Sophia Wang

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https://hdl.handle.net/1805/35093

A Pilot Study of the BE SMART (Brain Health Education to Promote Cognitive Screening in Minority Communities and to Increase Diverse Participation in Alzheimer’s Disease Research and Clinical Trials) Intervention

Black and Hispanic older adults are at higher risk for Alzheimer’s disease (AD). However, they are often unaware of the importance of early detection of AD and often lack access to cognitive screening. The BE SMART intervention will address these gaps by educating minority communities about the value of early detection of AD and offering free cognitive screening.

The overall goal of Dr. Wang's research project is to design and test the BE SMART intervention. The culturally tailored intervention includes a bilingual education program for minority communities about the value of early detection of AD and cognitive screening, optional free cognitive screening, and feedback about the screening results. Dr. Wang and her research partners use the sites of community partners to overcome access concerns about receiving cognitive screening. Bilingual educational materials in English and Spanish, e.g. brochures, videos, in person scripts are available to the community. The community outcomes of the research project include increased awareness of the value of early detection of AD and increased participation in cognitive screening. The intervention addresses health disparities in AD which disproportionately affects minority communities. Dr. Wang's translation of research into better health outcomes for Black and Hispanic older adults is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Aging and Post-Intensive Care Syndrome (PICS): A Critical Need for Geriatric Psychiatry
(Elsevier, 2017) Wang, Sophia; Allen, Duane; Kheir, You Na; Campbell, Noll; Khan, Babar; Department of Psychiatry, IU School of Medicine
Due to the aging of the intensive care unit (ICU) population and an improvement in survival rates after ICU hospitalization, an increasing number of older adults are suffering from long-term impairments due to critical illness, known as post-intensive care syndrome (PICS). This paper focuses on PICS-related cognitive, psychological, and physical impairments, and the impact of ICU hospitalization on families and caregivers. The authors also describe innovative models of care for PICS, and what roles geriatric psychiatrists could play in the future of this rapidly growing population.
Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial
(BioMed Central, 2018-02-07) Khan, Sikandar; Biju, Ashok; Wang, Sophia; Gao, Sujuan; Irfan, Omar; Harrawood, Amanda; Martinez, Stephanie; Brewer, Emily; Perkins, Anthony; Unverzagt, Frederick W.; Lasiter, Sue; Zarzaur, Ben; Rahman, Omar; Boustani, Malaz; Khan, Babar; Medicine, School of Medicine
BACKGROUND: Patients admitted to intensive care units (ICU) with acute respiratory failure (ARF) face chronic complications that can impede return to normal daily function. A mobile, collaborative critical care model may enhance the recovery of ARF survivors. METHODS: The Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. We will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation in a 1:1 ratio to one of two arms (310 patients per arm) - m-CCRP intervention versus attention control. Those in the intervention group will meet with a care coordinator after hospital discharge in predetermined intervals to aid in the recovery process. Baseline assessments and personalized goal setting will be used to develop an individualized care plan for each patient after discussion with an interdisciplinary team. The attention control arm will receive printed material and telephone reminders emphasizing mobility and management of chronic conditions. Duration of the intervention and follow-up is 12 months post-randomization. Our primary aim is to assess the efficacy of m-CCRP in improving the quality of life of ARF survivors at 12 months. Secondary aims of the study are to evaluate the efficacy of m-CCRP in improving function (cognitive, physical, and psychological) of ARF survivors and to determine the efficacy of m-CCRP in reducing acute healthcare utilization. DISCUSSION: The proposed randomized controlled trial will evaluate the efficacy of a collaborative critical care recovery program in accomplishing the Institute of Healthcare Improvement's triple aims of better health, better care, at lower cost. We have developed a collaborative critical care model to promote ARF survivors' recovery from the physical, psychological, and cognitive impacts of critical illness. In contrast to a single disease focus and clinic-based access, m-CCRP represents a comprehensive, accessible, mobile, ahead of the curve intervention, focused on the multiple aspects of the unique recovery needs of ARF survivors.
