From student proposal developed in CTS 301 to accepted abstract

Emily Houston, MS student in CTS

Emily will be presenting a poster as part of the Peter Como HD Research Symposium at HSG (Huntington Study Group) being held November 8-10 in Houston, TX.

Emily developed this proposal as part of her class in CTS 301- Designing Clinical Research.  She further developed the protocol while completing an independent study with Dr. Amanda Kennedy. 

The title of her project is: Predictive Testing for Huntington Disease through Telemedicine: A Pilot Study

Congratulations Emily on the acceptance of your abstract submission.

Recent milestones

Here are a few significant awards, honors and achievements that we should all admire.

Alan Rubin, MD

Vermont Academy of Science and Engineering- elected member Sept 2018
UVM Larner COM Travel Award- Sept 2018
Invited Workshop – International Conference on Communication in Health Care- Porto Portugal Sept 2018- Calibrating the Emotional Response in Training Simulated Patients
Invited Workshop- UVM Larner Teaching Academy- Facilitating Small Group Learning. Sept 2018

Juvena Hitt

20 years of service to UVM

Sylvie Frisbie

10 years of service to UVM

Congratulations!


-Ben Littenberg

Clinical Research Oriented Workshop (CROW) Meeting: Sept 20, 2018

Present:   Levi Bonnell, Jessica Clifton, Justine Dee, Nancy Gell, Juvena Hitt, Ben Littenberg, Jen Oshita, Gail Rose, Connie van Eeghen, Marianna Wingood

1.                   Warm Up: Introductions with Marianna Wingood, PT and PhD in CNHS

2.                   Nancy Gell: Interview Draft - The purpose of this study is to examine physical activity prescription by physical therapists. Through interviews and medical record analysis, we will characterize physical activity assessment and prescription for people receiving PT for treatment of chronic low back pain. The purpose of the interviews is to explore how physical therapists incorporate physical activity prescription in treatment plan, barriers and facilitators for prescription with the population, and how prescription rationale aligns with national recommendations (ACSM guidelines).

a.       Nancy provided a description of scope of project: is treatment plan inclusive of exercise for patients with LBP, if so, what type of exercise (several categories).  There is a movement to include exercise Rx in primary care by PCPs; there is little literature on the part of PTs who work with patients with LBP on an outpatient basis.  This is separate from their PT home maintenance program

                                                   i.      Data collection: EMR documentation (limited due to gaps in the record), with interviews of PTs to provide perceptions, including rationale, thoughts about guidelines

                                                 ii.      Mixed methods: narrowly focused interview

                                               iii.      Sampling frame: contacts through PT programs, in and out of VT

b.       Interview focuses on processes, as well as facilitators and challenges.  Time limit: 30 minutes.

                                                   i.      Consider moving some questions off-line, especially demographic questions (move to screening)

                                                 ii.      Consider changing “check box” questions to a pre-survey, that is referenced during the interview to ask deeper questions

                                               iii.      About challenges: set up the supportive lead as Jessica suggested: “We all have the experience of not providing a set of instructions.  What is an example of when that happens?  Why does it happen?”

c.       Another approach, based on Ben’s and Alan Rubin’s interest in patients with high A1c’s that have not responded with regular care, based on their own practice’s data.  Alan interviewed providers, using “In this case, what were the barriers…” and Dana (anthropologist) interviewed matching patients for their perspectives.  The results were highly informative, using qualitative research. 

                                                   i.      Nancy will start this study on 35 patients within the UVM MC system.  This approach could work.

                                                 ii.      Or use a case study/vignette to start the conversation, and then get into the experience.

d.       Introduction provides a detailed description of the guideline; consider a general description that doesn’t appear to lead the respondent. “This isn’t about PT, this about how health care providers talk about exercise.” 

e.       Assessment – this is low priority.  “How do you deal with that? What makes this challenging?” Make this an intro question only?  Or make it part of a pre-survey.

f.        Facilitators and challenges: opportunity for critical event analysis

g.       Is there a patient-centered opportunity here?  For the future. 

3.                   Next week: Connie and CR Macchi (Arizona State University) will provide a dress rehearsal of their workshop for a Collaborative Family Healthcare Association conference in October.

4.                   Future topic: Jessica Clifton’s update on outcomes of her dissertation work.

Recorded by: Connie

One of our colleagues in the IBHPC PCORI study is a clinical psychologist from UCSD, Bill Sieber.  I just found out that he is giving a full day seminar on anxiety management ("Calming an Overactive Brain") as a CEU workshop this Friday in Burlington.  He said: "Please let folks know if they need 6 CEUs, it is cheap, and I think I give an entertaining and useful 6 hours ! It is at the Hilton on Battery St."  I found the brochure online; you can find it here.  The registration URL is https://ibpceu.com/registration/6202?&state=Vermont&city=Burlington&seminar=CALMENHVTF18%20(VT). 

CROW Notes 9/13

Below are the notes Jessica took today in CROW from Marianne's paper titled Why Did VisualDx Fail to Make a Patient Outcome Difference in Primary Care? A Mixed Methods Evaluation of a Clinical Evidence Technology for Skin Disease

Title

·         Is using Visual DX in the title associated with Fail? Would fail in general go over well? Is it accurate?

·         Automatic word counters in the system

Abstract

·         Is explanatory mixed methods a term? Connie says Yes. Double check.

