decker
The document describes the development and validation of the Knowledge Questionnaire on Home Care of Schizophrenics (KQHS). The KQHS is a 32-item multiple choice questionnaire that assesses caregivers' knowledge of schizophrenia, including its meaning, causes, signs/symptoms, and home care. The development process involved literature review, blueprint creation, item writing, content validation, pretesting, and reliability testing. Content validity and internal consistency were established. The KQHS was found to be a brief, valid, and reliable tool for assessing caregivers' knowledge of caring for schizophrenic patients at home.
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
The first quasiexperiemental study of the ORS/SRS in a telephonic EAP company. Doubled outcomes and improved retension. Set the stage for the RCTs that followed
This document provides an overview of evidence-based medicine (EBM). It defines EBM as integrating the best research evidence with clinical expertise and patient values. The history and obstacles of EBM are discussed. The document outlines how to practice EBM using the 5 A's framework: Ask, Acquire, Appraise, Apply, and Assess. A case example is provided to demonstrate how to formulate a focused clinical question using the PICO format.
This article, "Casting a Wider Net in Behavioral Health Screening in Primary Care" found that the ORS identified more clients for behavioral healthcare consultation than the PHQ-9. A first step toward the upcoming RCT with PCOMS in an integrated setting.
The document discusses Cleveland Clinic, an academic medical center with 1300 bed main hospital and 9 regional hospitals. It sees over 54,000 admissions and 2 million outpatient visits annually. The clinic has a group practice of 2700 physicians and scientists, and is involved in over 3000 research projects. It operates an innovative medical school and has spun off 30 companies. The document then discusses how electronic medical records and clinical decision support systems can help reduce the 17 year lag time for implementing clinical research results into practice. It provides examples of how EMRs and CDS tools such as order sets, alerts and clinical guidelines can improve patient care, outcomes and efficiency. Registries created from EMR data are also discussed as a way to study conditions, treatments
The document summarizes a student's summer research project studying patient perspectives on teamwork in the emergency department. The student administered exit surveys to emergency department patients to assess how perceptions of provider teamwork related to patient satisfaction, confidence in providers, and likelihood of following treatment recommendations. The student hypothesized that patients would be less likely to endorse clear team roles but more likely to perceive providers as enjoying their work and sharing treatment goals. The student also hypothesized that more positive perceptions of teamwork would correlate with higher patient ratings in the areas studied. Preliminary results did not support the first hypothesis but supported associations between teamwork perceptions and patient outcomes as outlined in the second hypothesis.
The document summarizes the work of the RTI-UNC Evidence-based Practice Center (EPC) in conducting evidence syntheses (systematic reviews) to inform clinical practice, policy, and research. Key points:
- EPC evidence syntheses have helped shape guidelines and recommendations from organizations like the US Preventive Services Task Force.
- Examples are cited where EPC reviews uncovered gaps in evidence and influenced changes to clinical guidelines and practices, as well as new areas of research.
- EPC follows rigorous processes to ensure the quality, accuracy, and reliability of their evidence syntheses, which are used widely to support decision-making by patients, clinicians, and policymakers.
Clearing the Error: Patient Participation in Reducing Diagnostic ErrorJefferson Center
To generate new, patient-centered insights into diagnostic error, we convened diverse groups in public deliberation to recommend and evaluate actions that patients and/or their advocates would be willing and able to perform to improve diagnostic quality.
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)Karin Verspoor
A 68-year-old female presented to the emergency department with shortness of breath that had progressively worsened over 4-5 days. She was admitted and experienced intermittent severe shortness of breath. Testing found a positive D-dimer and chest imaging could not be done, so a nuclear scan was ordered but the patient was too unstable. Given the positive D-dimer and severity of symptoms, the patient was treated with anticoagulants due to concerns for a possible pulmonary embolism. She was admitted under a doctor for further care.
Comorbidity of Depression and Insomnia ProposalJennifer Ocasio
This document discusses the comorbidity of insomnia and depression and proposes studying their link using fMRI brain imaging. It notes commonalities in how these disorders affect the HPA axis and cerebral cortex. The author aims to determine if a relationship exists between insomnia and depression by comparing fMRI scans of healthy individuals and those with only one disorder or both. Finding this link could help develop more targeted treatments for the comorbidity.
Managing Stress - Time Urgency Perfectionism stressAntonio Rodrigues
This document discusses the relationship between stress and fertility. It finds that higher levels of stress, as measured by salivary alpha amylase, are associated with increased time to pregnancy and a 29% reduction in fecundity. A 10-week stress management program was found to significantly reduce symptoms of stress and improve pregnancy rates for women undergoing in vitro fertilization. The program teaches skills to recognize and manage stress over its 10 weeks.
