Clinical Research Oriented Workshop (CROW) Meeting: Aug 21, 2014

Present:  Marianne Burke, Rodger Kessler, Ben Littenberg, Connie van Eeghen

Start Up: CROW will continue its summer schedule into the fall: Thursdays, 11:45 – 12:45, with social getting-started at 11:30.

1.                  Discussion: Rodger’s SIM grant proposal on Behavioral Health Integration

a.       This proposal will be submitted in the fall to compare three models of integration and to compare the cost effectiveness of each one.  It must include designated state agencies (DAs) in mental health as well as the primary care providers it is focused on supporting.

b.      One VT county is the locus of a large BH practice (part of the FQHC), the FQHC that includes almost all primary care practices, a large women’s health center owned by the community hospital, and a county mental health service that is interested in change.

c.       An observational study could measure the cost of outcomes as the county system currently works.  Any changes to the system would likely be due to secular trends as well as other activities they engage in to move towards integration.

d.      A demonstration project could produce a design for integrated care and financial management.

e.       Inclusion of the DAs can be explicitly stated in the original description of the three models, under arm 1.  This is the simplest, most focused, and has the highest likelihood of success.

f.       Rodger to bring draft proposal back to CROW in two weeks.  Submission deadline is mid-September.

2.                  Ben’s Brain Teaser: for all surnames that are first names ending in “s,” (Roberts, Jacobs, …), why are they always male names?  And is the “s” short for “sons?”

3.                  Next Workshop Meeting(s): Thursdays, 11:30 a.m. – 12:45 p.m., at Given Courtyard South Level 4.   Remember: the first 15 minutes are for checking in with each other. WE WILL CONTINUE THIS SCHEDULE FOR THE FALL SEMESTER

a.       August 28: Kairn: draft of literature review/ quality improvement project

b.      Sept 4: Rodger: SIM grant draft review

c.       Sept 11:

Recorder: Connie van Eeghen

Clinical Research Oriented Workshop (CROW) Meeting: Aug 7, 2014

Present:  Marianne Burke, Kairn Kelley, Amanda Kennedy, Ben Littenberg, Connie van Eeghen

Start Up: We were too bashful to talk today – almost.  But fortunately one joke about enforced non-talkers (husbands?) opened the tap considerably.  See Ben for a resource for self-publishing – and the real story on what almost-positive thing he said about children.

1.                  Discussion: Marianne’s literature review article feedback

a.       Marianne, Amanda, and Neil submitted a manuscript to the Journal of the Medical Library Association, which was rejected but will be revised and submitted to another journal.  (It will also serve as the stand alone “lit review” required by the Grad College but needs to be refocused to become the first chapter of Marianne’s dissertation.)   Question:

                                                  i.      Where should this manuscript go next?

b.      Marianne provided some back story: it was not a tightly focused lit review at the start; she added topics and expanded the search over time.  The pitch is “PCPs use information resources for patient care, are successful in doing so, and affect patient care.”  The audience could be practicing providers, quality improvement participants, academic providers educating the next generation, and medical students.

                                                  i.      Journal of medical education (BMC Medical Education – pricey, if accepted)

                                                ii.      General journals (not so much for this article)

                                              iii.      Specialty journals (IM, FM…)

                                              iv.      American medical information (about 5 medical informatics journals)

                                                v.      Library audience (as a reference for other work)

c.       Topics: for example, is it focused on primary care or does it include hospitalists or is it only physicians…  select and focus.  Such as:

                                                  i.      Information source use; or the effect of electronic information sources in primary care, with a specific study of a dermatology information source; or the impact of information sources on primary care

                                                ii.      Other research/pub opps: NAMCES search for medical conditions related to dermatological care to answer the question: “what are the needs?” And, “how would the information resource be helpful?”

                                              iii.      Practical/policy implications: how to select information resources for medical/university libraries; what is the value of Visual Dx in terms of identifying missed diagnoses – a systematic catalogue on the pros and cons for this resource as a decision support system.  Cost includes the upfront cost and the hidden costs (update, maintenance, learning time, misleading outcomes) and other issues (increased comprehension of a medical condition) – all good points for a medical library journal article.  (To be tackled after the original study that makes up the dissertation.)

d.      Next steps:

                                                  i.      Revise manuscript and send out again – soon!

