Friday Afternoon Seminar Replacement Activity

Week of March 2^nd

Accelerating Innovative Strategies to Eliminate Racial and Ethnic Health Disparities

Keynote Speaker: Stephen B. Thomas, Ph.D.

HRSA Learning Institute

Originally Presented February 22^nd, 2012 11:00 am – 1:00pm

Accessed: February 28^th, 2012

http://services.choruscall.com/links/oeo2011/#

Dr. Thomas spoke at HRSA as part of Black History Month. He gave a lecture on racial and ethnic health disparities in the United States, providing a quick background on the history of health disparities and then focused on opportunities to improve health outcomes in the African American community.

Some Interesting Points from the Lecture:

1. When addressing racial and ethnic health disparities, it is important for healthcare and public health officials to make the community – places where people eat, work, worship, etc – the focus of health improvement, rather than focusing on the clinical setting.

2. Disparities in the quality of healthcare are primarily a function of two main factors: a broken healthcare system/environmental factors and discrimination (biases, stereotyping, uncertainty)

3. Historical inequalities (Tuskegee Syphilis Experiment, Henrietta Lacks, etc) are now part of “pop culture” and these issues shape the attitudes and beliefs of the communities that need to be reached to address the healthcare disparities. Training programs should encourage healthcare professionals to be sensitive to the role this history plays in community beliefs about the healthcare system.

4. We need to encourage increased participation by racial and ethnic minority population in ethical clinical trials research so that the evidence base can be more informative about how interventions work in these communities

5. Innovative, sustainable and results-oriented approaches are key. Example: The HHS program “Take a Loved One to the Doctor Day” became “Take a Healthcare Professional to the People Day,” where healthcare professionals partnered with black barbershops (important in the community, place where cultural norms are shaped) to provide care and outreach to the community. This expanded into a program called H.A.I.R. – Health Advocates In Reach. This program continued to bring healthcare into the community through salons and barbershops and out of the traditional clinical setting. The program also helped barbers become certified as first responders.

Register today and join ACRT, AFMR, and SCTS for Translational Science 2012

Register today and join ACRT, AFMR, and SCTS for Translational Science 2012 on April 18 - 20 at the Omni Shoreham Hotel in the heart of Washington, DC. This is a novel opportunity to become part of the mission to improve health through research and training. We encourage and welcome participation from all individuals involved in clinical and translational science including biostatisticians, nurses, researchers, educators, and scholars. Schedule At-A-Glance Be sure to take a look at the Schedule for a preview of session topics, dates, and times.   The schedule is color coded into sessions specific to scholar trainees, education/mentorship, clinical and translational science, general interest sessions, social sessions, and ancillary sessions. Plenary Speakers Francis Collins, MD, PhD, NIH Director Sherine Gabriel, MD., MSc, PCORI Methodology Chair John Ioannidis, MD, DSc., PCORI Methodology Committee Member Sessions to Talk About The meeting will showcase the latest developments in biomedical research, featuring experts from across the spectrum. Session highlights include: International Health Research with Chris Wilson, MD - Dr. Wilson is the Director of the Discover Program in Global Health for the Gates Foundation and will provide an overview of research aiming to prevent, treat, and diagnose diseases throughout the world. FDA and Industry: Designing and Modifying Clinical Trails When the Unexpected Happens with Abraham Thomas, MD -Unexpectedly there was a concern that one of the currently approved diabetes medications may actually increase mortality. This session will provide information from the FDA on how to develop and change guidelines for conducting clinical trials and assess safety outcomes while studies are currently in progress as well as for the design of future trials. Incorporating flexible adaptive designs into confirmatory phase trialschaired by Chris Lindsell, Ph.D.-- This session will focus on the potential efficiencies which may be gained by considering adaptive clinical trial designs, with motivational examples provided from the planning of confirmatory neurological emergency trials. Meetings with NIH Program Officers at Translational Science 2012- A highly valuable opportunity for researchers to meet with NIH Program Officers in small group settings to discuss grant applications and application strategies. Book Your Hotel Reservations The Omni Shoreham Hotel welcomes Translational Science 2012 guests to their four-diamond luxury hotel in the heart of Washington, DC. Attendees can benefit from a discounted room rate of $239 on the hotel site until March 28. Be sure to book soon.

