Trial of Asthma Self-Management Education in Patients with Depressive Symptoms

抑郁症状患者哮喘自我管理教育试验

• 批准号: 8494073
• 负责人: Carol A Mancuso
• 金额: $ 16.7万
• 依托单位: HOSPITAL FOR SPECIAL SURGERY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-14 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8494073
• 关键词: Absenteeism; Accident and Emergency department; Address; Adopted; Advocate; Affect; Age; American; Appointment; Area; Asthma; Award; Behavior; Behavior Therapy; Behavioral Sciences; Classification; Clinical; Clinical Investigator; Clinical Research; Conduct Clinical Trials; Contracts; Control Groups; DSM-IV; Depressed mood; Depressive disorder; Diagnosis; Disease; Dysthymic Disorder; Education; Educational Intervention; Educational process of instructing; Emergency Situation; Emergency treatment; Environment; Exercise; Faculty; Fellowship; Fostering; Funding; Future; Goals; Grant; Guidelines; Health Services Research; Hospitalization; Inhalators; Instruction; Internist; Intervention; Interview; Knowledge; Lead; Major Depressive Disorder; Master' s Degree; Medical; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mid-Career Clinical Scientist Award (K24); Motivation; National Heart, Lung, and Blood Institute; Outcome; Patients; Peer Review; Performance; Pharmaceutical Preparations; Physical activity; Physicians; Population; Prevalence; Prevention program; Primary Health Care; Protocols documentation; Psychiatry; Pulmonology; Quality of life; Questionnaires; Recording of previous events; Recruitment Activity; Recurrence; Research; Research Methodology; Research Personnel; Research Support; Resources; Risk; Role; Science; Self Efficacy; Self Management; Series; Structure; Symptoms; Telephone; Testing; Time; Training; Training Programs; United States Agency for Healthcare Research and Quality; Visit; Work; adverse outcome; base; cardiovascular risk factor; career; clinical epidemiology; depressive symptoms; design; experience; group intervention; high risk; improved; innovation; interest; medical schools; meetings; member; meter; minor depressive disorder; novel; primary outcome; programs; psychologic; routine care; skills

The K24 candidate is a general internist with a trajectory of peer-reviewed clinical research in asthma and extensive experience in mentoring fellows and junior faculty in clinical research through a formal Masters Degree Program in Clinical Epidemiology and Health Services Research. Supported by an RWJ Faculty Scholars Award, an NHLBI K23 award, and an NHLBI Translational Behavioral Science contract, the candidate has successfully completed a series of trials assessing interventions to improve self-management and to reduce cardiovascular risk in primary care asthma patients. An extension of this work is in progress in an NHLBI R01 trial to improve self-management in patients presenting to the emergency room for asthma. Throughout this work, the recurring theme of depressive symptoms as a risk for poor asthma outcomes has emerged. The objectives of this K24 award are to build on prior work and implement a new educational intervention targeted specifically at asthma patients with depressive symptoms. The K24 RCT will teach patients performance-based skills and use an innovative method to increase self-efficacy. The outcomes after 1 year will be quality of life, emergency resource utilization, work absenteeism, and the need for rescue medications. This trial will be the first to focus on asthma patients with depressive symptoms, a high risk population whose needs regarding education about self-management have been largely overlooked. An additional objective is for the candidate to develop expertise in diagnosing depressive disorders according to strict criteria using the standard Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). The candidate's short-term goals are to focus on asthma patients with depressive symptoms, to optimize their instruction in self-management, and to diagnose their spectrum of depressive disorders according to formal psychiatric criteria. The candidate's long-term goals are to develop interventions to simultaneously treat asthma and depression. Short-term goals in other related areas are to build on a recently completed RCT in physical activity in asthma patients by implementing a behavioral intervention to increase exercise among asthma patients, and to build on the findings of an ongoing emergency room RCT by implementing an intervention to decrease urgent resource utilization for asthma. Both goals will be addressed in R01 applications. As co-Director of the Masters Degree Program and AHRQ T32 Fellowship in Clinical Epidemiology and Health Services Research at the Weill Cornell Graduate School of Medical Sciences, the K24 candidate has been instrumental in developing a rigorous training program in clinical research and in mentoring fellows and junior faculty. The candidate has a successful track record of training physicians who become independent clinical investigators with peer-reviewed funding and academic appointments. During the K24 award, the candidate will increase her role as a primary mentor by decreasing her growing administrative responsibilities to the Masters Program. The award also will provide time for the candidate to extend her role to mentor medical residents. A rich research environment with experts and collaborators is available at Cornell for the K24 candidate. In particular, the candidate is an active member of the Research Methodology Core, a 'think tank' of established multi-disciplinary clinical researchers focusing on challenges in research methodology and the design and conduct of clinical trials. The Core has been extremely successful in supporting research initiatives of mid-career and senior investigators. In addition, the K24 candidate has established research relationships with experts in pulmonary medicine and psychiatry, and will continue to draw on their knowledge to meet the objectives of this multi-disciplinary K24 trial. In summary, the K24 award would advance the candidate's research career by permitting her to conduct an RCT targeted at asthma patients at high risk for poor outcomes. The award also would permit her to acquire expertise in diagnosing depressive disorders using the SCID and to develop co- interventions for asthma and depression. These are necessary steps to advance her research career. The K24 award also would grant the candidate dedicated time to provide one-on-one mentoring, to recruit mentees interested in research in pulmonary medicine, to establish a core of clinical asthma research in the Masters Program, and to establish a mentoring role for medical residents. Mentees will be able to participate in new asthma RCTs as well as the RCT proposed as part of this application. More time for mentoring will be derived by decreasing time spent in current and expanding administrative responsibilities to the Masters Program.

