26 weeks investing in Portland

Portland

Welcome to my INVESTing log. INVEST is the International Visiting Scientists & Technical Exchange Program for drug abuse research sponsored by NIDA (National Institute on Drug Abuse). From March-August, 2013, I was an INVEST researcher at the Oregon Health& Science University in Portland and this is a log about my experiences.

Three INVESTing points weekly (from newest to oldest):

Last Week 26 (August 26-31)

Windy and Sandy Jersey shore
Funny looking banknotes in my purse; different scent in my bathroom
With that soulful look on your face

Week 25 (August 19-25)

Here’s the opposite – a lot of professionals and not enough patients
A good bye lunch in the park
We don’t own anything; it’s on loan

Week 24 (August 12-18)

I lost my voice in Santa Rosa
I feel like I’m swimming upstream
Humans make up stories. Most people are better in the abstract

Week 23 (August 5-11)

Please note that your OHSU PC access will expire on 9/2/2013
The goal of writing is to stretch the limits of your thinking
Oregon spirit

Week 22 (July 29 – August 4)

A week of strong decisions
Picnic at Skidmore bluffs
Document the experience

Week 21 (July 22-28)

Swimming in the Frog lake under the Hood mountain
A beautiful place where I have time to think and write
The work ethics in US is different

Week 20 (July 15-21)

2 Free books in 2 days: paradise
Methamorphosis at Marquam hill
‘If the water is dark, the lake must be deep’

Week 19 (July 7-14)

It’s hard to get a credit line
Two writing workshops this week
You are my fountain of knowledge
Great art can emerge from aimless meanderings

Week 18 (July 1-7)

Charts reviews started, best time – 4.06 sec
The department is empty these days, the head brought a cake to appreciate staff
I thought I was here to learn more about research, but I’m actually learning a lot about leadership and group interaction

Week 17 (June 24-30)

73 new emails after a week out of office
A strange proposal will arrive soon
Everything depends on your determination

Week 16 (June 17-23)

at the CPDD conference, visiting San Diego again after 9 years
A complete different time space
Controlled expansion

Week 15 (June 10-16)

First focus group, first night ride through the Terwilliger… feels like on the top of the world
How long have you been using internet for? – 15 years
My first potluck at the OHSU public health

Week 14 (June 3-9)

Release from immediacy
Their number will grow, our number will die
The floor is slippery when wet (Really?)
Sometimes you don’t know what’s possible until you’re forced to do it

Week 13 (May 27 – June 2)

Where is the sun gone?
The atempt here is creating
sometimes, the most powerful and profound changes can be brought about by the most subttle and innocent moments
Journal of Japanese Gardens

Week 12 (May 20 -26)

IRB (Institutional Review Board) approval out now!
Working with other writers is good for me
Quote from a song: “Should I stay or should I go now?
If I stay, there will be trouble – If I go, there will be double.”

Week 11 (May 13 -19)

weeks started to fly by
I said: I’m an office monkey. They said: We are donkeys.
Work, Play, Love, Read

Week 10 (May 6 -12)

How to spill an oatmeal on the office floor
Two copulating mosquitos sucking blood from my arm
everybody has a different style of working

Week 9 (April 29-May 5)

My first ride to work on the cable car (aerial tram)
My friends at work make their own bread and apple preserves
I’ve been bitten by a writing buy

Week 8 (April 22-28)

First day at work in my 10-year old American sandals – the summer’s comming
Learning about my limits and acknowledging my strengths
“A lot of media advertising is based on things that make people insecure and anxious” (the Missrepresentation movie)

Getting warm welcomes by OHSU Department of Public Health and Preventive Medicine (PHPM) in The Liason Newsletter:

Dr. Jan Klimas joined PHPM as an INVEST Fellow beginning March 1. The National Institute on Drug Abuse supports the INVEST Fellows program to accelerate career development for new investigators who are citizens of a country other than the US. Jan will work in the US for six months assessing the value of screening and brief intervention for alcohol use disorders among opioid dependent patients being treated with an opioid agonist medication (i.e., methadone or buprenorphine). He plans to collaborate with Richmond Clinic and CODA to contrast US agonist treatment services with those in Ireland provided through general practitioners.

Jan and his wife Johanka Macekova are Slovakian. Jan is currently working in Ireland where he studies screening and brief intervention for alcohol use disorders among opioid dependent patients receiving agonist medication. The US provides opportunities for comparative research….
For more info, check the Winter 2013 edition of The Liaison, PHPM’s internal newsletter, is published the first week of the month and highlights news and events that took place the previous month, in addition to listing upcoming events as well.

Week 7 (April 15-21)

New office, new start
What is the American standard?
First stolen bike saddle
Forging new friendships

Week 6 (April 8-14)
car hand brake is actually a foot brake in new US cars
moving to a new desk next week
restrooms and water fountains are so common in Portland
tatoos and piercings are so tolerated… everywhere

Week 5 (April 1-7)

Who uses buses in Portland or US? Discovering Portland Metro area
Really tired
Changed my location on skype/ twitter to PDX

Week 4 (March 22-31)

First fruit of my labour on the INVEST project are here
Beautiful mornings, cycling to work on the hill
Work and life routine, getting used to it

Week 3 (March 15-21)

Conference at Washington DC
Getting to know myself better, my expectations
Everything’s so expensive
A photo from the Spring NIDA CTN 2013 conference: INVEST scholar links with Humphrey scholars:

Week 2 (March 8-14)

Why does it take so long to get used to this, longer than I expected
Too many things to do at work
I miss Ireland – listening to RTE Lyric.fm

Week 1 (March 1-7): starting in Portland

Jet lag, almost all week
My first chai
Everything is so big, different, weird
Arrived safely at OHSU; checking the “Hall of fame” aka Notice board with faculty publications by OHSU Department of Public Health (2011-13):