Friday Seminar replacement Feb 17, 2012

Friday Seminar replacement February 17, 2012
Title:
"Finding the Right Primers: Using NCBI for RT-PCR Primer
Design"

Presenter: Adam
Clore, PhD

Scientific Applications Specialist, IDT

The speaker gave an overview of the NCBI websites that are
helpful for primer design as well as IDT’s primer design software. Primer design is an integral part of
sequencing, genotyping and expression analysis.
Poor primer design can lead to erroneous results no matter if you are
studying bacteria or humans. IDT also
manufactures “g block” double stranded DNA which is a useful control for assay where
the minor allele is rare.

Friday Sem Activity - Week of 2/24

Lecture: “The Obesity Epidemic: Why Have We Failed”
Dr. Lewis H. Kuller, University of Pittsburg
NIH Wednesday Afternoon Lecture Series
Wednesday, February 15th 2012
Podcast accessed Monday February 21st

Link: http://videocast.nih.gov/launch.asp?17113

Dr. Kuller began his lecture by using obesity as an example of a common source epidemic. He made four main points to that end:
1. Disease is only successfully controlled by prevention
2. Understanding the determinants of disease are critical (host, agent, environment)
3. Epidemiology of chronic disease is due to a change in individual behaviors, a change in social and physical environment, and development of an epidemic in a susceptible population
4. Over time humans are destined to become obese given the available supply of food and a decrease in level of energy expenditure
He argued that successful interventions required an understanding of our personal and societal relationship with caloric intake and energy expenditures.

Other interesting points from the lecture included:
· Food has become the #1 social behavior in the United States
· It is most likely that behavioral (non-surgery) weight loss interventions must be continued for the lifetime of the individual
· In the United States we consume about 465 calories/day from fluids, mostly from sweetened beverages
· Gut bacteria may play a role in obesity
· Effective physical activity interventions for children and teenagers should be based on skill and interests – that is, tailored to the individual

Clinical Research Oriented Workshop (CROW) Meeting: February 9, 2012

Present: Abby Crocker, Kairn Kelley, Rodger Kessler, Ben Littenberg, Charlie MacLean

1. Presentation: Abby requested some feedback on the third deliverable for her dissertation, "Documented Knowledge of Health Policy"

a. Abby's been doing self-directed learning after contacting several health policy schools in the US. She now proposes to follow a piece of legislation (recently proposed by Peter Shumlin to treat opiate adicted people in VT through a "hub and spoke" system with 5 therapy sites in the state) and write a report for her deliverable. Planning details, report focus, contacts of interest, communication style, and IRB concerns were discussed in detail.

b. Charlie mentioned Jan Carney has recently written a course description for a special topics course in Public Health. Although this might not be the most efficient option for Abby, Jan will certainly be interested in Abby's experience.

2. Workshop Goals for 2012:

a. Journal club: identify UVM guests and articles; invite to CROW ahead of time

b. Research updates: share work-in-process

3. Next Workshop Meeting(s): Thursday, 1:00 p.m. – 2:30 p.m., at Given Courtyard Level 4.

a. Feb 23: Kairn: lit review update (no Amanda or Connie or Rodger)

b. Mar 1: (no Connie, ? Kairn)

c. Mar 8: Early start, for those available, 11:00 – 2:00, Connie’s dissertation defense

d. Mar 15: (no Ben, Connie)

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. Also: discuss design for PCBH clinical and cost research.

iii. Amanda: presentation and interpretation of data in articles

iv. Sharon Henry: article by Cleland, Thoracic Spine Manipulation, Physical Therapy 2007

v. 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

Investigating Outbreaks: The Epidemic Intelligence Service

Investigating Outbreaks: The Epidemic Intelligence Service

A presentation and panel discussion with

Mark Pendergrast

author of Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service

Tuesday, February 21, 2012

4:30 p.m.

Sullivan Classroom, Medical Education Center 200

University of Vermont

Reception to follow

Since 1951, Epidemic Intelligence Service officers have investigated new diseases such as Legionnaires’ disease, Lassa fever, Ebola, AIDS, hantavirus pulmonary syndrome, and Lyme disease.
Hear from some of these leaders who serve as public health detectives in stopping the spread of disease.

Co-sponsored by the Vermont Public Health Association (VtPHA), UVM College of Nursing & Health Sciences, UVM College of Medicine, and the Vermont Department of Health.

For more information, contact burton.wilcke@uvm.edu 656.0525

Posted by: Kairn Kelley

Friday Sem Replacement Activity

Week of February 17^th

Activity: Quality Care for Less Money: Can Regional Successes Go National?

