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

项目总结 候选人：Biren Kamdar博士，医学博士，MBA，MHS医学助理教授，重症监护病房 (ICU)医生，职业目标是在ICU环境下对精神错乱和睡眠做出新发现， 特别是在不断扩大的老年危重病人群体中。带着强大的研究成果回来- 地面，包括NIH支持的ICU睡眠促进努力的先前领导，Kamdar博士的短期 目标是获得独立设计、实施、评估和维持多站点间 改善老年ICU患者神志不清和睡眠-觉醒节律的方案。从长远来看，他的目标是获得 国内和国际公认的健康服务和老龄研究人员，具有深厚的专业知识和 关于危重病人精神错乱、睡眠和睡眠-觉醒节律的潜在机制的出版记录， 并具备在各种ICU环境中实施干预措施所需的知识和经验。 研究项目：ICU中年龄较大的患者容易出现精神错乱、睡眠质量差和错位 睡眠-觉醒节律，使他们在ICU出院后面临不良后果的高风险。作为年长的成年人 现在包括大多数危重病人和迅速扩大的ICU幸存者人口比例- 此外，需要以重症监护病房为基础的干预措施，将重点放在这一特别脆弱的人群上。在支持下 作为一个强大的导师和跨学科利益相关者团队的一部分，该提案涉及实施和测试- 对两个学术重症监护室进行多组分的夜间和日间干预。作为一种新的方法来重新 改善老年ICU患者的杜斯妄想和改善夜间睡眠质量，这项建议旨在使睡眠和觉醒相一致 通过将Kamdar博士先前夜间重点睡眠的组成部分与强健的睡眠相结合来促进节律 日间干预，源自医院老年人生活计划和之前进行的非ICU干预 他的指导团队的成员在老年住院患者中的表现。关键的结果指标将包括精神错乱/无昏迷 白天和睡眠-觉醒节律，通过手腕活动数据的高级分析进行测量。另外， 为了评估和完善干预措施，以便今后实施，这项提议将包括24小时声音和 光线水平测量，干预完成6个月后，对ICU工作人员进行半结构化访谈 关于干预本身。职业发展：卡姆达尔博士的职业发展计划包括正式 关于(A)睡眠-觉醒节律和衰老的课程作业和辅导培训；(B)先进的活动描记方法；(C) 干预发展；和(D)实施科学和保健领导。最终，这款K76 获奖将为他确立独立性提供最后的重要垫脚石，从而为他提供- 呼吁未来领导旨在改善精神错乱、睡眠和睡眠觉醒的大型多部位干预 老年危重病人的节律。

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.