Decreasing Delirium through Music (DDM) in critically ill, mechanically ventilated patients in the intensive care unit: study protocol for a pilot randomized controlled trial
(BMC, 2017-11-29) Khan, Sikandar H.; Wang, Sophia; Harrawood, Amanda; Martinez, Stephanie; Heiderscheit, Annie; Chlan, Linda; Perkins, Anthony J.; Tu, Wanzhu; Boustani, Malaz; Khan, Babar; Medicine, School of Medicine
Background Delirium is a highly prevalent and morbid syndrome in intensive care units (ICUs). Changing the stressful environment within the ICU via music may be an effective and a scalable way to reduce the burden of delirium. Methods/design The Decreasing Delirium through Music (DDM) study is a three-arm, single-blind, randomized controlled feasibility trial., Sixty patients admitted to the ICU with respiratory failure requiring mechanical ventilation will be randomized to one of three arms (20 participants per arm): (1) personalized music, (2) non-personalized relaxing music, or (3) attention-control. Music preferences will be obtained from all enrolled participants or their family caregivers. Participants will receive two 1-h audio sessions a day through noise-cancelling headphones and mp3 players. Our primary aim is to determine the feasibility of the trial design (recruitment, adherence, participant retention, design and delivery of the music intervention). Our secondary aim is to estimate the potential effect size of patient-preferred music listening in reducing delirium, as measured by the Confusion Assessment Method for the ICU (CAM-ICU). Participants will receive twice daily assessments for level of sedation and presence of delirium. Enrolled participants will be followed in the hospital until death, discharge, or up to 28 days, and seen in the Critical Care Recovery Clinic at 90 days. Discussion DDM is a feasibility trial to provide personalized and non-personalized music interventions for critically ill, mechanically ventilated patients. Our trial will also estimate the preliminary efficacy of music interventions on reducing delirium incidence and severity. Trial registration ClinicalTrials.gov, Identifier: NCT03095443. Registered on 23 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2324-6) contains supplementary material, which is available to authorized users.
Preoperative STOP-BANG Scores and Postoperative Delirium and Coma in Thoracic Surgery Patients
(Elsevier, 2018) Wang, Sophia; Sigua, Ninotchka Liban; Manchanda, Shalini; Gradney, Steve; Khan, Sikandar H.; Perkins, Anthony; Kesler, Kenneth; Khan, Babar; Psychiatry, School of Medicine
Background Obstructive sleep apnea (OSA) is associated with higher rates of postoperative delirium. The relationship between preoperative OSA risk and postoperative delirium and coma in thoracic surgery patients hospitalized in the intensive care unit (ICU) is not well understood. This study tests the hypothesis that thoracic surgery patients hospitalized in ICU with a higher preoperative risk for OSA are more likely to develop postoperative delirium and coma, resulting in longer hospital stays. Methods Preoperative OSA risk was measured using the STOP-BANG questionnaire. STOP-BANG scores of ≥ 3 were defined as intermediate-high risk for OSA. 128 patients who underwent major thoracic surgery completed the STOP-BANG questionnaire preoperatively. The Richmond Agitation and Sedation Scale was used to assess level of consciousness. The Confusion Assessment Method for the ICU was used to assess for delirium. Linear regression was used to assess the relationship between risk of OSA and outcome measures. Results were adjusted for age, gender, body mass index, Charlson Comorbidity Index, instrumental activities of daily living, and surgery type. Results 96 out of 128 patients (76%) were in the intermediate-high risk OSA group. Adjusted analyses showed that the intermediate-high risk OSA group had a longer duration of postoperative ICU delirium and coma compared to the low risk OSA group (1.4 days ± 1.3 vs 0.9 days ± 1.4; P = 0.04). Total number of hospital days was not significantly different. Conclusions Higher preoperative risk for OSA in thoracic surgery patients was associated with a longer duration of postoperative delirium and coma.
