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New horizons in community engagement: Virtual community engagement studios amplifying community voices about health research in New Mexico. 社区参与的新视野:虚拟社区参与工作室放大了社区对新墨西哥州健康研究的声音。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.608
Cynthia M Killough, Julia Martinez, Holly Mata, Donna Sedillo, Pilar Sanjuan, Alexandra Roesch, Christopher Hudson, Brenda Bishop, Jose Gonzalez, Heidi Rishel Brakey, Nancy Pandhi

There is increasing recognition of the crucial need for robust community engagement in health research and clinical trials. Despite this awareness, challenges persist in bridging the gap between researchers and communities. Much of the current discourse focuses on addressing issues such as cultural humility and equitable partnerships. To expand this conversation, we conducted community engagement studios, following the model by Joosten et al. We wanted to gather perspectives on research involvement across New Mexico. This process and resultant findings offer valuable insights into effective community engagement practices and advance clinical and translational science by amplifying community voices and needs.

越来越多的人认识到,在健康研究和临床试验中,社区的积极参与至关重要。尽管认识到了这一点,但在弥合研究人员与社区之间的差距方面仍然存在挑战。目前的讨论大多集中在解决文化谦逊和公平合作等问题上。为了扩大讨论范围,我们按照 Joosten 等人的模式开展了社区参与工作室活动。这一过程和结果为有效的社区参与实践提供了宝贵的见解,并通过扩大社区的声音和需求来推动临床和转化科学的发展。
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引用次数: 0
The Translational Science Benefits Model, a new training tool for demonstrating implementation science impact: A pilot study. 转化科学效益模型--展示实施科学影响的新培训工具:试点研究。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.573
Stephanie Andersen, Annalee Wilson, Todd Combs, Laura Brossart, Julie Heidbreder, Stacey McCrary, Rinad S Beidas, Leopoldo J Cabassa, Erin P Finley, Emma E McGinty, Jonathan Purtle, Lisa Saldana, Enola Proctor, Douglas Luke

Introduction: Demonstrating the impact of implementation science presents a new frontier for the field, and operationalizing downstream impact is challenging. The Translational Science Benefits Model (TSBM) offers a new approach for assessing and demonstrating research impact. Here we describe integration of the TSBM into a mentored training network.

Methods: Washington University's Clinical and Translational Science Awards TSBM team collaborated with a National Institute of Mental Health-supported training program, the Implementation Research Institute (IRI), a 2-year training institute in mental health implementation science. This partnership included three phases: (1) introductory workshop on research impact, (2) workshop on demonstrating impact, and (3) sessions to guide dissemination, including interactive tools and consultation with the TSBM research team. Fifteen IRI alumni were invited to participate in the pilot; six responded agreeing to participate in the training, develop TSBM case studies, and provide feedback about their experiences. Participants applied the tools and gave feedback on design, usability, and content. We present their case studies and describe how the IRI used the results to incorporate TSBM into future trainings.

Results: The case studies identified 40 benefits spanning all four TSBM domains, including 21 community, 11 policy, five economic, and three clinical benefits. Participants reported that TSBM training helped them develop a framework for talking about impact. Selecting benefits was challenging for early-stage projects, suggesting the importance of early training.

Conclusions: The case studies showcased the institute's impact and the fellows' work and informed refinement of tools and methods for incorporating TSBM into future IRI training.

