Abstracts Due Jan. 12 for AcademyHealth Annual Research Meeting

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Showcase Your Work at the 2012 Annual Research Meeting  Call for Abstracts Submission Deadline: January 12, 2012 The AcademyHealth 2012 Annual Research Meeting (ARM) call for abstracts is now open. With more than 50 percent of the conference agenda selected through the call for abstracts process, the ARM is an opportunity for researchers to share important findings with policymakers and providers who can move the research into action. Abstracts are invited for four categories: call for papers, call for posters, call for research panels, and call for policy roundtables. AcademyHealth seeks abstracts on 18 themes reflecting a variety of critical areas of study in health services research, as well as proposals for panels that present research or discuss key health policy topics. Abstracts submitted to the call for papers will also be considered for publication in JAMA.  Submit to the call for abstracts by January 12 to be considered for presentation at the 2012 ARM, June 24-26 in Orlando. Details on the specific theme topics, submission criteria, and instructions can be found online at www.academyhealth.org/arm/abstracts.

Clinical Research Oriented Workshop (CROW) Meeting: December 15, 2011

Present: Kairn Kelley, Amanda Kennedy, Charlie MacLean, Connie van Eeghen

1. Start Up: Kairn’s update on her dissertation study – In a recent meeting with Ben, it was suggested that perhaps Kairn should look at a different test with better reliability. Kairn explained the reasons for looking at dichotic words tests and acknowledged reliability is a major concern. The “goodness” of auditory processing tests as a category has not been established based on current literature. Comments made:

a. Consider the current state of auditory tests as the topic for the review article that is required of the PhD.

b. This study will not answer all the questions of what is true, what clinical practice should be, and how one helps an individual patient. That effort describes a career, specifically, a post-PhD career.

2. Kairn: Lit review progress. Kairn brought a chapter for discussion and support on normative values of a SCAN-3 auditory processing test, including how they were determined and what they mean. The group discussed the purpose of review. Instead of reviewing this article, the group sketched the outline of the review article that Kairn should write.

a. Audience: clinical audience

b. What is available (auditory tests) – cast the widest net possible, but must be available

i. Keep a separate listing of all tests, whether or not available

c. What studies have been done (not many)

d. How to select appropriate tests (based on what is available) – like a Consumer’s Report digest

i. Develop criteria for rating those tests

ii. Rate them

iii. Check a standard reference (Cochrane’s?) for examples

iv. Goal: one stop shopping for clinicians

e. Anticipate the dissertation study by outlining a method for further study

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Dec 22: Rodger – Discussion of Web-Based Self-Management Intervention for Multi-Morbidity (no Amanda, maybe no Kairn)

b. Dec 29: UVM closed

c. Jan 5: Kairn – review of “Development and Evidence of Reliability and Validity” chapter from SCAN-3; start new meeting time from 1:00 – 2:30 on Thursdays

d. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding

iii. Amanda: presentation and interpretation of data in articles

iv. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)

Recorder: C. van Eeghen

Alan Rubin is Teacher of the Year

Last night the Fletcher Allen - University of Vermont Medical Group honored Alan Rubin, MD as the Teacher of the Year. In fact, a case could easily be made that he is the Teacher of the Decade, of the Century, of the Epoch! His excellence in teaching is matched only by his remarkable energy, his willingness to explore new ideas, engage new topics, address new audiences, and care for his friends, colleagues, neighbors and patients in new and thoughtful ways.

Alan is a major ingredient in the secret sauce that makes General Internal Medicine Research and the CTS grad program work, that makes it fun to be here, and that keeps me coming in to do all the great stuff we all do together.  Thank you, Alan!

Clinical Research Oriented Workshop (CROW) Meeting: December 8, 2011

Present: Kairn Kelley, Amanda Kennedy, Connie van Eeghen

1. Start Up: Plan for spring semester: Ben, Amanda, Charlie, Rodger and Kairn are good with the current schedule on Thursday afternoons. Abby gets out of class on Thursdays at 12:45. We agreed to reschedule CROW meetings for spring semester starting January 5, 2012 from 1:00 – 2:30.

