Clinical Research Oriented Workshop (CROW) Meeting: Dec 4, 2014

Present:  Marianne Burke, Sylvie Frisbie, Nancy Gell, Juvena Hitt, Kairn Kelley, Amanda Kennedy, Ben Littenberg, Connie van Eeghen

Start Up:  (Connie was trapped in Hewlett-Packard land, and missed this.)

1.                  Discussion Ben Littenberg reviewed the PROMIS29 survey, planned as the primary outcome measure of a PCORI research study for which the application is due in February.   

a.       The survey read well, although the presentation of raw scores is hard to interpret and may be misleading.  Version 2 has updated questions that include family and friends (matching a comment made in a recent patient feedback group working on this grant).

b.      The T-scores present the percentiles related to the individual responses (not the  number of standard deviations from the mean).  However, these totals appear to provide artificial ceilings and perhaps artificial floors for scores.  (Ben later corrected this: the T-scores represent a standardized score in 10ths of a sd with the mean set to 50. Given the T-score, you get the percentile by looking it up in the cumulative normal distribution.) 

c.       Ben and Juvena to explore further.  Face validity is good, content flow decent, format acceptable; scoring is mysterious.  Further research needed: website, NIH staff. Nancy has a colleague who might be of assistance.

2.                  Discussion: Connie shared the abstract of a manuscript in the process of a re-write after re-running all the data.  She shared 2 tables: description of patient-subjects (Table 3) and outcomes (Table 4).

a.       Table 3 data, describing the underlying population, is unusual in that it compares two time periods.  Consider one table for the 17 month period.  Move the bottom row (visits pppm) to the top of the result table. 

b.      The 12 month pre-window provides a conservative approach to assessing the change, relative to the 5 month post-window.  The 5 month post-window has a higher prevalence of older, sicker, and higher level of visits (i.e. frequent flyers) than the 12 month window has.

c.       Briefly discuss the new Table 3, then focus the discussion on Table 4.  Then discuss (without a new table) the changes in the population attributed to the intervention.

d.      Limitations: secular changes induced by the intervention

e.       Kaplan Meier plots: makes the lines show up differently when viewed in black and white

f.       Thank you, everyone!

3.                  Discussion: Next semester’s meeting plan for CROW

a.       Kairn to send out DoodlePoll

4.                  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.       Dec 11: Kairn: manuscript (no Ben)

b.      Dec 18: Marianne: data collection tools (no Ben)

c.       Jan 8: TBD

d.      Jan 15: TBD

Recorder: Connie van Eeghen

PCP as secret therapist

Here's a NYT opinion piece, explaining the intricacies of PCP and young adult patients.  Any reactions?
http://opinionator.blogs.nytimes.com/2014/12/01/the-secret-therapist/?hp&action=click&pgtype=Homepage&module=c-column-top-span-region&region=c-column-top-span-region&WT.nav=c-column-top-span-region&_r=1

Connie

Report by Marianne Burke, PhD student

I attended a presentation by Richard Platt MD, Chair of Population Health at Harvard Pilgrim Health Care (HPHC) Institute, November 8 2014. Chicago Ill AAMC Conference, Matheson Lecture entitled “On a Clear Day You Can See the Learning Health System.”

Dr. Platt discussed the work of the HPHC Institute as the Coordinating Center of the National Patient-Centered Clinical Research Network funded with a 9 million grant from PCORI (Patient Centered Clinical Research Institute). He introduced the presentation by stating that there are so many patient care questions for which there are no evidence-based answers, and that we (medical professionals) have overestimated what we know. He stated that less than 15% of medical guidelines are supported by firm evidence. Most are expert opinion or consensus of practice. He made the case for finding the problems in large data surveillance sets even as we try use these sets more often and try to combine them to answer patient centered questions.

The Matheson Lecture “at the juncture of Technology, Informatics and Medical Library Science” occurs annually at AAMC (Association of American Medical Colleges) co-sponsored by the AAMC Group on Information Resources and the Association of Academic Health Sciences Libraries.

This lecture was interesting and well-documented though not surprising to me as a CTS student (of our excellent faculty) and medical librarian.