                                                ii.      Proceed with research study: IRB protocol

2.                  Next Workshop Meeting(s): Thursdays, 11:30 a.m. – 12:45 p.m., at Given Courtyard South Level 4.   Remember: the first 15 minutes are for checking in with each other.

a.       August 14: Connie: Stata analysis

b.      August 21: Rodger: SIM grant application

c.       August 28: (Fall semester starts Aug 25 – this time may change, but will probably continue on Thursdays; no Kairn at this session)

d.      Sept 4: Kairn: draft of literature review/ quality improvement project

Recorder: Connie van Eeghen

Clinical Research Oriented Workshop (CROW) Meeting: July 31, 2014

Present:  Marianne Burke, Kairn Kelley, Rodger Kessler, Ben Littenberg, Connie van Eeghen

Start Up: FRED’s AV cables are kept in the drawer on the screen – useful fact to know and remember! According to Rodger, the only good gnocchi’s come from northern Italy.  Ben, Rodger and Connie are waiting for feedback from PCORI on an LOI – no news, in this case, is no news.

1.                  Discussion: Kairn’s research update

a.       Kairn previously sent out two documents describing her literature review:

                                                  i.      Spreadsheet with over 340 sources, with 7 studies that identify trials with subjects

                                                ii.      Whether there should be a formal, systematic level of literature review (such as meeting inclusion criteria) is the subject of today’s discussion

b.      The research question: what do we know about auditory tests to assess auditory systems of children from 7-14?

                                                  i.      There is very little in the literature that met what Kairn is looking for

                                                ii.      Strategies for discussing what is known:

1.      Chronological story of the development of literature, little that there is.  There are no norms or standardized assessment methods.  In fact, clinicians are told to “collect your own norms,” but there is no structure for doing so.

2.      Practice guidelines – little offered

3.      Bottom line: little studied, unknown efficacy.  These tests have never been evaluated in a broad population (beyond children referred for audiology testing) for routine clinical use.

c.       This literature review effort is intended to meet the requirements of the degree program but could be used to write an article with a major finding, which also meets the requirements.  The Graduate College wants to ensure that graduates know the basics of article generation; this can be demonstrated in several ways. For example:

                                                  i.      Key milestones in the development of evidence

                                                ii.      A biologically based assessment of plausibility for those milestone-studies (NOT all of them)

                                              iii.      Review of test development process, with pros/cons

1.      Address different tests, including experimental tests that have been discarded

2.      Currently available tests limited to a selected set

3.      Known intermediate outcomes on only those tests that are available.  These may be limited (there is an average of 38 subjects per study of the 7 that Kairn has found), but can be evaluated using a set of criteria that Kairn can develop

                                              iv.      Conclusion: criticality of the need for Kairn’s study.  The level of detail should be appropriate for a clinician audience of the journal; it will satisfy the requirements of the committee.

d.      Next steps

                                                  i.      Document the methodology, with the criteria that were the conditions of including and excluding the sources found (from the 340+), for example:

1.      Reference source

2.      Focused on children

3.      The type of tests used, including their availability

                                                ii.      This methodology may be different for different milestones in the literature review, which is A-OK.  Keep track of those that were useful; let go of the others – this is a tightening exercise. 

                                              iii.      Develop a standard “lit review” data collection tool, with the filters specified for each criteria.  The literature will not make it easy, so creating a tool to mine the data from the data is critical.

1.      Were the conclusions supported by the data and analysis?

2.      Is it germane to the topic?

                                              iv.      Identify the weak studies, and cite them.

                                                v.      Acknowledge what evidence does exist, regardless of how much/little there is.

                                              vi.      ETA for literature review draft: August 28

2.                  Next Workshop Meeting(s): Thursdays, 11:30 a.m. – 12:45 p.m., at Given Courtyard South Level 4.   Remember: the first 15 minutes are for checking in with each other.

a.       August 7: Marianne’s literature review with editor comments (no Ben)

b.      August 14: Rodger’s SIM proposal

c.       August 21: Kairn: draft of literature review

d.      August 28:

Recorder: Connie van Eeghen