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Transcript of The University of North Carolina at Chapel Hill Mary H. Palmer, PhD, RN,C,FAAN...
The University of North Carolina at Chapel HillThe University of North Carolina at Chapel Hill
Mary H. Palmer, PhD, RN,C,FAAN
Translational Research: Introduction
Definition
Translational research, “transforms scientific discoveries arising from the laboratory, clinical, or population studies into clinical applications…”
Source: National Cancer Institute, National Institutes of Health
The Translation ContinuumSource: National Cancer Institute
Basic Scientific Discovery
Early Translation
Late Translation
Dissemination Adoption
•Promising gene•Basic epidemiological finding
•Partnerships•Intervention development
•Phase III trials•Regulatory approval•Partnerships•Health services research to support dissemination and adoption
•To community providers•To patients and public
•Adoption of advance by providers, patients, and public•Payment mechanisms to enable adoption
The National Institutes of Health Roadmap
• Designed to provide the “bricks” of the homes of translational research – Homes are academic centers with cadre of
well-trained researchers• Integrated resources (including informatics,
upgraded biostatistics)• Commitment to tearing down programmatic and
disciplinary “silos”• Flexible and individual – one size will not fit all
Issues
• Translation is not linear• Penetration of the most successful
interventions rarely exceeds 1% of target population
• Barriers to transfer– Political atmosphere– Public awareness– Financing concerns– Timing
More Issues
• Discovery of the solution is out of synch with providers “readiness to use it”
• Scientific inquiry can limit translation
• Costs of training and lag time until performance exceeds baseline
Source: Ginexi & Hilton 2006
Creation of a new intellectual discipline
• Strengths– Designed to improve health– Systems based approach proposed– Multi-disciplinary– Innovative– Flexible and responsive to environment– Collaborations within and outside of academic
centers
Creation of a new intellectual discipline
• Potential barriers– Institutional culture change– Infusion of resources – Infrastructure for funding, payments, tenure,
institutional reviews – Existing curricula for training scientists
emphasis on independent research– Shortage of mentors with skills
Is Translational Research New?
Identification of Broad Street pump required
– Forgoing the existing theory of miasma
– Creating an alternative theory
– Compiling data from more than one source
– In-depth knowledge of the environment
– Understanding of human behavior
– Ability to communicate and display the findings
– Risk taking and innovation
Example: 1854 Cholera epidemic in London
http://www.makingthemodernworld.org.uk/learning_modules/geography/05.TU.01/?section=2
Source: http://www.ph.ucla.edu/EPI/snow/snowmap1_1854_lge.htm
For the 1854 cholera outbreak in London's Broad Street region, John Snow created this map, first shown on December 4, 1854 at a meeting of the London Epidemiological Society, which was later published in his book, On the Mode of Communication of Cholera, 2nd Edition. Snow used bars to represent deaths that occurred at the specified households.
Source: http://www.ph.ucla.edu/EPI/snow/snowmap1_1854_lge.htm
Detailed section of Snow’s 1854 map (pumps shown highlighted)
Source: http://www.ph.ucla.edu/EPI/snow/mapsbroadstreet.html
Section of map submitted by John Snow to the Cholera Inquiry Committee of St. James Parish, later issued as part of the Committee's general report in July 1855. Snow used bars to represent deaths that occurred at the specified households.
Translational Research
• Dissemination of the innovation
• Adoption of the innovation
• Maintaining the innovation
• Refining and evolving as body of knowledge expands
Dissemination
• How to disseminate findings into practice?
– Theory based interventions• Evidence based interventions • Diffusion of innovation
– Guidelines • www.guidelines.gov
– Regulation
Adoption
• Organizations– Systems change theories
• Individuals– Behavioral change theories
• Health Belief Model• Theory of Reasoned Action/Planned Change• Social Cognitive Theory• Stages of change
Maintenance
• Adherence theories– Short term adherence theories
– Long term adherence theories • Acknowledge relapse is inevitable
Refining and Evolving
• Two way street– Human needs– Environmental press– Technological advances– Resource allocations– Effectiveness and efficacy reviews– Life cycle of theories