Acute Decompensated Heart Failure: Treatment Timing and Effects on Outcomes

急性失代偿性心力衰竭：治疗时机和对结果的影响

• 批准号: 8677952
• 负责人: Chad Eric Darling
• 金额: $ 13.37万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-15 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8677952
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; American; Basic Science; Biometry; Cardiovascular system; Caring; Characteristics; Clinical; Clinical Management; Clinical Research; Clinical Trials; Collaborations; Communities; Community Hospitals; Complement; Coupled; Data; Data Collection; Decision Making; Development Plans; Diagnosis; Diuresis; Diuretics; Dose; Dyspnea; Early treatment; Educational process of instructing; Emergency Department patient; Emergency Medicine; Enrollment; Ethics; Expert Opinion; Floor; Funding; Goals; Grant; Growth; Healthcare Systems; Heart failure; Hospitalization; Hospitals; Hour; Inpatients; Institution; Intratracheal Intubation; K-Series Research Career Programs; Learning; Length; Length of Stay; Manuscripts; Massachusetts; Medical center; Mentors; Mining; Monitor; Morbidity - disease rate; Observational Study; Outcome; Outpatients; Patient Care; Patients; Pharmaceutical Preparations; Phase; Physicians; Preparation; Productivity; Quality of Care; Renal function; Research; Research Design; Research Personnel; Research Proposals; Resources; Staging; Students; Symptoms; Teaching Hospitals; Time; Training; Training Programs; Uncertainty; United States; United States National Institutes of Health; Visual; Work; Writing; analog; base; biomedical informatics; cardiovascular disorder epidemiology; career; career development; clinical epidemiology; cost; design; experience; high risk; improved; indexing; insight; interest; medical schools; mortality; primary outcome; programs; prospective; randomized trial; response; secondary outcome; skills; tertiary care; tool; Accident and Emergency department; Acute; Address; Admission activity; American; Basic Science; Biometry; Cardiovascular system; Caring; Characteristics; Clinical; Clinical Management; Clinical Research; Clinical Trials; Collaborations; Communities; Community Hospitals; Complement; Coupled; Data; Data Collection; Decision Making; Development Plans; Diagnosis; Diuresis; Diuretics; Dose; Dyspnea; Early treatment; Educational process of instructing; Emergency Department patient; Emergency Medicine; Enrollment; Ethics; Expert Opinion; Floor; Funding; Goals; Grant; Growth; Healthcare Systems; Heart failure; Hospitalization; Hospitals; Hour; Inpatients; Institution; Intratracheal Intubation; K-Series Research Career Programs; Learning; Length; Length of Stay; Manuscripts; Massachusetts; Medical center; Mentors; Mining; Monitor; Morbidity - disease rate; Observational Study; Outcome; Outpatients; Patient Care; Patients; Pharmaceutical Preparations; Phase; Physicians; Preparation; Productivity; Quality of Care; Renal function; Research; Research Design; Research Personnel; Research Proposals; Resources; Staging; Students; Symptoms; Teaching Hospitals; Time; Training; Training Programs; Uncertainty; United States; United States National Institutes of Health; Visual; Work; Writing; analog; base; biomedical informatics; cardiovascular disorder epidemiology; career; career development; clinical epidemiology; cost; design; experience; high risk; improved; indexing; insight; interest; medical schools; mortality; primary outcome; programs; prospective; randomized trial; response; secondary outcome; skills; tertiary care; tool