Internet Post On Depression Among ElderlyNurse Dianne
NURSING THESIS 2: ELDERLY DEPRESSION (CHAPTERS 1, 2 AND 3 FOR ONLY 1000PESOS)
You can view my blog at nurse1283.blogspot.com for more details. Or you can reach me through 09352009437.
2015 Proposal Medial Prefrontal Cortex & DepressionEmily Anderson
This document summarizes a proposed study that would examine the effects of inhibiting the medial prefrontal cortex (mPFC) on symptoms of depression in female Long Evans rats. The study would use an animal model of depression involving unpredictable chronic mild stress. Rats would then undergo surgery to implant cannulae targeting the mPFC. Prior to behavioral tests measuring learned helplessness, lethargy, and anhedonia, the mPFC would be inhibited with baclofen and muscimol. It is hypothesized that inhibiting the mPFC will decrease depressive-like symptoms in the rats. The study aims to further examine the role of the mPFC in mediating depression.
ROLE OF MICRONUTRIENTS IN INFERTILITY, ROLE OF CARNITINE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the role of micronutrients in fertility for both males and females. It focuses on the role of L-carnitine in male and female infertility. For males, L-carnitine supports sperm maturation, motility, and production by providing energy. Clinical trials show L-carnitine supplements improve sperm parameters. For females, L-carnitine may help with conditions like PCOS by supporting weight loss and improving insulin function.
This document proposes a study called the RISE Program to determine if and how the antidepressant Prozac helps depression patients. The study would evaluate 20 patients with similar depression characteristics before and after being given either Prozac or a placebo for a week using fMRI scans and evaluations to analyze changes in neural activity and emotional state. The goal is to find the true cause of depression and alternative treatments through analyzing how Prozac affects patients over time on a neural level compared to a control group.
1) Infections can cause male infertility by disrupting the normal functioning of the male reproductive system and blood-testis barrier, changing semen parameters, and disrupting sperm morphology, biochemistry, and function.
2) Infections promote oxidative stress and reactive oxygen species production, which can damage sperm DNA and membranes and lead to sperm apoptosis.
3) Specific bacteria, viruses, parasites, and fungi are known to infect the male reproductive tract and directly cause damage that impairs sperm production and function, leading to infertility.
Role of hysteroscopy in Infertility, Dr Rajesh GajbhiyeRajesh Gajbhiye
Hysteroscopy plays an important role in the evaluation and treatment of intrauterine abnormalities found in infertile women. Diagnostic hysteroscopy is considered the gold standard for diagnosing conditions like submucous fibroids, uterine septum, intrauterine adhesions, and endometrial polyps that are common in infertile patients. Surgical treatment of these abnormalities by hysteroscopy has been shown to improve pregnancy rates compared to diagnostic hysteroscopy alone. Additionally, performing hysteroscopy before IVF treatment or endometrial scratching prior to a cycle has been associated with higher success rates, though more research is still needed to confirm these findings.
The document outlines Dr. Kathryn Greenwood's route to becoming a clinical psychologist. It describes her educational path, including obtaining a PhD in a clinically relevant area and completing a DClinPsy. It also details her clinical experiences working as a nurse, observing specialist assessments and therapy, and evaluating trauma. The document provides tips for those pursuing clinical psychology, emphasizing the importance of a strong academic profile, meaningful experiences, communication skills, maintaining balance in life, and standing out for the right reasons in the application process.
Short educational powerpoint presenation on the need for metabolic monitoring for patients prescribed atypical antipsychotic drugs for entire staff in psychiatric setting. Linked to Master's Capstone Project- Creating a Metabolic Monitoring Protocol for Patients Prescribed Atypical Antipsychotic Drugs
A 79-year-old female patient presented with end-stage coronary artery disease as evidenced by a history of diabetes, hypertension, prior heart attacks, angina, and reduced ejection fraction on echocardiogram. The presenting physician, Dr. Ariel Duran, had no financial conflicts of interest to disclose.
Pathophysiology of Coronary artery d iseaseUrmila Aswar
The document discusses coronary artery disease (CAD), which occurs when fatty deposits build up in the coronary arteries and restrict blood flow to the heart. CAD is one of the leading causes of death worldwide. It describes how the heart works and the role of the coronary arteries in supplying blood to the heart muscle. Risk factors for CAD include age, family history, smoking, high blood pressure, high cholesterol, obesity, and lack of exercise. Symptoms range from chest pain to a heart attack. Treatment involves lifestyle changes, medications, procedures like angioplasty and stenting, or bypass surgery in severe cases.