导言:展示实施科学的影响是该领域的一个新领域,而将下游影响可操作化则具有挑战性。转化科学效益模型(TSBM)为评估和展示研究影响提供了一种新方法。在此,我们介绍了将 TSBM 纳入指导培训网络的情况:方法:华盛顿大学临床与转化科学奖 TSBM 团队与美国国家心理健康研究所支持的培训项目--实施研究所 (IRI)--合作,这是一个为期 2 年的心理健康实施科学培训机构。合作包括三个阶段:(1) 关于研究影响的入门讲习班;(2) 关于展示影响的讲习班;(3) 指导传播的课程,包括互动工具和与 TSBM 研究团队的咨询。15 名 IRI 校友应邀参加了试点项目,其中 6 人同意参加培训、开展 TSBM 案例研究并提供经验反馈。参与者应用了这些工具,并就设计、可用性和内容提出了反馈意见。我们介绍了他们的案例研究,并描述了国际注册研究所如何利用这些结果将 TSBM 纳入未来的培训中:结果:案例研究发现了 40 项横跨 TSBM 全部四个领域的益处,包括 21 项社区益处、11 项政策益处、5 项经济益处和 3 项临床益处。参与者表示,TSBM 培训帮助他们建立了一个谈论影响的框架。选择效益对于早期项目来说具有挑战性,这表明早期培训的重要性:案例研究展示了研究所的影响和研究员的工作,并为改进工具和方法提供了信息,以便将 TSBM 纳入未来的 IRI 培训中。
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引用次数: 0
A schema for coding health equity scholarship within pediatric research. 儿科研究中健康公平奖学金的编码模式。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.594
Najma Abdi, Sabrina W Tso, Cheyenne Roduin, Elisabeth Nylander, Amanda L Jones, Susan L Groshong, Julia Paulsen, Brian E Saelens

Introduction: Seattle Children's Research Institute is identifying the amount and type of health equity scholarship being conducted institution wide. However, methods for categorizing how scholarship is equity-focused are lacking. We developed and evaluated the reliability of a health equity scholarship coding schema applied to Seattle Children's affiliated scholarship.

Methods: A 2021-2022 Ovid MEDLINE affiliation search yielded 3551 affiliated scholarship records, with 1079 records identified via an existing filter as scholarship addressing social determinants of health. Through reliability testing and examining concordance and discordance across three independent coders of these records, we developed a coding schema to classify health equity scholarship (yes/no). When health equity scholarship proved positive/Yes, the coders assigned a one through five maturity rating of the scholarship towards addressing inequities. Subsequent reliability testing including a new coder was conducted for 992 subsequent affiliated scholarship records (Oct 2022-June 2023), with additional testing of the sensitivity and specificity of the existing filter relative to the new coding schema.

Results: Reliability for identifying health equity scholarship was consistently high (Fleiss kappas ≥ .78) and categorization of health equity scholarship into maturity levels was moderate (Fleiss kappas ≥ .47). The coding schema identified additional health equity scholarship not captured in an existing filter for social determinants of health scholarship. Based on the new schema, 23.3% of Seattle Childrens' affiliated scholarship published October 2002-June 2023 was health equity focused.

Conclusions: This new coding schema can be used to identify and categorize health equity scholarship to help quantitate the health equity focus of portfolios of human-focused research.

简介:西雅图儿童研究所(Seattle Children's Research Institute)正在确定全校范围内开展的健康公平奖学金的数量和类型。然而,目前还缺乏对以公平为重点的奖学金进行分类的方法。我们开发并评估了适用于西雅图儿童研究所附属奖学金的健康公平奖学金编码模式的可靠性:方法:在 2021-2022 年的 Ovid MEDLINE 关联检索中,我们获得了 3551 条关联奖学金记录,其中有 1079 条记录通过现有的过滤器被识别为涉及健康的社会决定因素的奖学金。通过可靠性测试以及对这些记录的三位独立编码者的一致性和不一致性进行检查,我们制定了一个编码模式来对健康公平奖学金进行分类(是/否)。当健康公平奖学金被证明为 "是/否 "时,编码员会对解决不公平问题的奖学金进行一至五级的成熟度评级。随后,包括一名新的编码员在内,对992份后续附属奖学金记录(2022年10月至2023年6月)进行了可靠性测试,并根据新的编码模式对现有过滤器的灵敏度和特异性进行了额外测试:识别健康公平奖学金的可信度一直很高(Fleiss kappas ≥ .78),健康公平奖学金的成熟度分类适中(Fleiss kappas ≥ .47)。编码模式确定了现有的健康社会决定因素奖学金筛选中未包含的其他健康公平奖学金。根据新的模式,2002 年 10 月至 2023 年 6 月发表的西雅图儿童医院附属奖学金中有 23.3% 以健康公平为重点:结论:这一新的编码模式可用于识别和分类健康公平奖学金,以帮助量化以人为本的研究组合对健康公平的关注。
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引用次数: 0
Expanding pathways to clinical and translational research training with stackable microcredentials: A pilot study. 利用可叠加微证书拓展临床和转化研究培训途径:试点研究。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.601
Marie K Norman, Thomas R Radomski, Colleen A Mayowski, MaLinda Zimmerman-Cooney, Isabel Crevasse, Doris M Rubio