February 15^th 12pm – 1:45pm

Barbara Jordan Conference Center

Kaiser Family Foundation Office

The Kaiser Family Foundation hosted an event featuring an upcoming PBS documentary, U.S. Health Care: The Good News. The documentary highlights unique models of efficient, low cost, quality health care happening in the United States. The event began with a five-minute clip screening of the documentary and then segued into an hour-long panel discussion about challenges and potential solutions for achieving affordable and effective health care nation-wide.

The panelists were:

Dr. Elliott Fisher, Professor of Medicine and Director, Population Health & Policy, The Dartmouth Institute for Health Policy & Clinical Practice

Carol Beasley, Director of Strategic Projects, Institute for Healthcare Improvement

Dr. Mark McClellan, Director, The Engelberg Center for Health Care Reform, Brookings Institution

Sean Cavanaugh, Acting Deputy Director of Programs & Policy, Center for Medicare & Medicaid Innovation, CMS

The event was moderated by Jackie Judd, Vice President & Executive Producer of Multimedia, Kaiser Family Foundation.

There were several key points that emerged from the panel discussion:

1. It is important to use rigorous methodologies to evaluate the effectiveness of current practices and quality improvement initiatives
2. Healthcare policies need to be aligned with practices that promote better care at lower costs
3. When evaluating quality, the subjective (Does my provider know me? Know my circumstances? Can I access care when I need it? i.e. “patient-centered”) is just as important as the more objective IOM aims (safe, effective, timely, equitable, efficient)
4. Effective quality improvement depends on a strong sense of community, a focus on continuous improvement and a strong leader – a quality “champion”

Overall, I thought that this was a great panel discussion. For anyone interested, an archived webcast, a transcript and a podcast should be available at kff.org/content/video.cfm. See if you can spot me in the crowd!

The PBS documentary U.S. Healthcare: The Good News premieres Thursday, February 16^th at 9pm.

Clinical Research Oriented Workshop (CROW) Meeting: February 9, 2012

Present: Abby Crocker, Kairn Kelley, Amanda Kennedy, Ben Littenberg, Connie van Eeghen

1. Start Up: The presentation was also conducted on “Adobe Connect,” the UNC distance learning platform, which Kairn signed onto. It worked.

2. Presentation: “Improving the Quality of Quality Improvement in Health Care: Case Studies of Provider Office Practices in the Use of Office Systems Analysis within a Quality Improvement Project

a. Connie provided a mock-dissertation defense presentation on her topic, which produced many helpful pieces of advice. Key items:

b. A mixed method study needs a balanced presentation of quantitative and qualitative results; too heavy on quantitative

c. Structure of presentation was reviewed: more in Background; less in detailed explanations about study. Support work through literature and own experiences.

d. Use examples to walk through slides.

e. Quantitative results should include information about distribution of data (e.g. IQR); scales should be “anchored” to give relevance to the audience. When there’s not much to say about a slide, a simple “there were no changes” is enough.

f. The presentation took 40 minutes and will need a haircut – thank you all for helping prepare the defendant!

3. Workshop Goals for 2012:

a. Journal club: identify UVM guests and articles; invite to CROW ahead of time

b. Research updates: share work-in-process

4. Next Workshop Meeting(s): Thursday, 1:00 p.m. – 2:30 p.m., at Given Courtyard Level 4.

a. Feb 16: Abby: feedback from lit review – new edited version (no Connie)

b. Feb 23: Kairn: lit review update (no Amanda or Connie)

c. Mar 1: (no Connie, ? Kairn)

d. Mar 8: Early start, for those available, 11:00 – 2:00, Connie’s dissertation defense

e. Mar 15: (no Ben, Connie)

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. Also: discuss design for PCBH clinical and cost research.

iii. Amanda: presentation and interpretation of data in articles

iv. Sharon Henry: article by Cleland, Thoracic Spine Manipulation, Physical Therapy 2007

v. 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

Friday Sem Replacement Activities

Week of January 27th

Activity: Presentation for HHS Staff “Affordable Care Act and You”

Mayra Alvarez, Director of Public Health Policy (Office of Health Reform) gave a presentation on the new health care law (ACA) including an overview of ACA, goals of the law, potential benefits and HHS progress on implementation.

Week of February 3rd

Activity: Presentation on the Mobile Health Map Project (www.mobilehealthmap.org)
January 31st 2-3pm at HRSA

Jennifer Bennet, ED of The Family Van in Boston, MA/Co-Investigator of Mobile Health Map gave a presentation on the role of mobile health in urban and rural areas, including challenges for mobile health units (logistics, funding, staffing, snowbanks) and unique successes (provide an unintimidating access point into the healthcare system, convenient, can go to where the need is). She also discussed collaborations between The Family Van and FQHCs/EDs in the Boston area and its impact in terms of financial and health outcome successes.