Clinical Research Oriented Workshop (CROW) Meeting: Nov 13, 2014

Present:  Marianne Burke, Nancy Gell, Kairn Kelley (by phone), Connie van Eeghen

Start Up:  Welcome Nancy!  Nancy is a new Assistant Professor in RMS, teaching in the PT program (public policy in Spring 2014; cardio-pulmonary – next year; health promotion – next year). Her background is PT, Public Health – Health Behavior and Health Education, Exercise Science.

1.                  Discussion Marianne Burke shared her updated draft application to the Lindberg Research Fellowship offered by the Medical Library Association

a.       Marianne made many substantial changes regarding organization and language.  We focused on grantsman(woman)ship issues:

b.      Bring out the applicant – make her easy to see.  Include voice, roles, and management responsibility (the grant pays for research assistant(s)) as appropriate

c.       Move the goals of the research grant forward – it’s buried on the second page

d.      Make the language in the new diagram consistent with the narrative

e.       Next step: submission deadline is tomorrow – good luck!

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.       Nov 20: Nancy – project proposal on physical activity maintenance

b.      Nov 27: Thanksgiving! No CROW; eat turkey instead J

c.       Dec 4: Connie – manuscript: findings and discussion

Recorder: Connie van Eeghen

Clinical Research Oriented Workshop (CROW) Meeting: Oct 30, 2014

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

Start Up:  (Missed this!) 

1.                  Discussion Marianne Burke shared her draft application to the Lindberg Research Fellowship offered by the Medical Library Association

a.       Concise, clear language

                                                  i.      Literature review

                                                ii.      Significance – three specific ideas leading to the need for evidence-based information about library-based services, using dermatology because… leading to a cluster randomized trial. (Minimizes bias and strengthen validity…)

1.      Software attached to outcomes

2.      Library services attached to outcomes

3.      Cost may be affected

b.      Consistent headings and outline form: help the reader understand, using terms from the application instructions

                                                  i.      What each topic is (headers)

                                                ii.      Flow of information: why this is important before what the details are

c.       Aims: aims are broad; hypotheses are specific (e.g. there is no difference in time to resolution for patients in the intervention group compared to patients in the control group)

                                                  i.      One aim

                                                ii.      Two hypotheses   

d.      Budget: present the entire budget?  Or just the portion paid for by the fellowship?

e.       Research design:

                                                  i.      Sub-headings to support flow

                                                ii.      Diagram of recruitment, randomization, patient visits, recruitment, and interviews

f.       Limitations: watch for tone

g.      Timeline: make consistent with application; remember final report

h.      Research Dissemination Plan: this is a separate criterion in the reviewer’s instructions.  Buff this up!

i.        Next steps

                                                  i.      Letter of support (set up for Ben)

                                                ii.      Revise

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.       Oct 30: Marianne’s topic – doctoral fellowship application(s)

b.      Nov 6: Connie to check with Ben on BHI data analysis (No Marianne, Charlie, or Amanda)

c.       Nov 13: Marianne – grant applications

Recorder: Connie van Eeghen

CTS Noon Seminar on Friday , November 7

Please join us in welcoming Dr. Tom Ahearn to the CTS Seminar this Friday, November 7 at Noon in the Given Courtyard S359.  Dr. Ahearn completed his MPH and PHD in Epidemiology at Boston University and is currently an Assistant Professor in the Department of Surgery.  He was a visiting fellow in the Department of Clinical Epidemiology at Aarhus University in Denmark in 2012-13 and will be sharing a presentation on “ Pharmacoepidemiology studies using the Danish national health registries” .

Report by Marianne Burke, PhD student

Report by Marianne Burke

Robyn Bluhm PhD, Old Dominion University, presented  “Teaching Critical Appraisal of Critical Appraisal” on October 31, in HSRF 400.

The presentation was sponsored by the College of Medicine’s Office of Medical Student Education as part of its Faculty Development Series. Professor Bluhm’s area of expertise is the philosophy of science and medicine.

Dr. Bluhm reviewed the critical appraisal aspect of the evidence-based medicine model (EBM) as it has been classically described. She examined how EBM guidelines for the appraisal of treatment studies are flawed. She argued that while EBM methods for examining the internal validity of a RCT or systematic review are strong, the EBM approach to external validity and application to patient care are weak.

Much discussion ensued among those present.