Showing 21 ideas for tag "care"

Goal 2: Reduce Human Disease

Role of sleep quality in critical care

Would improving sleep and circadian rhythms in the critical care setting result in improved patient outcomes (e.g., reduce severity of infection, duration of intubation, length of hospital stay)?

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

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71 net votes
98 up votes
27 down votes
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Goal 2: Reduce Human Disease

Dietary nitrates and the enterosalivary nitrate cycle

Are dietary fruits and vegetables, particularly leafy greens, protective against cardiovascular disease due to their ability to increase bioavailability of nitric oxide?

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

Details on the impact of addressing this CQ or CC

Understanding the biological rationale behind the benefit of a particular dietary component that promotes CV health will substantiate public health recommendations about diet.

Feasibility and challenges of addressing this CQ or CC

Our understanding of the nitrate/nitrite cycle and of cardiovascular activity of nitric oxide has advanced rapidly in the past 10-15 years. The time is ripe for linking these advances in the science of nitrates to the consequences of dietary nitrate.
The role of dietary fruits and vegetables in the protection against cardiovascular disease is supported by many studies, especially leafy green vegetables. However, identification of the component of fruits and vegetables affording this protection has been elusive. Recent discoveries about the ability of the body to cycle dietary nitrates to produce bioactive nitric oxide via the enterosalivary cycle and lingual microbiome lends strength to the argument that leafy green vegetables may be protective due to their high nitrate content. This possibility should be examined in both large cohort studies and in clinical series. Would be helpful for the USDA to add nitrates to their standard database of food nutrients. NHLBI needs to partner with NCI to coordinate with ongoing research about the potential nitrosylation of dietary nitrites to carcinogenic n-nitrosamines in the setting of low antioxidant intake.

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

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17 net votes
52 up votes
35 down votes
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Goal 2: Reduce Human Disease

Integrating palliative care into the care of patients with heart, lung, and blood disease

How can we best integrate primary and specialty palliative care into the care of patients with serious heart, lung, and blood diseases?

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

Details on the impact of addressing this CQ or CC

There is increasing awareness of the importance of palliative care in the care of patients with serious illness. Palliative care focuses on improving quality of life and reducing the stress of a serious illness for patients and their families and can be provided together with curative or life-prolonging treatments. It includes both primary palliative care (delivered by all cliniicans who care for patients with serious illness) and specialty palliative care (delivered by physicians, nurses, social workers, chaplains and others with special training in palliative care.) Patients with serious heart, lung, and blood diseases have profound unmet palliative care needs and it is not clear how these needs can best be met.

Feasibility and challenges of addressing this CQ or CC

Studies show dramatic benefit of integrating palliative care into the care of patients with cancer, but there is little data on the best way to improve palliative care for patients with serious heart, lung, and blood disease. The opportunity exists to support research that develops and evaluates interventions to improve primary and specialty palliative care for patients with heart, lung, and blood diseases.

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31 net votes
37 up votes
6 down votes
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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?

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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26 net votes
40 up votes
14 down votes
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Goal 2: Reduce Human Disease

Molecular determinants of pulmonary failure in sepsis

Respiratory failure in sepsis is almost universal and leads to worse clinical outcomes, yet it is poorly understood. Recent epidemics of pulmonary failure from respiratory viruses (e.g. influenza, SARS, MERS, etc) makes understanding molecular determinants of respiratory failure and the associated inflammatory and physiologic responses, critical for improving the health of our nation and potentially mitigating future... more »

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

Details on the impact of addressing this CQ or CC

Exploring and understanding the molecular determinants of pulmonary failure will impact not only the predictable complications of acute respiratory illnesses such as influenza, but also inform our understanidng and treatment of myriad other common respiratory illnesses resulting in pulmonary failure, such as pneumonia, chronic obstructive pulmonary disease, asthma, obesity hypoventilation, etc.

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. This highly monitored population is a nature source for studying longitudinal changes in molecular patterns and respiratory physiology.

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

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6 net votes
9 up votes
3 down votes
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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.

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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4 net votes
4 up votes
0 down votes
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Goal 2: Reduce Human Disease

What is the optimal process for terminal withdrawal of mechanical ventilation?

This palliative care process permits a natural death. The process is largely unstandardized and reflects local practice customs. In fact, the process may vary across ICUs and even within an ICU based on whose attending the patient. This process continues to be an under-investigated area of ICU care for terminally ill patients undergoing terminal ventilator withdrawal.

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

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1 net vote
7 up votes
6 down votes
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Goal 2: Reduce Human Disease

Pathogenesis and treatment of cardiovascular disease in survivors of critical illness.

Acute cardiovascular complications are frequent in critical illness and injury, occurring on a spectrum that includes troponin leak or demand ischemia to acute occlusive coronary events and lethal arrhythmias. They arise in the course of similar acute illnesses but they epidemiology, pathogenesis, treatment and long-term consequences are unknown. Are they the result of a generalized inflammatory state that persists... more »

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

Details on the impact of addressing this CQ or CC

Complications of critical illness are frequent and the most common are cardiovascular in nature but not well understood. Understanding the pathogenesis of these consequences will lead to improve treatments, acute survival of critical illness and injury, and improved long-term outcomes.

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 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

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

Palliation of symptoms associated with pulmonary conditions; promotion of patient participation in symptom self-management

Palliation of symptoms associated with a number of pulmonary conditions; promotion of patient participation in symptom self-management across the spectrum of illness, from ICU admission to rehabilitation to home; requires a multi-disciplinary perspective and team.

There are a plethora of distressing symptoms (anxiety, shortness of breath, cough, fatigue, weakness) associated with a number of chronic pulmonary conditions,... 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

Innovative symptom management strategies are needed that empower patients and their family members to engage in self-management strategies across the spectrum of illness from hospitalization through recovery.

Feasibility and challenges of addressing this CQ or CC

Longitudinal studies with a multi-disciplinary team of investigators are needed to address the varying needs of these patients and their family members over the course of recovery or transition to death in these patients. Interventions need to be cost-effective and prevent readmission to the critical care unit.

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

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

Phenotyping patients with respiratory failure requiring mechanical ventilation

What is the most effective way to phenotype (classify) patients with respiratory failure requiring mechanical ventilation?

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

Postoperative respiratory failure

Ventilating patients in the operating room constitutes the largest number of patients exposed to mechanical ventilation in this country and world wide [many millions of patients]. Postoperative pulmonary problems may, in part, due to the mechanical ventilation received in the OR. Yet, this cohort has never been systematically studied in terms of the effect of specific ventilatory patterns on postoperative outcomes. Data... more »

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

Feasibility and challenges of addressing this CQ or CC

There is an international trial [Provilho] but no US trials.

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

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1 up votes
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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 »

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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2 up votes
2 down votes
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