Goal 3: Advance Translational Research

Community Trials for Cardiovascular Health Enhancement

There is a need to initiate innovative community trials that are: theory-based; are integrated multi-component, multi-setting, and multi-level (i.e., they target individual, family, community, and built environment); engage community stakeholders; and use community-participatory research principles to enhance cardiovascular health (CVH) in vulnerable and diverse populations.

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 :

Global impact on cardiovascular health.

Feasibility and challenges of addressing this CQ or CC :

There are smaller scale community interventions but none in the literature that focuses on larger-scale multi-level trials as proposed here. This CQ would target vulnerable and diverse populations to reduce health disparities.

NHLBI supported the stroke belt initiative, and the exemplars in community CV health research: (e.g., the Stanford 5 City Project, The Minnesota Heart Health Program, The Pawtucket Heart Health). The next generation of community CVH research should harness the lessons from these studies, findings for the 8 Americas (Chris Murray), and numerous results from NHLBI cohort studies to implement large-scale community trials for cardiovascular health enhancement.

Resources for a large scale study could be a challenge. Ability to motivate a whole community, to prevent contamination, and to sustain interventions would be a challenge.

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

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9 up 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
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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)

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12 net votes
22 up votes
10 down votes
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Goal 2: Reduce Human Disease

e-cigarette and mental health

What is nicotine addiction in the absence of other materials? What cues are associated with smoking? We would like to see brain reward studies in special populations. We are also interested in understanding possible reduced harm in people who use e-cigarettes in cessation attempts, and understanding whether e-cigs are a gateway to other risky behaviors for young people who are experimenting.

Submitted by (@anna.adachimejia)

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 : Anna Adachi-Mejia for colleagues at Dartmouth

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1 up votes
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Goal 1: Promote Human Health

Predictive analytics to engage healthy behaviors and maintain health while reducing cost

Predictive Health employs the principle that using modern health testing and predictive analytics will better define true health (not just absence of disease) and, in combination with large-scale data analytics, will facilitate predicting deviations from the healthy trajectory earlier than traditional disease diagnosis, thus allowing more effective and less costly interventions to maintain health. Predictive Health educates ...more »

Submitted by (@greg.martin)

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

Details on the impact of addressing this CQ or CC :

By addressing this CC the health of the nation will be improved: better national and individual understanding of health, greater longevity of sustained health and productivity, reduced costs of healthcare by focusing on health than on disease diagnosis and management.

Feasibility and challenges of addressing this CQ or CC :

The Emory/Georgia Tech Predictive Health Institute (http://predictivehealth.emory.edu) was founded ~10 years ago by launching educational (http://predictivehealth.emory.edu/education/index.html) and scientific (http://predictivehealth.emory.edu/chd/index.html) programs to achieve the Predictive Health goals. The scientific approach created a prospective longitudinal cohort of individuals who have been richly phenotyped according to traditional medical testing (clinical laboratory, stress testing, etc) and research testing (genomics, metabolomics, regenerative cell potential, oxidative stress) to create the deepest understanding of current and future health. The success of the Predictive Health Institute demonstrates the feasibility and potential success of such a critical challenge to both human health and healthcare expenditures.

Name of idea submitter and other team members who worked on this idea : Greg Martin, for the Emory/Georgia Tech Predictive Health Institute

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5 net votes
9 up votes
4 down votes
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Goal 1: Promote Human Health

Achieving Excellence in Health and Science Communication

At least two thirds of US adults use the internet to access health information. The accuracy and quality of health and science information found on news media websites, corporate websites of the healthcare industry, blogs of healthcare providers and social media networks varies widely. Nevertheless, this information can have a profound influence on the healthcare-related decision-making of patients. The anti-vaccination ...more »

Submitted by (@jalees)

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

Details on the impact of addressing this CQ or CC :

The NHLBI could lead the way by providing resources and funding to study the most effective ways to improve health and science communication. Examples of such approaches could be grants that fund how information pertaining to heart, lung and blood disease is disseminated to the public and how the quality of the content is regulated.

 

How do information hubs (media organizations, blogs, Twitter and Facebook accounts) assess the accuracy and quality of the medical and scientific content disseminated to their audiences?

 

Can collaborations between communicators (journalists, TED talkers, writers, etc.) and scientists/physicians help provide a more realistic and evidence-based portrayal of ongoing research efforts and the efficacy of treatments?

