Goal 2: Reduce Human Disease

Early cognitive rehabilitation

Does early cognitive rehabilitation (while on vent) improve long term cognitive function in ALI survivors?

Submitted by (@nhlbiforumadministrator)

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 : American Thoracic Society member

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Goal 2: Reduce Human Disease

Addition of albumin to fluid conservative management of AL

Does the addition of albumin to fluid conservative management of ALI (ARDSnet FACTT trial protocol, Wiedemann et al) further shorten ventilator time and/or improve survival?

Submitted by (@nhlbiforumadministrator)

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

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Goal 3: Advance Translational Research

High Quality COPD care coordination

What factors are associated with high quality care coordination in patients with COPD?

Submitted by (@kdeit1946)

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

Details on the impact of addressing this CQ or CC :

Patients would benefit from high quality care coordination; costs to insurance companies would probably decrease as would hospitalizations; would result in better quality of life for patients.

Feasibility and challenges of addressing this CQ or CC :

All providers must be willing to share information; PCP's must be willing to screen for COPD and make referrals when indicated; would be a challenge in very rural areas with very few resources.

Name of idea submitter and other team members who worked on this idea : Karen Deitemeyer, COPD Foundation State Captain Program

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Goal 2: Reduce Human Disease

What are the molecular mechanisms of lung injury, and how do they differ in children?

Both adults and children have significant morbidity and mortality due to lung injury, but have different etiologies and outcomes. It is possible that the underlying pathobiology in the two groups is different. There are no targeted therapies for lung injury, indicating that the cause is still not understood.

Submitted by (@rft2106)

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

Details on the impact of addressing this CQ or CC :

Mortality rates for acute lung injury in pediatrics vary from about 10-30%. Immunosuppressed patients and those with cancer have higher rates. Morbidity following long ICU stays have social impacts on family and education, and can put patients at risk of future lung complications.

 

Though ECMO shows promise of improving outcomes, large clinical studies are lacking. ECMO is also fraught with signifiant risks and high costs. A molecular understanding of the pathobiology of lung injury could lead to specific therapies to improve survival and decrease morbidity.

Feasibility and challenges of addressing this CQ or CC :

(1) The heterogeneity of both adults and children with lung injury hinders the applicability of clinical and translational studies. (2) Reliable animal models of pediatric lung injury are lacking.

Name of idea submitter and other team members who worked on this idea : Rebecca Turcotte

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Goal 3: Advance Translational Research

Integrated Clinical Guideline on Comorbidities in Primary Care

The development of systematic evidence reviews (SER) that provide the evidence that partner organizations can use to develop an integrated clinical practice guideline for use by primary care providers for the treatment of patients with single and multiple conditions for the primary and secondary prevention of heart, lung, blood, and sleep (heart, lung, blood, sleep) diseases.

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

• Despite the success of single condition/disease guidelines, patients often have multiple conditions/risk factors that interact in various ways and can accelerate the development of atherosclerosis and chronic lung diseases. Effective management therefore requires a more integrated approach to assessment and treatment that spans all of relevant risk factors and conditions.

• The development of an integrated guideline has been recommended by participants in several NHLBI forums, including the NHLBI Strategic Planning process, the NHLBI Conference to Create a Cardiovascular Knowledge Network, and the Cardiovascular Disease Thought Leaders Meeting.

Feasibility and challenges of addressing this CQ or CC :

Feasibility: • NHLBI currently participates with other Institutes in funding research on comorbidities, Behavioral Interventions to Address Multiple Chronic Health Conditions in Primary Care (R01, PA-12-024).

• An increasing number of scholarly articles are addressing the magnitude and cost of the problem and calling for guidelines that address this reality.

 

Challenges: .

 

• Few studies have focused on the management of patients with multiple chronic conditions.

 

• Clinical research often excludes persons with multiple chronic conditions.

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

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Goal 2: Reduce Human Disease

Vasopressin layered on to norepinephrine treatment for septic shock

We know that vasopressin layered on to norepinephrine treatment for septic shock tends to produce better outcomes (VASST trial, Russell et al) than norepinephrine alone. We still need to know if norepinephrine should be first line or if vasopressin should be first line (and perhaps monotherapy) for septic shock.