Antidepressant Use and Depressive Symptoms in Intensive Care Unit Survivors
(SHM, 2017) Wang, Sophia; Mosher, Chris; Gao, Sujuan; Kirk, Kayla; Lasiter, Sue; Khan, Sikandar; Kheir, You Na; Boustani, Malaz; Khan, Babar; Psychiatry, School of Medicine
Nearly 30% of intensive care unit (ICU) survivors have depressive symptoms 2-12 months after hospital discharge. We examined the prevalence of depressive symptoms and risk factors for depressive symptoms in 204 patients at their initial evaluation in the Critical Care Recovery Center (CCRC), an ICU survivor clinic based at Eskenazi Hospital in Indianapolis, Indiana. Thirty-two percent (N = 65) of patients had depressive symptoms on initial CCRC visit. For patients who are not on an antidepressant at their initial CCRC visit (N = 135), younger age and lower education level were associated with a higher likelihood of having depressive symptoms. For patients on an antidepressant at their initial CCRC visit (N = 69), younger age and being African American race were associated with a higher likelihood of having depressive symptoms. Future studies will need to confirm these findings and examine new approaches to increase access to depression treatment and test new antidepressant regimens for post-ICU depression.
Post-Intensive Care Unit Psychiatric Comorbidity and Quality of Life
(SHM, 2017) Wang, Sophia; Mosher, Chris; Perkins, Anthony J.; Gao, Sujuan; Lasiter, Sue; Khan, Sikandar; Boustani, Malaz; Khan, Babar; Psychiatry, School of Medicine
The prevalence of psychiatric symptoms ranges from 17% to 44% in intensive care unit (ICU) survivors. The relationship between the comorbidity of psychiatric symptoms and quality of life (QoL) in ICU survivors has not been carefully examined. This study examined the relationship between psychiatric comorbidities and QoL in 58 survivors of ICU delirium. Patients completed 3 psychiatric screens at 3 months after discharge from the hospital, including the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalized Anxiety Disorder-7 (GAD-7) questionnaire for anxiety, and the Post-Traumatic Stress Syndrome (PTSS-10) questionnaire for posttraumatic stress disorder. Patients with 3 positive screens (PHQ-9 ≥ 10; GAD-7 ≥ 10; and PTSS-10 > 35) comprised the high psychiatric comorbidity group. Patients with 1 to 2 positive screens were labeled the low to moderate (low-moderate) psychiatric comorbidity group. Patients with 3 negative screens were labeled the no psychiatric morbidity group. Thirty-one percent of patients met the criteria for high psychiatric comorbidity. After adjusting for age, gender, Charlson Comorbidity Index, discharge status, and prior history of depression and anxiety, patients who had high psychiatric comorbidity were more likely to have a poorer QoL compared with the low-moderate comorbidity and no morbidity groups, as measured by a lower EuroQol 5 dimensions questionnaire 3-level Index (no, 0.69 ± 0.25; low-moderate, 0.70 ± 0.19; high, 0.48 ± 0.24; P = 0.017). Future studies should confirm these findings and examine whether survivors of ICU delirium with high psychiatric comorbidity have different treatment needs from survivors with lower psychiatric comorbidity.
Post-Intensive Care Syndrome: Recognizing the Critical Need for Psychiatric Care
(UBM, 2018-02) Wang, Sophia; Kheir, You Na; Allen, Duane; Khan, Babar; Psychiatry, School of Medicine
Post-intensive care syndrome (PICS) is a rapidly growing phenomenon in older adults. As survival rates from ICU hospitalizations have increased over the past few decades, the long-term cognitive, psychological, and physical sequelae of the illness have become a major challenge in critical care medicine. More than half of all ICU survivors suffer from at least one PICS-related impairment, and these effects can persist as long as 5 or more years.
