Goal 4: Develop Workforce and Resources

Medical student research training in LMIC settings

What are the strategies for heart, lung, blood, sleep workforce to gain first-hand international experience in clinical research/implementation research training in low- and middle-income country (LMIC) settings?

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

• Among the students who earn medical degrees in the United States, very few of them have been sufficiently trained to address the health needs of the most vulnerable populations.

• An international exposure in an LMIC setting would have enormous impact on clinical practice and research

• Any medical student interested in broadening their training may have opportunities for clinical and non-clinical hands-on experience and in turn this would increase number of physicians and researchers in global health.

Feasibility and challenges of addressing this CQ or CC :

Feasibility: • The NHLBI has a wealth of experience in training and career development programs in general and has supported and worked with global centers of excellence in this area.

• This experience can be used to leverage international experience in clinical practice and research outcomes in LMIC settings.

 

Challenges: • NHLBI would have to develop additional training mechanism(s) to foster clinical practice and research in an LMIC area.

 

• Resources for this unique training may be a challenge.

 

• Helping patients from vulnerable populations would involve confronting cultural differences and language barriers.

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

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-30 net votes
5 up votes
35 down votes
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Goal 3: Advance Translational Research

T4 Implementation Research Platform in Low Income Countries

What are the best strategies to stimulate development of a T4 Implementation Research network within low income countries (LICs)?

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

• Currently there are huge implementation challenges within LIC contexts and only limited progress is being made to address the gaps

• Conducting research in the context where its finding will be scaled up will vastly increase its appropriateness, adoption and uptake, fidelity, and sustainability

• Small improvements in the challenging context of LICs should provide opportunities to make a large burden reduction

Feasibility and challenges of addressing this CQ or CC :

• Currently there are formative efforts to engage biomedical research in LICs with H3Africa, Global Alliance for Chronic Diseases, and others

• NHLBI Think Tanks and Workshops have found much interest and demand to T4 Implementation research engagement

• Key non-traditional partners (World Bank, USAID) are working on implementation strategies in LICs currently and will be strong partners

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

Voting

-22 net votes
7 up votes
29 down votes
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Goal 3: Advance Translational Research

Implementation science research to reduce adverse effects of SCD

From various publications and reports, we have characterized the risks associated with sickle cell disease (SCD) and understand many of the barriers for treatment of SCD in LMICs. How can implementation science research be used to reduce the negative outcomes of SCD in low/middle income countries?

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

• Reduction of deaths and negative outcomes associated with SCD and in LMICs

• Provide the evidence base that supports culturally relevant implementation strategies that reduce deaths associated with SCD in LIMCs

Feasibility and challenges of addressing this CQ or CC :

• Yes

, this is feasible

• Common goals and deliverables between NHLBI and partners will need to be identified

• Partnerships can be with international organizations, Ministries of Health and other partners

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

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18 net votes
31 up votes
13 down votes
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Goal 3: Advance Translational Research

Health Behavior Change in Vulnerable Individuals

What knowledge about health behavior change can be leveraged to design innovative and effective strategies for behavior change among the most vulnerable individuals?

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

Significant health disparities exist in part because primary and secondary prevention strategies are not optimal for particularly vulnerable populations, who often grapple with multiple co-morbidities and low resources. Improving health promotion efforts by targeting health behaviors could help to close the disparity gap.

Feasibility and challenges of addressing this CQ or CC :

Many health damaging behaviors, such as smoking, are much more prevalent in certain groups than in the population at large. Multi-level efforts to promote health behavior change have not been optimally effective in these vulnerable groups. We need to build on what we know, understand the gaps, and develop new, culturally sensitive behavior change intervention strategies that will be effective for all groups.

Multi-level strategies to change health-damaging behaviors are effective for some behaviors, but tend to be least effective for the most vulnerable populations. For example, the percentage of people who smoke has decreased dramatically in the last 60 years, but significantly less so for racial and ethnic minorities, those with mental health issues, low income groups, and other vulnerable individuals. These differences contribute to health disparities among these groups, and are in part due to the need for multiple risk reduction and for strategies that are culturally informed.