Diabetes, PHRs,at teams - Hopkins CapstoneWade Schuette
The document proposes using personal health records and peer support teams to help disadvantaged urban diabetes patients better manage their condition. It suggests that giving patients control of their personal health records and decision support tools, as well as connecting them with a support team, may help improve empowerment, access to care, and health outcomes. Key metrics like HbA1c levels would be measured before, during, and after a 3-month intervention combining these approaches to evaluate its impact. The proposal references using principles from control systems engineering to design effective feedback loops to support patient self-management.
Developing Self Regulation In Individuals With Type 2 Diabetes Proposallusimartin
This document discusses developing self-regulation in individuals with type 2 diabetes through a randomized controlled trial comparing a self-regulation intervention to an education and self-monitoring only intervention. The self-regulation intervention will involve participants self-monitoring their blood glucose and adjusting their dietary intake and physical activity using guidelines to help regulate their blood glucose levels. The prevalence and economic toll of diabetes is increasing in the United States. While self-monitoring of blood glucose can improve glycemic control in type 1 diabetes, its importance in type 2 diabetes is less clear. Self-regulation of blood glucose may impact self-efficacy and compliance with diabetes self-management behaviors.
SLC CME- Evidence based medicine 07/27/2007cddirks
Saint Luke's Care, a quality improvement organization within Saint Luke's Health System, presents a CME presentation by Dr. Brent Beasley on Evidence Based Medical Care.
The document discusses the multiple lives of clinical data. It begins by describing how clinical data is first used in patient care by being documented in the electronic medical record. It then discusses how clinical data can be transformed and used for research purposes by analyzing aggregate data from clinical documentation. The document provides examples of how clinical data from a clinic was analyzed over time to enable new research studies. Finally, the document discusses how clinical data can have a third life in an enterprise data warehouse, where operational and strategic questions can be answered by analyzing and reporting on clinical data. It provides examples of the types of analyses that can be done using an enterprise data warehouse.
This document summarizes a transitional care workgroup meeting held on July 12, 2013. The meeting included introductions and presentations on transitional care evidence and measuring patient-centered outcomes. Participants discussed a vignette about a patient being discharged from the hospital to identify questions patients would have about participating in a new transitional care program. The group's objectives were to understand transitional care broadly and narrow the topic by prioritizing important questions from multiple stakeholder perspectives. Breakout sessions allowed for submitted questions and discussion of proposed research topics. The meeting concluded with recapping next steps and welcoming further input.
DN 703 Unit 8 Identifying a Target Population.docxwrite5
This document discusses identifying a target population for a DNP project aimed at reducing emergency department readmissions. The target population is identified as the adult population who have been discharged from the emergency department without proper education or instructions, often due to language barriers. Cultural, psychosocial, environmental, and demographic factors of this target population are analyzed. The document also outlines an intervention strategy of providing patient education and a discharge checklist to improve understanding and reduce unnecessary returns to the emergency department. An implementation plan, expected outcomes, and evaluation strategy for the project are required to address this issue.
Community-based Chronic Care ManagementBrent Feorene
The document discusses strategies for community-based chronic illness management to reduce costs and improve outcomes. It outlines several programs that have shown promise, including transitional care programs and house call programs. Transitional care programs of varying intensity use nurses and nurse practitioners to coach patients after hospital discharge. House call programs provide primary care to high-risk elderly patients in their homes through visits from physicians and nurse practitioners. Evaluation of these programs has found reduced utilization, lower costs, and improved outcomes and quality of life.
Health Care Processes and Decision Making_lecture 1_slidesCMDLearning
The document discusses the classic paradigm of the clinical process. It describes the elements of the classic paradigm, which assumes a single patient interacts with a single clinician to address a single problem during a single visit. It also examines different types of information clinicians use and how this information is organized. The document outlines the steps in the classic clinical process, including gathering data, analyzing findings, making a diagnosis, and communicating the treatment plan.