Developing the Agile Implementation Playbook for Integrating Evidence-Based Health Care Services into Clinical Practice
(Wolters Kluwer, 2018-10) Boustani, Malaz A.; van der Marck, Marjolein A.; Adams, Nadia; Azar, Jose M.; Holden, Richard J.; Vollmar, Horst C.; Wang, Sophia; Williams, Christopher; Alder, Catherine; Suarez, Shelley; Khan, Babar; Zarzaur, Ben; Fowler, Nicole R.; Overley, Ashley; Solid, Craig A.; Gatmaitan, Alfonso; Medicine, School of Medicine
Problem: Despite the more than $32 billion the National Institutes of Health has invested annually, evidence-based health care services are not reliably implemented, sustained, or distributed in health care delivery organizations, resulting in suboptimal care and patient harm. New organizational approaches and frameworks that reflect the complex nature of health care systems are needed to achieve this goal. Approach: To guide the implementation of evidence-based health care services at their institution, the authors used a number of behavioral theories and frameworks to develop the Agile Implementation (AI) Playbook, which was finalized in 2015. The AI Playbook leverages these theories in an integrated approach to selecting an evidence-based health care service to meet a specific opportunity, rapidly implementing the service, evaluating its fidelity and impact, and sustaining and scaling up the service across health care delivery organizations. The AI Playbook includes an interconnected eight-step cycle: (1) identify opportunities; (2) identify evidence-based health care services; (3) develop evaluation and termination plans; (4) assemble a team to develop a minimally viable service; (5) perform implementation sprints; (6) monitor implementation performance; (7) monitor whole system performance; and (8) develop a minimally standardized operating procedure. Outcomes: The AI Playbook has helped to improve care and clinical outcomes for intensive care unit survivors and is being used to train clinicians and scientists in AI to be quality improvement advisors. Next Steps: The authors plan to continue disseminating the details of the AI Playbook and illustrating how health care delivery organizations can successfully leverage it.
Aging and Post-Intensive Care Syndrome–Family (PICS-F): A Critical Need for Geriatric Psychiatry
(Elsevier, 2019) Serrano, Patricia; Kheir, You Na P.; Wang, Sophia; Khan, Sikandar; Scheunemann, Leslie; Khan, Babar; Psychiatry, School of Medicine
Postintensive care syndrome–family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons. First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment compared with older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared with other geriatric populations. Second, as caregivers themselves age, caring for this unique burden can be more challenging compared with other geriatric populations. Third, evidence for models of care centered on patients with multimorbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multimorbidity and their caregivers. Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers.
Perioperative Risk Factors for Postoperative Delirium in Patients Undergoing Esophagectomy
(Elsevier, 2019) Fuchita, Mikita; Khan, Sikandar H.; Perkins, Anthony J.; Gao, Sujuan; Wang, Sophia; Kesler, Kenneth A.; Khan, Babar A.; Anesthesia, School of Medicine
Background Postoperative delirium affects up to 50% of patients undergoing esophagectomy and is associated with negative outcomes. The perioperative risk factors for delirium in this population are not well understood. We conducted this study to assess perioperative risk factors for postoperative delirium among esophagectomy patients. Methods We performed a secondary data analysis of patients enrolled in a randomized controlled trial evaluating the efficacy of haloperidol prophylaxis postoperatively in reducing delirium among esophagectomy patients. Postoperative delirium was assessed twice daily using the Confusion Assessment Method for the ICU. Univariate and logistic regression analyses were performed to examine the association between perioperative variables and development of postoperative delirium. Results Of 84 consecutive esophagectomy patients, 27 (32%) developed postoperative delirium. Patients who developed postoperative delirium had higher APACHE II scores [22.1 (6.5) versus 17.4 (6.8); p=0.003], longer mechanical ventilation days [1.7 (1.4) versus 1.0 (1.1); p=0.001], and longer ICU days [5.1 (2.6) versus 2.6 (1.6); p<0.001]. In a logistic regression model, only ICU length of stay was found to have significant association with postoperative delirium [OR 1.65; 95% CI 1.21-2.25]. Conclusions ICU length of stay was significantly associated with postoperative delirium. Other perioperative factors including duration of surgery, blood loss, and hemoglobin levels were not significantly associated with postoperative delirium.

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