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

项目总结/摘要 这份K23申请概述了一个职业发展计划，将推动Heidi Lindroth博士走上 成为一名独立的临床护士科学家她的长期职业目标是 成为国际领导者，专注于减轻老年人谵妄的严重程度，降低风险， 不良后果的负担，包括阿尔茨海默病和相关痴呆症（ADRD）。 谵妄是意识和认知的急性波动性障碍，影响70-80%的 机械通气的重症监护室（ICU）老年人。严重的谵妄会加速全球性的 认知能力下降导致ADRD风险增加。因此，降低谵妄的严重程度， 减少ADRD负担的承诺。不幸的是，谵妄的严重程度很少在ICU监测。准确 及时测量谵妄的严重程度是迫切需要实施适当的，基于证据的 在正确的时间进行治疗。为了开始填补临床护理的这一重大空白，Lindroth博士提出的研究 研究将利用马约诊所Herasevich临床信息学完成的基础工作 实验室开发和初步测试危重患者谵妄严重程度的被动数字标记（PDM）， 老年人就像一个连续的生命体征，该PDM将提供即时和可操作的反馈， 临床医生对ICU患者谵妄严重程度的状态。老年（>65岁）患者， 预期在ICU中停留>24小时的患者将在他们入院时前瞻性招募。 明尼苏达州罗切斯特市马约诊所的医学ICU和威斯康星州欧克莱尔市马约诊所的普通ICU 研究阶段（开发-目标1和2;试点RCT-目标3;总n=230），并随访至死亡 和/或从ICU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，研究小组进行谵妄严重程度评估。试点RCT 将参与者随机分配（1：1，计算机生成分配）到干预（PDM， 谵妄严重程度）或常规护理，主要结局为可用性和可接受性。 博士Lindroth与她的跨学科合作设计了职业发展计划和研究提案 导师团队完成以下短期目标：1）获取信息学和数据科学 设计/构建支持临床决策的工具的知识; 2）获得进行 老年人的前瞻性ICU临床试验; 3）获得和发展赠款写作技能。这些短期 目标将通过正式培训（医疗保健人工智能硕士）， 体验式学习（进行拟议的研究），并重点指导因此，这个K23奖将允许博士。 Lindroth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， 概述的研究技能，知识和经验，以继续她走向独立的道路。

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.