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Resident Research

The Springfield Committee for Research Involving Human Subjects (SCRIHS) reviews all studies involving human subjects research.  The research projects described below include studies approved by SCRIHS, or studies using de-identified data not requiring SCRIHS approval. References have been deleted for brevity.

 

CORRELATES OF HEALTH LITERACY LEVELS AMONG PATIENTS WITH CHRONIC AND SEVERE MENTAL ILLNESS: A PILOT STUDY
Investigators
Dorcas Adaramola, MD (Medicine/Psychiatry resident)
Obiora Onwuameze, MD
 
Objectives:  The objectives of this study are as follows:  (1) To assess levels of functional health literacy of clients of the Community Support Network (CSN) program and a comparable group of patients in the outpatient psychiatry clinic; and (2) to assess for relationships between health literacy levels and frequency of hospitalizations and emergency services utilization in these individuals.

Background:  Health literacy is the ability to read, understand, and act on health-related information which is used routinely in the relaying of medical instructions to patients and to the general public.  Despite a growing body of research on the subject of health literacy, persons suffering from mental illness have not often been included in research studies, possibly due to less access to the settings in which these studies have been conducted.  This study will help enrich the extant research by providing insight into levels of health literacy in patients with chronic and severe mental illness, as well as the relationship between these factors and patients’ utilization of emergency services and hospitalizations.

Design:  Functional health literacy levels will be assessed using the shortened version of the Test of Functional Health Literacy in Adults (S-TOFHLA).  Demographic data will also be collected.  The clinical setting is the outpatient clinic at the SIU Department of Psychiatry.  The sample size is ~75.

 

PERCEPTIONS OF BURNOUT, DEPRESSION, AND SELF-CARE AMONG PHYSICIANS-IN-TRAINING
Investigators
Kristin Parks, DO (Med/Psych Resident)
Karen Broquet, MD
Jan Hill-Jordan, PhD
 
Objective:  The purpose of this research project is to explore the level of burnout and depression in PIT and to assess their perceived access to services and willingness to utilize those services.  This research will also assess the perception of stigma among residents and whether these perceptions will present barriers to accessing services.  Additionally, this study will explore overall perceptions of mental health of PIT colleagues to determine if there is underreporting of symptoms.  Gathering information about these issues will enable SIU School of Medicine to better determine how to support PIT.

Background:  This study will contribute to existing literature by further exploring the prevalence of depression among PIT in the 21st century.  The implications of this study may include changes to policies affecting training programs, such as establishing mental health resources for their trainees.  Pitt et al. (2014) described the development and utilization of the House Officer Mental Health Program and the barriers to PIT utilizing the existing services; they noted concern about confidentiality, impaired recognition of one’s own psychiatric problems, demanding residency schedules, and financial constraints as causes for lack of utilization of the available mental health services.  The American Medical Association consensus statement found in “Confronting Depression and Suicide in Physicians” stated, “Barriers to physicians’ seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement” (Center et al., 2003).

Design:  This is a cross-sectional survey in which each resident will be surveyed once.  All individuals within the graduate medical education programs for academic year 2016-2017 at SIU School of Medicine will be invited to participate in the survey, which will be administered by paper.  The primary outcome measures include prevalence of burnout and depression among participants as well as their knowledge and perceptions of mental health resources. This will be measured using the Abbreviated Maslach Burnout Inventory, a modified Patient Health Questionnaire-9, and general questions related to assessing participant demographics.  The secondary outcome measures will include the identification of available services and identification of difference in needs between foreign medical graduates, US international medical graduates, and US medical graduates.  Qualitative date regarding needs and perceptions will be collected via a free-answer section.  Independent or predictor variables in this study include: residency year in training; gender; type of program; self-identification as a US medical graduate, US international medical graduate, or foreign medical graduate; and knowledge of available mental health support systems.