 

If the NHLBI is able to build such collaborations then the benefit to society could be quite significant. The public will be provided with resources to understand ongoing research efforts as well as obtain high-quality, up-to-date analyses of how research studies are relevant for them and their personal decisions regarding their health.

 

Even citizens who are not seeking medical advice would benefit from this because it would allow them to develop a realistic perspective and appropriate enthusiasm for the ongoing efforts in the basic sciences.

Feasibility and challenges of addressing this CQ or CC :

One challenge will be that this approach will require collaborations between diverse disciplines in order to be successful. Clinicians/Researchers in the cardiovascular, pulmonary and hematologic sciences will need to work closely with experts in communication sciences, behavioral experts and journalists to develop new approaches to health and science communication.

 

On the one hand, we want the science and medicine to be portrayed accurately, on the other hand, it is also important to ensure that this information is conveyed in a manner that is accessible for a non-specialist audience.

Name of idea submitter and other team members who worked on this idea : Jalees Rehman

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5 net votes
5 up votes
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Goal 4: Develop Workforce and Resources

Leveraging big data for T1 translational research

How best to train T1 investigators in using big health care data to test their basic science hypotheses related to heart, lung, blood, and sleep disorders and thus generate sufficient confirmation to justify clinical interventions.

Submitted by (@collerb)

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

Details on the impact of addressing this CQ or CC :

• Hypotheses that emerge from small studies of patients focused on mechanistic questions often are not able to be tested at the population level and thus remain unconfirmed. The increasing availability of big data from EHRs permits corroboration at the population level, but requires skills in framing queries and minimizing bias and confounders.

• The emergence of large clinical data sets such as PCORNet and the NIH Collaboratory make this particularly timely.

• By sampling existing data sets rather than having to conduct new randomized studies, this type of research can be performed at relatively low cost and in a much more timely way.

 

T1 investigators are not usually trained in the techniques of using large clinical data sets and so require targeted training.

Feasibility and challenges of addressing this CQ or CC :

Developing educational programs for T1 investigators should be straightforward. Resources will be required to support the queries by T1 investigators required as part of the training, but this should be modest compared to other forms of research.

Name of idea submitter and other team members who worked on this idea : Barry Coller

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3 up 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 1: Promote Human Health

Human normal variation and resilience across lifespan

What is the measureable normal human variation at the -omic, cellular, organ, and system levels within the population and across the lifespan? • What are the range of normal human cellular functions that create resilience at all levels—cells, organs, organ systems? • What inter-organ, tissue, and cellular communications maintain individual health and the health of populations? • How do we understand why individuals with ...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 :

• Will provide a better definition of what is normal in order to better interpret and exploit the big data available through increased personalized monitoring and use of EMRs.

• Insights into the underlying mechanisms of resilient phenotypes will provide new paradigms for disease prevention and treatment.

Feasibility and challenges of addressing this CQ or CC :

Feasibility will depend on the level of investment (large) and accessibility to commons data.

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

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19 net votes
26 up votes
7 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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6 up votes
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Goal 3: Advance Translational Research

Treating cardiovascular disease in persons with mental health disorders

How can we most effectively prevent and treat cardiovascular disease among persons with serious mental disorders?

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 :

Clinical anxiety disorders affects 40 million people in the US and the lifetime prevalence of PTSD is 6-8%,. The incidence of PTSD in particular is rapidly expanding in the US; this condition doubles the risk of a cardiac event.

 

The prevalence rates are higher in some populations; 3 out of 10 US military veterans have a diagnosis of PTSD, and many more are undiagnosed. Among patients at a VA, a diagnosis of PTSD increased the probability of circulatory problems (odds ratio 3.7). In another study, every additional PTSD symptom increased the risk of developing cardiovascular disease by 17%. Thus, the impact of developing more effective treatments adapted to the needs of this vulnerable population could be significant.

Feasibility and challenges of addressing this CQ or CC :

As the incidence of many mental health disorders such as PTSD and depression increases, the need for developing and adapting treatments for this population becomes critical.

 

Effective treatments may not be optimal for persons with serious mental illnesses and strategies to tailor treatments to the challenges of this vulnerable population are needed.

Individuals with mental illnesses such as major depressive disorder, bipolar disorder, and anxiety disorders are at significantly higher risk for cardiovascular disease than are those without these illnesses. Those with serious mental illnesses die an average of 25 years earlier, frequently from cardiovascular disease. The incidence of PTSD is rapidly expanding in the US; this condition doubles the risk of cardiovascular events.

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

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19 net votes
30 up votes
11 down votes
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