High-priority Research Questions Research Articles

Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support.

BackgroundLittle is known about how well or under what conditions health innovations are sustained and their gains maintained once they are put into practice. Implementation science typically focuses on uptake by early adopters of one healthcare innovation at a time. The later-stage challenges of scaling up and sustaining evidence-supported interventions receive too little attention. This project identifies the challenges associated with sustainability research and generates recommendations for accelerating and strengthening this work.MethodsA multi-method, multi-stage approach, was used: (1) identifying and recruiting experts in sustainability as participants, (2) conducting research on sustainability using concept mapping, (3) action planning during an intensive working conference of sustainability experts to expand the concept mapping quantitative results, and (4) consolidating results into a set of recommendations for research, methodological advances, and infrastructure building to advance understanding of sustainability. Participants comprised researchers, funders, and leaders in health, mental health, and public health with shared interest in the sustainability of evidence-based health care.ResultsPrompted to identify important issues for sustainability research, participants generated 91 distinct statements, for which a concept mapping process produced 11 conceptually distinct clusters. During the conference, participants built upon the concept mapping clusters to generate recommendations for sustainability research. The recommendations fell into three domains: (1) pursue high priority research questions as a unified agenda on sustainability; (2) advance methods for sustainability research; (3) advance infrastructure to support sustainability research.ConclusionsImplementation science needs to pursue later-stage translation research questions required for population impact. Priorities include conceptual consistency and operational clarity for measuring sustainability, developing evidence about the value of sustaining interventions over time, identifying correlates of sustainability along with strategies for sustaining evidence-supported interventions, advancing the theoretical base and research designs for sustainability research, and advancing the workforce capacity, research culture, and funding mechanisms for this important work.

Accessing Open PHACTS: interactive exploration of compounds and targets from the semantic web

Pharmacological research is hampered by scattered data which have to be retrieved by varying methods and in different data formats. This heterogeneity increases research costs and limits throughput. Over the last two years, the Open PHACTS Discovery Platform [1] has been developed as a centralized repository, integrating pharmacological data from a variety of information resources and providing tools and services to query these integrated data in pharmacological research. Following an application-oriented approach, the Open PHACTS project started with the definition of potential use cases in the form of prioritized research questions [2], most of which can only be answered by accessing multiple data sources in the web. The development of the platform as well as the services has been guided by these questions. Here, we present the ChemBioNavigator (CBN) [3], a web application allowing to navigate the Open PHACTS chem-bio space with a focus on small molecules and their targets. CBN comprises of a large visualization area with different view modes and two information panels, allowing a deeper insight in information for compounds and targets. It allows interactive exploration of compound sets through sorting and subset selection as well as extending sets by substructure or similarity search. The relation between compounds and targets is defined by assay data from the Discovery Platform. Each compound and each target is annotated with information from multiple data sources which is provided together with the provenance for each data point. In this contribution we roughly outline the OpenPHACTS/CBN technology and present a number of high-priority research questions, highlight the advantages of exploiting the integrated data through the CBN's smart and intuitive interface.

Comparative Effectiveness Topics from a Large, Integrated Delivery System

To identify high-priority comparative effectiveness questions directly relevant to care delivery in a large, US integrated health care system. In 2010, a total of 792 clinical and operational leaders in Kaiser Permanente were sent an electronic survey requesting nominations of comparative effectiveness research questions; most recipients (83%) had direct clinical roles. Nominated questions were divided into 18 surveys of related topics that included 9 to 23 questions for prioritization. The next year, 648 recipients were electronically sent 1 of the 18 surveys to prioritize nominated questions. Surveys were assigned to recipients on the basis of their nominations or specialty. High-priority questions were identified by comparing the frequency a question was selected to an "expected" frequency, calculated to account for the varying number of questions and respondents across prioritization surveys. High-priority questions were those selected more frequently than expected. More than 320 research questions were nominated from 181 individuals. Questions most frequently addressed cardiovascular and peripheral vascular disease; obesity, diabetes, endocrinology, and metabolic disorders; or service delivery and systems-level questions. Ninety-five high-priority research questions were identified, encompassing a wide range of health questions that ranged from prevention and screening to treatment and quality of life. Many were complex questions from a systems perspective regarding how to deliver the best care. The 95 questions identified and prioritized by leaders on the front lines of health care delivery may inform the national discussion regarding comparative effectiveness research. Additionally, our experience provides insight in engaging real-world stakeholders in setting a health care research agenda.

