Important Unanswered Research Questions Research Articles

Patient, Caregiver, and Clinician Participation in Prioritization of Research Questions in Pediatric Hospital Medicine

The research agenda in pediatric hospital medicine has seldom considered the perspectives of young people, parents and caregivers, and health care professionals. Their perspectives may be useful in identifying questions on topics for research. To prioritize unanswered research questions in pediatric hospital medicine from the perspectives of young people, parents/caregivers, and health care professionals. Between August 4, 2020, and August 19, 2021, two online surveys and a virtual workshop were conducted, using modified Delphi technique and nominal group technique. Young people, parents/caregivers, and health care professionals with experiences in pediatric hospital medicine in Canada were included. The established James Lind Alliance Priority Setting Partnership method was used. In phase 1, a survey collected unanswered questions regarding pediatric hospital medicine via 3 open-ended questions. Survey responses were used to develop summary questions that went through an evidence-checking process. Unanswered questions were brought to a phase 2 interim prioritization survey. The top 10 unanswered research questions in pediatric hospital medicine were established at the final priority setting workshop. Survey responses, top 10 research questions. The phase 1 survey was completed by 188 participants (148 of 167 [89%] females; 17 of 167 [10%] males; mean [SD] age, 39.5 [12.4] years) and generated 495 unanswered research questions and comments, of which 58 were deemed out of scope. The remaining 437 responses were grouped into themes (eg, communication, shared decision-making, health service delivery, and health service management) and then refined to 75 unanswered research questions. Of these 75, only 4 questions had sufficient evidence. To make the number of questions in phase 2 manageable, 21 questions submitted by only 1 respondent were eliminated. Fifty unanswered research questions were included in the phase 2 survey, which was completed by 201 participants (165 of 186 [89%] females; 19 of 186 [10%] males; mean [SD] age, 40.0 [11.0] years). A short list of 16 questions-the top 10 questions from patient partners (youths, parents/caregivers) and clinicians-was presented at the final priority setting workshop and the top 10 questions were prioritized. The top 10 questions focused on the care of special inpatient populations (eg, children with medical complexity), communication, shared decision-making, support strategies in the hospital, mental health supports, shortening length of stay, and supporting Indigenous patients, parents/caregivers, and families. This patient-oriented pediatric hospital medicine priority setting partnership identified the most important unanswered research questions focused on the care of children in the hospital. These questions provide a possible roadmap for research on areas deemed important to young people, parents/caregivers, and clinicians.

What are the most important unanswered research questions on rapid review methodology? A James Lind Alliance research methodology Priority Setting Partnership: the Priority III study protocol.

Background: The value of rapid reviews in informing health care decisions is more evident since the onset of the coronavirus disease 2019 (COVID-19) pandemic. While systematic reviews can be completed rapidly, rapid reviews are usually a type of evidence synthesis in which components of the systematic review process may be simplified or omitted to produce information more efficiently within constraints of time, expertise, funding or any combination thereof. There is an absence of high-quality evidence underpinning some decisions about how we plan, do and share rapid reviews. We will conduct a modified James Lind Alliance Priority Setting Partnership to determine the top 10 unanswered research questions about how we plan, do and share rapid reviews in collaboration with patients, public, reviewers, researchers, clinicians, policymakers and funders. Methods: An international steering group consisting of key stakeholder perspectives (patients, the public, reviewers, researchers, clinicians, policymakers and funders) will facilitate broad reach, recruitment and participation across stakeholder groups. An initial online survey will identify stakeholders' perceptions of research uncertainties about how we plan, do and share rapid reviews. Responses will be categorised to generate a long list of questions. The list will be checked against systematic reviews published within the past three years to identify if the question is unanswered. A second online stakeholder survey will rank the long list in order of priority. Finally, a virtual consensus workshop of key stakeholders will agree on the top 10 unanswered questions. Discussion: Research prioritisation is an important means for minimising research waste and ensuring that research resources are targeted towards answering the most important questions. Identifying the top 10 rapid review methodology research priorities will help target research to improve how we plan, do and share rapid reviews and ultimately enhance the use of high-quality synthesised evidence to inform health care policy and practice.

What are the most important unanswered research questions on rapid review methodology? A James Lind Alliance research methodology Priority Setting Partnership: the Priority III study protocol

Background: The value of rapid reviews in informing health care decisions is more evident since the onset of the coronavirus disease 2019 (COVID-19) pandemic. While systematic reviews can be completed rapidly, rapid reviews are usually a type of evidence synthesis in which components of the systematic review process may be simplified or omitted to produce information more efficiently within constraints of time, expertise, funding or any combination thereof. There is an absence of high-quality evidence underpinning some decisions about how we plan, do and share rapid reviews. We will conduct a modified James Lind Alliance Priority Setting Partnership to determine the top 10 unanswered research questions about how we plan, do and share rapid reviews in collaboration with patients, public, reviewers, researchers, clinicians, policymakers and funders. Methods: An international steering group consisting of key stakeholder perspectives (patients, the public, reviewers, researchers, clinicians, policymakers and funders) will facilitate broad reach, recruitment and participation across stakeholder groups. An initial online survey will identify stakeholders’ perceptions of research uncertainties about how we plan, do and share rapid reviews. Responses will be categorised to generate a long list of questions. The list will be checked against systematic reviews published within the past three years to identify if the question is unanswered. A second online stakeholder survey will rank the long list in order of priority. Finally, a virtual consensus workshop of key stakeholders will agree on the top 10 unanswered questions. Discussion: Research prioritisation is an important means for minimising research waste and ensuring that research resources are targeted towards answering the most important questions. Identifying the top 10 rapid review methodology research priorities will help target research to improve how we plan, do and share rapid reviews and ultimately enhance the use of high-quality synthesised evidence to inform health care policy and practice.

