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

点击翻译按钮获取中文摘要

PROJECT SUMMARY Candidate: Biren Kamdar, MD, MBA, MHS is an Associate 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, par- ticularly in the ever-expanding population of older critically ill patients. Bringing a strong research background, including prior leadership of an NIH-supported ICU sleep promoting effort, Dr. Kamdar’s career goal is to gain the skills necessary to independently design, implement, evaluate and sustain multi-site interventions to im- prove delirium and sleep-wake rhythms in older ICU patients. Research Project: Older patients in the ICU are predisposed to delirium and misaligned sleep-wake rhythms, placing them at high risk for adverse out- comes following ICU discharge. As older adults comprise the majority of ICU patients and a rapidly expanding proportion of the ICU survivor population, ICU-based interventions are needed to focus on this particularly vul- nerable population. With the support of a strong mentorship and interdisciplinary stakeholder team, the parent K76 proposal involves implementation and testing of a multicomponent intervention in two academic ICUs. To reduce delirium and improve nighttime sleep quality in older ICU patients, the parent proposal pairs compo- nents of Dr. Kamdar’s prior nighttime-focused efforts with daytime interventions. To enhance intervention im- plementation, Dr. Kamdar’s team developed a video-based digital “ICU Delirium Playbook,” which includes instructions for bedside providers regarding delivery of nighttime and daytime interventions. To extend this effort further, Dr. Kamdar’s team partnered with diversity-focused experts to develop an “ICU Delirium Play- book: Spanish Edition.” Support from this Diversity, Equity, Inclusion and Accessibility (DEIA) supplement will help extend the parent K76 award to include outcomes data collection (e.g., actigraphy and delirium) in primari- ly Spanish-speaking patients, and bolster mentoring activities for Dr. Kamdar’s diverse group of trainees, in- cluding those from underrepresented and disadvantaged backgrounds. Career Development: Dr. Kamdar’s career development plan includes mentored activities to develop expertise in (a) sleep-wake rhythms and delir- ium and aging; (b) advanced actigraphy methods; (c) intervention development; and (d) implementation sci- ence. The parent K76 award has provided Dr. Kamdar with a foundation for an independent research career and leadership of large multi-site ICU interventions. Dr. Kamdar has mentored ~50 trainees over the past 13 years, including individuals from backgrounds underrepresented in biomedical research, and undergraduates who lack direct access to clinical opportunities and research mentorship. This DEIA supplement will support Dr. Kamdar’s mentoring efforts by providing stipends for trainees and by adding DEIA-focused research sup- port to guide the team in delivering interventions to more diverse ICU populations.