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

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58 net votes
80 up votes
22 down votes
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Goal 2: Reduce Human Disease

HEALTH CARE DISPARITIES IN DIAGNOSIS AND TREATMENT OF COMMON SLEEP AND CIRCADIAN DISORDERS

There is evidence of a higher prevalence of sleep and circadian disorders in different ethnic groups. This is true for both adult and pediatric subjects. There is also evidence that minority populations in lower socioeconomic groups do not seek evaluation for sleep disorders as frequently as other segments of our population. There is also evidence that they are less adherent to treatments such as nasal CPAP for obstructive ...more »

Submitted by (@jnoel0)

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

Details on the impact of addressing this CQ or CC :

Sleep disorders are more common in minority populations. Moreover, these populations have higher rates of the known consequences of these disorders such as stroke, myocardial infarction, hypertension, resistant hypertension. Despite this, current population studies such as the Sleep Heart Health Study have included only a very small percentage of African Americans. The impact of this would be the following:

 

a. Elucidating the basis of barriers to case identification in these group

b. Designing specific intervention to overcome these barriers.

c. Developing methods to improve adherence to therapy in this group.

d. Removing sleep and circadian disorders as a risk factor for consequences such as stroke, cardiovascular disease and resistant hypertension in minority populations

Feasibility and challenges of addressing this CQ or CC :

There is a developing interest in this area in the field of circadian and sleep research. There is a developing knowledge base about health disparities in sleep and circadian disorders. Minority institutions such as Morehouse have developing programs in this area. We also have mobile technology that facilitates study of sleep and circadian disorders in minority populations.

Name of idea submitter and other team members who worked on this idea : Sleep Research Society

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118 net votes
163 up votes
45 down votes
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Goal 3: Advance Translational Research

To Improve Clinical Practice Recommendations for Asthma

What are the strategies to improve the use of evidence-based clinical practice recommendations and thereby increase the quality of care and improve outcomes for people with asthma? • Lack of provider awareness, knowledge, agreement, and/or self-efficacy in using the guidelines • Inconsistent use of guidelines-based asthma care in clinical practice. • Scarce/limited resources and limited access to target audiences. • ...more »

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

• Asthma is a chronic lung disease that affects 26 million people in the U.S., including more than 7 million children, at an estimated cost to the nation of $56 billion. Asthma accounts for 14.2 million missed work days, 10.5 million missed school days, 10.6 million physician office visits, and 1.8 million emergency department visits, and 439,000 hospitalizations each year.

• Despite widespread availability of evidence-based clinical practice guidelines for the diagnosis and management of asthma, only about half of individuals with asthma in the U.S. receive guidelines-based care.

• Identifying strategies to improve use of evidence-based clinical practice recommendations would 1) increase the number of people with asthma who receive evidence-based clinical care, 2) increase the number of health care providers who use (implement) evidence-based clinical practice recommendations, 3) increase the quality of care of people with asthma, and 4) improve outcomes and quality of life for people with asthma.

Feasibility and challenges of addressing this CQ or CC :

• Investigators could evaluate guidelines-based implementation strategies in implementation settings such as community and regional health systems, private medical practices, federally qualified health centers and other safety-net clinics, and hospitals throughout the U.S.

• Documented successful and sustainable implementation strategies could be shared more broadly and applied to future efforts to improve asthma care and control as well as reduce asthma disparities.

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

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1 net vote
6 up votes
5 down votes
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Goal 1: Promote Human Health

Studying Health in Addition to Disease

Why do some people stop smoking after a stroke or myocardial infarction, whereas others do not? What motivates people who adopt a healthier diet and exercise program during their lifetime or after a significant health event? How can we promote healthier lifestyle choices at all stages of life? How do we ensure equitable health promoting activities for minorities, vulnerable populations, and lower socio-economic status ...more »

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

Answering this critical question would enable us to have a more complete picture both of disease and of health.

Feasibility and challenges of addressing this CQ or CC :

It is feasible to address this critical question because we need to expand our understanding of how people remain healthy or regain health, especially given the unhappy statistics concerning obesity, physical activity, blood pressure, diabetes, etc.