2. Connie: Presented her data from “Office Systems Analysis Case Study 2,” which focused on a quality improvement (QI) project conducted by an academic medical center’s primary care office practice in Burlington, VT. The project’s focus: integrate a new position for a behavioral health clinician into the primary care process, team, and systems. This project was conducted by using a QI process called “A3” to complete the team’s work, which took place from August 2010 to November 2010, followed by three months of implementation. Data were collected from the EHR system, staff surveys, and interviews. Connie’s question: which of two directions should she go to produce an article on this work?

a. Option 1: “An Effective Change Process,” which provides a tutorial of the A3 method in the context of a hypothetical project to integrate behavioral health into a primary care practice. The advantage of this choice is that it leads to a further publication on the application of the method.

b. Option 2: “A Case Study on an Effective Change Process,” which provides the data presented above as the outcomes of an implementation using the A3 method. The advantage of this choice is that it is likely to be seen as more practical and compelling.

The intended audience for this article are primary care and behavioral health clinicians. The group provided helpful feedback:

a. One good article that gets published is more valuable than several that never quite get written or accepted.

b. Case studies are compelling; multiple case studies even more so

c. Whichever chosen, research the publication, write the abstract, and email the editor. Publications to consider:

a. Journal of General Internal Medicine

b. Archives of Internal Medicine

c. Other publications related to Family Medicine

Connie will develop an outline based on a case study of her work with Rodger and circulate it for comments. Thank you to all!

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Dec 15: Kairn: Review of normative values of a SCAN-3 auditory processing test, including how they were determined and what they mean. (No Ben)

b. Dec 22: Rodger (no Amanda, Kairn)

c. Dec 29: UVM closed

d. Jan 5: Kairn – update; start new meeting time from 1:00 – 2:30 on Thursdays

e. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding

iii. Amanda: presentation and interpretation of data in articles

iv. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)

Clinical Research Oriented Workshop (CROW) Meeting: December 1, 2011

Present: Kairn Kelley, Ben Littenberg, Connie van Eeghen

1. Start Up: Connie has done some new learning about homelessness in Burlington. After a brief case history, we redirected ourselves to planned (rather than spontaneous) research.

2. Connie: Shared an overly long re-draft of an R03 grant application to develop and implement a “toolkit” for integration of behavioral health in primary care office practices. The group shared three kinds of feedback:

a. Language: rewrite in short, declarative sentences with little/no jargon using well structure paragraphs.

b. Logical relationships: re-evaluate the reason why each sentence is in the document. Some are just “extras” and don’t reflect the purpose of the heading.

c. Intent: it was not clear to everyone what the purpose of the study was. Develop a clearer message along with a more process-based table of study steps:

i. Previous site evaluates draft tool kit

ii. Review and revise tool kit

iii. First implementation

iv. First site evaluation:

1. By participants (Aim 1)

2. By EHR (Aim 2)

v. Review and revise again

vi. Second implementation

vii. Second site evaluation:

1. By participants (Aim 1)

2. By EHR (Aim 2)

viii. Final review and revision

d. Connie will have a new draft soon… stay tuned. And a big thank you to all!

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Dec 8: Connie – case study data; outline for paper (no Ben)

b. Dec 15: Rodger (no Ben)

c. Dec 22: (no Amanda, Kairn)

d. Dec 29: UVM closed

e. Jan 5: Kairn – update; check for spring schedule for CROW meetings

f. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding

iii. Amanda: presentation and interpretation of data in articles

iv. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)

Recorder: C. van Eeghen

For those who are supposed to be working on their dissertations... or not

Tone Matrix

Enjoy! Connie

Clinical Research Oriented Workshop (CROW) Meeting: Nov 17, 2011

Present: Kairn Kelley, Amanda Kennedy, Rodger Kessler, Ben Littenberg, Connie van Eeghen

1. Start Up: Amanda – goal for today is to become fluent in “survival analysis” and why the article (Ridker, Rosuvastatin…, 2008) raises flags about supporting the treatment it advises.