The goal of the Mobile Health Map project is to create an innovative method for assessing the benefit and impact of mobile health units on healthcare in the areas that they serve as well as a creating a tool for nationwide collaboration between mobile health units, many of which operate in isolation.

Week of February 10th

Activity: Webinar/Teleconference “Output vs. Outcomes”
February 8th 3-4:30pm

Bethany Adams, MHA, CHE, Mountain States Group gave a presentation to the State Office of Rural Health Directors on the importance of understanding the difference between output (project contract deliverables) and outcomes (expected impact from the intervention) when conducting quality improvement projects. She gave suggestions for documentation and for using indicators to monitor performance improvement gains.

Observational Research vs. RCTs

This is a very interesting article by Jan Vandenbroucke from the Netherlands about why RCTs are always/never the right way to answer a question. I found it very helpful in understanding some of the recent push-back against evidence-based medicine.

Enjoy.

Ben

Summary

Two views exist of medical science: one emphasises discovery and explanation, the other emphasises evaluation of interventions. This essay analyses in what respects these views differ, and how they lead to opposite research hierarchies, with randomisation on top for evaluation and at bottom for discovery and explanation. The two views also differ strongly in their thinking about the role of prior specification of a research hypothesis. Hence, the essay explores the controversies surrounding subgroup analyses and multiplicity of analyses in observational research. This exploration leads to a rethinking of the universally accepted hierarchy of strength of study designs, which has the randomised trial on top: this hierarchy may be confounded by the prior odds of the research hypothesis. Finally, the strong opinions that are sometimes displayed in pitting the two types of medical science against each other may be explained by a difference in “loss function”: the difference in penalty for being wrong.

Citation: Vandenbroucke JP (2008) Observational Research, Randomised Trials, and Two Views of Medical Science. PLoS Med 5(3): e67. doi:10.1371/journal.pmed.0050067

Clinical Research Oriented Workshop (CROW) Meeting: February 2, 2012

Present: Abby Crocker, Kairn Kelley, Amanda Kennedy, Ben Littenberg, Connie van Eeghen

1. Start Up: Amanda had a great vacation and got her camera back from the taxi she left it in – hooray! Many stories about what we’ve left where, what happens, and what happens when it’s on purpose (i.e. as part of a study).

2. Presentation: Amanda gave an update on pharmacists integrated into primary care practices as part of a VDH-funded grant.

a. Plan: five sites, with a part time pharmacist in each one. The goal is to use existing pharmaceutical resources (health organizations, community), with the likelihood of assigning those resources to more than one practice (1:5). Sites were “cherry picked” to ensure 100% commitment. This was a rocky process, as the budget was set before the process was determined.

b. FAHC pharmacy leader today volunteered another .20 FTE to support a sixth practice. Monday, January 30, saw the kick-off meeting, attended by almost all physician leaders.

c. Current timeline: now interviewing pharmacists and selecting them for assignment. Steps to implement:

i. Pharmacist shadows physician, and understands practice flow

ii. Amanda negotiates what actions pharmacists will start with:

1. Education (answer questions from community, staff, CHIT…)

2. Direct patient care (pharmacists can bill for this)

a. Recommendations of Rx to doctor

b. Adjustment of meds based on a pre-set algorithm

c. Re-write Rx (true collaborative practice) – some details need to be worked out here, based on laws, systems, and practice

3. Consultation (see next item) – using the data system to identify patients who need a change in medication intervention.

d. Implications: the pharmacist is not seen as a care manager but as a consultant. One approach is to use the EHR to clean up the practice’s medication management. The pharmacist can look for patterns of medication management and for patients who need follow-up on out-dated or needed meds.

e. Future: one year to explore; in one year will need a sustainability plan. For now: how to integrate into the practice, negotiating with the practice providers/leaders. Amanda is budgeted at 20% of her time, which already appears too low.

i. April: start up with pharmacist, continue for a year

ii. July 2013: analyze data and determine level of success

f. Evaluation plan: mostly process measures. Not a clinical trial, this project is organized under the model of the Blueprint. The focus of the work will be determined by the practice. No one primary outcome; a ‘wacky’ project but very exciting.

