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，拥有临床 在持续性危重疾病和生物伦理学方面的专长，以及在纵向调查中的方法论专长。 临床问题：长时间入住ICU的患者费用高昂，患病率增加，并导致 长期发病率。不幸的是，我们未能及早发现这群患者， 因此，一直未能建立以证据为基础的程序来防止其发展。 候选人背景和成就：维格利安蒂博士是一名肺部和重症监护讲师 密歇根大学(UM)医学专业。她获得了杜克大学的医学博士学位， 北卡罗来纳大学教堂山分校，密歇根大学理科硕士。到目前为止，她发表了23篇论文，其中包括14篇 经过同行评审的原始手稿；其中7篇是她的第一作者。她获得了少数人资助奖 美国胸科学会，NHLBI颁发的F32和贷款偿还奖，以及机构K12。 无论这项提议的结果如何，她所在的部门都预计她将被任命为助理 2021年7月1日或之前的教授，以及包括25万美元可自由支配研究基金的启动方案。 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 方法论和分析，以及通过正式课程和指导研究进行的生物伦理学。她的初选 导师是密歇根大学的西奥多·J·伊瓦希纳博士，他曾指导过7名获得K奖的临床医生和科学家，包括4到 R级资金。她将由社会研究所的研究教授米克·库珀博士共同指导 在密歇根大学从事研究，是设计和实施纵向调查的专家。 目标：使用前瞻性和回溯性调查以及二手数据，她将1)确定 医生预测新的迟发性休克和急性缺氧性呼吸衰竭的准确性；2)发展 关于预测准确性和不准确性来源的假设，通过探索启发式、认知偏差 和生命伦理原则和价值观；3)决定持续性住院率的变化程度 危重疾病的解释是新的迟发性器官衰竭和姑息治疗的利用。 来自AIMS的交付成果：提议的AIMS将导致至少4本出版物，并为Viglianti博士做好准备 撰写2份R01建议书：1)开发和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处理迟发性器官衰竭中的应用。

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.