 

THE EXPERIENCE OF CHRONIC PAIN AND ITS TREATMENT
Investigators
Clayton Parks, MD (Medicine/Psychiatry Resident)
Santosh Shrestha, MD
Jan Hill-Jordan, PhD
Kathy Bottum, MD
Susan Hingle, MD
 
Objective:  What is the relationship between of chronic opioid therapy (COT) and quality of life and mental health status among people with chronic nonmalignant pain (CNMP)?  The approach in this study will be one of appraisal of COT for CNMP in the interests of securing the best possible treatment modalities to reduce suffering.  The purpose of this study is to explore the differences in quality of life, overall mental health, symptomatology, attribution of problems, and appraisal of therapy between people with CNMP who are taking opioids and those with CNMP who are not.  Secondary objectives for our study include exploration of patient experiences with opioid misuse and symptoms of tolerance or withdrawal.

Background:  In recent years, the use COT to treat CNMP has quickly moved center stage for healthcare research in the U.S., beginning with the conjoint statement of the American Pain Society and American Academy of Pain Medicine in 1996 declaring that “pain is often managed inadequately, despite the ready availability of safe and effective treatments” and considering opioids to be “an essential part of a pain management plan.”  Such opinions were promulgated in an effort that patients with CNMP might receive pain relief at a level commensurate with those suffering from cancer or other terminal illnesses and were based on the assumption that sustained analgesia for CNMP is possible with stable doses of opioids.  However, since the time these statements were issued, no appreciable evidence has emerged attesting to the efficacy of COT for CNMP.  At the same time, harms from COT can be substantial, and their risk appears to be dose-dependent.  Despite the wealth of studies that have analyzed the potential risks and benefits of long-term opioid therapy, there is a paucity of literature on individual CNMP patient perspectives regarding efficacy of COT for their condition as well as adverse effects on mental health and quality of life related directly to COT.  The premise of Huber and colleagues’ (2016) article is that little research has been conducted involving people who are prescribed low doses of opioids and have adequate pain control and functioning; such people may actually stand to benefit from chronic opioid therapy for CNMP.  Given the frequency with which opioid medications are currently prescribed, it is important to better understand the effects these medications have on both societal measures and well as individual factors related to safety, mental health, and quality of life.

Design:  This qualitative study will use open-ended interviews of individuals with CNMP.  Data from these interviews will be coded according to grounded theory methodology.  The study will use a cross-sectional (observational) design with a comparison group (i.e., patients with CNMP who are not taking COT).  Outcome measures will be developed following the study and will likely include measures relevant to quality of life and mental health.  To address the identification of core outcome domains, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations will be utilized for comparison.  These include the following core domains: pain, physical functioning, emotional functioning, participant ratings of global improvement, symptoms and adverse effects, and participant disposition (including adherence to the treatment regimen and reasons for not doing so).  There will be no scripted questions to be asked during the interviews. For all cases, the predictor/independent measure is the use of COT.  Demographic information will also be collected, including age, gender, and race/ethnicity.

 

YOUTUBE™ AS A SOURCE OF PATIENT EDUCATION FOR DEPRESSION
Investigators 
Hitekshya Nepal, MD (Resident)
Eric Black, MD
 
Objective:  The purpose of the study is to access the quality of the YouTube™ videos for the patient education for the diagnosis of depression.  Our specific research questions are:
  1. Is YouTube™ as an effective means to define the diagnosis of depression?
  2. Is YouTube™ considered a reliable tool for patients in seeking medical attention?

Background:  Depression is the most common psychiatric illness and the leading cause of disability for ages 15-44.  Educating patients in the management of chronic illness to enhance patient engagement and improve health outcomes has been well recognized.  Patient delays in seeking treatment are well-known in stigmatizing illnesses such as depression.  However, explaining the diagnosis of depression in public settings has been problematic, especially in the era of social networking. YouTube™ is one of the most important sources of social media information to the public.  We sought to evaluate the quality of YouTube™ video content in accurately defining the symptoms of depression.