2. Ben: Has been reading “Made to Stick” – a book that indicates that numbers alone are rarely enough to change behavior; the “story” needs to be present too. (Relates back to H. Pylori as the cause of ulcers, with treatment by antibiotics, translated to practice by personal demonstration rather than RCTs.) The interpretation of survival analysis studies is based on the following:

a. Approach like any hypothesis testing exercise, with time involved

b. Two variable outcome: will there be an event and when will it happen?

c. Analytical rules

i. One event (even a non-fatal event) removes the subject from the study

ii. Death for any reason is a cause for removal as well

d. The curves illustrated in the article (placebo and experimental drug) show the cumulative incidence to time “t,” or the rate of events for the entire population up to any time “t” conditional on being at risk in the time period (“time to event” analysis)

e. Kochs figured out how to smooth the step-wise curve; Kaplan-Meier created a log rank, non-parametric test. It is an omnibus test: it tests all comparisons but doesn’t say where any differences lie, just whether they are present.

f. The p value indicates whether the cumulative survival rate over time is (or is not) different.

g. This analysis gets a little more complicated when subjects are recruited over time (they don’t all start at the same time); survival for a “short time” subject isn’t as meaningful as for a “long time” subject. Calendar time survival shows incoming and outgoing subjects throughout the study:

i. Survivors who are short timers are “censored out” of the denominators and numerators. Elapsed time survival “pulls back” new recruits; they don’t have an effect on later time periods because they haven’t been in the study long enough:

ii. K-M calculates the cumulative effect of the probability for each time period within the study

h. Is the graph in the article convincing? Reasons that the difference between 2 groups could exist:

i. Randomness, which is affected by:

1. Sample size

2. Measure of variance

3. Effect size

4. And is measured by p value

ii. Bias – systematic error, sampling bias, or fraud – in general, we never know for sure

iii. Real effect – the difference is a reflection of the truth – and we’ll never know, again

i. Precision: decreases over time, as the number of survivors decreases over time. This is why the “number at risk” should be included below the graph for each time interval.

j. Questions to ask about a study:

i. Is it worth it (to prescribe a drug) if the drug costs $1000/year, which for every 20 out of 100 will have unwelcome effects and 1 will be saved a critical event that would cost ~$50K? Is the effect size worth it?

ii. Is the biology convincing?

iii. Was it funded by a neutral source? Some judgment is required here.

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Nov 24: Cancelled – Thanksgiving

b. Dec 1: Connie – data presentation or R03 draft (no Rodger)

c. Dec 8: (no Ben)

d. Dec 15: (no Ben)

e. Dec 22: (no Amanda, Kairn)

f. Dec 29: UVM closed

g. Jan 5: Kairn - update

h. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding

iii. Amanda: presentation and interpretation of data in articles

iv. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)

Recorder: C. van Eeghen

UVM Publication cited in Boston Globe

The Boston Globe picked up on an article by Nancy Morris RN, PhD about her work done when she was a Faculty Scholar with us.  Congratulations to Nancy and UVM co-authors Steven Grant MD, Alan Repp MD, Charles MacLean MD  and Benjamin Littenberg MD.

Nurs Res. 2011 Sep-Oct;60(5):361-6.

Prevalence of limited health literacy and compensatory strategies used by hospitalized patients.

Morris NS, Grant S, Repp A, Maclean C, Littenberg B.

Source

Graduate School of Nursing,University of Massachusetts, Worcester 01655, USA. nancy.morris@umassmed.edu

Abstract

BACKGROUND:

Limited health literacy is associated with higher rates of hospitalization. However, the prevalence and etiology of limited health literacy among hospitalized adults and the compensatory strategies used are not known.

OBJECTIVES:

The aims of this study were to determine the prevalence and demographic associations of limited health literacy in hospitalized patients and to identify the perceived etiology and use of any compensatory strategies.

METHOD:

A cross-sectional study was implemented of a consecutive sample of hospitalized adults admitted to the Internal Medicine Hospitalist Service at a 440-bed academic medical center (n = 103) in Vermont. Health literacy was determined using the short form of the Test of Functional Health Literacy in Adults. Demographic data, perceived etiology of difficulties in reading or understanding health information, and use of compensatory strategies were self-reported.

RESULTS:

Sixty percent of medical inpatients have limited health literacy. Thirty-six percent of patients with limited health literacy attribute this to difficulties with vision. Sixty-two percent of all medical inpatients rely on help from a health professional, and 23% look to a family member when faced with challenges in reading or understanding health information.

DISCUSSION:

The prevalence of limited health literacy is high in hospitalized medical patients. Further study of the timing and methods of communicating information to hospitalized patients is warranted. Assuring that the patient and/or family understand the postdischarge plans will be an important step to improving quality and safety.

