Harnessing the Power of Technology to Transform Delirium Severity Measurement in the ICU

利用技术的力量改变 ICU 谵妄严重程度的测量

• 批准号: 10424978
• 负责人: Heidi Lindroth
• 金额: $ 16.2万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10424978
• 关键词: Active Learning; Activities of Daily Living; Acute; Address; Admission activity; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Artificial Intelligence; Brain; Caring; Cessation of life; Clinic; Clinical; Clinical Informatics; Clinical Nurse Specialists; Clinical Trials Unit; Cognition; Computer Vision Systems; Confusion; Conscious; Critical Illness; Data; Data Science; Decision Making; Delirium; Development; Development Plans; Effectiveness; Elderly; Electronic Health Record; Evidence based treatment; Extramural Activities; Failure; Feedback; Foundations; Funding; Future; Goals; Grant; Healthcare; Hospitalization; Hour; Impaired cognition; Informatics; Institutionalization; Intensive Care Units; International; Intervention; K-Series Research Career Programs; Knowledge; Laboratories; Measurement; Measures; Mechanical ventilation; Medical; Mentored Patient-Oriented Research Career Development Award; Mentorship; Monitor; National Institute on Aging; Outcome; Participant; Pathway interactions; Patients; Performance; Postdoctoral Fellow; Quality of Care; Quality of life; Randomized; Randomized Controlled Clinical Trials; Research; Research Project Grants; Research Proposals; Risk; Scientist; Severities; System; Technology; Testing; Time; Training; Work; Workload; Writing; adverse outcome; career; career development; clinical care; clinical decision-making; cohort; computer generated; convolutional neural network; dementia risk; design; digital; digital video recording; evidence base; experience; human old age (65+); improved; mortality; novel; primary outcome; prospective; recruit; research study; sensor; skills; support tools; temporal measurement; tool; treatment as usual; usability

PROJECT SUMMARY/ABSTRACT This K23 application outlines a career development plan that will advance Dr. Heidi Lindroth on her pathway to becoming an extramurally funded, independent clinician-nurse scientist. Her long-term career goal is to become an international leader focused on mitigating delirium severity in older adults, reducing the risk and burden of adverse outcomes, including Alzheimer’s Disease and related Dementias (ADRD). Delirium, an acute and fluctuating disturbance in consciousness and cognition, impacts 70-80% of mechanically ventilated, intensive care unit (ICU) older adults. Severe delirium accelerates the rate of global cognitive decline leading to an increased risk of ADRD. Therefore, reducing delirium severity holds great promise in decreasing ADRD burden. Unfortunately, delirium severity is seldom monitored in the ICU. Accurate and timely measurement of delirium severity is urgently needed to implement the proper, evidence-based treatment at the right time. To begin to fill this significant gap in clinical care, Dr. Lindroth’s proposed research study will leverage the foundational work completed in the Mayo Clinic Herasevich Clinical Informatics Laboratory to develop and preliminary test a passive digital marker (PDM) for delirium severity in critically ill, older adults. Like a continuous vital sign, this PDM would provide immediate and actionable feedback to clinicians on the status of delirium severity in ICU patients. Older adult (>65 years old) patients who are anticipated to remain in the ICU for >24 hours will be prospectively recruited upon their admission to the medical ICU at Mayo Clinic, Rochester, MN, and the general ICU at the Mayo Clinic, Eau Claire, WI for both stages of the study (development-aims 1 and 2; pilot RCT-aim 3; total n=230) and followed until either death and/or discharge from the ICU. Data collected will include continuous digital video recordings of the patient in their ICU room, routine EHR data, and study team administered delirium severity assessments. The pilot RCT in Aim 3 will randomize participants (1:1, computer-generated assignment) to either the intervention (PDM for delirium severity) or usual care with the primary outcomes of usability and acceptability. Dr. Lindroth has co-designed a career development plan and a research proposal with her transdisciplinary mentorship team to accomplish the following short-term objectives to: 1) acquire informatics and data science knowledge to design/build tools that support clinical decision making; 2) gain experience in the conduct of prospective ICU clinical trials in older adults, and; 3) acquire and develop grant writing skills. These short-term objectives will be accomplished through formal training (Masters in Artificial Intelligence in Healthcare), experiential learning (conduct of proposed study), and focused mentorship Thus, this K23 award will allow Dr. Lindroth to progress in her career development plan and provide her with necessary protected time to acquire the outlined research skills, knowledge, and experience to continue her pathway towards independence.

项目摘要/摘要 该K23应用程序概述了一项职业发展计划，该计划将使Heidi Lindroth博士踏上前往 成为一名具有外部资助的独立临床和核科学家。她的长期职业目标是 成为一名致力于减轻老年人ir妄严重性的国际领导人，降低了风险和 不良后果的负担，包括阿尔茨海默氏病和相关痴呆症（ADRD）。 ir妄，是意识和认知中的急性灾难，影响了70-80％ 机械通风的重症监护病房（ICU）老年人。严重的ir妄加速了全球的速度 认知能力下降导致ADRD的风险增加。因此，降低ir妄严重性很大 承诺减轻Adrd负担。不幸的是，在ICU中很少监测ir妄的严重性。准确的 迫切需要及时测量ir妄严重性以实施适当的基于证据的 在正确的时间进行治疗。为了开始填补临床护理中的这一重大空白，林德罗斯博士的拟议研究 研究将利用Mayo诊所Herasevich临床信息学完成的基础工作 实验室开发和初步测试被动数字标记（PDM），以使危害严重性的严重程度 老年人。就像连续的生命体征一样，此PDM将为 ICU患者del妄严重程度的临床医生。老年人（> 65岁）患者 预计将在ICU中保留> 24小时，预计将在入院后招募 Mayo诊所，明尼苏达州罗切斯特的Mayo诊所和威斯康星州EAU Claire的Mayo Clinic的一般ICU， 研究阶段（开发-AIMS 1和2； PILOT RCT-AIM 3；总n = 230），然后直到死亡 和/或从ICU出院。收集的数据将包括患者的连续数字视频记录 他们的ICU室，常规的EHR数据和研究团队管理了ir妄严重性评估。飞行员RCT 在AIM 3中，将随机将参与者（1：1，计算机生成的任务）随机进行干预（PDM del妄严重性）或通常的护理，具有可用性和可接受性的主要结果。 Lindroth博士与她的跨学科共同设计了职业发展计划和研究建议 识别团队实现以下短期目标，以：1）获取信息和数据科学 设计/构建支持临床决策的工具的知识； 2）获得行为的经验 老年人的前瞻性ICU临床试验，以及； 3）获取和发展赠款写作技巧。这些短期 目标将通过正规培训（医疗保健人工智能硕士）实现， 体验式学习（拟议的研究的行为），并以精力为重点，这一K23奖将允许博士 林德罗斯（Lindroth）在她的职业发展计划中进步，并为她提供必要的保护时间 概述了研究技能，知识和经验，以继续她的独立道路。