K24候选人是一名普通内科医生，拥有同行评审的哮喘临床研究轨迹，并通过临床流行病学和卫生服务研究的正式硕士学位课程在指导研究员和初级教师进行临床研究方面拥有丰富的经验。 在RWJ教师学者奖，NHLBI K23奖和NHLBI转化行为科学合同的支持下，候选人成功完成了一系列评估干预措施的试验，以改善自我管理并降低初级保健哮喘患者的心血管风险。这项工作的扩展正在NHLBI R 01试验中进行，以改善哮喘急诊室患者的自我管理。在这项工作中，抑郁症状作为哮喘不良结局的风险这一反复出现的主题已经出现。K24奖项的目标是在先前工作的基础上，实施一种专门针对有抑郁症状的哮喘患者的新的教育干预措施。K24 RCT将教授患者基于表现的技能，并使用创新方法来提高自我效能。1年后的结果将是生活质量，紧急资源利用，缺勤和抢救药物的需要。这项试验将是第一个关注有抑郁症状的哮喘患者的试验，这是一个高危人群，他们对自我管理教育的需求在很大程度上被忽视了。另一个目标是候选人根据严格的标准使用DSM-IV轴I障碍（SCID）的标准结构化临床访谈来发展诊断抑郁症的专业知识。候选人的短期目标是关注有抑郁症状的哮喘患者，优化他们的自我管理指导，并根据正式的精神病学标准诊断他们的抑郁症谱。候选人的长期目标是开发同时治疗哮喘和抑郁症的干预措施。其他相关领域的短期目标是在最近完成的哮喘患者体力活动RCT的基础上，通过实施行为干预来增加哮喘患者的运动，并在正在进行的急诊室RCT的结果基础上，通过实施干预来减少哮喘的紧急资源利用。这两个目标都将在R 01应用程序中解决。 作为威尔康奈尔大学医学研究生院临床流行病学和卫生服务研究硕士学位课程和AHRQ T32奖学金的共同主任，K24候选人在制定严格的临床研究培训计划和指导研究员和初级教师方面发挥了重要作用。候选人在培训医生方面有成功的记录，这些医生成为独立的临床研究者，并获得同行评审的资金和学术任命。在K24奖，候选人将通过减少她越来越多的管理责任，以硕士课程增加她作为主要导师的作用。该奖项还将为候选人提供时间，以扩大她的作用，指导医疗居民。 康奈尔大学为K24候选人提供了丰富的专家和合作者研究环境。特别是，候选人是研究方法核心的积极成员，这是一个由多学科临床研究人员组成的“智囊团”，专注于研究方法和临床试验的设计和实施。核心在支持职业中期和高级调查人员的研究举措方面非常成功。此外，K24候选人已与肺部医学和精神病学专家建立了研究关系，并将继续利用他们的知识来实现这项多学科K24试验的目标。 总之，K24奖将通过允许候选人进行针对高风险哮喘患者的RCT来促进候选人的研究生涯。该奖项还将允许她获得使用SCID诊断抑郁症的专业知识，并开发哮喘和抑郁症的联合干预措施。这些都是推进她的研究事业的必要步骤。K24奖还将授予候选人专门的时间来提供一对一的指导，招募对肺部医学研究感兴趣的学员，在硕士课程中建立临床哮喘研究的核心，并为住院医师建立指导作用。学员将能够参加新的哮喘RCT以及作为本申请一部分提出的RCT。更多的指导时间将通过减少当前花费的时间和扩大硕士课程的行政责任来获得。