Introduction: The proportion of physician-investigators involved in biomedical research is shrinking even as the need for high-quality, interdisciplinary research is growing. Building the physician-investigator workforce is thus a pressing concern. Flexible, "light-weight" training modalities can help busy physician-investigators prepare for key stages of the research life cycle and personalize their learning to their own needs. Such training can also support researchers from diverse backgrounds and lighten the work of mentors.

Materials and methods: The University of Pittsburgh's Institute for Clinical Research Education designed the Stackables Microcredentials in Clinical and Translational Research (Stackables) program to provide flexible, online training to supplement and enhance formal training programs. This training utilizes a self-paced, just-in-time format along with an interactive, storytelling approach to sustain learner engagement. Learners earn badges for completing modules and certificates for completing "stacks" in key competency areas. In this paper, we describe the genesis and development of the Stackables program and report the results of a pilot study in which we evaluated changes in confidence in key skill areas from pretest to posttest, as well as engagement and perceived effectiveness.

Results: Our Stackables pilot study showed statistically significant gains in learner confidence in all skill areas from pretest to posttest. Pilot participants reported that the module generated high levels of engagement and enhanced their skills, knowledge, and interest in the subject.

Conclusions: Stackables provide an important complement to formal coursework by focusing on discrete skill areas and allowing learners to access the training they need when they need it.

导言:尽管对高质量、跨学科研究的需求与日俱增,但参与生物医学研究的医生研究员的比例却在下降。因此,培养医生研究员队伍是当务之急。灵活、"轻量级 "的培训模式可以帮助忙碌的医生研究员为研究生命周期的关键阶段做好准备,并根据自身需要进行个性化学习。这种培训还能为来自不同背景的研究人员提供支持,并减轻导师的工作负担:匹兹堡大学临床研究教育研究所设计了临床和转化研究微证书 Stackables(Stackables)计划,提供灵活的在线培训,以补充和加强正规培训计划。该培训采用自定进度、按时完成的形式,并采用互动、讲故事的方法来维持学员的参与度。学员完成模块可获得徽章,完成关键能力领域的 "堆栈 "可获得证书。在本文中,我们介绍了 Stackables 项目的起源和发展,并报告了一项试点研究的结果,其中我们评估了从测试前到测试后关键技能领域的信心变化,以及参与度和感知效果:我们的 Stackables 试点研究表明,从测试前到测试后,学习者在所有技能领域的自信心都有了统计学意义上的显著提高。试点参与者表示,该模块激发了他们的高度参与,提高了他们的技能、知识和对该学科的兴趣:堆栈式学习模块是对正规课程学习的重要补充,它侧重于独立的技能领域,允许学习者在需要时获得所需的培训。
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引用次数: 0
Addressing social needs in oncology practices: A case study of a patient-centered approach using health information technology. 在肿瘤学实践中满足社会需求:以患者为中心的医疗信息技术案例研究。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.570
Helen M Parsons, David Haynes, Anne Blaes, Timothy R Church, Julia Halberg, Steven G Johnson, Pinar Karaca-Mandic

Given the dramatic growth in the financial burden of cancer care over the past decades, individuals with cancer are increasingly susceptible to developing social needs (e.g., housing instability and food insecurity) and experiencing an adverse impact of these needs on care management and health outcomes. However, resources required to connect individuals with needed social and community services typically exceed the available staffing within clinical teams. Using input from focus groups, key informant interviews, user experience/user interface testing, and a multidisciplinary community advisory board, we developed a new technology solution, ConnectedNest, which connects individuals in need to community based organizations (CBOs) that provide services through direct and/or oncology team referrals, with interfaces to support all three groups (patients, CBOs, and oncology care teams). After prototype development, we conducted usability testing, with participants noting the importance of the technology for filling a current gap in screening and connecting individuals with cancer with needed social and community services. We employ a patient-empowered approach that engages the support of an individual's healthcare team and community organizations. Future work will examine the integration and implementation of ConnectedNest for oncology patients, oncology care teams, and cancer-focused CBOs to build capacity for effectively addressing distress in this population.