Few would disagree with the importance of studying the epidemiology, mechanisms, and progression of disease: research is focused on preventing or curing diseases. In addition to this disease-focused model, there are untapped opportunities to examine health and wellness. Borrowing from the field of Positive Psychology, which is the study of the aspects or characteristics of mental health (e.g., the strengths, values, behavior that contribute to well-being), we can expand this idea to study the aspects of those who remain healthy, who have retained health after disease, or who have successfully made healthy lifestyle changes. In terms of obesity, an example of this idea is Rena Wing’s National Weight Control Registry, which studies individuals who have successfully maintained long-term weight loss.

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

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135 net votes
176 up votes
41 down votes
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Goal 1: Promote Human Health

ORAL HEALTH AND HEART TREATMENT

Compelling Question:

It is very well established now that oral health, particularly gingavitis, play a significant role in cardiac health.

Why this reality is not considered as integral part of Cardiac care?

Submitted by (@abasit88)

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

Details on the impact of addressing this CQ or CC :

It is expected that incorporating Oral Bacterial ailments such as Gingivitis for cardiac care will more than pay for itself. It will significantly improve the cardiac event prognoses and CUT THE COST OF CARDIAC CARE.

Feasibility and challenges of addressing this CQ or CC :

It is quite feasible and practically possible to incorporate Gingivitis or other serious bacterial oral health problems as integral part of the work of a Cardiologist.

CHALLENGES: Researching the contribution of Oral bacterial issues such as Gingivitis as compared to smoking, obesity and cholesterol levels.

My hypothesis is that Chronoc Oral Bactrial diseases are significant contributors to cardiac problems.

Name of idea submitter and other team members who worked on this idea : Abdul Basit, Ph. D.

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7 net votes
14 up votes
7 down votes
Active

Goal 1: Promote Human Health

Using the Electronic Health Record to improve population and individual health.

Every year millions of individuals suffer diseases of the heart, lungs, and blood. Some diseases have centralized care but rare diseases and diseases treated by a variety of provider types are difficult to study. The electronic health record feels primarily a tool for billing rather than for improving individual and population health. The challenges are:: 1. How can we structure a clinical health record which can ...more »

Submitted by (@neil.zakai)

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

Voting

12 net votes
22 up votes
10 down votes
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Goal 3: Advance Translational Research

Addressing Health Inequities through Nontraditional Partnerships

What non-traditional partnerships can be leveraged to address health inequities?

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

- Broaden reach to underserved populations

- Increase ability to generate evidence based solutions to address health inequities

- Bring expertise and resources to core partner (NIH)

- Enhance ability to identify unanticipated problems and strengthen efforts across all phases of the implementation research agenda

Feasibility and challenges of addressing this CQ or CC :

Feasibility:

- Increased emphasis on health and health inequities by non-profit and particularly, for-profit organizations

- Affordable Care Act (ACA) includes both general and explicit provisions that could narrow the health disparities gaps through implementation research.

- Can leverage and build upon current research partnerships that exist between government agencies and health care delivery systems to address questions of major public health importance

- Opportune time to employ implementation research addressing health inequities through non-traditional research partnership with sectors such as education, state and local government, transportation (built environment), penal and re-entry systems (health risks and disparities), ministries of health, and for-profits, foundations, and non-profits with health care focus.

 

 

Challenges:

 

 

- Risk of disagreements and friction among partners and management with different priorities

 

- Synchronization of timing for decision making

 

- Achieving partners’ concurrence on decisions that provide the most cost effective solutions

 

- Time needed to establish trust among partners that do not routinely partner to address health inequities

 

- There are limited resources dedicated to fostering Public Private Partnerships

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

Voting

6 net votes
19 up votes
13 down votes
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Goal 3: Advance Translational Research

Impact of care coordination programs on depression detection and treatment in COPD patients

Does a care coordination program improve the detection and treatment of co-morbid depression in patients with COPD?

Submitted by (@eshattuck)

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 : Edna Shattuck, COPD Foundation Patient Advocate

Voting

13 net votes
17 up votes
4 down votes
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