i. Clinical measures: meds and changes made

1. Medication Management System is an example of a vendor that can support the pharmacists work, to be copied into the EHR

2. Web-based system might be financially viable, with limited access (not all pharmacists will use at the same time)

ii. Satisfaction: prescriber, staff, pharmacist, patient

iii. Cost: estimates of time spent by pharmacist, costs related to drug changes, diary study of providers to study efficiency

iv. Sustainability: proportion of time that the pharmacists could bill for

3. Workshop Goals for 2012:

a. Journal club: identify UVM guests and articles; invite to CROW ahead of time

b. Research updates: share work-in-process

4. Next Workshop Meeting(s): Thursday, 1:00 p.m. – 2:30 p.m., at Given Courtyard Level 4.

a. Feb 9: Connie: oral presentation for defense (no Ben)

b. Feb 16: Abby: feedback from lit review – new edited version (no Connie)

c. Feb 23: Kairn: lit review update (no Amanda or Connie)

d. Mar 1: (no Connie, ? Kairn)

e. Mar 8: Early start, for those available, 11:00 – 2:00, Connie’s dissertation defense

f. Mar 15: (no Ben, Connie)

g. 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. Also: discuss design for PCBH clinical and cost research.

iii. Amanda: presentation and interpretation of data in articles

iv. Sharon Henry: article by Cleland, Thoracic Spine Manipulation, Physical Therapy 2007

v. 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

VLC Seminar

Since I am unable to attend the CTS Seminar this week I decided to attend the Vermont Lung Center (VLC) Basic Science Seminar on Tuesday February 7, 2012 in HSRF 300 at 8:15 am.  Jos van der Velden, PhD presented “The role of c-Jun-N-Terminal Kinase in Epithelial plasticity

I decided to attend this particular conference because I know that the presenter’s lab focuses on cell signaling pathways related to the development of pulmonary fibrosis.  Pulmonary fibrosis is a devastating disease with no useful treatment available at this time.  There are a lot of new clinical research protocols using several different agents including agents using JNK1.  I thought this seminar would be help me gain a better understanding of how these agents act and how pulmonary fibrosis research goes from “bench to the bedside”.

He concluded that JNK1 ablation from lung epithelial cells almost completely protects against TGF-β1 or bleomycin-induced fibrosis and delayed JNK1 ablation prevents further enhancement of fibrosis. This demonstrates the crucial role for epithelial-based JNK1 activation in the development of the fibrogenic response, a part of EMT (epithelial mesenchymal transformation).  He then went on to dicuss the utility of micro RNA analysis to understand the specific signaling pathways involved in these responsed.  He found that JNK1 / Smad 3 regulates Let-7g miRNA expression and that Let-7 miRNA expression is down regulated in vivo following TGF-b1 expression.  This is very novel information and the data was quite convincing.  The future plans for his lab include determining whether lack of EMT in the absence of JNK1 or SMAD3 is overcome by expression of let-7g anti-miRNA inhibitor. This would be a significant outcome for future clinical trials.   His methods were clear and extremely interesting, this presenter was clear and his audience was a mix of basic and clinical researchers and he did a fantastic job appealing to both groups. 

Somewhat to my own astonishment I learned a lot from this experience. First, I learned basic concepts in lung physiology such as the role of EMT in pathology and gained an understanding as to what the VLC research projects entail. Second, I always thought the VLC projects were interesting but not necessarily clinically relevant.  This was a contradiction to that way of thinking.  It was clear that this group understands the science, is enthusiastic about continuing research in this topic and has a clinical application in mind for the future.   I believe that I will be able to collaborate with this group to some extent in the future when they are looking for human samples and I look forward to it.

Lit review help classes at Dana Library

Hi – I thought some
students might be interested in literature review help classes at Dana Library
this semester. All classes are at noon
in the Main Conference Room in the Library. In addition, you can always ask a librarian
at the reference desk, M-F 10-4 for help.
Marianne
Managing
References With EndNote
Learn the basics of EndNote.
Wednesday, February
15, Noon-1pm
Databases
for Systematic Reviews
How to carry out an exhaustive search for relevant research on a specific
subject.
Wednesday
March 14, 2012
Noon-1pm

Managing
References With Zotero
Learn the basics of Zotero. Capture citation information about books, articles,
web sites, and more while you search.
Wednesday March
21, 2012
Noon-1pm

Lit
Search Clinic
Doing a literature review? Explore ways to improve your literature searching
and increase access to journal articles.
Wednesday
April 11, 2012
Noon-1pm