在过去几十年中,癌症护理的经济负担急剧增加,因此癌症患者越来越容易产生社会需求(如住房不稳定和食物无保障),并因这些需求对护理管理和健康结果产生不利影响。然而,将患者与所需的社会和社区服务联系起来所需的资源通常超出了临床团队的可用人员编制。利用焦点小组、关键信息提供者访谈、用户体验/用户界面测试和多学科社区咨询委员会的意见,我们开发了一种新的技术解决方案 ConnectedNest,它将有需要的个人与通过直接和/或肿瘤团队转介提供服务的社区组织 (CBO) 联系起来,并提供支持所有三个群体(患者、社区组织和肿瘤护理团队)的界面。原型开发完成后,我们进行了可用性测试,测试结果表明,该技术对于填补目前癌症筛查的空白以及将癌症患者与所需的社会和社区服务联系起来非常重要。我们采用了患者授权的方法,让个人的医疗团队和社区组织参与支持。未来的工作将研究如何为肿瘤患者、肿瘤护理团队和以癌症为重点的社区组织整合和实施 ConnectedNest,以建设有效解决这一人群困扰的能力。
{"title":"Addressing social needs in oncology practices: A case study of a patient-centered approach using health information technology.","authors":"Helen M Parsons, David Haynes, Anne Blaes, Timothy R Church, Julia Halberg, Steven G Johnson, Pinar Karaca-Mandic","doi":"10.1017/cts.2024.570","DOIUrl":"10.1017/cts.2024.570","url":null,"abstract":"<p><p>Given the dramatic growth in the financial burden of cancer care over the past decades, individuals with cancer are increasingly susceptible to developing social needs (e.g., housing instability and food insecurity) and experiencing an adverse impact of these needs on care management and health outcomes. However, resources required to connect individuals with needed social and community services typically exceed the available staffing within clinical teams. Using input from focus groups, key informant interviews, user experience/user interface testing, and a multidisciplinary community advisory board, we developed a new technology solution, ConnectedNest, which connects individuals in need to community based organizations (CBOs) that provide services through direct and/or oncology team referrals, with interfaces to support all three groups (patients, CBOs, and oncology care teams). After prototype development, we conducted usability testing, with participants noting the importance of the technology for filling a current gap in screening and connecting individuals with cancer with needed social and community services. We employ a patient-empowered approach that engages the support of an individual's healthcare team and community organizations. Future work will examine the integration and implementation of ConnectedNest for oncology patients, oncology care teams, and cancer-focused CBOs to build capacity for effectively addressing distress in this population.</p>","PeriodicalId":15529,"journal":{"name":"Journal of Clinical and Translational Science","volume":"8 1","pages":"e139"},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Phase I clinical trial designs in oncology: A systematic literature review from 2020 to 2022. 肿瘤学 I 期临床试验设计:2020 年至 2022 年系统性文献综述。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-24 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.599
Ning Li, Xitong Zhou, Donglin Yan

Background: Phase I clinical trials aim to find the highest dose of a novel drug that may be administrated safely without having serious adverse effects. Model-based designs have recently become popular in dose-finding procedures. Our objective is to provide an overview of phase I clinical trials in oncology.

Methods: A retrospective analysis of phase I clinical trials in oncology was performed by using the PubMed database between January 1, 2020, and December 31, 2022. We extracted all papers with the inclusion of trials in oncology and kept only those in which dose escalation or/ and dose expansion were conducted. We also compared the study parameters, design parameters, and patient parameters between industry-sponsored studies and academia-sponsored research.

Result: Among the 1450 papers retrieved, 256 trials described phase I clinical trials in oncology. Overall, 71.1% of trials were done with a single study cohort, 56.64% of trials collected a group of at least 20 study volunteers, 55.1% were sponsored by industry, and 99.2% of trials had less than 10 patients who experienced DLTs.The traditional 3 + 3 (73.85%) was still the most prevailing method for the dose-escalation approach. More than 50% of the trials did not reach MTDs. Industry-sponsored study enrolled more patients in dose-escalation trials with benefits of continental cooperation. Compared to previous findings, the usage of model-based design increased to about 10%, and the percentage of traditional 3 + 3 design decreased to 74%.

