Multicomponent intervention to improve delirium and sleep-wake rhythms in older ICU patients

项目摘要 候选人：Biren Kamdar博士，医学博士，工商管理硕士，MHS是医学和重症监护病房的助理教授 (ICU)作为一名医生，他的职业目标是在ICU环境中对谵妄和睡眠进行新的发现， 特别是在不断扩大的老年重症患者群体中。把一个强有力的研究带回- 地面，包括先前领导的NIH支持的ICU睡眠促进工作，Kamdar博士的短期 目标是获得必要的技能，独立设计，实施，评估和维持多站点间， 改善老年ICU患者的谵妄和睡眠-觉醒节律。从长远来看，他的目标是获得 国家和国际公认的健康服务和老龄化研究人员具有深厚的专业知识， 关于危重患者谵妄、睡眠和睡眠-觉醒节律的潜在机制的出版记录， 并具有在各种ICU环境中实施干预所需的知识和经验。 研究项目：ICU中的老年患者易患谵妄、睡眠质量差和失调 睡眠-觉醒节律，使他们在ICU出院后出现不良结局的风险很高。作为老年人 现在包括大多数重症患者和ICU幸存者人口的比例迅速扩大， 因此，需要采取以ICU为基础的干预措施，重点关注这一特别脆弱的人群。与支撑 一个强大的导师和跨学科的利益相关者团队，这一建议涉及实施和测试- 在两个学术ICU中进行多组分夜间和日间干预。作为一种新的方法来重新- 减少谵妄和改善老年ICU患者的夜间睡眠质量，该提案旨在调整睡眠-觉醒 通过将Kamdar博士先前以夜间为重点的睡眠的组成部分与一个强大的 日间干预，来自医院老年人生活计划和先前进行的非ICU干预 在老年住院病人中的应用。关键结局指标将包括无谵妄/无昏迷 使用腕动记录仪数据的高级分析测量的天数和睡眠-觉醒节律。此外，本发明还 为了评估和改进干预措施，以便将来实施，本提案将包括24小时录音， 光水平测量，并在干预完成后6个月，与ICU工作人员进行半结构化访谈 关于干预本身。职业发展：Kamdar博士的职业发展计划包括正式的 关于（a）睡眠-觉醒节律和衰老的课程和指导培训;（B）先进的活动记录法;（c） 干预发展;以及（d）实施科学和保健领导。最终，这辆K76 裁决将提供最后的重要垫脚石，以建立他的独立性，从而提供了基础- 旨在改善谵妄、睡眠和睡眠-觉醒的大型多地点干预措施的未来领导作用 老年重症患者的心律失常

PROJECT SUMMARY Candidate: Dr. Biren Kamdar, MD, MBA, MHS is an Assistant Professor of Medicine and intensive care unit (ICU) physician with a career goal of making novel discoveries regarding delirium and sleep in the ICU setting, particularly in the ever-expanding population of older critically ill patients. Bringing a strong research back- ground, including prior leadership of an NIH-supported ICU sleep promoting effort, Dr. Kamdar's short-term goal is to gain the skills necessary to independently design, implement, evaluate and sustain multi-site inter- ventions to improve delirium and sleep-wake rhythms in older ICU patients. Over the long term, he aims to gain national and international recognition as a health services and aging researcher with a deep expertise and publication record on the underlying mechanisms of delirium, sleep, and sleep-wake rhythms in the critically ill, and with the knowledge and experience necessary to implement interventions in various ICU settings. Research Project: Older patients in the ICU are predisposed to delirium, poor sleep quality, and misaligned sleep-wake rhythms, placing them at high risk for adverse outcomes following ICU discharge. As older adults now comprise the majority of critically ill patients and a rapidly expanding proportion of the ICU survivor popu- lation, ICU-based interventions are needed to focus on this particularly vulnerable population. With the support of a strong mentorship and interdisciplinary stakeholder team, this proposal involves implementation and test- ing of a multicomponent nighttime and daytime intervention in two academic ICUs. As a novel method to re- duce delirium and improve nighttime sleep quality in older ICU patients, this proposal aims to align sleep-wake rhythms by coupling components of Dr. Kamdar's prior nighttime-focused sleep promoting effort with a robust daytime intervention, derived from the Hospital Elder Life Program and prior non-ICU interventions conducted in older inpatients by members of his mentorship team. Key outcome measures will include delirium/coma-free days and sleep-wake rhythms, as measured using advanced analyses from wrist actigraphy data. Additionally, to evaluate and refine the intervention for future implementation, this proposal will include 24-hour sound and light level measurements and, 6 months after intervention completion, semi-structured interviews with ICU staff regarding the intervention itself. Career Development: Dr. Kamdar's career development plan includes formal coursework and mentored training on (a) sleep-wake rhythms and aging; (b) advanced actigraphy methods; (c) intervention development; and (d) implementation science and healthcare leadership. Ultimately, this K76 award will provide the final important stepping stone to establish his independence, thus providing the founda- tion for future leadership of large multi-site interventions aimed at improving delirium, sleep and sleep-wake rhythms in older critically ill patients.