Crew Resource Management Slides - including Handoffs - from 2008 National Pat...Noel Eldridge
Presentation on Crew Resource Management and Team Training in the Department of Veterans Affairs. Dr. Dunn did most of the presentation, and I covered the handoffs portion. (Afterward someone from NPSF told me that this was the highest-rated breakout session at the conference.) One related video is on Youtube at: https://www.youtube.com/watch?v=aYZx1l8rkXA . A story on the software tool we developed for handoffs is at this website, see pages 12-13. http://www.va.gov/opa/publications/vanguard/09janfebVG.pdf
An article on the tool in the Joint Commission Journal is on-line at: http://www.ingentaconnect.com/content/jcaho/jcjqs/2010/00000036/00000002/art00003 Sorry it's not a full-text freebie. If you would like a pdf copy of it you can email me at neldridge202@yahoo.com.
- Project HealthDesign engaged five teams to demonstrate how patient-generated health data from mobile apps and devices could improve care for conditions like asthma, Crohn's disease, cognitive decline, infant health, and obesity.
- The projects explored technical, legal, and policy issues and found that patient data could help identify medication non-adherence, adjust treatment plans, and reduce visits and prescriptions. Integration into clinical workflows and electronic health records was challenging.
- Patients reported feeling less alone, improved quality of life, and empowerment. Providers were able to better educate patients and manage conditions.
The document discusses evidence-based nursing practice. It defines evidence-based practice as integrating the best research evidence, clinical expertise, and patient values and needs. The key steps in evidence-based practice are asking questions, acquiring evidence, appraising the evidence, applying it to a patient, and evaluating outcomes. Barriers to evidence-based nursing include lack of time and resources, as well as difficulties interpreting and applying research. Facilitators include administrative support and accessible, clearly written research. Maximizing evidence-based nursing requires overcoming barriers, incorporating different types of evidence, and accounting for issues beyond measurement like patient preferences.
This ppt will help dentists in taking Evidence Based decision in daily practice and will also help researchers to categorized result of research on the basis of hierarchy of Evidence Based Dentistry
This document discusses the implementation of a psychosocial distress screening program at the Robert H. Lurie Comprehensive Cancer Center. It describes barriers to screening, the use of a computerized adaptive testing system to efficiently measure multiple domains of distress, and lessons learned from piloting the program. Screening results are integrated into patients' electronic health records and trigger messages to clinicians if severe distress is reported, in order to better manage patients' psychosocial needs. The goal is to systematically identify and address sources of distress throughout the cancer care process.
Workshop: Effective Patient Adherence Management by Engaging Enabling Technologies
Pei-Yun Sabrina Hsueha, Vimla L. Patelb, Fernando Sanchezc, Marcia Itod,e, Chohreh Partoviana, María V. Giussi Bordonig, Marion Ballf,a
a IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
b Center for Cognitive Studies in Medicine and Public Health, the New York Academy of Medicine, New York, NY, USA
c Health and Biomedical Informatics Center, University of Melbourne, Melbourne, Australia
d IBM Brazil Research Lab, Sao Paolo, Brazil
e Telehealth/Teledentistry Center, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
f Johns Hopkins University, Baltimore, MD, USA
g Health Informatics Department, Hospital Italiano de Buenos Aires, Argentina.
Abstract
Effective patient adherence management strategies require better understanding of patient-generated data, including patient-reported data and measurements from devices and sensors, as key to assisting providers in learning more about their patients’needs and enhancing patient centric care. Gaining “meaningful use” of patient-generated data could ultimately lead to improvements in patient safety and outcomes. In this workshop, we review proof of concept studies using technology to assess patient health literacy and self-efficacy with the goal of providing timely intervention, remedy, and improvements in cost and quality of care. In particular, we focus on engagement-enabling technolgoies that can leverage non-clinical information sources and reflect patient activities in the “wild”. We look into barriers to adherence, patients and providers roles in improving adherence, and the use of technology to assist patients in staying on track. The speakers will address the issues related tothe integration of patient-generated data into everyday life and clinical practice and share lessons learned from implementing these designs in practice. This workshop aims to share requirements gathered for the design of next-generation healthcare systems, especially in areas where the explosive availability of patient-generated data is expected to make impacts.
This document summarizes a panel discussion on transforming patient-generated health data for wellness and biomedical research. The panelists were Susan Peterson, Katherine Kim, Fernando Martin-Sanchez, Cagatay Demiralp, and Pei-Yun Sabrina Hsueh (moderator). Peterson discussed using sensors and mobile apps to monitor cancer patients undergoing radiation therapy to detect early signs of dehydration. Kim discussed leveraging patient data for personalized care coordination. Martin-Sanchez discussed generating evidence from patient data to inform research. Demiralp discussed visualization of patient data. Overall the panel explored opportunities and barriers to using patient-generated data from behavioral sensing to clinical decision support.
