The 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

Two Way Street Source: National Cancer Institute Clinic Lab Population New Tools & Applications

The Translation Continuum Source: National Cancer Institute Basic Scientific Discovery Early Translation Late Translation DisseminationAdoption 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

Source: 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: Detailed section of Snow’s 1854 map (pumps shown highlighted)

Source: 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 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 –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