Conclusions: Phase I traditional 3 + 3 designs perform well, but there is still room for development in novel model-based dose-escalation designs in clinical practice.

背景:I 期临床试验的目的是找到一种新药的最高剂量,使其能够在不产生严重不良反应的情况下安全给药。基于模型的设计近来在剂量寻找程序中很受欢迎。我们的目的是概述肿瘤学 I 期临床试验:方法:我们使用 PubMed 数据库对 2020 年 1 月 1 日至 2022 年 12 月 31 日期间的肿瘤学 I 期临床试验进行了回顾性分析。我们提取了所有纳入肿瘤学试验的论文,仅保留了进行剂量升级或/和剂量扩增的论文。我们还比较了工业界资助的研究与学术界资助的研究之间的研究参数、设计参数和患者参数:在检索到的 1450 篇论文中,有 256 项试验描述了肿瘤学的 I 期临床试验。总体而言,71.1%的试验采用单一研究队列,56.64%的试验收集了至少20名研究志愿者,55.1%的试验由企业赞助,99.2%的试验中出现DLT的患者少于10人。超过 50% 的试验未达到 MTD。行业赞助的研究在剂量递增试验中招募了更多患者,这有利于大陆的合作。与之前的研究结果相比,基于模型的设计的使用率增加到约 10%,而传统 3 + 3 设计的使用率下降到 74%:结论:I期传统3+3设计表现良好,但基于模型的新型剂量递增设计在临床实践中仍有发展空间。
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引用次数: 0
Adapting the Translational Science Benefits Model to improve health and advance health equity in diabetes: The Centers for Diabetes Translation Research Impact Framework. 调整转化科学效益模式,改善糖尿病患者的健康状况并促进健康公平:糖尿病转化研究中心影响框架。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.580
Julie A Schmittdiel, William H Herman, Pamela Thornton, Marlon Pragnell, Debra Haire-Joshu
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引用次数: 0
Building a multistate model from electronic health records data for modeling long-term diabetes complications. 利用电子健康记录数据建立多州模型,以模拟长期糖尿病并发症。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.583
Riza C Li, Shanshan Ding, Kevin Ndura, Vishal Patel, Claudine Jurkovitz

Objective: The progression of long-term diabetes complications has led to a decreased quality of life. Our objective was to evaluate the adverse outcomes associated with diabetes based on a patient's clinical profile by utilizing a multistate modeling approach.

Methods: This was a retrospective study of diabetes patients seen in primary care practices from 2013 to 2017. We implemented a five-state model to examine the progression of patients transitioning from one complication to having multiple complications. Our model incorporated high dimensional covariates from multisource data to investigate the possible effects of different types of factors that are associated with the progression of diabetes.

Results: The cohort consisted of 10,596 patients diagnosed with diabetes and no previous complications associated with the disease. Most of the patients in our study were female, White, and had type 2 diabetes. During our study period, 5928 did not develop complications, 3323 developed microvascular complications, 1313 developed macrovascular complications, and 1129 developed both micro- and macrovascular complications. From our model, we determined that patients had a 0.1334 [0.1284, .1386] rate of developing a microvascular complication compared to 0.0508 [0.0479, .0540] rate of developing a macrovascular complication. The area deprivation index score we incorporated as a proxy for socioeconomic information indicated that patients who reside in more disadvantaged areas have a higher rate of developing a complication compared to those who reside in least disadvantaged areas.

Conclusions: Our work demonstrates how a multistate modeling framework is a comprehensive approach to analyzing the progression of long-term complications associated with diabetes.

