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!
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
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