PMID:

 

21878798

 

[PubMed - indexed for MEDLINE] 

PMCID: PMC3212986

 [Available on 2012/9/1]

Clinical Research Oriented Workshop (CROW) Meeting: Nov 3, 2011

Present: Kim Dittus and guest Dr. O'Brien, Kairn Kelley, Amanda Kennedy, Rodger Kessler, Charlie MacLean

1. Rodger: Rodger is preparing an R01 in which practice demographics could impact outcome. He asked if he should stratify. Clarifying discussion about stratification, block randomization, and block randomization with stratification ended in the conclusion that, for Rodger's current grant, block randomization makes sense but effects of demographics should be looked at during analysis not assumed and stratified for.

2. Kim: Kim shared a power-point presentation describing an oncology rehabilitation program which she would like to see paid for by insurance companies. Dr. Wheeler from BC/BS indicated an interest in the program if it can be shown that "it works." Kim shared successes in getting the program going thus far for breast cancer survivors completing treatment. Ideas for gathering and presenting useful pilot data and future evaluation with comparison groups were discussed.

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Nov 10: Amanda: survivor analysis chalk talk

b. Nov 17: Connie: Review of Case Study #2 data

c. Nov 24: Cancelled – Thanksgiving

d. Dec 1:

e. Dec 7:

f. Dec 15: (no Ben)

g. Dec 22:

h. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished)

iii. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)

Recorder: K. Kelley

Example of Visual Data Points in Nature

This is a video of a Murmuration; I had to watch it a few times before I could stop staring.

http://vimeo.com/31158841

Enjoy...

New Funding Opportunity for the NIH Director’s Transformative Research Award

NIH Common Fund’s High Risk-High Reward Program:

New Funding Opportunity for the NIH Director’s Transformative Research Award

Date: November 8, 2011

Time: 1:00-2:45 PM EST

Background

The NIH Director’s High Risk-High Reward (HRHR) program, supported through the NIH Common Fund, was created to test new ways of stimulating the biomedical workforce by providing support for highly creative researchers and ideas that have the potential to fundamentally change the way we think about and conduct biomedical research. Four different NIH Director’s awards comprise the HRHR program: the NIH Director’s Transformative Research Award, Pioneer Award, New Innovator Award, and the Early Independence Award.

This informational webinar will provide information and answer questions about NEW funding opportunity announcements (FOAs) for the HRHR program, specifically for the Transformative Research Award, which is open until January 12, 2012 (5:00 PM local time of applicant organization). The types of questions to be addressed during the webinar include, but are not limited to:
· What types of projects have been funded to date?
· Why don’t there seem to be so many clinical and/or behavioral science projects funded?
· What are the expectations regarding preliminary data?
· What are typical budgets of successful applications?
· What are the most common criticisms?
· What makes a particularly strong application?
· Can you give some examples of projects that might be considered transformative or not transformative?
· What is the review process?
· How are reviewers selected?
· How can applications with such diverse topic areas be reasonably reviewed by a single panel?

Agenda
1:00 PM Welcome
James Anderson, M.D., Ph.D., Director, Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI), NIH
1:05 PM New Funding Announcement for High Risk-High Reward Program:
NIH Director’s Transformative Research Award
Ravi Basavappa, Ph.D., Program Director, Office of Strategic Coordination, DPCPSI, NIH
1:30 PM Review process for Transformative Research Award applications
John Bowers, Ph.D., Initial Review Group Chief and Scientific Review Officer for the
Transformative Research Award initiative, Center for Scientific Review, NIH
1:40 PM Question and Answer Session
Members of the High Risk-High Reward Working Group will answer questions submitted via Email and phone
2:45 PM Adjourn

Access the webinar via: https://webmeeting.nih.gov/hrhr
The computer system requirements for joining the webinar can be found here: http://webcollaboration.nih.gov/systemRequirements.asp

Please send us your questions in advance or during the program via Email at Transformative_Awards@mail.nih.gov or by phone at 1-800-593-9895, pass code 10699.

The webinar is open to external participants and NIH staff. The webinar is being broadcast from the NIH Bethesda campus, Bldg 31, 6C/7. In-person seating is limited. The webinar will be closed captioned and video archived on the Common Fund website (http://commonfund.nih.gov).

The NIH Common Fund (formerly the NIH Roadmap) encourages collaboration and supports a series of exceptionally high impact, trans-NIH programs. These programs are supported by the Common Fund, and managed by the NIH Office of the Director in partnership with the various NIH Institutes, Centers and Offices. Additional information about the NIH Common Fund can be found at http://commonfund.nih.gov.

