Opportunities to meet with Visiting Professor Larry Appel

Dear Vermont Vascular Medicine Group,

We are working on organizing plans for an upcoming cardiovascular Research Institute Visiting Professor, Dr. Larry Appel, who will give Medicine Grand Rounds Feb 5 at 8 am. Please mark your calendar on this as it will be a great talk!

Speaker:              Larry Appel MD, MPH

Grand Rounds: Translating Effective Lifestyle Interventions into Practice:  Lessons from the Hopkins-Healthways Collaboration  

Bio:                        Professor of Medicine, Epidemiology and International Health (Human Nutrition), Director, Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins Medical Institutions.

Dr. Appel is current chair of the AHA Council on Lifestyle and Cardiometabolic Health. He is an expert in design and interpretation of epidemiological, clinical and translational research studies

He has conducted clinical research with a particular focus on preventing blood pressure-related cardiovascular and kidney diseases. He has three active lines of research: (1) controlled feeding studies, (2) behavioral intervention trials, that test novel strategies to accomplish lifestyle changes, often related to obesity, and (3) cohort studies and trials related to chronic kidney disease and its consequences. A particularly notable feature of his research is the focus on conditions and diseases that disproportionately afflict minorities and on interventions that have the potential to substantially reduce racial disparities

Dr. Appel is a wonderful person and outstanding scientist and we are very fortunate to have him come to campus. The CVRI Early Career Advisory Committee, Dr. Jon Halevy and myself will be working on planning events around the visit that I hope people will be interested in, some for which we are looking for participants, so I ask you to review this and respond as indicated:

1.       Research in Progress Session:  this will take place at time TBN on Feb 5 (likely noon with lunch). We are looking for early career level volunteers who would like to give informal presentation of a project they are working on.  Early career = trainee at any level + assistant professors. We would only ask that you bring several copies of a 0.5-1 page (no longer) summary of the work (could be a meeting abstract) and present for several minutes on it. You might think in advance of elements of the project where you need advice. This will be followed by Q+A and discussion of the group. Please email Rebecca Aksdal and myself (Rebecca.aksdal@uvm.edu;mary.cushman@uvm.edu) if you would like to present or just be present in the audience.

2.       One on One Meetings. Anyone interested in meeting with Dr. Appel should email me by Jan 14 to indicate this.

Best to all,

Mary Cushman

Mary Cushman, MD, MSc

Professor of Medicine

University of Vermont College of Medicine

Director, Thrombosis and Hemostasis Program

University of Vermont Medical Center

Burlington, VT

Laboratory for Clinical Biochemistry Research

Cardiovascular Research Institute of Vermont

Thrombosis and Hemostasis Program

Clinical Research Oriented Workshop (CROW) Meeting: December 17, 2015

Present:  Marianne Burke, Kairn Kelley, Ayodelle LeBruin, Ben Littenberg, Gail Rose, Adam Sprouse-Blum, Connie van Eeghen

Start Up:  Welcome to Adam! Adam is a Family Medicine MD; headache fellowship; trained in the Bronx.

1.                  Discussion: Specific Aims for STTR grant application due Jan 5 2016 (Small Business Technology Transfer Research)

a.       The focus is on using medical record data (biomarkers in lab values) to predict alcohol problems in the absence of the AUDIT by an honest responder.  There may be an opportunity for a private company (PES) to use these data in support of care management for primary care practices.

b.      STTR has two phases:

                                                  i.      Phase 1: concept, development over 6 months to a year

1.      More time to develop Phase 2, less risk of rejection

                                                ii.      Phase 1 and 2 (fast track): feasibility and implementation, including commercialization of product, with commitment letters and preliminary data

                                              iii.      Good funding source; SBIR is an avenue for many small businesses – more competition (note that 3% of NIH must go to small businesses)

c.       Diagram: process flow of how the data are used to develop a PCP letter, website, and mobile app

                                                  i.      Algorithm to identify at risk patients based on lab values – to be developed by this project

