CVAHEC Student Project Reports

Jack Nicolet
Freeman Scholar Program 2006

Background

Often patients and their loved ones want to learn more about a disease or symptom that their physician has diagnosed. The resources available to them are vast, yet unfortunately the most authoritative sources of information contain language and detailed information that is difficult for the lay person to comprehend. Take, for example, the following paragraph from the esteemed British Medical Journal:

Table 2 describes the nine trials (279 participants) included in the efficacy analysis for secondary sleep disorders. 14-25 The median quality score, based on the Jadad scale, was 4 out of 5 (interquartile range 2-4). Concealment of allocation was unclear in all studies except one, 23 which had adequate allocation concealment.

The average person may grow frustrated with the technical jargon contained in this paragraph. In order to truly understand the significance of these three sentences, one would need to have taken classes in statistics, epidemiology and sleep physiology. This is far too much to expect from patients and their loved ones.

Goals

Develop patient-friendly and easy-to-read mental health information resource materials - based on the latest clinical research - for patients and their loved ones.

Distribute information via the Fletcher Allen Health Care - Community Health Improvement website program Studies Show.

Package information in the form of pamphlets and web-based content for distribution via the CVAHEC healthcare provider network.

Methods

Intersting and relevant articles were chosen from leading medical journals by Dr. Rubin and approved by the Studies Show program administrator Dr. Hood. The articles are listed below:

Mortality after the Hospitalization of a Spouse. 2006 NEJM; 354;7:719-30

Efficacy and safety of exogenous melatonin for secondary sleep disorders and accompanying sleep restriction: meta-analysis. 2006 BMJ;332:385-88

Risk and resilience markers in bipolar disorder: Brain responses to emotional challenges in bipolar patients and their healthy siblings. 2006 Am J Psychiatry; 163:2:257-64

Suicide risk during antidepressant therapy. 2006 Am J Psychiatry; 163:1:41-7

Under the editorial and technical guidance of Dr. Alan Rubin, the articles were deciphered and distilled into an easy-to-read format by Jack Nicolet. The authors met regularly to review salient points from journal articles, to discuss strategies for making the information more accessible to patients and their loved ones, and to edit drafts for submission. Additional time was spent throughout the summer attending Psychiatric Medicine Grand Rounds at Fletcher Allen Health Care Center in Burlington to gain perspective and context for the project.

Results

The four articles chosen by Dr. Rubin were completed and submitted to Dr. Hood for final approval and inclusion in the Studies Show program. In addition, the articles were forwarded to CVAHEC for editorial review and incorporation into the PTOP Referral Tool for Physicians in their Chittenden County catchment area.

This experience has granted me unique insight into how to better understand medical literature, the field of study in Psychiatric Medicine, and the trappings of effectively communicating with patients and their loved ones. The discipline of reading and evaluating medical literature not only for my own understanding, but also for that of my patients was far more difficult than I had realized. Yet, what a valuable experience! In addition, the intense exposure to issues in mental health - both through our work on the articles, as well as time spent rounding on the Psychiatric ward - was fascinating and thought-provoking. Dr. Rubin has been more than generous in sharing his time and experiences with me to make this summer project a rewarding endeavor.

Thank you for such a wonderful opportunity.