What happened before my arrival to OHSU in Portland, Oregon:

31/Jan/2013

Jan will speak about his previous and current research in Ireland and plans for future research in Portland, OR at the The Spring 2013 CTN Steering Committee Meeting. It will be held at the Hyatt Regency Bethesda, Bethesda, Maryland, on March 12-15, 2013.
For more info, check the section about International Symposium in the latest issue of the NIDA CTN Bulletin (January 31, 2013, Volume 13 – 02): http://ctndisseminationlibrary.org/ctnbulletin.htm

15/Nov/2012

Jan Klimas, PhD, joins the Western States Node on March 1, 2013, as a NIDA CTN INVEST Fellow.  NIDA is National Institute on Drug Abuse, and INVEST is International Visiting Scientists & Technical Exchange Program for drug abuse research, which combines
“postdoctoral research training in the US with professional development activities and grant-writing guidance to form a unique program for drug abuse scientists”(link).
Oregon Health & Sciences University hosts Dr. Klimas’ six months fellowship during which he will assess the use of Screening and Brief Intervention (SBIRT) for alcohol use disorders among patients receiving agonist medication for opioid use disorders.

Professor Dennis McCarty, Co-PI for the Western States Node, will supervise Dr. Klimas during his fellowship.  The research examines addiction treatment in primary and specialty care settings with respect to implementation of screening and treatment for unhealthy alcohol use among opioid-dependent patients in methadone or buprenorphine maintenance treatment in Ireland and Oregon.  Dr. Klimas’ prior work in Ireland informs the U.S. investigation… read more in the NIDA CTN bulletin, (issue November 15th, 2012): http://ctndisseminationlibrary.org/bulletin/20121115.pdf

Doing research with busy doctors – an open space world

Family doctors are notoriously busy. Lack of their time is the number #1 barrier of doing anything outside their patient workload, including research. And yet, some enthusiasts get involved in the research endeavour, believing it can enhance primary care.

Knowing this, I looked for ways to do research with busy family physicians for my INVEST fellowship in Portland, OR. I needed to get them in one room and ask the group a couple of questions about their recent resident training initiative, SBIRT Oregon. The only time when my doctors were all in the clinic was right after another meeting. One of them suggested doing an open meeting technology. The phrase vaguely rang a bell with me.

‘Open space’ describes the process by which a wide range of individuals, in any organisation, can facilitate creative meetings around a complex theme of importance to all stakeholders 1. While a theme may be important to all stakeholders, they may have differing perspectives and responses, so this approach permits all voices to be heard and facilitates a process where stakeholders move from conflicting views to consensus. The approach has been widely used in commerce, religious communities, (non-)governmental agencies and war zones 2.

How did this work for us?

Our field ‘experiment’ lasted for about 90 minutes with two meetings in one room, right after each other. The meetings were unrelated, but 3/4 of the participants from the first meeting were scheduled for the second meeting too. I and my co-facilitator arrived well ahead of the first meeting. As doctors started to show up for the 2nd meeting – the 1st meeting was still in progress – some people were confused; others patiently listened to people talking at the 1st meeting. I found it very useful to sit on the 1st meeting and the transition to the 2nd meeting was much easier – all were in their seats already.

All in all, this set up had many advantages for multiple meetings with extra busy attendees. It can help solve problems and it works best with many people attending your meeting, but maybe it’s not ideal for research focus groups. A tip for a freshman facilitator: it’s amazing how much powerful an incentive for research can food be, especially pizza.

__
1http://www.michaelherman.com/cgi/wiki.cgi
2http://www.openspaceworld.com/papers.htm

Relationships of drug users change, but slowly

relationships change

Are social relationships sensitive to therapeutic change?

The ‘‘Phase Model of Change’’ –  a famous model in psychotherapy – says that change in overall functioning in life, including interpersonal problems, occurs during later phases of therapy. Well-being and symptoms take precedence. Social problems may last long, but this cross-sectional Slovakian study showed it’s worth asking drug users about their relationships. Intrusiveness and affectionate support seem to be the key players.

Read More: http://informahealthcare.com/doi/abs/10.3109/14659891.2013.790496

Honor pot: testing doctors’ drug counselling skills in a new pilot study in Ireland

In our new new paper, we outline plans for doing a study which should tell us whether doctors and agonist patients accept psychological interventions as means of curbing alcohol in primary care; it should also tell us whether we can do more research on this topic in Ireland. Access the full protocol here  http://www.researchprotocols.org/2013/2/e26/

For some people, publishing research protocols is not fun because of two reasons:

  1. everybody knows what you’re doing
  2. you have to do what you said – everybody knows now.

However tough for researchers, these two reasons make publicly available research protocols the best way to achieve transparency in research. Transparent research is in line with ethical principles of research conduct and makes an honorable contribution to the scientific knowledge – to the honor pot. Together with accountability, it should be the core pillar of scientific discovery.

If these safeguards fail, we may see more instances of academic fraud and data falsification, such as Diederik Stapels’. The social psychology community has been embarassed by the revelation that Diederik Stapels made up the data for his papers.  The NY Times link provides a detailed analysis of the Stapels and his academic fraud.

Helping agonist patients with alcohol problems: A NEW guide for primary care staff

What should doctors do differently when screening for alcohol use and delivering brief interventions for agonist patients in primary care? General principles remain the same like for other people, but:
  1. the screening and treatment processes should be more systematic and proactive in all problem drug users, especially in those with concurrent chronic illnesses or psychiatric co-morbidity,
  2. lower thresholds should be applied for both identification and intervention of problem alcohol use and referral to specialist services,
  3. special skills and specialist supervision is required if managing persistent/dependent alcohol use in primary care.