This document summarizes PCORI's efforts to engage patients in research and tool development. It discusses PCORI's priorities in comparative clinical effectiveness research and shared decision making. Examples are provided of pilot projects developing tools like a digital portal for multiple sclerosis patients and integrating patient-reported outcomes into arthritis care. PCORI's vision for a National Patient-Centered Clinical Research Network is outlined, with plans to fund Clinical Data Research Networks and Patient-Powered Research Networks through cooperative agreements.
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The document discusses decision support in VA clinical information systems. It covers several topics including the diffusion of medical innovations, clinical knowledge as a special case, unexplained practice variation, business drivers for evidence-based medicine, challenges of clinical decision support, and knowledge management throughout the lifecycle of clinical guidelines.
This study developed and tested a brief self-administered questionnaire called the Complementary and Alternative Management for Asthma (CAM-A) instrument to identify negative beliefs about inhaled corticosteroids (ICS) and endorsement of complementary and alternative medicine (CAM) among urban minority adults with asthma. Psychometric testing identified 17 items representing ICS beliefs and CAM endorsement that demonstrated acceptable reliability. High rates of CAM endorsement, negative ICS beliefs, and uncontrolled asthma were found. CAM endorsement was significantly associated with uncontrolled asthma. Qualitative analysis provided preliminary evidence that use of the CAM-A instrument in primary care visits prompted providers to discuss ICS beliefs and CAM endorsement with patients.
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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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
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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
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
1. PROS IN CLINICAL CARE
Paul K. Crane, MD MPH
Associate Professor, Department of Medicine, School of Medicine
Adjunct Associate Professor, Department of Health Services, School of Public Health
University ofWashington
pcrane@uw.edu
2. Outline
How did I come to this topic?
Intro to PROMIS
How did my wife come to this topic?
Intro to CNICS
PROMIS 2 research on depression
PROMIS 2 network / Clinical Practice
Subcommittee
Future forecast
3. Outline
How did I come to this topic?
Intro to PROMIS
How did my wife come to this topic?
Intro to CNICS
PROMIS 2 research on depression
PROMIS 2 network / Clinical Practice
Subcommittee
Future forecast
4. My background
UW med school (1997)
Internal medicine internship (UW) and
residency (Barnes-Jewish) 1997-2000
Hospitalist and Health Behavior Research
fellow 2000-01 (Washington U, St. Louis)
General Internal Medicine Fellow, MPH, UW
(2001-03)
5. Interest in measurement
Decided as a Health Behavior fellow to study
diabetes, depression, and health related
quality of life
Determined that to know anything about
that topic, had to know something about how
to measure HRQL
Lots of diabetes-specific HRQL scales, all of which
made claims that I did not understand
And I thought I knew how to read the medical
literature!
6. Faries et al. paper
A paper on the Hamilton Depression Rating
Scale looked at responsiveness of each item,
which they defined as differences between
placebo and active treatments with their drug
Certainly didn’t like that way of defining things
But it’s the item, not the scale!
Faries D et al.The responsiveness of the Hamilton Depression Rating
Scale. Journal of Psychiatric Research 2000; 34: 3-10.
7. GIM Fellowship: Psychometrics
Worked with Gerald van Belle during fellowship
We taught each other modern psychometrics
Hambleton et al. (1991): Fundamentals of Item
ResponseTheory
Embretson and Reise (2000): Item ResponseTheory for
Psychologists
McDonald (1999):TestTheory: a Unified Treatment
Would add to this list:
Wainer et al. (2007): Testlet ResponseTheory and its
Applications.
8. Fellowship psychometrics
research - 1
K08 proposal, “Improving cognitive tests with
modern psychometrics” – Alzheimer’s disease
specific 3-year K award
Worked with item-level cognitive and PRO data
Dan Mungas at UC Davis
PROMIS I application on self-reported cognition
Not discussed – “cognition is not important to HRQL”
Became aware of a second UW PROMIS I
proposal from Dagmar Amtmann
9. Psychometrics Research – 2
Dagmar’s project was funded, and she was
happy to have me involved as I wished during
my K award.
So, I went.
10. PROMIS 1
Large project (7 U01 projects, 1 StatisticalCoordinating Center,
each with an NIH Project Officer)
One Danish physician (Jakob Bjorner) involved with one of the
projects
No other practicing clinicians with modern psychometrics expertise
No projects really integrated with clinical care
I felt the need to speak up!