Submitted by (@nhlbiforumadministrator)

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

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Goal 3: Advance Translational Research

Embedding Clinical Trials in Learning Health Systems

What are the best methods for using genotype information and other EMR data to randomize heart, lung, blood, sleep patients to different treatment strategies? One big challenge is how to consent patients for this sort of trial. Must patients be consented separately for every such trial or could there be blanket consent for participating in the learning health care model? This would also require a paradigm shift in how ...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 :

If successful this approach should enable the conduct of cheap pragmatic trials that are fueled by data from clinical care. The integration into clinical care helps assure efficiency and generalizability of results.

Feasibility and challenges of addressing this CQ or CC :

The advent of electronic medical records and the explosion of big data technology has made it possible to gain access to and analyze data in a manner that would have been unthinkable 10 years ago. This is already going on in other fields.

Health care systems are increasingly using "big data" approaches to track outcomes in the patients treated with different strategies and drugs, and apply the knowledge gained from outcomes in previous patients to inform decision making in subsequent patients ("learning"). This approach could be used to personalize treatment. A recent example from cancer is to genotype lung tumors, and tailor the treatment of a new patients to drugs producing good results in patients with similar tumor genotypes. When two or more treatments produce similar results, one could randomize. Cardiovascular disease presents a challenge in using genotyping information to personalize treatment, because the manifestations are the results of complex genetic and environmental risk factors.

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

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Goal 3: Advance Translational Research

Point of care detection of rare cells in blood

Laboratory analyses at the bedside or in the hinterlands can reduce the cost and increase the capture of disease states in underserved populations. The injection of a blood draw directly into a portable device that requires no further operator interventions is a Critical Challenge. With today’s automated chemistry and a miniaturized flow cytometer this challenge could be met.

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

Although portable flow cytometers exist, they are not equipped with chemical automation and rare-cell enrichment capability. An integrated system could be applied to multiple diagnostic goals. A sufficiently versatile design should be able to detect and enumerate specific cell populations at any level (not only rare cells) in the circulation — T-cell subsets in AIDS, for example.

Feasibility and challenges of addressing this CQ or CC :

Automated mixing and labeling, magnetic bioseparations, microfluidics, high-intensity LEDs and sensitive avalanche photodiodes can be combined to address this CC.

Name of idea submitter and other team members who worked on this idea : Paul Todd

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Goal 2: Reduce Human Disease

Benefits of intraosseous access on outcomes from OHCA

Vascular access is a challenge in the setting of out-of-hospital cardiac arrest (OHCA). The failure of medications to impact outcomes may be in part related to the delay in drug delivery from the IV route. EMS systems have adopted intraosseous (IO) access but it is not clear if these are affecting outcome and there has been no large RCT. The current IO access devices are expensive and use different routes (sternal, tibia, ...more »

Submitted by (@dayam0)

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

Details on the impact of addressing this CQ or CC :

At over a 100 dollars per device, the costs of using an IO line for estimated 300K arrests in the United States is 30 million dollars. We need to know if this route works and the optimal location for placement.

Feasibility and challenges of addressing this CQ or CC :

Funding, willingness to study this in a well designed clinical trial

Name of idea submitter and other team members who worked on this idea : Mohamud Daya

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Goal 4: Develop Workforce and Resources

NIH trans-IC office of critical care research

Would an NIH trans-IC office of critical care research improve coordination and strategic planning across?

Submitted by (@nhlbiforumadministrator)

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

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Goal 2: Reduce Human Disease

Evidence-based holistic care for sickle cell disease

What are the best, evidence-based models to facilitate holistic care across the lifespan for individuals living with sickle cell?

Submitted by (@sicklecellwarrior)

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

Details on the impact of addressing this CQ or CC :

Unless an individual is a candidate for transplantation, sickle cell will be a lifelong challenge. Much effort has been focused in the pediatric area and on physical aspects of the disease. However, adult care and mental/psycho-social health have not been adequately addressed. A holistic approach across the lifespan would fill these gaps and perhaps lead to better health outcomes and addresses NHLBI's goal of reducing the burden of human disease.

Name of idea submitter and other team members who worked on this idea : Sickle Cell Warriors, Inc. community members

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40 up votes
14 down votes
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