Leveraging Epidemiology and Clinical Studies of Cancer Outcomes: Recommendations and Opportunities for Translational Research

As the number of cancer survivors continues to grow, research investigating the factors that affect cancer outcomes, such as disease recurrence, risk of second malignant neoplasms, and the late effects of cancer treatments, becomes ever more important. Numerous epidemiologic studies have investigated factors that affect cancer risk, but far fewer have addressed the extent to which demographic, lifestyle, genomic, clinical, and psychosocial factors influence cancer outcomes. To identify research priorities as well as resources and infrastructure needed to advance the field of cancer outcomes and survivorship research, the National Cancer Institute sponsored a workshop titled "Utilizing Data from Cancer Survivor Cohorts: Understanding the Current State of Knowledge and Developing Future Research Priorities" on November 3, 2011, in Washington, DC. This commentary highlights recent findings presented at the workshop, opportunities to leverage existing data, and recommendations for future research, data, and infrastructure needed to address high priority clinical and research questions. Multidisciplinary teams that include epidemiologists, clinicians, biostatisticians, and bioinformaticists will be essential to facilitate future cancer outcome studies focused on improving clinical care of cancer patients, identifying those at high risk of poor outcomes, and implementing effective interventions to ultimately improve the quality and duration of survival.

Prevention and self-management interventions are top priorities for osteoarthritis systematic reviews

ObjectiveTo identify high-priority research questions for osteoarthritis systematic reviews with consideration of health equity and the social determinants of health (SDH). Study Design and SettingWe consulted with experts and conducted a literature search to identify a priority-setting method that could be adapted to address the health equity and SDH. We selected the Global Evidence Mapping priority-setting method, and through consultations and consensus, we adapted the method to meet our objectives. This involves developing an evidence map of the existing systematic reviews on osteoarthritis; conducting one face-to-face workshop with patients and another one with clinicians, researchers, and patients; and conducting an online survey of patients to rank the top 10 research questions. We piloted the adapted method with the Cochrane Musculoskeletal Review Group to set research priorities for osteoarthritis. ResultsOur focus was on systematic reviews: we identified 34 high-priority research questions for osteoarthritis systematic reviews. Prevention and self-management interventions, mainly diet and exercise, are top priorities for osteoarthritis systematic reviews. Evaluation against our predefined objectives showed that this method did prioritize SDH (50% of the research questions considered SDH). There were marked gaps: no high-priority topics were identified for access to care until patients had advanced disease–lifestyle changes once the disease was diagnosed. This method was felt feasible if conducted annually. ConclusionWe confirmed the utility of an adapted priority-setting method that is feasible and considers SDH. Further testing of this method is needed to assess whether considerations of health equity are prioritized and involve disadvantaged groups of the population.

High Priority Research Needs for Gestational Diabetes Mellitus

Identification of unanswered research questions about the management of gestational diabetes mellitus (GDM) is necessary to focus future research endeavors. We developed a process for elucidating the highest priority research questions on GDM. Using a systematic review on GDM as a starting point, we developed an eight-step process: (1) identification of research gaps, (2) feedback from the review's authors, (3) translation of gaps into researchable questions using population, intervention, comparators, outcomes, setting (PICOS) framework, (4) local institutions' stakeholders' refinement of research questions, (5) national stakeholders' use of Delphi method to develop consensus on the importance of research questions, (6) prioritization of outcomes, (7) conceptual framework, and (8) evaluation. We identified 15 high priority research questions for GDM. The research questions focused on medication management of GDM (e.g., various oral agents vs. insulin), delivery management for women with GDM (e.g., induction vs. expectant management), and identification of risk factors for, prevention of, and screening for type 2 diabetes in women with prior GDM. Stakeholders rated the development of chronic diseases in offspring, cesarean delivery, and birth trauma as high priority outcomes to measure in future studies. We developed an eight-step process using a multidisciplinary group of stakeholders to identify 15 research questions of high clinical importance. Researchers, policymakers, and funders can use this list to direct research efforts and resources to the highest priority areas to improve care for women with GDM.

Cystic fibrosis research in allied health and nursing professions

This report is the result of the “Allied Health and Nursing Professions Working Group” meeting which took place in Verona, Italy, November 2009, which was organised by the European Cystic Fibrosis Society, and involved 32 experts. The meeting was designed to provide a “roadmap” of high priority research questions that can be addressed by Allied Health Professionals (AHP) and nursing. The other goal was to identify research skills that would be beneficial to AHP and nursing researchers and would ultimately improve the research capacity and capability of these professions. The following tasks were accomplished: 1) a Delphi survey was used to identify high priority research areas and themes, 2) common research designs used in AHP and nursing research were evaluated in terms of their strengths and weaknesses, 3) methods for assessing the clinimetric and psychometric properties, as well as feasibility, of relevant outcome measures were reviewed, and 4) a common skill set for AHPs and nurses undertaking clinical research was agreed on and will guide the planning of future research opportunities. This report has identified important areas and themes for future research which include: adherence; physical activity/exercise; nutritional interventions; interventions for the newborn with CF and evaluation of outcome measures for use in AHP and nursing research. It has highlighted the significant challenges AHPs and nurses experience in conducting clinical research, and proposes strategies to overcome these challenges. It is hoped that this report will encourage research initiatives that assess the efficacy/effectiveness of AHP and nursing interventions in order to improve the evidence base. This should increase the quality of research conducted by these professions, justify services they currently provide, and expand their skills in new areas, with the ultimate goal of improving care for patients with CF.

