Improving Gastrointestinal Disease Outcomes in Vulnerable Populations

改善弱势群体胃肠道疾病的治疗效果

• 批准号: 9308949
• 负责人: JOHN MATTHEW INADOMI
• 金额: $ 17.43万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9308949
• 关键词: Academic skills; Adherence; Adverse effects; American; Applications Grants; Award; Barrett Esophagus; Biometry; Clinical; Clinical Research; Clinical Trials; Colonoscopy; Colorectal Neoplasms; Communities; Consent; Data; Data Analyses; Decision Modeling; Detection; Development; Dimensions; Disease Outcome; Doctor of Philosophy; Dysplasia; Educational process of instructing; Educational workshop; Enrollment; Environment; Epidemiology; Epigenetic Process; Evaluation; Faculty; Foundations; Funding; Gastroenterology; Gastrointestinal Diseases; Goals; Health Services Research; Image; Imaging Techniques; International; Investigation; Journals; Learning; Level of Evidence; Liver diseases; Malignant Neoplasms; Malignant neoplasm of esophagus; Manuscripts; Medical; Medicine; Mentors; Mentorship; Methods; Modeling; Molecular; Morphology; Online Systems; Outcome; Outcomes and Health Services Research; Participant; Patients; Peer Review; Physicians; Population; Postdoctoral Fellow; Preparation; Prevention; Program Development; Publishing; Randomized Clinical Trials; Research; Research Design; Research Infrastructure; Research Methodology; Research Personnel; Research Project Grants; Research Technics; Risk stratification; Students; Surveys; Techniques; Testing; Training; Training Programs; Trust; Underserved Population; United States National Institutes of Health; Universities; Validation; Vulnerable Populations; Washington; Writing; base; cancer risk; career; clinical practice; comparative effectiveness; data acquisition; data management; design; experience; follow-up; health belief; human subject; improved; interactive multimedia; literacy; multi-scale modeling; novel; patient oriented; patient oriented research; precision medicine; programs; prospective; prospective test; public health relevance; screening; shared decision making; skills; tool; trial comparing

 DESCRIPTION (provided by applicant): The aim of this K24 application is to enable me to mentor young investigators so they may successfully integrate translational, clinical, outcomes and health services research methods to optimize management of patients with gastrointestinal and liver disease. I have developed a successful NIH-funded program of patient- oriented research and have an established record of mentoring junior investigators who have been successful in conducting patient-oriented research, publishing in peer-reviewed journals and obtaining NIH support of their own. I have been invited to teach patient-oriented research design to national and international audiences and have published several reviews of research techniques in leading journals. Mentoring plan: My environment at the University of Washington allows young investigators to obtain formal training in clinical study design, epidemiology and biostatistics. I propose to teach quantitative analysis in order to generate hypotheses, which can be tested through properly designed prospective clinical trials. Data derived from these studies can be integrated into revised decision models to identify the optimal competing strategies of management, which can then be prospectively tested via comparative effectiveness. I plan to improve my mentoring skills by participating in regional programs of mentor development and through formation of the Mentorship Committee for the University of Washington Department of Medicine. Research plan: Two main themes of my personal research portfolio are expressed in this application: increasing adherence to screening for colorectal neoplasia, and comparative effectiveness analysis of strategies to detect and manage Barrett's esophagus. This broad range of topics allows my mentees to be exposed not only to different study designs but also different scientific content. In this manner I am able to assist each junior investigator to develo a unique niche within the greater community of patient-oriented investigation. Regarding adherence to screening for colorectal neoplasia, my projects include: 1) 3-year follow up of a prospective randomized clinical trial comparing adherence to competing colorectal neoplasia screening strategies, 2) identification of health beliefs associated with screening adherence, 3) the impact of trust in physicians on screening adherence, 4) shared decision-making influence on adherence, and 5) development and validation of an interactive multimedia program to increase adherence to the colonic preparation required for colonoscopy among low- literacy underserved populations. My studies examining Barrett's esophagus include: 6) comparative effectiveness analysis of competing strategies to screen, survey and treat patients with Barrett's esophagus, 7) multiscale modeling incorporating molecular mechanisms of cancer development into population models to test how precision medicine may improve risk stratification and detection, prevention and treatment of Barrett's esophagus and esophageal cancer, and 8) prospectively utilize novel imaging techniques to identify en-vivo morphological changes associated with Barrett's esophagus and dysplasia, and incorporate epigenetic tools to further characterize molecular changes that enhance cancer risk stratification. These studies will form the basis for my training program for junior faculty, gastroenterology fellows, residents in training, post-doctoral fellows and medical and PhD students. My overall goals are to combine these research projects with formal training in patient-oriented research to provide the foundation necessary for my mentees to establish an independent research program and a successful career in academic medicine.

 描述（由申请人提供）：此K24应用程序的目的是使我能够指导年轻的研究人员，使他们能够成功地整合翻译，临床，结果和卫生服务研究方法，以优化胃肠道和肝脏疾病患者的管理。我开发了一个成功的NIH资助的以患者为导向的研究项目，并有指导初级研究人员的记录，这些研究人员成功地进行了以患者为导向的研究，在同行评审的期刊上发表文章，并获得了NIH的支持。我被邀请向国内和国际观众教授以患者为导向的研究设计，并在领先期刊上发表了几篇研究技术的评论。指导计划：我在华盛顿大学的环境使年轻的研究人员能够获得临床研究设计、流行病学和生物统计学方面的正式培训。我建议教定量分析，以产生假设，这可以通过适当设计的前瞻性临床试验进行测试。从这些研究中获得的数据可以整合到修订后的决策模型中，以确定管理层的最佳竞争策略，然后通过比较有效性进行前瞻性测试。我计划通过参加地区导师发展计划和组建华盛顿大学医学系导师委员会来提高我的导师技能。研究计划：我的个人研究组合的两个主要主题在这个应用程序中表达：增加坚持筛查结直肠肿瘤，和比较有效性分析的策略，以检测和管理巴雷特食管。这一广泛的主题使我的学员不仅可以接触到不同的研究设计，而且还可以接触到不同的科学内容。通过这种方式，我能够帮助每个初级研究者在以患者为导向的研究的更大社区中发展独特的利基。关于坚持筛查结直肠肿瘤，我的项目包括：1）对一项前瞻性随机临床试验的3年随访，该试验比较了与竞争性结肠直肠肿瘤筛查策略的依从性，2）识别与筛查依从性相关的健康信念，3）对医生的信任对筛查依从性的影响，4）共同决策对依从性的影响，以及5）开发和验证交互式多媒体程序，以提高低文化水平的服务不足人群对结肠镜检查所需结肠准备的依从性。我的研究检查巴雷特食管包括：7）将癌症发展的分子机制并入群体模型中的多尺度建模，以测试精准医学如何可以改善风险分层以及巴雷特食管和食管癌的检测、预防和治疗，和8）前瞻性地利用新的成像技术来鉴定与Barrett食管和发育不良相关的体内形态学变化，并结合表观遗传学工具来进一步表征增强癌症风险分层的分子变化。这些研究将成为我为初级教师、胃肠病学研究员、住院医师、博士后研究员、医学和博士生提供培训的基础。我的总体目标是将联合收割机这些研究项目与以患者为导向的研究的正式培训相结合，为我的学员建立独立的研究计划和成功的学术医学事业提供必要的基础。