The Effects of Lung Transplant on Disability and Health-Related Quality of Life

肺移植对残疾和健康相关生活质量的影响

基本信息

项目摘要

DESCRIPTION (provided by applicant): As a lung transplant pulmonologist and junior faculty at UC San Francisco, my long term career goal is to become a successful independent investigator of patient-oriented outcomes in recipients of lung transplantation, specifically disability and health related quality of life (HRQL). Importantly, while poor HRQL is a primary indication for lung transplant and, although HRQL is a central, patient-centered outcome measure in many other chronic diseases, HRQL remains a relatively understudied area of research in the field of lung transplantation. Thus, to pursue my long term career goal and address this knowledge gap, I propose to 1) prospectively evaluate how lung transplant effects change in disability and HRQL in subjects suffering from end-stage lung disease and 2) identify key predictors, both pulmonary and extra-pulmonary, of change in disability and HRQL in lung transplant recipients. Three Specific Aims make operational these objectives: Aim 1: Determine changes in disability and HRQL over time among lung transplant recipients; AIM 2: Identify pulmonary and extra-pulmonary physiological and psychosocial predictors of change in disability and HRQL among lung transplant recipients; and AIM 3. Estimate the effect of additional psychosocial factors on HRQL among lung transplant recipients. To accomplish these Aims, I propose a mixed-methods analytic approach that leverages my ongoing pilot study currently supported by my F32 award and an extramural grant from Novartis. 105 subjects listed for lung transplant will be identified and prospectively followed for three years after transplant. Before transplant, baseline measures of pulmonary and extra-pulmonary physiological functioning, co-morbidities, disability and HRQL will be assessed through medical record review, a home visit, and a structured telephone survey. After transplant these measures will be repeated at 3, 6, 12, 18, 24, 30, and 36 months post-transplant. A subset of 15 subjects will complete semi-structured qualitative interviews examining the impact of psychosocial factors on HRQL. Statistical analyses will employ mixed-effects models to analyze the repeated measures nature of the dataset. To determine the change in disability and HRQL over time, longitudinal changes in disability and HRQL scores will be compared to baseline pre-transplant scores. Next, a hierarchical approach to mixed-effects modeling will be used to identify physiological predictors of change in disability and HRQL following transplant. Delineating the effects of lung transplant on disability and HRQL has immediate clinical and research implications. This contribution will permit clinicians to provide data- driven preoperative counseling on the trajectory, magnitude, and durability of reduced disability and improved HRQL that can be anticipated from lung transplant. Also, highlighting the importance of extra-pulmonary impairments as risk factors for disability and impaired HRQL post-transplant could impact care and improve outcomes. Further, identifying residual or new limitations in post-transplant functional status impart particular risk for poor disability/HRQL outcomes permits the development of novel intervention strategies. Though I have had a productive start to my research career, to achieve objectives of this project and independence as an investigator I need further training. The Division of Pulmonary Medicine at UC San Francisco offers a rich environment with a long history of training successful academic pulmonologists that includes an impressive infrastructure and network of researchers dedicated to my career development. Within this environment, I have identified 5 short-term career goals. These goals include (1) the design and implementation of prospective studies with multiple waves of data; (2) advanced quantitative methods including repeated measures analysis to best handle multi-wave data sets; (3) additional training in measuring disability and HRQL with existing instruments; 4) qualitative research methodology relevant to HRQL instrument development; and (5) focused and structured career development through the UCSF Clinical and Translational K Scholars (CTSK) program. To help me achieve these 5 goals, under the guidance of my mentor, I have designed a 5-year career development plan that includes didactic coursework in advanced biostatistics including mixed effects models, measurement of self-reported health (including HRQL) using questionnaires, and qualitative research methodology. This plan also includes one-on-one apprenticeship training in the design and implementation of prospective cohort studies; advanced biostatistics; how to conceptualize and interpret measures of disability, functioning, and HRQL; and qualitative research methods including the design of semi- structured interviews, the coding of interview responses, and data interpretation. Finally, my plan includes "hands-on" practical experiences in implementing prospective studies, interpreting disability and HRQL data within the context of lung transplantation, analyzing results from my study within a mixed-effects modeling framework, and executing all aspects of the qualitative component of this research project. This tailored 5- year career development plan coupled with the prospective cohort study proposed for this award will help me to achieve independence as an investigator with a clearly defined research niche of my own that is unique at UC San Francisco and that also addresses an important but relatively understudied area of investigation in the field of lung transplant medicine.
描述(由申请人提供):作为一名肺移植肺科专家和加州大学旧金山分校的初级教员,我的长期职业目标是成为一名成功的独立调查者,研究肺移植受者以患者为中心的结局,特别是残疾和与健康相关的生活质量(HRQL)。重要的是,虽然较差的HRQL是肺移植的主要指征,尽管HRQL是许多其他慢性疾病的中心、以患者为中心的结果衡量标准,但在肺移植领域,HRQL仍然是一个研究相对较少的领域。因此,为了追求我的长期职业目标并解决这一知识差距,我建议1)前瞻性地评估肺移植对终末期肺部疾病患者的残疾和HRQL的影响,以及2)确定肺移植受者残疾和HRQL变化的关键预测因素,包括肺和肺外。三个具体的目标使这些目标具有可操作性:目的1:确定肺移植受者残疾和HRQL随时间的变化;目的2:确定肺和肺外生理和心理社会因素对肺移植受者残疾和HRQL变化的预测;以及目的3.评估其他心理社会因素对肺移植受者HRQL的影响。为了实现这些目标,我提出了一种混合方法分析方法,该方法利用了我目前正在进行的试点研究,该研究目前得到了我的F32奖和诺华公司的一笔校外赠款的支持。将确定105名被列为肺移植的受试者,并在移植后对其进行前瞻性的三年跟踪调查。 在移植前,肺和肺外生理功能、合并症、残疾和HRQL的基线测量将通过病历回顾、家访和结构化电话调查进行评估。移植后,这些措施将在移植后3、6、12、18、24、30和36个月重复。15名受试者将完成半结构定性访谈,考察心理社会因素对HRQL的影响。统计分析将使用混合效应模型来分析数据集的重复测量性质。为了确定残疾和HRQL随时间的变化,残疾和HRQL得分的纵向变化将与移植前的基线得分进行比较。下一步,将使用混合效应建模的分层方法来识别移植后残疾和HRQL变化的生理预测因子。描述肺移植对残疾和HRQL的影响具有直接的临床和研究意义。这一贡献将允许临床医生提供数据驱动的术前咨询,以了解肺移植可预期的减少残疾和改善HRQL的轨迹、幅度和持久性。此外,强调肺外损伤作为移植后残疾和HRQL受损的风险因素的重要性,可能会影响护理和改善结果。此外,识别移植后功能状态的残留或新的限制会导致较差的残疾/HRQL结果的特殊风险,从而允许开发新的干预策略。虽然我的研究生涯有了一个富有成效的开始,但为了实现这个项目的目标和作为一名调查人员的独立性,我需要进一步的培训。加州大学旧金山分校的肺部医学部提供了一个丰富的环境,具有培养成功的学术肺科医生的悠久历史,其中包括令人印象深刻的基础设施和致力于我的职业发展的研究人员网络。在这种环境下,我确定了5个短期职业目标。这些目标包括(1)设计和实施具有多波数据的前瞻性研究;(2)先进的量化方法,包括重复测量分析,以最好地处理多波数据集;(3)利用现有工具在衡量残疾和HRQL方面的额外培训;(4)与HRQL工具开发相关的定性研究方法;以及(5)通过加州大学旧金山分校临床和翻译K学者(CTSK)计划进行有重点和有条理的职业发展。为了帮助我实现这五个目标,在我的导师的指导下,我设计了一个为期5年的职业发展计划,其中包括高级生物统计学的教学课程,包括混合效应模型,使用问卷测量自我报告的健康状况(包括HRQL),以及定性研究方法。该计划还包括设计和实施前瞻性队列研究的一对一学徒培训;高级生物统计学;如何概念化和解释残疾、功能和HRQL的衡量标准;以及定性研究方法,包括半结构化访谈的设计、访谈答复的编码和数据解释。最后,我的计划包括在实施前瞻性研究、在肺移植的背景下解释残疾和HRQL数据、在混合效应建模框架内分析我的研究结果以及执行该研究项目定性部分的所有方面方面的实践经验。这份量身定制的5年职业发展计划,加上为该奖项提出的前瞻性队列研究,将帮助我作为一名调查员实现独立,拥有自己明确定义的研究利基,这在加州大学旧金山分校是独一无二的,也解决了该领域一个重要但相对研究较少的研究领域。 肺移植药物。