Network structure; first set of domains built by the Network
Depression;
Anxiety;
Alcohol abuse;
Anger;
Physical function;
Fatigue impact / experience;
Social role performance /satisfaction;
Pain interference / quality / behavior
11. Pilkonis PA et al. Item banks for measuring emotional distress from the Patient-ReportedOutcomes Measurement
Information System (PROMIS®): depression, anxiety, and anger.Assessment 2011; 18: 263-283.
12.
13.
14. Some PROMIS strengths
Extraordinary amount of attention, with
reasonable choices made
Item QC led to items that are relatively easy to
read, simple to interpret, similarly worded, etc.
Domain-to-domain look and feel is consistent
Scores across the domains look similar
Direction based on name of domain
Scaled so 50 is mean of US, +/- 10 is 1 SD
Attention to intellectual property
Increasingly important consideration
Proprietary items = $, risk for lawyer involvement
15. PROMIS Product: Short forms
Brief group of items
“Developed … based on simulations of CAT
results, item information, and item content”
Candidate items identified based on psychometric
characteristics, and then reviewed by content
experts (Pilkonis 2011)
16. PROMIS product: CAT
Efficient and brilliant use of computers
You already know the CAT algorithm: pick a
number (“binary search”)
Need an item bank, a scoring algorithm, and a
stopping rule
Stopping rule can be composite
Result: precise-enough scores for a domain after
a very few items (like 4 or 5)
If IRT assumptions are appropriate, it’s very slick!
Assumption: all items are equally useful
17. PROMIS 2
1 coordinating center becomes 3 (technology
center, statistical center, network center
12 PROMIS projects
Structure different: no network projects (or
we’re all network projects)
And one of the 12 PROMIS projects was ours!
We’ll come back to this in a bit.
18. Outline
How did I come to this topic?
Intro to PROMIS
How did my wife come to this topic?
Intro to CNICS
PROMIS 2 research on depression
PROMIS 2 network / Clinical Practice
Subcommittee
Future forecast
19. Heidi Crane, MD MPH
UW undergrad, UW med school, Barnes-Jewish
Medicine Residency, UW ID fellowship
K23 on body morphology disorder among people
with HIV
Self-reported body morphology changes
Tablets in the waiting room for people with long
waits ahead of them
Other PRO domains on the assessment
Crane HM et al. Routine collection of patient-reported
outcomes in an HIV clinic setting: the first 100
patients. Current HIV Research 2007; 5: 109-118)
20. Chart reviews for same-day
visits
Depression: not identified by providers
Substance use: not identified by providers
Poor adherence: not identified by providers
And alarmingly high prevalence of patients who told
the computer they were having problems, whose
providers documented “No problems with
adherence,” “Perfect adherence,” “Taking all meds”
Reviewed these findings with clinic leadership
Imperative to measure these things and make
sure providers have access to the findings at
the point of care
21. Integrating into routine care:
not trivial Instead of patients with long anticipated wait times
for research protocol, change to all patients
Except not all patients; super frequent fliers for wound
care excluded
So who?
Offset the clinical day, so patients scheduled to
interact with tablet 20 minutes before provider
scheduled in the room
Front desk implications, rooming staff / vitals
implications, …
In short: a clinical change with an impact on patient
flow
Importance of Clinic Leadership buy-in essential
Other elements of case on succeeding slides
23. Extension of Chronic Care Model
clinical information system, delivery
system design, decision support
“Listening to the patient’s voice in a systematic
standardized way”
Delivering data to providers using 21st century
informatics tools
Ultimate goals: Tailored, personalized,
evidence-based recommendations for clinical
actions
24. Patient-provider
relationship
Devote time during the clinic session to elements
both patients and providers deem important
Clarify patient concerns
Patients more honest to CASI than they are to a
provider, less social desirability bias. More likely
to report to CASI poor adherence, substance
abuse, depression, risk behavior than to provider
Fredericksen R et al. Integrating a web-based, patient-
administered assessment into primary care for HIV-
infected adults. Journal of AIDS and HIV Research
25. Figure 1A. Common situation in routine clinical care
Figure 1B. Situation with valid adherence measurement incorporated into clinical care
Poor
adherence
Adherence
not assessed
System not
aware No
intervention
Continued poor
adherence
Poor HIV
outcomes
Structural barriers
Provider barriers
Patient barriers to
assessment
Patient factors
*substance
abuse
*mental illness
*other
Poor
adherence
Patient factors
*substance
abuse
*mental illness
*other
Adherence
assessed
Intervention
Poor
adherence
Good
adherence
Better HIV
outcomes
Adherence
assessed
System aware
26. CNICS
Madison Clinic part of UW Centers for AIDS
Research (CFAR)
CFARs banded together to form CNICS, the
CFAR Network of Integrated Clinical Systems
Initial partnership with the 1919 Clinic at
University of Alabama at Birmingham
28. PROs at UAB
Paper free clinic
Never a feedback form on paper
Touch screens provider room with feedback; monitors
in exam rooms
Aspects of PROs at every visit (ROS)
Patient flow is different – patients in a physical
“circuit” around the clinic
Patient flow at Madison was much more waiting room
-> vitals -> back to waiting room -> exam room
Addressed the “circuit” with “ticket numbers” so could
pick up the PRO Assessment where they left off
Addressed these differences with personal visits
29. PROs in CNICS
Extension to Fenway (Boston), UC San Diego
(large Latino population; Spanish essential),
others (UCSF, Hopkins, UNC, CaseWestern)
Different EMR systems, different leadership / clinic
cultures, different patient groups, different patient
flow
All PRO collection is local!
