Showing 9 ideas for tag "screening"

Goal 2: Reduce Human Disease

Viscoelastic vs traditional coagulation tests as a guide to hemostatic treatments

Does the use of viscoelastic testing to guide plasma transfusion improve outcomes when compared to traditional coagulation testing?

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

Details on the impact of addressing this CQ or CC

The PT/INR are frequently used to guide hemostatic interventions, particularly in the ICU where the risk for hemorrhage is increased. In part, this is the result of long standing misconceptions regarding the relationship between PT/INR values with in vivo coagulation factor concentrations and clinical coagulation or hemostasis. Indeed, this misinformation almost certainly contributes to the well-documented inappropriate use of plasma products. To this point, it has now been demonstrated in a variety of clinical settings that the PT/INR is often poorly predictive of clinical coagulopathy or peri-procedural bleeding complications.

The last decade has seen a resurgence of interest in viscoelastic tests as alternatives assessments of hemostasis and guides to blood component use. Indeed, a body of literature supports the potential value of these tests in specific clinical settings. However, the value of such testing strategies has not been well described in the setting of the intensive care unit. Ongoing equipoise regarding the optimal assessment of coagulation status in the ICU suggests that a well conducted trial in this domain would have the potential to be truly transformative.

Feasibility and challenges of addressing this CQ or CC

The assessment of coagulation status and decisions related to plasma transfusion occurs multiple times throughout the day in essentially every intensive care unit across the US. Therefore, an adequately sized study population is clearly present and therefore, a multicenter trial is feasible with NHLBI support.

A potential challenge with a study evaluating the optimal coagulation testing strategy is the incomplete penetration of viscoelastic testing in current clinical practice raising concerns related to the resource and educational requirements if such a trial were pursued. Additionally, viscoelastic testing can take several forms, each of which may impose specific confounders. Therefore, specific technologies and transfusion algorithms would likely need to be employed.

Importantly, innovative trial designs may also help us to address some of the feasibility concerns noted above. One such design that may prove valuable in this setting is the stepped-wedge cluster randomization design. Implementation of such a design might be expected to improve investigator/clinician cooperation/compliance and may help reduce treatment group contamination.

Name of idea submitter and other team members who worked on this idea Daryl J. Kor, MD and Walter H. Dzik, MD for the 2015 NHLBI State of the Science in Transfusion Medicine.

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19 net votes
43 up votes
24 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?

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

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13 net votes
17 up votes
4 down votes
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Goal 3: Advance Translational Research

Impact of depression screening in COPD patients

What is the impact of screening for depression on outcomes of patients with COPD?

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 Cara Pasquale, COPD Foundation

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12 net votes
14 up votes
2 down votes
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Goal 3: Advance Translational Research

The effectiveness of a protocol-based screening in treating common COPD comorbidities

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?

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

Details on the impact of addressing this CQ or CC

Many times co- morbidities are not address appropriately in patients with COPD- a protocol- based screening would support better identification and adherence to guidelines and would improve management and outcomes of individuals with COPD>

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13 net votes
15 up votes
2 down votes
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Goal 3: Advance Translational Research

Addressing Unrecognized and Over Diagnosis of COPD

How can we create precision diagnostics for COPD in practice settings that will help inform the transition from screening to better diagnosis and treatment strategies and that will help identify patients or communities at highest risk for unrecognized or over diagnosed COPD.

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

Details on the impact of addressing this CQ or CC

About 12 million individuals are estimated to have undiagnosed COPD and in most cases patients aren’t diagnosed until they have lost over half of their lung function leading to worse outcomes short and long term. Conversely there are challenges with over and mis diagnosed COPD that can result in over treatment and incorrect treatment. Fine tuning screening, diagnostic and management tools can result in earlier and proper identification of disease, earlier initiation of risk mitigation and/or treatment strategies and improved health outcomes as well as improved efficiencies in the healthcare system.

Name of idea submitter and other team members who worked on this idea COPD Foundation, Nancy Leidy, COPDF MASAC

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11 net votes
12 up votes
1 down votes
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Goal 1: Promote Human Health

Functional and high throughput screening assays

There is a need to develop functional assays and high throughput screening to develop probes and potential drug therapies.
A. Functional Assays. Researchers face a challenging gap between identifying many sequence variations of potential interest and recognizing which of these variations have a direct functional effect on the physiological system of interest, as opposed to merely being associated with the actual causal... more »

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

Details on the impact of addressing this CQ or CC

Better tools and assays will help develop therapeutics faster and understand basic mechanisms. Improved genes-to-function screens are critical to accelerating the translation of genomic findings, by making screens of genes and variants for altered physiological function faster, cheaper, and more accurate.

Feasibility and challenges of addressing this CQ or CC

Current technologies and recent NIH pushes for this type of research has investigators and technological advances primed to influence NHLBI disease areas.

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

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-1 net votes
9 up votes
10 down votes
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Goal 1: Promote Human Health

Screening for asymptomatic vascular disease

Does screening for asymptomatic vascular disease increase awareness, promote compliance with lifestyle interventions, and improve overall health?

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 Society for Vascular Surgery

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

Congenital Heart Disease (CHD) Screening Access

What is needed to improve access to quality neonatal health care in order to get a more accurate idea of CHD prevalence in children, especially in underrepresented populations and those with limited access to primary care?

What role could safety net programs and community health centers play with screening (and subsequent treatment, education)?

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

Details on the impact of addressing this CQ or CC

More accurate CHD prevalence numbers, especially in underrepresented populations and those with limited access to healthcare.

Feasibility and challenges of addressing this CQ or CC

Agreement on CHD screening practices/standards.

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

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-5 net votes
6 up votes
11 down votes
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Goal 3: Advance Translational Research

Funding for synthesis and screening of potentially therapeutic molecules

Currently, there are limited, if none, funding resources to synthesize and screen potentially therapeutic molecules, based on supportive findings in cells, biopsy tissues from the patients with the disease in question, and the preliminary data to support the development of a series of compounds to screen them for their pharmacokinetics, pharmacodynamics, toxicity and use in clinically-relevant large animal models.

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

Details on the impact of addressing this CQ or CC

Although NHLBI-NIH and other institutes emphasize on mechanistic approach, to my knowledge, translation of the findings into the development of novel molecules is rarely pursued in a multi-disciplinary manner. this could have a significant impact on developing better therapeutic and/or management approaches of various diseases.

Feasibility and challenges of addressing this CQ or CC

In the past, NIH has come up with many RFAs related to this issue. However, one of the major challenges has been the screening of the compounds in a model relevant to human disease. For example, in cardiovascular diseases, about 99% studies are done in mouse models. From genetic studies point of view, this is acceptable, even though now large animals are used for knock-in and knock out gene studies. However, from the screening point of view, an emphasis must be placed on clinically-relevant model, for example, swine, where most of the findings, if not all, could translated to human disease.

Name of idea submitter and other team members who worked on this idea Devendra K. Agrawal, PhD

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-6 net votes
5 up votes
11 down votes
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