Tuesday, December 4, 2012

Clinical Research Oriented Workshop (CROW) Meeting: Nov 29, 2012

1.                  Start Up:  How to engage surgical students in research – timing is everything.

2.                  Presentation: Prema’s hypothesis and specific aims of her 15 page, career development grant.  This is the second application to a palliative care private foundation.  Comments:
a.       Explain the acuity of this population of ICU patients.  They are sicker for a reason.
b.      This is your “sell sheet.”  The goal is to help people make decisions.  Explain the vulnerability of these patients and why we care.
c.       Start with the connection to palliative care (and reducing avoidable transfers - paragraph 1), and then move to informed decision making (paragraph 2), with telemedicine following (paragraph 3).  Aim 2 can break into subheadings for quantitative and qualitative measures of family satisfaction, the quality of communication/care, and outcome scores. 
d.      Use consistent language across aims: create, pilot test with quantitative and qualitative outcomes.
e.       The specific aims and methods should be planned to set up the future RCT study that Prema wants to conduct next.  One option: the referral centers (like Malone and Alice Hyde) could be the location where patients are randomized to either “teleconference and transfer” or “transfer” groups.  Another option: pre/post at the tertiary institution level, to avoid contaminating participants with a new (better) way of conducting the conference, which happens anyway. 
f.       This led to an interesting finding that Prema shared: the suggestion of a conference, made by the ICU MD to the referring MD, causes a conference to happen with the family off-line that results in fewer transfers to the ICU.  There is already evidence that participants are contaminated by being asked to talk to the family in order to set up a teleconference.  The long term cost of contamination is that follow up studies get harder to set up.
g.      Another option: the experimental group is Prema and 2 other intensivist’s patients; the control group is the other 13 intensivists.  There is a risk of under powering the study, as the three experimental MD’s may be unusually effective in conducting this intervention. 
h.      There is a delicate balance between alluding to key issues (like costs) for long term interests and staying focused on the key measure for this study. 
i.        There are around 300 transfers/year, and growing to almost 400. 
j.        This is an intervention with a comparison based on convenience.  Subjects are family members clustered by the provider. The intervention is the telemedicine family conference.  Study type: an experimental, prospective study with convenience assignment.  Because the goal is to create enough data to power a larger study, it might be more efficient to run only the experimental arm, and compare the results to the results reported in the literature.  Prema will re-examine the literature.  This will also keep the application focused on career development, rather than focusing solely on the research. 
k.      Clarify that the patient group of interest is not those that are transferring, but considering transfer. 
l.        Consider Annette O’Connor’s decisional conflict scale: from decision aid literature – conflict of the decision and satisfaction with the result.  Dates back to 1990s. 
m.    Consider a future grant to “train the colleague” in other ICU’s, like the Vermont Oxford approach, to help other intensivists run their own studies.  Start your own PBRN!

3.                  Next Workshop Meeting(s): Thursday, 2:00 p.m. – 3:30 p.m., at Given Courtyard Level 4. 
a.       Dec 6: Kairn: TBD
b.      Dec 13: Prema: draft grant application.
c.       Dec 20: Winter break – next meeting is in January
d.      Next semester: move to 1:30 – 3:00 instead of 2:00 – 3:30?  Connie will check with Rodger and Abby. 
e.       Future agenda to consider:
                                                  i.      Ben: budgeting exercise for grant applications; NHANES – lower female mortality for women taking birth control medications
                                                ii.      Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding.  Also: discuss design for PCBH clinical and cost research.  Also: Prezi demo. 
                                              iii.      Amanda: presentation and interpretation of data in articles
                                              iv.      Christina Cruz, 3rd year FM resident with questionnaire for mild serotonin withdrawal syndrome on 12/6 or 12/13

Recorder: Connie van Eeghen

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