30. Our PROMIS 2 proposal
CNICS infrastructure now with 30,000 PRO
Assessments from 8 CFARs around the country
Extensive harmonized clinical data
Uniquely situated in clinical care for PLWH
Aim 1: PROMIS domains in clinical care
Ask patients which domains they think are most
important
Focus on groups of items patients see, not the whole bank
Simulated CAT, PROMIS short form
As of April 2012, 809 studies set up in Assessment Center;
only 2 administered an entire bank
Other parts: 2 new domains; RCT on adherence;
active involvement with the Network
31. Outline
How did I come to this topic?
Intro to PROMIS
How did my wife come to this topic?
Intro to CNICS
PROMIS 2 research on depression
PROMIS 2 network / Clinical Practice
Subcommittee
Future forecast
32. Depression domain
Simulated CAT: 5 items for severe, moderate,
and mild depression
Compared with short form content
Short Form CAT: Mild CAT: Moderate, Severe
Sad Sad Sad
Unhappy Unhappy Unhappy
Depressed Depressed Depressed
Helpless Helpless
Hopeless
Worthless
Like a failure
Nothing to look forward to
Discouraged about future Discouraged about future
Disappointed in self
33. Analyses of depression domain
Qualitative analyses
97 PLWH in 4 cities, stratified by depression severity
“Repetitive,” “Redundant,” “Mas o menos lo mismo”
(both the Short Form and each of the simulated CATs)
“What would a provider need to know to take great
care of a person with HIV?
SUICIDALITY
Providers: Distinct preference for PHQ-9 content
Patients: Distinct preference for PHQ-9 content
Quantitative analyses
1299 PLWH in 4 cities
PROMIS and PHQ-9 work fine, nothing to distinguish
either one
34. WSCD (“What Should CNICS Do”)?
• Administer PHQ-9, score using PROMIS item
parameters
Gibbons LE et al. Migrating from a legacy fixed-
format measure to CAT administration: calibrating
the PHQ-9 to the PROMIS depression measures. Qual
Life Res 2011; 1349-1357.
Best of both worlds
Content providers and patients want, scores on
PROMIS metric, brief enough
35. Outline
How did I come to this topic?
Intro to PROMIS
How did my wife come to this topic?
Intro to CNICS
PROMIS 2 research on depression
PROMIS 2 network / Clinical Practice
Subcommittee
Future forecast
36. PROMIS Clinical Practice Subcommittee
Growing demand for PROMIS scales from clinicians
Groundswell of understanding of need for PROMIS
focus on this issue
“Sorry, I have to go, there goes my group, and I am their
leader!”
Big initiatives to date: two papers (Broderick et al.
2013; Jensen et al. to be re-submitted) and EPIC
Steering Committee vote:Work with EPIC to ensure
PROMIS content included
Extensive discussion of which domains and
calibrations
Initial build: short forms, scored using total scores
(not IRT scoring)
Hopefully CATs in next build
37. PROMIS 2 Network
Large number of additional domains being developed
(sexual function, self efficacy, substance use, GI symptoms)
Bigger efforts in pediatric settings (CincinnatiChildren’s,
CHOP, UNC)
Other initiatives: cancer, instantaneous assessment,
broaden physical functioning to address ceiling, …
Less cohesive than PROMIS 1 (by design) in terms of
projects
PROMIS standards document, domain framework, PROMIS
at NIH Clinical Center, PROMIS in National Children’s Study,
PROMIS in DoD care settings, ….