The National Institutes of Health (NIH) –“The Nation's Medical Research Agency” – includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

American Medical Informatics Association Annual Symposium

Our roving correspondent reports this news from the AMIA Annual Symposium that was held October 22-26 in Washington, DC (http://www.amia.org/amia2011).

UVM (particularly, CTS faculty) had quite a presence with 3 papers, 2 panels, and 1 poster this year – all the papers were up for awards and won 2 of them.

Full-Lenth Papers
Chen ES, Manaktala S, Sarkar IN, Melton GB. A multi-site content analysis of social history information in clinical notes. AMIA Annu Symp Proc. 2011:227-236. [Distinguished Paper Award Winner]

Sarkar IN. A vector space model approach to identify genetically related diseases. AMIA Annu Symp Proc. 2011:1206. [Distinguished Paper Award Winner; under consideration for journal publication]

Ye H, Chen ES. Attribute utility motivated k-anonymization of datasets to support the heterogeneous needs of biomedical researchers. AMIA Annu Symp Proc. 2011:1573-1582. [Student Paper Competition Finalist]

Panels
Bhavnani SK, Bassler K, Sarkar IN, Gundlapalli AV, Shaikh AR. Can Network Visualization and Analysis Accelerate Medical Discoveries? Theoretical, Applied, and Funding Perspectives. AMIA Annu Symp Proc. 2011:2035-2037.

Payne PRO, Sarkar IN. The Joint Summits on Translational Science: Reflections and Aspirations. AMIA Annu Symp Proc. 2011.

Poster
Kost R, Littenberg B, Chen ES. Assessing disease co-occurrences using association rule mining and public health data sets. AMIA Annu Symp Proc. 2011:1841.

Congratulations to Director Neil Sarkar and Associate Director Liz Chen for putting together a remarkable showing in only the second year of the CCTS Biomedical Informatics program.

Clinical Research Oriented Workshop (CROW) Meeting: Oct 27, 2011

Present: Kairn Kelley, Amanda Kennedy, Rodger Kessler, Ben Littenberg, and guest Mike Kenny from the Vermont Oxford Network

1. Ben: How to match individual data from two sources without exchanging any PHI

a. Ben described an area for research that attempts to analyze the impact of geographic factors on health outcomes. Ben and his collaborators hope to connect health data with information about geographic factors (“geomarkers”) near subjects’ homes. The health data may come from clinical and research databases registries housed in different health organizations. The challenge discussed today is how to respect the legal and political needs of data partners that collect the protected health information while still gaining enough information to meaningfully link health outcomes with "geomarkers" (geographic factors).

b. Potential research questions would include:

i. What are the best ways to model geomarkers?

ii. What is the relationship between geomarker ‘x’ (e.g., density of commercial real estate, or topographical slope) and health status ‘y’ (e.g., BMI or breast cancer diagnosis)?

iii. What level of analysis (i.e., individual, zip code, county, etc.) shows the strongest association between geomarkers and health status?

c. Recent stories of the consequences of erroneous release of PHI (Protected health Information) have made many organizations nervous about sharing data even for permitted purposes. In order to respond to data security concerns, Ben proposed a number of data sharing strategies that could be offered to potential partners (not all will be offered). The hope is that presenting choices to the data partner will increase trust so the least restrictive option can be selected. At least one of these options is a novel strategy, and Ben may wish to expand this into a paper. For that reason, I am limiting notes to listing the potential strategies by name:

i. Simple transfer

ii. Partner geocoding

iii. Partner geocoding with random error

iv. Partner geocoding with "snap”

v. Remote access

vi. Sneaker net

vii. Partner geocoding and association

viii. ARC model

ix. Triple transfer (name changed from Triple swap due to negative connotations for the word “swap” re: trust)

x. (Amanda also suggested “Trusted Third Party”)

2. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Nov 3: Kim: research/grant opportunity (no Ben)

b. Nov 10: Amanda: survivor analysis chalk talk

c. Nov 17:

d. Nov 24: Cancelled – Thanksgiving

e. Dec 1:

f. Dec 7:

g. Dec 15: (no Ben)

h. Dec 22:

i. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished)

iii. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)

Recorder: K. Kelley