Defining the research agenda to reduce the joint burden of disease from Diabetes mellitus and Tuberculosis

The steadily growing epidemic of diabetes mellitus poses a threat for global tuberculosis (TB) control. Previous studies have identified an important association between diabetes mellitus and TB. However, these studies have limitations: very few were carried out in low-income countries, with none in Africa, raising uncertainty about the strength of the diabetes mellitus-TB association in these settings, and many critical questions remain unanswered. An expert meeting was held in November 2009 to discuss where there was sufficient evidence to make firm recommendations about joint management of both diseases, to address research gaps and to develop a research agenda. Ten key research questions were identified, of which 4 were selected as high priority: (i) whether, when and how to screen for TB in patients with diabetes mellitus and vice versa; (ii) the impact of diabetes mellitus and non-diabetes mellitus hyperglycaemia on TB treatment outcomes and deaths, and the development of strategies to improve outcomes; (iii) implementation and evaluation of the tuberculosis 'DOTS' model for diabetes mellitus management; and (iv) the development and evaluation of better point-of-care diagnostic and monitoring tests, including measurements of blood glucose and glycated haemoglobin A(1c) (HbA(1c)) for patients with diabetes mellitus. Implementation of this research agenda will benefit the control of both diseases.

Ecosystem simulations supporting ecosystem-based fisheries management in the Coral Triangle, Indonesia

A comprehensive field study ongoing in Eastern Indonesia has provided data for a trophodynamic Ecosim ecosystem model of the Raja Ampat archipelago on the west coast of New Guinea. Model dynamics have been tuned to agree with local catch and relative biomass time series data developed for this project, and validated by experts. The model is used in this article to investigate five high priority research questions related to ecosystem-based fisheries management (EBFM) in the region. Regency fisheries managers and scientific partners working in Indonesia posed the questions. Here, we analyze the ecosystem impacts of blast fishing, including trophic effects and removal of refuge space. Removal of refuge space is as harmful to juvenile reef fish populations as direct mortality from the fishery itself; reef damage is cumulative due to the slow re-growth rate of corals. We quantify the likely ecological and economic impacts of limiting commercial fisheries for groupers. Artisanal fisheries benefit slightly and system biodiversity is improved, but the improvement is lost if artisanal fisheries increase effort to compensate for missing catch. We forecast the effects of limiting commercial net fisheries for reef fish. There is a marginal increase in reef fish biomass and an unexpected benefit to large pelagic species due to reduced interception of their anchovy prey. We evaluate the exploitation status of anchovy and tuna and report on the ecosystem effects of these fisheries. All fisheries appear fully exploited in Raja Ampat or nearly so. There is an indication that anchovies provide an ecosystem service: a large population may act to buffer fluctuations in large pelagic fish biomass under climate variation.

Dual diagnosis in offenders with intellectual disability: setting research priorities: a review of research findings concerning psychiatric disorder (excluding personality disorder) among offenders with intellectual disability

Studies of so-called 'dual diagnosis', i.e. intellectual disability (ID) with an additional psychiatric disorder, are reviewed with particular reference to offending behaviour. Because of the paucity of studies of psychopathology in offenders with ID, the present paper opens with studies of broader issues of psychopathology among people with ID, notably those with depression, schizophrenia, mild depressive disorder, other major psychotic disorders, anxiety/neurotic disorder, autistic spectrum disorders and attention deficit hyperactivity disorder. There follows a review of the most established and commonly used measurement scales for dual diagnosis in ID. The review then focuses directly on those studies which have looked at the issues of dual diagnosis among offenders with ID. In keeping with other reviews in this series, the latter studies are classified according to the same criteria. Based on this review, it is apparent that there are high-priority research questions which concern the extent and nature of psychopathology among offenders with ID, most notably those with autistic spectrum disorders.

Pan-European research challenges in toxicology and epidemiology: twinning for the better

At the Third Ministerial Conference on Environment and Health held in London in June 1999, a document on environment and health research for Europe was discussed and endorsed. This initiative — developed by the European Science Foundation, the European Commission and the WHO European Region — will be one of the largest of its kind in Europe. The programme described in particular an analysis of the more than 80 research recommendations which served as the basis for the high priority research questions presented in London. The need for an integrated multi-disciplinary approach is emphasised. The ultimate aim is to provide risk managers with tools to implement remediation and prevention effectively and efficiently in a prioritised fashion. Related research challenges in toxicology for the new millennium are described.