1.      Generates both false positives and false negatives

2.      First draft exists; to be fine-tuned with NHANES data (a sample of data were held out while developing the initial algorithm)

3.      To be validated with PRISM data

4.      Includes: SGOT, MCV, hemoglobin, HDL cholesterol, LDH, … is a self-teaching algorithm (via recursive partitioning)

                                                ii.      Well-developed process for generating letter to PCP

1.      Consider accessing email address instead of postal address, with link

2.      Or text for link to app

                                              iii.      Web-site (AUDIT) is not yet developed and will not be funded by this project – easy to do

1.      If this were to be the first step, the percent positive is about 30%

2.      Must have sufficient security to ensure that the person completing the AUDIT is genuine

3.      Might this be eliminated and made part of the app?  The letter from the PCP can say something like “due to information from lab data in your chart, you are at risk for the following health issues…” Provide link and security sign on. Front load with a disclaimer such as “this is a trial for our office to see if this helps you…”

a.       Can also include other questions: workplace abnormalities, diet (vegan),…

b.      Branch to a reassuring message if all is negative

c.       Provide text or phone number option for live follow up for problems

d.      Check with Damon: can security protection be set up without the web stop?

                                              iv.      Mobile app – to be developed by this project

1.      Need expert developer/evaluator for mobile app prototype

d.      Benefit: when SBIRT and other interventions are used, alcohol consumption goes down and medical costs, absenteeism all improve

2.                  Next Workshop Meeting(s): NOTE NEW TIME: Thursdays, 1:30 p.m. – 2:30 p.m., at Given Courtyard South Level 4.   

a.       December 24: UVM closed

b.      December 31: UVM closed

c.       January 7, 2016: Kairn updated draft of test/retest reliability manuscript

Recorder: Connie van Eeghen

Clinical Research Oriented Workshop (CROW) Meeting: December 10, 2015

Present:  Marianne Burke, Kairn Kelley, Rodger Kessler, Ayodelle LeBruin, Connie van Eeghen

Start Up:  Consilience, Edward O. Wilson, is available in Connie’s office (and currently on loan to Kairn)

1.                  Discussion: Marianne’s update: Study response rates

a.       Types of invitations: invitation emails, letters, telephone calls.

b.      The link below gives some advice:

                                                  i.       http://nnlm.gov/ner/blog/2015/11/04/boosting-response-rates-with-invitation-letters/

c.       The team is experiencing difficulty recruiting providers via email and are now employing a more time consuming personal approach. 

d.      Next the team will experience the challenges of patient recruitment by means of a mailed information letter followed by phone call for consent and survey.

e.       Feedback on these methods.  What is realistic? What if we don't reach adequate sample sizes (in a reasonable amount of time) to answer the research question as planned?

                                                  i.      Less than 25% of providers have signed on (22 out of about 100); need 30

	Prvd Cons	Sign	Orient	3 Checks	Info Pt	Phone-30	Phone-60	Phone-90
Mult Cont	22--16 tot	18-gift Buddy?	18		22
Tell why
Who
Status
Sm Gift

2.                  Discussion: Connie’s Honors College Course: Mapping and Final Project

a.       Mapping template (handout)

                                                  i.      Be explicit about the health event and how it relates to the context

1.      Specify for reading assignments: customize the worksheet

                                                ii.      Change the format for the in-class assignments – easy note taking

                                              iii.      Re-think each row header

                                              iv.      Consider a “sun” diagram

                                                v.      Separate out:

1.      Who is this person

2.      What is the setting

b.      Plan for final project

                                                  i.      Template

                                                ii.      FOCUS

                                              iii.      Start of MIPP template

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

a.       December 17: Rodger on data set of “at-risk type 2 DM”

b.      December 24: UVM closed

c.       December 31: UVM closed

d.      January 7, 2016: (need to plan dates/times for spring semester)

a.       Mondays at noon

b.      Thursdays at 1:30

Recorder: Connie van Eeghen