目的:糖尿病长期并发症的发展导致生活质量下降。我们的目标是利用多州建模方法,根据患者的临床特征评估与糖尿病相关的不良后果:这是一项回顾性研究,研究对象是 2013 年至 2017 年在初级保健诊所就诊的糖尿病患者。我们采用了一个五状态模型来研究患者从一种并发症转变为多种并发症的过程。我们的模型纳入了来自多源数据的高维协变量,以研究与糖尿病进展相关的不同类型因素可能产生的影响:研究队列由 10,596 名确诊为糖尿病且之前未出现相关并发症的患者组成。研究中的大多数患者为女性、白人和 2 型糖尿病患者。在研究期间,5928 人未出现并发症,3323 人出现微血管并发症,1313 人出现大血管并发症,1129 人同时出现微血管和大血管并发症。根据我们的模型,我们确定患者发生微血管并发症的比率为 0.1334 [0.1284, .1386],而发生大血管并发症的比率为 0.0508 [0.0479, .0540]。我们纳入了地区贫困指数评分作为社会经济信息的替代指标,结果表明,与居住在最贫困地区的患者相比,居住在较贫困地区的患者发生并发症的比例更高:我们的研究表明,多州建模框架是分析糖尿病长期并发症进展的综合方法。
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引用次数: 0
Development and implementation of a clinical decision support system-based quality initiative to reduce central line-associated bloodstream infections. 开发和实施基于临床决策支持系统的质量计划,以减少中央管路相关血流感染。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.566
Michelle C Spiegel, Andrew J Goodwin

Background: Central venous lines (CVLs) are frequently utilized in critically ill patients and confer a risk of central line-associated bloodstream infections (CLABSIs). CLABSIs are associated with increased mortality, extended hospitalization, and increased costs. Unnecessary CVL utilization contributes to CLABSIs. This initiative sought to implement a clinical decision support system (CDSS) within an electronic health record (EHR) to quantify the prevalence of potentially unnecessary CVLs and improve their timely removal in six adult intensive care units (ICUs).

Methods: Intervention components included: (1) evaluating existing CDSS' effectiveness, (2) clinician education, (3) developing/implementing an EHR-based CDSS to identify potentially unnecessary CVLs, (4) audit/feedback, and (5) reviewing EHR/institutional data to compare rates of removal of potentially unnecessary CVLs, device utilization, and CLABSIs pre- and postimplementation. Data was evaluated with statistical process control charts, chi-square analyses, and incidence rate ratios.

Results: Preimplementation, 25.2% of CVLs were potentially removable, and the mean weekly proportion of these CVLs that were removed within 24 hours was 20.0%. Postimplementation, a greater proportion of potentially unnecessary CVLs were removed (29%, p < 0.0001), CVL utilization decreased, and days between CLABSIs increased. The intervention was most effective in ICUs staffed by pulmonary/critical care physicians, who received monthly audit/feedback, where timely CVL removal increased from a mean of 18.0% to 30.5% (p < 0.0001) and days between CLABSIs increased from 17.3 to 25.7.

Conclusions: A significant proportion of active CVLs were potentially unnecessary. CDSS implementation, in conjunction with audit and feedback, correlated with a sustained increase in timely CVL removal and an increase in days between CLABSIs.

背景:重症患者经常使用中心静脉置管(CVL),这有可能导致中心静脉置管相关血流感染(CLABSIs)。CLABSI 与死亡率升高、住院时间延长和费用增加有关。不必要地使用中心静脉置管是导致 CLABSI 的原因之一。该计划旨在通过在电子病历 (EHR) 中实施临床决策支持系统 (CDSS),量化可能不必要的 CVL 的使用率,并改善六家成人重症监护病房 (ICU) 及时移除 CVL 的情况:干预内容包括方法: 干预内容包括:(1) 评估现有 CDSS 的有效性;(2) 临床医师教育;(3) 开发/实施基于 EHR 的 CDSS,以识别潜在不必要的 CVL;(4) 审计/反馈;(5) 审查 EHR/机构数据,以比较实施前后潜在不必要 CVL 的移除率、设备使用率和 CLABSI。数据通过统计过程控制图、卡方分析和发病率比进行评估:结果:实施前,25.2% 的 CVL 有可能被移除,每周在 24 小时内被移除的 CVL 平均比例为 20.0%。干预措施实施后,潜在不必要的 CVL 被移除的比例增加(29%,p < 0.0001),CVL 使用率降低,CLABSI 间隔天数增加。在由肺科/重症监护医生负责的重症监护病房中,干预措施最为有效,他们每月都会接受审核/反馈,及时移除CVL的比例从平均18.0%增加到30.5%(p < 0.0001),CLABSIs间隔天数从17.3天增加到25.7天:很大一部分有效的 CVL 可能是不必要的。CDSS 的实施与审计和反馈相结合,可持续提高 CVL 的及时移除率,并增加 CLABSI 的间隔天数。
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引用次数: 0
Leveraging oncology collaborative networks and biomedical informatics data resources to rapidly recruit and enroll rural residents into oncology quality of life clinical trials. 利用肿瘤学协作网络和生物医学信息学数据资源,快速招募农村居民参与肿瘤学生活质量临床试验。
IF 2.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.1017/cts.2024.576
Heath A Davis, Asher A Hoberg, Laura S Jacobus, Kenneth Nepple, Aaron T Seaman, Jamie Sorensen, George J Weiner, Stephanie Gilbertson-White

