Improving Risk-Stratification in Patients with Prolonged ICU Stays

项目摘要 候选人的长期职业目标：成为一名独立资助的医生-科学家， 在持续性危重疾病和生物伦理学方面的专业知识，在纵向调查方面的方法学专业知识。 临床问题：长期ICU停留的患者费用昂贵，患病率增加，并导致 长期发病率。不幸的是，我们还没有能够早期识别出这组患者， 随后，未能建立循证程序来防止其发展。 候选人背景和成就：Viglianti博士是肺部和重症监护讲师 密歇根大学医学院（UM）。她获得了杜克大学的医学博士学位， 北卡罗来纳州查佩尔山大学，密歇根大学理学硕士。迄今为止，她已发表23篇论文，其中包括14篇 原始同行评审的手稿; 7其中她是第一作者。她获得了少数民族补助金 美国胸科协会，F32和贷款偿还奖从NHLBI，和机构K12。 无论这一提议的结果如何，她所在的部门预计她将被任命为助理 教授或之前2021年7月1日，与启动包，包括$250，000的自由裁量研究基金。 职业发展计划：Viglianti博士建议在纵向调查中发展新的专业知识 通过正式的课程和指导研究，学习方法和分析以及生物伦理学。她的主要 导师是UM的西奥多J. Iwashyna博士，他指导了7名获得K奖的临床科学家，包括4名 R级融资。她将由社会研究所的研究教授Mick Couper博士共同指导 在UM进行研究，他是纵向调查设计和实施方面的专家。 目的：使用前瞻性和回顾性调查以及二手数据，她将1）确定 医生诊断新发迟发性休克和急性缺氧性呼吸衰竭的准确性; 2）开发 通过探索语言学、认知偏差， 和生物伦理学原则和价值观; 3）确定在何种程度上变化的医院率的持续 危重病的原因是新发迟发性器官衰竭和姑息治疗的利用。 目标的可行性：拟定的目标将导致至少4篇出版物，并使Viglianti博士准备 编写2个R 01提案：1）开发并验证新的风险预测工具; 2）识别基于证据的 高绩效医院在预防和管理迟发性器官衰竭方面的实践。

Project Summary Candidate’s Long-Term Career Goal: To become an independently funded physician-scientist with a clinical expertise in persistent critical illness and bioethics with a methodological expertise in longitudinal surveys. Clinical Problem: Patients with prolonged ICU stays are costly, increasing in prevalence, and resulting in long-term morbidity. Unfortunately, we have not been able to identify this cohort of patients early and subsequently have not been able to institute evidence-based processes to prevent its development. Candidate Background and Achievements: Dr. Viglianti is a Lecturer in Pulmonary and Critical Care Medicine at the University of Michigan (UM). She received her MD from Duke University, MPH from the University of North Carolina Chapel Hill, and MSc from UM. To date she has published 23 papers, including 14 original peer-reviewed manuscripts; 7 of which she is first author. She won a minority grant award from the American Thoracic Society, an F32 and loan repayment award from NHLBI, and an institutional K12. Regardless of the outcome of this proposal, her department anticipates she will be appointed to an assistant professor on or before July 1, 2021, with a start-up package including $250,000 of discretionary research fund. Career Development Plan: Dr. Viglianti proposes to develop new expertise in longitudinal survey methodology and analysis, and bioethics through formal coursework and mentored research. Her primary mentor is Dr. Theodore J. Iwashyna at UM, who has mentored 7 clinician-scientists on K awards, including 4 to R-level funding. She will be co-mentored by Dr. Mick Couper a research professor at the Institute of Social Research at UM who is an expert in design and implementation of longitudinal surveys. Aims: Using both prospective and retrospective surveys and secondary data, she will 1) Determine the accuracy of physicians to prognosticate new late-onset shock and acute hypoxic respiratory failure; 2) Develop hypotheses about sources of prognostication accuracy and inaccuracy by exploring heuristics, cognitive biases and bioethical principles and values; 3) Determine the extent to which variation in hospital rates of persistent critical illness are explained by new late-onset organ failures and palliative care utilization. Deliverables from Aims: The proposed aims will lead to at least 4 publications and prepare Dr. Viglianti to write 2 R01 proposals: 1) Develop and validate a new risk-prediction tool; 2) Identification of evidence-based practices utilized by high performing hospitals in the prevention and management of late-onset organ failures.