3 Coordinating Centers transitioning to ??? In future
PROMIS, NIHToolbox, NeuroQOL
38. RFA-CA-13-008
The purpose … is to support the creation of a research resource
infrastructure for the administration of research investigations using person-
centered health outcomes … the Person-Centered Outcomes Research
Resource (PCORR).
The PCORR will be expected to support the use and enhancement of the
following four measurement information systems, currently funded as
separate NIH programs:
Patient Reported Outcomes Measurement Information System® (PROMIS®);
the NIHToolbox for Assessment of Neurological and Behavioral Function (NIH
Toolbox);
the Quality of Life (QOL) Outcomes in Neurological Disorders (Neuro-QOL;
andThe Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-
Mef).
The main goal for the PCORR is to provide an integrated platform for
automated use of the four measurement information systems.
This platform must be compatible with various modes of information collection
(including web/mobile-based entry, non-digital paper source data, and others).
The PCORR platform must also be designed to allow resource users (i.e.,
external researchers and clinicians unaffiliated with the resource) to access
and use any of the four systems together or in isolation and tailor use to
meet the specific study needs…
39. PCORI funding
Not surprising PCORI is interested in PROs
Their default is that patients are the experts
Atlanta meeting last fall on integrating PROs
in EHRs
PROMIS measurement RFP now
Additional input on PCORI priorities sought
Additional funding initiatives likely
Network-ness
40. Outline
How did I come to this topic?
Intro to PROMIS
How did my wife come to this topic?
Intro to CNICS
PROMIS 2 research on depression
PROMIS 2 network / Clinical Practice
Subcommittee
Future forecast
41. “Prediction is very difficult,
especially about the future”
(N Bohr / Y Berra)
Growing demand for PROs in clinical care
ACOs, PCORI, Quality measures, IOM, Meaningful
use….
Technological issues much less of a barrier
Ubiquitous tablets and iPhones
Initiatives such as PROMIS developing a lot of
content
Where should this head?
43. University of Utah Orthopedics
PROMIS colleague Nan Rothrock got me
connected with Orthopedics faculty at U of
Utah
Discussion with Dr. Darrel Brodke
Chair interested in PRO collection x years
ODI, NDI, SF-36, PROMIS PF, EQ5D
Floor effects of ODI and NDI
Data warehouse, also scores at point of care
44. Score interpretability
Clinicians are not innumerate people!
mmHg, HCT, chemistries, creatinine, saturations,
SNPs, omics, MRI physics…
How do we get used to all these numbers and
different scales? The old fashioned way – we
use them!
45. Black box of score production
Modern psychometrics, confirmatory factor
analysis, item response theory, graded response
model, polytomous data, computerized adaptive
testing, etc.
There’s a whole science in there!
But there is a whole science in producing the
creatinine value we use clinically too, and I don’t know
what’s in that black box
I don’t think one needs expertise inside the black
box to use the output from the black box to take
great care of patients
46. Future will be longitudinal
Power will come from integrating PRO data
alongside other clinical data
Conceptualize PRO collection as an extension
of history taking
Quantified history?
Not the end of the discussion but a launching
point
Launch from a deeper place than “So how’s your
depression been doing?”
48. Next things to tackle
One size fits all
Great place to start
Heterogeneity across patients within a clinical
setting
Primary care may be the hardest
Critical need to value patients’ time – can’t
possibly collect everything on everyone
Measurement prior to visits vs. web-based
More and more people are connected
Critically important to reach those who are not!
49. Lessons learned
Patient care is local
Stakeholder buy-in is critical for clinical change to
survive
Patients appreciate being asked
The only way to study the data is to have the data
Old questions of whether what we do makes a difference
21st century technology to address those questions
Personalized care is not just omics, it’s got a person
at the center
Patient-provider relationship at the center of the Chronic
Care Model makes a ton of sense!
50. Too many great colleagues to thank
Thanks for the invitation!
Thanks to Joan Broderick and other PROMIS Clinical Practice
Subcommittee authors on the eGEMS paper, which caught your
eye and led to my talk today
UW/MadisonClinic Colleagues
UW PROMIS Colleagues
CNICS investigators
DagmarAmtmann and PROMIS 1
Gerald van Belle, Dan Mungas, Eric Larson, EdWagner for
mentorship
My local shop: Laura Gibbons, Shubhabrata
Mukherjee, Elizabeth Sanders
Funding from NIH
Patients