Design:  Our study is a cross-sectional design.  The dependent variables are the presentation of accurate depressive symptoms to the public via existing YouTube™ videos as well as the potential for such data to be used as a reliable resource for patients to seek medical care.  The independent variable is the categorization of the videos themselves based on groupings ranging from uploads from individuals to academic institutions. 

 

DO WE HAVE A FAILURE TO COMMUNICATE?
Investigators
Chrystal Joseph, MD (Medicine/Psychiatry Resident)
Mary Dobbins, MD
Jan Hill-Jordan, PhD
 
Objective:  The purpose of this study is to assess the quality of physician-physician communication as patients are transferred from outlying hospitals to a psychiatric inpatient unit for treatment.

Background:  Inadequate physician-physician communications can cause significant harm to patients. Miscommunications about important medication changes, abnormal tests or physical symptoms can lead to inappropriate care of patients which can be life threatening.  This becomes even more significant in patients who may be unable to provide their own history, specifically seniors with cognitive impairment which can be compounded by psychiatric disorders.  As patients are transferred from outlying hospitals to our acute care psychiatric units, it is essential to have as much of the patient’s clinical background as possible to provide accurate, efficient healthcare.

Design:  A retrospective review of physician-physician telephone communication from the St. John’s Call Connect recordings of elderly patients admitted to the psychiatric unit at St. John’s Hospital in Springfield, IL, quantifying the deficiencies in basic admission information.  Total sample:  N=100.

 

NEUROCOGNITIVE FUNCTIONING IN MOOD DISORDERS
Investigators
Sowmya Puvvada, MD (Resident)
Chad Noggle, PhD
 
Objective:  To analyze and compare the outcomes of various subsets of neuropsychological testing specific to the diagnoses bipolar disorder (BPD) and major depressive disorder (MDD) to determine if a consistent discrepancy may be found between the two presentations.

Background:  Cognitive impairment in mood disorders is a widely studied topic in the field of neuropsychiatry/neuropsychology.  Though it is believed they are associated with active episodes of mania/depression, studies have noted that cognitive deficits persist during remission, suggesting they could be a part of fundamental genetic traits in predisposed individuals. Various studies have shown that the intellectual impairment during remission also affects the level of functioning of the individual.  The areas of dysfunction primarily include, but may not be limited to, memory, attention, and executive functioning.  Neuropsychological testing is an excellent tool to determine the specific areas involved and also the severity of involvement.

Design:  A quasi-experimental research design in which we are using pre-existing group differences in this case diagnostic grouping, as the independent variable (i.e., MDD or BPD).  The dependent variables will involve multiple neuropsychological outcomes across various neurocognitive measures including processing speed, sustained attention, fluency, and immediate and delayed memory.

 

COST–EFFICIENCY AND UTILITY OF OBTAINING ROUTINE ADMISSION LABORATORY TESTING IN ADULT PSYCHIATRIC INPATIENTS
Investigators
Thripura Thirtala, MD (Resident)
Jeffrey Bennett, MD
 
Background:  Revisiting the question of utilization of routine screening is important in this age of cost effective health care.  Targeted laboratory tests may produce cost savings while not adversely affecting patient care, however the value of routine screening for all patients must be scrutinized carefully.  Given the possibility that spurious results may increase costs and create unnecessary anxiety provoking further evaluation.

Objective:  The main objectives of this study are to understand the prevalence of abnormal findings of lab tests performed routinely during psychiatric admission; compare the prevalence of clinically significant lab abnormalities by diagnosis; clarify if these tests alter the treatment modalities of psychiatric inpatients; and provide qualitative information about the level of cost-effectiveness for various screening laboratory tests.

Design:  This retrospective chart review will analyze records from 100 randomly selected patients admitted to Memorial Medical Center adult inpatient psychiatric unit over a 12 month period to determine the importance of routine laboratory screening in the treatment of psychiatric patients.  The study will also analyze how the results of screening lab tests are utilized and if any abnormal tests alter our treatment modalities.