Purpose: This study assesses the feasibility of biomedical informatics resources for efficient recruitment of rural residents with cancer to a clinical trial of a quality-of-life (QOL) mobile app. These resources have the potential to reduce costly, time-consuming, in-person recruitment methods.

Methods: A cohort was identified from the electronic health record data repository and cross-referenced with patients who consented to additional research contact. Rural-urban commuting area codes were computed to identify rurality. Potential participants were emailed study details, screening questions, and an e-consent link via REDCap. Consented individuals received baseline questionnaires automatically. A sample minimum of n = 80 [n = 40 care as usual (CAU) n = 40 mobile app intervention] was needed.

Results: N = 1298 potential participants (n = 365 CAU; n = 833 intervention) were screened for eligibility. For CAU, 68 consented, 67 completed baseline questionnaires, and 54 completed follow-up questionnaires. For intervention, 100 consented, 97 completed baseline questionnaires, and 58 completed follow-up questionnaires. The CAU/intervention reached 82.5%/122.5% of the enrollment target within 2 days. Recruitment and retention rates were 15.3% and 57.5%, respectively. The mean age was 59.5 ± 13.5 years. The sample was 65% women, 20% racial/ethnic minority, and 35% resided in rural areas.

Conclusion: These results demonstrate that biomedical informatics resources can be highly effective in recruiting for cancer QOL research. Precisely identifying individuals likely to meet inclusion criteria who previously indicated interest in research participation expedited recruitment. Participants completed the consent and baseline questionnaires with zero follow-up contacts from the research team. This low-touch, repeatable process may be highly effective for multisite clinical trials research seeking to include rural residents.

目的:本研究评估了生物医学信息学资源在有效招募农村癌症患者参加生活质量(QOL)移动应用程序临床试验方面的可行性。这些资源有可能减少昂贵、耗时的现场招募方法:方法:从电子健康记录数据存储库中确定一个群组,并与同意接受额外研究接触的患者进行交叉对比。通过计算农村-城市通勤区代码来确定农村地区。通过 REDCap 向潜在参与者发送研究详情、筛选问题和电子同意链接的电子邮件。获得同意的个人会自动收到基线问卷。样本最少需要 n = 80 [n = 40 照常护理 (CAU) n = 40 移动应用干预]:筛选出符合条件的 1298 名潜在参与者(n = 365 名常规护理参与者;n = 833 名干预参与者)。CAU 有 68 人同意,67 人完成了基线问卷,54 人完成了后续问卷。干预组有 100 人同意,97 人完成了基线问卷,58 人完成了后续问卷。CAU/ 干预在 2 天内达到了 82.5%/122.5% 的招募目标。招募率和保留率分别为 15.3% 和 57.5%。平均年龄为 59.5 ± 13.5 岁。样本中 65% 为女性,20% 为少数民族,35% 居住在农村地区:这些结果表明,生物医学信息学资源可以非常有效地为癌症 QOL 研究招募人员。精确识别可能符合纳入标准且之前表示有兴趣参与研究的人员加快了招募速度。参与者在完成同意书和基线问卷后,研究团队只需进行零次后续联系。这种低接触、可重复的流程可能对寻求纳入农村居民的多地点临床试验研究非常有效。
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Journal of Clinical and Translational Science
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