·         Results: Focused on randomized trial, not qualitative.

·         Check out SRQR…like consort it has a check-list of things you are supposed to hit on when submitting a publication to this journal.

·         Conclusion: This matches the TAM model…in conclusion the model supported …consider using the TAM

Background

Look over grammatical/structural issues of sentences. Think about combining the paragraphs or expand or provide examples on them.

Objective

Are the questions,

·         Love mixed method research

·         Love technology and want to know where this could be helpful

·         Interested in use of tech in medicine

Keeping the reader in mind, who are you writing for? Are they interested in health and interested in mixed-quality research.

Or are they the librarians and health IT professionals?

Author decision: we are interested in librarian, IT, and primary care..

Sequential Mixed Methods: Array of things happening are informing each other as the quantitative and qualitive inform each other. It’s inside a single study. This is a follow-up study that has qualitative and quantitative pieces to it…

Talk to a qualitative researcher: how do you fit these pieces together…if you are going to make it

It could be sequential…but it’s not written as such. Revise terminology OR revise description.

Librarians or physicians doing practice may find this useful for X reasons. Target why it is important and to whom.

Methods

This is where how do mixed methods researchers think about their stuff…this is a high level description…they want more

-show me a picture of the model

-show me how the pieces fit together

-make it clear to reviewers how you understand nuances that are part of the industry

 Maybe include a picture to make the description of the groups clearer (you could also include the mixed-methods approach here). CONSORT?

Showing the qualitative and quantitative

The survey informed us…we didn’t ask everyone everything because it wasn’t relevant

Consider reorganizing:

Show the model,

Qualitative

Quantitative

Methods (with participants and groups)

What’s the research question and who is the audience. 

Figure 1/Models

May want to highlight this is novel…

Dilema: This is more than one paper…it’s doing something fairly novel:

One is care

One is acceptance

Why did visual Dx fail…

Open it up more…how did you see these things fit together. Technology acceptance model…usability is a big part of that model…every time you use that word it makes me think TAM…but sometimes you use it associated with other topics…(also use is included in multiple ways)…See Connie’s responses

Good job talking about Visual Dx, but not a good job with how the models come together. Doesn’t need the two models, think about who is interested and who is using it..

When I got to the end of the article, I had heard more about TAM vs. how did we consider the way we use data.

To think about the way we use data…

Interested pictures:

Technology acceptance

How two models fit together (what has it taught us)

How does our analysis about Visual Dx teach us about evidence-based models and practice?

The comparison of the modes may distract.

Qualitative Analysis

Move this (IRB statement) because it is out of place. Either in the beginning or end of the methods.

Otherwise fairly clear. Interviews being coded may have been an issue…see Connie’s commetns.

Have a qualitative expert look at it before sending it out.

Table 1

This part was exciting…may want to talk about why people said it wasn’t helpful but they kept using it...include the p-value

Table 4

Not necessarily themes..because the researcher set this up..you created the structure and then the sub-themes are the actual themes. So maybe use structure/

Mixed methods results summary

Did you need this model to understand your results..I noted that in my copy…I think this could be presented more simply..I think this is more about methodology than practice of care.

Conclusions

Graphics and tables are great. So we can interpret what you have…it’s done both ways..think about how you are reading it and where it’s easier to find it…

Put the quote in the table versus not

Jane - The Journal/Author Name Estimator

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-Ben Littenberg

Clinical Research Oriented Workshop (CROW) Meeting: Sept 6, 2018

Present:   Levi Bonnell, Marianne Burke, Jessica Clifton, Justine Dee, Nancy Gell, Kairn Kelley, Ben Littenberg, Jen Oshita, Gail Rose, Connie van Eeghen

1.                   Warm Up: New members coming to CROW soon: Lisa Watts Natkin

2.                   Rodger Kessler & Connie van Eeghen: PRECIS evaluation of IBHPC study: pragmatic vs. explanatory continuum

a.       Background: Rodger Kessler, Stephanie Brennhofer, and Connie van Eeghen are working on a manuscript to describe the PCORI Integrated Behavioral Health in Primary Care study from a research study management perspective: the inherent complexity of large pragmatic trials using IBHPC as a starting point, supplemented with results from a literature review.  They have come to CROW to conduct an exercise in re-evaluating IBHPC on the PRECIS continuum of pragmatic/explanatory trials.

b.       One key issue: in using this continuum, discussion focused on who the participants are (recipients of the intervention) and who the practitioners are (those who deliver the intervention).  IBHPC has two kinds of recipients: patients and practice members.  It has two kinds of practitioners: practice members and “the practice.”  The group used both perspectives in evaluating the study. 

c.       Provider as Participant (Provider is Practice Leadership or the Practice as an entity?  The latter)

                                                   i.            Comparison intervention – practitioner expertise: 10

                                                 ii.            Follow up intensity: collecting a fair amount of data, but not from everyone: drifting from 5 to 4

                                               iii.            Primary trial outcome: 10

                                               iv.            Participant compliance with “prescribed” intervention: education reports are part of the intervention, not part of the research. But the identification of patients and use of the Community Panel are prescribed.  8

                                                 v.            Practitioner adherence to study protocol: 9

                                               vi.            Analysis of primary outcome: 10

d.       THANK YOU EVERYONE!

e.       Final Radar Charts: