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Thank you to all who contributed to the National Heart, Lung, and Blood Institute (NHLBI) Strategic Visioning Forum. Ultimately, over 1,000 ideas were submitted, with more than 42,000 votes. This remarkable response exceeded expectations and provided a wealth of ideas to draw upon as NHLBI moves forward. Please visit the NHLBI Strategic Visioning page to find out more about the NHLBI Strategic Visioning process.


Welcome to the National Heart, Lung, and Blood Institute (NHLBI) Strategic Visioning Forum. The Institute is gathering ideas for the most compelling scientific priorities in the four NHLBI Strategic Goals to address over the next decade.

Strategic Goal: Goal 2: Reduce Human Disease

Funding for Cardiothoracic Surgery Research

The continued development of new technologies requires cardiothoracic surgeons to maintain a strong level of research to ensure the highest quality of patient care and surgical outcomes are received across the world. The level of support for CT surgery within the NIH has continued to drop over the last decade. This is a substantial problem for the specialty as the limited funding available creates difficulty in the continued ...more »

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

CT Surgeons are performing procedures on some of the sickest patients while effecting some of the most dramatic favorable outcomes and the continue support for research in this specialty is essential to ensuring improvements in quality patient care. CT surgeons are provided the opportunity to participate in both the research lab and operating room which provides an important opportunity for a role in both the scientific discovery and implementation of new outcomes.

Feasibility and challenges of addressing this CQ or CC :

Cardiothoracic diseases are one of the top health issues facing the global population and the research being conducted is integral in helping cure the issues facing the current generation. With expanded support for research, new areas of the heart, lung, and esophagus can be studied with the hopes of identifying new technologies and procedures to help ensure the next generation is given the highest quality of care possible.

Name of idea submitter and other team members who worked on this idea : Matt E.

Voting

105 net votes
155 up votes
50 down votes
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Strategic Goal: Goal 2: Reduce Human Disease

Lung cell stimuli responses

What alterations in respiratory epithelia in response to environmental / external insults are irreversible and lead to disease onset or progression?

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

-2 net votes
7 up votes
9 down votes
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Strategic Goal: Goal 3: Advance Translational Research

The use of administrative and billing data in COPD care quality improvement

What is the validity of administrative/billing data to evaluate the quality of COPD care as part of quality improvement initiatives? What care practices can be assessed using these data?

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Nina Bracken, COPD Foundation advocate

Voting

2 net votes
2 up votes
0 down votes
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Strategic Goal: Goal 3: Advance Translational Research

Non-invasive vs Invasive Positive Pressure Ventilation in Managing Acute Respiratory Failure

What is the comparative effectiveness of a Non-invasive vs. Invasive Positive Pressure

 

Ventilation Protocol for managing acute respiratory failure due to acute exacerbations of COPD

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Voting

1 net vote
1 up votes
0 down votes
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Strategic Goal: Goal 2: Reduce Human Disease

Moonshot: Turning the BMT EMR into a Research Record

The critical challenge is to develop a standards-based BMT electronic medical record (EMR) and integrate research capacity into the architecture of EMR systems. The ultimate goal would be to build de-identified complete data-sets which can be used to support observational studies and clinical trials, improve transplant outcomes and inform public policy.

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Clinical research is constrained by a clumsy method of acquiring biomedical data, generally relying on manual capture of information from EMR back-to-paper which is then transcribed into registry or specific clinical trial databases. This method is labor intensive, fraught with opportunities for error, and increasingly difficult to defend in light of the high costs associated with clinical trials. Adoption of standards-based clinical documentation and creating access to source clinical data would reduce or do-away with resource-intensive, very expensive and time-consuming data abstraction, enhance data quality and depth, and accelerate translational research.

Feasibility and challenges of addressing this CQ or CC :

As BMT centers increasingly adopt EMR systems in the United States, a vast and potentially very useful data resource is being created. However, most EMR systems offer very generic formats for clinical documentation and the medical information is inconsistently expressed in vocabulary, structure, and format. One challenge is the development of common standards-based clinical documentation format and its adoption by EMR system vendors and BMT institutions to support structured data sharing.

 

Large transplant centers can build their own integration engines to link EMR with stem cell lab, HLA, donor care, workflow etc. However, a broad implementation of integration IT solutions would be needed amongst centers conducting BMT clinical trials.

 

While CIBMTR's FormsNet application and Clinical Trials Network allow electronic data submission, data professionals still need to manually enter the data. Another challenge in creating a centralized data resource would be to build interoperability between transplant centers and research entities. An alternative to a large centralized database could be a distributed research network which allows data holders to maintain logical and physical control over their data and mitigate security, proprietary, legal, and privacy concerns.

Name of idea submitter and other team members who worked on this idea : Rakesh Goyal

Voting

57 net votes
71 up votes
14 down votes
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Strategic Goal: Goal 3: Advance Translational Research

Disease-modifying treatments for asthma

Develop disease modifying treatments for asthma and asthma disease prevention.

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

This is an opportunity for additional research

Name of idea submitter and other team members who worked on this idea : Asthma and Allergy Foundation of America (AAFA)

Voting

1 net vote
1 up votes
0 down votes
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Strategic Goal: Goal 2: Reduce Human Disease

Kinetic analysis of transcriptional regulation by aberrant transcription factors in vivo

Aberrant transcription factors, such as leukemia fusion proteins, promote diseases by deregulating transcription of target genes. Recent genome-wide studies have provided new insight into transcriptional deregulation by aberrant transcription factors. Most of these studies have not used cells with synchronized transcriptional activities at specific repression/activation steps and, therefore, may have limited value in ...more »

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Feasibility and challenges of addressing this CQ or CC :

These studies are feasible. Transcriptional regulation of a population of cells may be synchronized by epigenetic drugs, or by using inducible expression/knockdown approaches. Alternatively, it may be possible to overcome the heterogeneity issue by single-cell-based analysis. Next, time-dependent genome-wide studies may be applied to the cells to reconstruct dynamic transcriptional pathways associated with aberrant transcription factors. These approaches may be generally applicable to the study of other disease-related transcriptional and signaling molecules.

Name of idea submitter and other team members who worked on this idea : Jinsong Zhang

Voting

1 net vote
1 up votes
0 down votes
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Strategic Goal: Goal 2: Reduce Human Disease

Diaphragmatic dysfunction in critical illness

Diaphragmatic dysfunction occurs more frequently than clinically recognized in the setting of acute critical illness or injury. This contributes to both incipient and prolonged respiratory failure, as well as the growth of long-term acute care/rehab hospitalizations. We need a better understanding of the mechanisms of dysfunction as well as strategies to mitigate loss of diaphragmatic muscle mass, ultimately leading ...more »

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

This problem can be addressed through a combination of Integrative physiology and real-time data analytics.

Feasibility and challenges of addressing this CQ or CC :

Patients receiving critical care services in the United States are among the most close monitored, including continuous monitoring of cardiorespiratory physiology. Integrating high dimensional data from ICU data streams and applying big data analytics, in combination with primetime genomic and metabolomic technologies, makes answering this question imminently feasible.

Name of idea submitter and other team members who worked on this idea : Society of Critical Care Medicine Executive Committee/Council

Voting

-1 net votes
1 up votes
2 down votes
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Strategic Goal: Goal 2: Reduce Human Disease

Evidence based approaches to Red Blood Cell transfusion

What are the optimal RBC transfusion thresholds for adult and pediatric cancer patients undergoing chemotherapy regimens that may improve functional status and quality of life?

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Cancer patients undergo intensive medical and surgical therapies to treat their underlying disease. Treatment commonly results in anemia requiring RBC and platelet transfusions to support the patient through the hypoproliferative phase of chemotherapy. This is particularly true for those patients requiring hematopoetic stem cell transplantation (HSCT). Following therapy, cancer outpatients commonly receive RBC transfusions for weeks to months to maintain their functional status.

 

Common causes of death in patients with hematological malignancies and other cancers are infections and bleeding. A meta-analysis of clinical trials suggested that liberal transfusion is associated with greater risk of infection. Conversely, restrictive transfusion could adversely affect quality of life and functional status in oncology populations. In addition, pre-clinical and clinical studies support that concomitant anemia and thrombocytopenia significantly compound bleeding risk, and that hemostasis can be optimized in thrombocytopenia by maintaining a higher hematocrit. Although bleeding risks in relation to platelet transfusion thresholds are well studied in patients with hematological malignancy, optimal hemoglobin levels in thrombocytopenic patients are not known. Despite the significant allocation of blood components to cancer patients as a whole, RBC transfusion practices are not well studied within this group.

Feasibility and challenges of addressing this CQ or CC :

Randomized controlled clinical trials and other studies investigating optimal transfusion thresholds and other measures of practice are required to provide health care providers with evidence to guide one of the most common therapies administered in the setting of malignancy. The clinically important end points of well-designed studies could include: 1) quality of life and functional status for both inpatients and outpatients; 2) neurocognitive development in pediatric populations; 3) bleeding events / bleeding scores; 4) impact on immunity including immunomodulation and infection; 5) reconstitution of hematopoiesis; and 6) survival and/or recurrence of disease.. Besides a generalizable study population, certain target populations of interest are those with high risk disease, HSCT patients, patients undergoing radiation therapy, and pediatric patients.

 

There are >1.6 million new cases of cancer annually in the USA, including >50,000 with leukemia and >6,000 with HSCT. Cancer therapies are rapidly advancing in the era of genomics and immunotherapy. Capitalizing on the tradition of research in cancer, single and multicenter studies of RBC transfusion are feasible using randomized controlled designs in conjunction with clinical trials of chemotherapeutic regimens. The results of these studies will impact a large patient population’s quality of life, and may ultimately impact healthcare cost and blood demand.

Name of idea submitter and other team members who worked on this idea : Nareg Roubinian, MD and Naomi Luban, MD for the 2015 NHLBI State of the Science in Transfusion Medicine

Voting

43 net votes
61 up votes
18 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Asthma Treatment Recommendations for Blacks

Considering the fact that Blacks bear a disproportionate degree of asthma morbidity and mortality, should treatment recommendations be different for Blacks vs. Caucasians?

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society

Voting

1 net vote
1 up votes
0 down votes
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Strategic Goal: Goal 2: Reduce Human Disease

Management of COPD in the presence of comorbidity

Management of COPD in the presence of comorbidity • Does a protocol-based screening for commonly occurring comorbid conditions in patients with COPD (eg. CAD, CHF, depression, sleep apnea) improve management and outcomes for patients with COPD? • How should providers coordinate management strategies and treatment goals in patients with COPD and other co-existing chronic diseases? • What is the comparative effectiveness ...more »

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

Voting

1 net vote
1 up votes
0 down votes
Active

Strategic Goal: Goal 3: Advance Translational Research

Animal Models for COPD -- Core Facilities

COPD is a major health problem with more than 140,000 deaths per year and yet there is a relative paucity of treatments that might modify the course of this disease. In part, this is due to the poor efficiency of animal models that require months of exposure to cigarette smoke. Moreover, there are no well validated small animal models of chronic mucus hypersecretion. Funding of core facilities that could both provide ...more »

Submitted by

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Funding of core facilities that could both provide support for researchers wishing to study COPD, and the development of efficient research models as well as models of chronic bronchitis would be a major advance for screening for treatments of COPD.

Feasibility and challenges of addressing this CQ or CC :

Current technology is well established for exposure of small animals to combustible tobacco smoker. However there remains to be developed standardized exposures to e-Cigarettes and Biomass fuels.

Name of idea submitter and other team members who worked on this idea : Robert A. Wise

Voting

20 net votes
24 up votes
4 down votes
Active