Harnessing the Power of Technology to Transform Delirium Severity Measurement in the ICU

项目摘要/摘要 这份K23申请表概述了一份职业发展计划，该计划将推动海蒂·林德罗斯博士在她的职业道路上 成为一名外部资助的、独立的临床医生兼护士科学家。她的长期职业目标是 成为专注于减轻老年人精神错乱严重程度的国际领导者，降低风险和 不良后果的负担，包括阿尔茨海默病和相关痴呆(ADRD)。 精神错乱是一种严重的意识和认知波动障碍，影响70%-80%的 机械通风的重症监护病房(ICU)老年人。严重的精神错乱加速了全球 认知能力下降导致ADRD风险增加。因此，减少精神错乱的严重程度具有重大意义 在减轻ADRD负担方面的承诺。不幸的是，ICU很少监测精神错乱的严重程度。准确 而及时测量精神错乱的严重程度是迫切需要的，以实施适当的、循证的 在正确的时间进行治疗。为了开始填补临床护理方面的这一重大缺口，林德罗斯博士提出的研究 研究将利用在梅奥诊所完成的基础工作Herasevich临床信息学 实验室开发和初步测试一种无源数字标记器(PDM)，用于检测危重患者的妄想严重程度， 上了年纪的人。就像一个持续的生命体征，这一产品数据管理将提供即时和可行的反馈 临床医生对ICU患者神志不清严重程度的了解。年龄较大(65岁)的患者 预计将在重症监护病房停留24小时的人将在被录取后被招募 明尼苏达州罗切斯特市梅奥诊所的内科ICU和威斯康星州尤克莱尔梅奥诊所的普通ICU 研究的各个阶段(发展阶段--目标1和目标2；试点随机对照试验--目标3；总数n=230)，直到死亡 和/或从重症监护室出院。收集的数据将包括患者的连续数字视频记录 他们的ICU病房、常规EHR数据和研究小组进行了妄想严重程度的评估。试点RCT 在目标3中，参与者(1：1，计算机生成的分配)将随机分配到干预(用于 严重精神错乱)或常规护理，主要结果是可用性和可接受性。 Lindroth博士与她的跨学科合作设计了一份职业发展计划和一份研究提案 导师团队将完成以下短期目标：1)获取信息学和数据科学 具有设计/构建支持临床决策的工具的知识；2)获得实施 在老年人中进行预期的ICU临床试验，以及3)获得和发展赠款撰写技能。这些短期的 目标将通过正式培训(医疗保健人工智能硕士)来实现， 体验式学习(进行拟议的研究)和专注的指导因此，这个K23奖将允许博士。 林德罗斯在她的职业发展计划中取得进展，并为她提供必要的保护时间来获得 概述的研究技能，知识和经验，继续她的独立之路。

PROJECT SUMMARY/ABSTRACT This K23 application outlines a career development plan that will advance Dr. Heidi Lindroth on her pathway to becoming an extramurally funded, independent clinician-nurse scientist. Her long-term career goal is to become an international leader focused on mitigating delirium severity in older adults, reducing the risk and burden of adverse outcomes, including Alzheimer’s Disease and related Dementias (ADRD). Delirium, an acute and fluctuating disturbance in consciousness and cognition, impacts 70-80% of mechanically ventilated, intensive care unit (ICU) older adults. Severe delirium accelerates the rate of global cognitive decline leading to an increased risk of ADRD. Therefore, reducing delirium severity holds great promise in decreasing ADRD burden. Unfortunately, delirium severity is seldom monitored in the ICU. Accurate and timely measurement of delirium severity is urgently needed to implement the proper, evidence-based treatment at the right time. To begin to fill this significant gap in clinical care, Dr. Lindroth’s proposed research study will leverage the foundational work completed in the Mayo Clinic Herasevich Clinical Informatics Laboratory to develop and preliminary test a passive digital marker (PDM) for delirium severity in critically ill, older adults. Like a continuous vital sign, this PDM would provide immediate and actionable feedback to clinicians on the status of delirium severity in ICU patients. Older adult (>65 years old) patients who are anticipated to remain in the ICU for >24 hours will be prospectively recruited upon their admission to the medical ICU at Mayo Clinic, Rochester, MN, and the general ICU at the Mayo Clinic, Eau Claire, WI for both stages of the study (development-aims 1 and 2; pilot RCT-aim 3; total n=230) and followed until either death and/or discharge from the ICU. Data collected will include continuous digital video recordings of the patient in their ICU room, routine EHR data, and study team administered delirium severity assessments. The pilot RCT in Aim 3 will randomize participants (1:1, computer-generated assignment) to either the intervention (PDM for delirium severity) or usual care with the primary outcomes of usability and acceptability. Dr. Lindroth has co-designed a career development plan and a research proposal with her transdisciplinary mentorship team to accomplish the following short-term objectives to: 1) acquire informatics and data science knowledge to design/build tools that support clinical decision making; 2) gain experience in the conduct of prospective ICU clinical trials in older adults, and; 3) acquire and develop grant writing skills. These short-term objectives will be accomplished through formal training (Masters in Artificial Intelligence in Healthcare), experiential learning (conduct of proposed study), and focused mentorship Thus, this K23 award will allow Dr. Lindroth to progress in her career development plan and provide her with necessary protected time to acquire the outlined research skills, knowledge, and experience to continue her pathway towards independence.