Rearch Implications of the Theme Issues “Recreation Fees and Pricing Issues in the Public Sector” (Journal of Park and Recreation Administration) and “Societal Response to Recreation Fees on Public Lands” (Journal of Leisure Research)

Introduction The articles contained in the 3rd Quarter 1999 companion theme issues of the Journal of Park and Recreation Administration and the Journal of Leisure Research represent hundreds of thousands of dollars of investment by our society in developing and sharing knowledge to contribute to public recreation fee policy. These articles represent the best research available on the topic at this point in time. Through literature reviews and creative efforts, these authors have built well upon the limited research available previously. There are some minor inconsistencies in findings, but for the most part, the articles are very complementary, increasing our understanding of response to fees in a greater variety of recreation contexts and with a greater variety, of public segments. All authors and their sponsoring institutions are to be commended for responding to the immediate need for knowledge on this important topic. The purpose of this final article is not merely to summarize the findings of each article or to point out inconsistencies or agreement. Rather, we now have the ability to stop and think about the usefulness of the information contained in these two special issues, and use the information gathered here to guide us in future research and application of that research. It is neither a simple task nor one beyond controversy. The most controversial issue was evident in comments by many reviewers and within several articles. There has been a pervasive impulse to depend upon a strictly economic paradigm to answer public lands fee and pricing questions though there are huge social science issues of equity, public trust, government subsidies for public goods, and fair pricing that extend beyond traditional economic models. For that reason, an invitation was extended to Gamini Herath to spend four months in residence at the Leopold Institute, on sabbatical from the Business Department of LaTrobe University in Victoria (Australia), to contribute to this final analysis. Herath (an economist) and Watson (a social scientist) reviewed all papers submitted, all review comments, and all author responses. In some cases, we learned as much from papers that were rejected or ideas that were not accepted by reviewers of accepted papers as we learned from the final papers themselves. Our approach has been to summarize our response to this intellectual exercise of submittal, review and publication of these papers into a set of high priority research and application questions. While this is not an exhaustive list of research issues, these questions should be addressed before final decisions are made about the future of fees and pricing approaches in the public sector. 1. How can recreation fee research methodology address the controversial tradeoffs between considering fees from the public or collective perspective versus a purely consumer point of view? Today, there is a call for government to be more like private business in the way it describes and meets public needs. Public recreation agencies at all levels are responding with slogans and policies that place the recreation visitor in the light of a valued customer. It sometimes seems that pricing approaches which are based purely upon marginal demand curves may be taking this ideal too far. Trainor and Norgaard (JPRA) reference Schroeder's (1995) differentiation between a community metaphor and a customer metaphor in describing values associated with public land. Is use of public lands simply an act of individual utility maximization, as economic theory describes, or an activity in which one interacts with the land in a way that creates a relationship with the land to the benefit of the land, society, and the individual? An answer to that question will lead us closer to decisions about appropriate pricing methods. Additional conceptual reasoning is needed to help us all understand the original function of public lands and how subsequent legislation, policy actions and societal changes may have influenced this function. …

Prioritization Of Research Under National Aids Control Programme In India Using Nominal Group Technique

Introduction: During the fi rst 2 years of the fi ve year plan of India’s National AIDS Control Programme Phase-III (NACP-III; 2007-12), various interactive consultative workshops were organized in collaboration with development partners with the objective of identifying priority areas for operational research and further development of research protocols adopting mentorship approach. Methodology: This article is an attempt to present the Nominal Group Technique (NGT) which was used to identify a set of fundable and practically feasible research priorities under NACP-III specifi cally focusing on Prevention of Parent to Child Transmission (PPTCT) and Pediatric HIV Care in India. The activity was undertaken with support of UNICEF in the year 2010. A total of 110 persons participated in the consultation clustering into 37, 36 and 37 members in Group A, B and C, respectively. The participants refl ected the mix of policy makers / decision makers (8), programme managers (12), implementers (36), subject experts / researchers (28), other stakeholders (16). Results: A total of nine highest priority research questions were identifi ed by all the groups in the assigned themes. The value of Kendall’s W coeffi cient of concordance was 0.68, which shows signifi cant agreement among raters on priority research questions (chi-square=16.35; p=0.03). Conclusion: Based on our experience, we can conclude that NGT was found to be an important tool for setting research priorities that is more democratic and transparent than the traditional methods. By applying various stages of the group sessions, participants can experience the rethinking process with reference information to enhance their judgment. The results of our experience may help programme managers / policy makers to plan similar and more improved method in other element of NACP as well as other health programmes. DOI: http://dx.doi.org/10.3126/saarctb.v8i1.5888 SAARCTB 2011; 8(1): 20-30