项目成果

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Jonathan Paul Singer其他文献

Jonathan Paul Singer的其他文献

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{{ truncateString('Jonathan Paul Singer', 18)}}的其他基金

The impact of body composition on peri-operative and patient-centered outcomes in lung transplantation.
身体成分对肺移植围手术期和以患者为中心的结果的影响。
  • 批准号:
    10677598
  • 财政年份:
    2022
  • 资助金额:
    $ 15.84万
  • 项目类别:
The impact of body composition on peri-operative and patient-centered outcomes in lung transplantation.
身体成分对肺移植围手术期和以患者为中心的结果的影响。
  • 批准号:
    10429878
  • 财政年份:
    2022
  • 资助金额:
    $ 15.84万
  • 项目类别:
Frailty and patient centered outcomes in candidates for lung transplantation
肺移植候选人的虚弱和以患者为中心的结果
  • 批准号:
    10191001
  • 财政年份:
    2017
  • 资助金额:
    $ 15.84万
  • 项目类别:
The Effects of Lung Transplant on Disability and Health-Related Quality of Life
肺移植对残疾和健康相关生活质量的影响
  • 批准号:
    8534269
  • 财政年份:
    2012
  • 资助金额:
    $ 15.84万
  • 项目类别:
The Effects of Lung Transplant on Disability and Health-Related Quality of Life
肺移植对残疾和健康相关生活质量的影响
  • 批准号:
    9114646
  • 财政年份:
    2012
  • 资助金额:
    $ 15.84万
  • 项目类别:
The Effects of Lung Transplant on Disability and Health-Related Quality of Life
肺移植对残疾和健康相关生活质量的影响
  • 批准号:
    8703763
  • 财政年份:
    2012
  • 资助金额:
    $ 15.84万
  • 项目类别:
The effects of lung transplantation on lung disease related disabilities
肺移植对肺病相关残疾的影响
  • 批准号:
    8057964
  • 财政年份:
    2011
  • 资助金额:
    $ 15.84万
  • 项目类别:

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