DESCRIPTION (provided by applicant): I have a longstanding interest in cardiovascular research, and I have been involved in basic science, translational, and clinical projects. I am applying for this Career Development Award (CDA) in an effort to acquire additional training so that I can independently design and conduct meaningful clinical research. A key short-term goal of mine is to use the skills obtained from my proposed training program to develop collaborative research efforts both within and outside my institution. I have found it enjoyable to work with other researchers as I find such collaborations stimulate new research ideas and provide for additional learning opportunities. In the nearterm I also hope to increase my research productivity and writing skills by working with my mentor and his research group. My long-term goals are to become a leader in clinical research for my Department and use those skills to build productive research relationships between Emergency Departments (ED) in my region and to be able to mentor others interested in research careers. I believe that Emergency Medicine provides a wealth of potential research opportunities but lacks experienced leaders and mentors that can develop and guide clinical research proposals. The career development plan I am proposing is multifaceted. At the core is obtaining didactic training in the UMass Medical School Masters in Clinical Investigation Program. This program is directed by my mentor and focuses on coursework that is tailored specifically to provide students with the tools they need to become independent investigators. The courses cover clinical epidemiology, biostatistics, biomedical informatics, ethics, and the design and conduct of clinical research. My growth as a clinical researcher will also depend on the guidance of my mentor, co-mentor, and advisors. Dr. Robert Goldberg will serve as my primary mentor, and Dr. Theo Meyer as a co-mentor. Dr's. Goldberg and Meyer complement each other with regards to the expertise they bring to this proposal. Dr. Goldberg provides particular expertise with regards to study design, cardiovascular epidemiology, grant writing and manuscript preparation, and has a long track-record of obtaining NIH funding. Dr. Meyer is a practicing cardiologist with substantial expertise in the clinical management of heart failure (HF) as well as HF research. The primary aim of this proposal focuses on studying the effect that the timing of pharmacologic treatment for Acute Decompensated Heart Failure (ADHF) in the ED has on short term outcomes. I believe this is an important question not just because uncertainty exists with regards to how best to treat ADHF, but also because the quality of care provided is likely impacted by this uncertainty. The outcomes I am interested in are all related to the index hospitalization and include such things as the type of admission (ICU vs. floor), length of stay, and improvement in symptoms over 24 hours (via Visual Analog Scale Scores). These aims will be addressed both by collecting multicenter retrospective data and through prospective enrollment of ADHF patients in the ED. This approach will allow me to address my aims in multiple ED settings including teaching and community hospitals.

描述（由申请人提供）：我对心血管研究一直很感兴趣，并且我参与了基础科学，转化和临床项目。我正在申请该职业发展奖（CDA），以便获得其他培训，以便我可以独立设计和进行有意义的临床研究。我的主要短期目标是利用我提出的培训计划获得的技能来开发机构内部和外部的协作研究工作。我发现与其他研究人员一起工作很愉快，因为我发现此类合作刺激了新的研究思想并提供了更多的学习机会。在近期，我也希望通过与我的导师和他的研究小组合作来提高我的研究生产力和写作技巧。我的长期目标是成为我部门临床研究的领导者，并利用这些技能来建立我所在地区急诊部门（ED）之间的生产研究关系，并能够指导对研究职业感兴趣的其他人。我认为急诊医学提供了大量潜在的研究机会，但缺乏经验丰富的领导者和导师，可以发展和指导临床研究建议。 我建议的职业发展计划是多方面的。核心正在获得教学 在UMass医学院硕士学位培训临床调查计划中。这个程序是 由我的导师指导，专注于专门为学生提供专门为学生提供的课程 使用工具，他们需要成为独立研究人员。这些课程涵盖了临床流行病学，生物医学信息学，伦理学以及临床研究的设计和行为。我作为临床研究人员的成长也将取决于我的导师，同事和顾问的指导。罗伯特·戈德伯格（Robert Goldberg）博士将担任我的主要导师，而西奥·迈尔（Theo Meyer）博士将担任联合学者。博士。 Goldberg和Meyer互相补充，这些专业知识带给了这一建议。 Goldberg博士在研究设计，心血管流行病学，赠款写作和手稿准备方面提供了特殊的专业知识，并具有长期获得NIH资金的踪迹。 Meyer博士是一位执业心脏病专家，在心力衰竭（HF）和HF研究方面具有丰富的专业知识。 该提案的主要目的是研究药理时机的作用 ED中急性代偿性心力衰竭（ADHF）的治疗在短期结局中具有。我认为这是一个重要的问题，不仅是因为在如何最好地治疗ADHF方面存在不确定性，还因为所提供的护理质量可能受到这种不确定性的影响。我感兴趣的结果都与指数住院有关，包括入院类型（ICU与地板），住院时间和症状的改善（通过视觉模拟量表得分）。这些目标将通过收集多中心回顾性数据以及ED中的ADHF患者的预期入学来解决。这种方法将使我能够在包括教学和社区医院在内的多个ED设置中解决目标。