Identifying the top research priorities in postmastectomy breast cancer reconstruction: a James Lind Alliance priority setting partnership

BackgroundMajor improvements in breast cancer treatment in the last decade include advancements in postmastectomy breast reconstruction (PMBR). Unfortunately, the studies in PMBR are primarily researcher or industry led with minimal...

What are the most important unanswered research questions on rapid review methodology? A James Lind Alliance research methodology Priority Setting Partnership: the Priority III study protocol

Background: The value of rapid reviews in informing health care decisions is more evident since the onset of the coronavirus disease 2019 (COVID-19) pandemic. While systematic reviews can be completed rapidly, rapid reviews are usually a type of evidence synthesis in which components of the systematic review process may be simplified or omitted to produce information more efficiently within constraints of time, expertise, funding or any combination thereof. There is an absence of high-quality evidence underpinning some decisions about how we plan, do and share rapid reviews. We will conduct a modified James Lind Alliance Priority Setting Partnership to determine the top 10 unanswered research questions about how we plan, do and share rapid reviews in collaboration with patients, public, reviewers, researchers, clinicians, policymakers and funders. Methods: An international steering group consisting of key stakeholder perspectives (patients, the public, reviewers, researchers, clinicians, policymakers and funders) will facilitate broad reach, recruitment and participation across stakeholder groups. An initial online survey will identify stakeholders’ perceptions of research uncertainties about how we plan, do and share rapid reviews. Responses will be categorised to generate a long list of questions. The list will be checked against systematic reviews published within the past three years to identify if the question is unanswered. A second online stakeholder survey will rank the long list in order of priority. Finally, a virtual consensus workshop of key stakeholders will agree on the top 10 unanswered questions. Discussion: Research prioritisation is an important means for minimising research waste and ensuring that research resources are targeted towards answering the most important questions. Identifying the top 10 rapid review methodology research priorities will help target research to improve how we plan, do and share rapid reviews and ultimately enhance the use of high-quality synthesised evidence to inform health care policy and practice.

Workplace Positivity: Creating, Taking in, and Maintaining the Good

This panel symposium focuses on discussing theoretical and empirical questions that will help broaden our sight of, and deepen our insights into, constructs, phenomena, and processes involved in workplace positivity. Specifically, the focus of this panel discussion will be on how to create, take in, and sustain positivity at work each and every day. A group of experts will discuss 1) established and new key constructs in the area of workplace positivity, 2) established and new theoretical frameworks for the study of workplace positivity, 3) important unanswered research questions in the context of workplace positivity, and 4) opportunities and roadblocks in the study of workplace positivity.

What are the most important unanswered research questions in trial retention? A James Lind Alliance Priority Setting Partnership: the PRioRiTy II (Prioritising Retention in Randomised Trials) study

BackgroundOne of the top three research priorities for the UK clinical trial community is to address the gap in evidence-based approaches to improving participant retention in randomised trials. Despite this, there is little evidence supporting methods to improve retention. This paper reports the PRioRiTy II project, a Priority Setting Partnership (PSP) that identified and prioritised unanswered questions and uncertainties around trial retention in collaboration with key stakeholders.MethodsThis PSP was conducted in collaboration with the James Lind Alliance, a non-profit making initiative, to support key stakeholders (researchers, patients, and the public) in jointly identifying and agreeing on priority research questions.There were three stages. (1) First an initial online survey was conducted consisting of six open-ended questions about retention in randomised trials. Responses were coded into thematic groups to create a longlist of questions. The longlist of questions was checked against existing evidence to ensure that they had not been answered by existing research. (2) An interim stage involved a further online survey where stakeholders were asked to select questions of key importance from the longlist. (3) A face-to-face consensus meeting was held, where key stakeholder representatives agreed on an ordered list of 21 unanswered research questions for methods of improving retention in randomised trials.ResultsA total of 456 respondents yielded 2431 answers to six open-ended questions, from which 372 questions specifically about retention were identified. Further analysis included thematically grouping all data items within answers and merging questions in consultation with the Steering Group. This produced 27 questions for further rating during the interim survey. The top 21 questions from the interim online survey were brought to a face-to-face consensus meeting in which key stakeholder representatives prioritised the order. The ‘Top 10’ of these are reported in this paper. The number one ranked question was ’What motivates a participant’s decision to complete a clinical trial?’ The entire list will be available at www.priorityresearch.ie.ConclusionThe Top 10 list can inform the direction of future research on trial methods and be used by funders to guide projects aiming to address and improve retention in randomised trials.

Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder

Over the past several decades there has been a surge of research on the contextual, biological, and psychological factors associated with transportation safety in adolescence. However, we know much less about the factors contributing to transportation safety among adolescents who do not follow a typical developmental trajectory. Adolescents with developmental disabilities (DD) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) have a wide range of behavioral and psychological deficits that may make the complex task of driving even more challenging. Because these adolescents often retain characteristic symptoms of their disorder into adulthood, it may impede their ability to achieve important milestones during the developmental transition from adolescent to adult. As the motivating force behind autonomous living and employment, the capacity for independent transportation is paramount to an adolescent’s overall success. This critical review will draw from the current body of literature on adolescent drivers with developmental disabilities to determine (1) areas of impairment; (2) safety risk factors; and (3) effective interventions for improving driving safety in this vulnerable population of adolescent drivers between the ages of 15–22. This review will also identify important unanswered research questions, and summarize the current state of the literature.

Adiposity and gastrointestinal cancers: epidemiology, mechanisms and future directions.

Excess adiposity is a risk factor for several cancers of the gastrointestinal system, specifically oesophageal adenocarcinoma and colorectal, small intestine, pancreatic, liver, gallbladder and stomach cancers. With the increasing prevalence of obesity in nearly all regions of the world, this relationship could represent a growing source of cancers of the digestive system. Experimental and molecular epidemiological studies indicate important roles for alterations in insulin signalling, adipose tissue-derived inflammation and sex hormone pathways in mediating the association between adiposity and gastrointestinal cancer. The intestinal microbiome, gut hormones and non alcoholic fatty liver disease (NAFLD) also have possible roles. However, important gaps remain in our knowledge. For instance, our understanding of how adiposity throughout the life course is related to the risk of gastrointestinal cancer development and of how obesity influences gastrointestinal cancer prognosis and survival is limited. Nonetheless, the increasing use of state-of-the-art analytical methods (such as omics technologies, Mendelian randomization and MRI) in large-scale epidemiological studies offers exciting opportunities to advance our understanding of the complex relationship between adiposity and gastrointestinal cancers. Here, we examine the epidemiology of associations between obesity and gastrointestinal cancer, explore potential mechanisms underlying these relationships and highlight important unanswered research questions.

Priority setting in paediatric preventive care research

ObjectivesTo identify the unanswered research questions in paediatric preventive care that are most important to parents and clinicians, and to explore how questions from parents and clinicians may differ.DesignIterative mixed...

Working together to shape the endometrial cancer research agenda: The top ten unanswered research questions

BackgroundEndometrial cancer (EC) is the most common gynaecological cancer in developed nations and its incidence is rising. As a direct consequence, more women are dying from EC despite advances in care and improved survivorship. There is a lack of research activity and funding, as well as public awareness about EC. We sought to engage patients, carers and healthcare professionals to identify the most important unanswered research questions in EC. MethodologyThe priority setting methodology was developed by the James Lind Alliance and involved four key stages: gathering research questions; checking these against existing evidence; interim prioritisation; and a final consensus meeting during which the top ten unanswered research questions were agreed using modified nominal group methodology. ResultsOur first online survey yielded 786 individual submissions from 413 respondents, of whom 211 were EC survivors or carers, and from which 202 unique unanswered research questions were generated. 253 individuals, including 108 EC survivors and carers, completed an online interim prioritisation survey. The resulting top 30 questions were ranked in a final consensus meeting. Our top ten spanned the breadth of patient experience of this disease and included developing personalised risk scoring, refining criteria for specialist referral, understanding the underlying biology of different types of EC, developing novel personalised treatment and prevention strategies, prognostic and predictive biomarkers, increasing public awareness and interventions for psychological issues. ConclusionHaving established the top ten unanswered research questions in EC, we hope this galvanises researchers, healthcare professionals and the public to collaborate, coordinate and invest in research to improve the lives of women affected by EC.

Employee Mobility and Organizational Outcomes

A large and growing literature spanning multiple fields has identified employee mobility as a critical influence on several important organizational outcomes. However, extant research on the topic is highly fragmented and lacks a unifying theoretical framework, impeding the development of a cumulative conceptually integrated body of research. We seek to remedy this situation by undertaking a review of research on employee mobility and its organizational impacts and casting it within a novel integrative conceptual framework. As a critical foundation for this framework, we highlight how the various organizational impacts of employee mobility are ultimately engendered by different dimensions of human and/or relational capital that are conveyed by mobile individuals. Building on this foundation, we describe how multilevel contextual factors—characterized as attributes of the employee, source and destination firms, and environmental conditions—may moderate the transfer and utilization of human and relational capital held by mobile individuals. Finally, we review how constraining factors, such as labor market imperfections on both demand and supply sides, can impede employee mobility and also how alternative competing channels—for example, alliances, networks and geographic spillovers, and acquisitions—may be used for effectuating the same organizational impacts as mobility events. These constraints and competing channels are important because they circumscribe the conditions under which employee mobility can be a critical influence on organizational outcomes. We seek to provide a rich integrative theoretical understanding of employee mobility and spur future research on important unanswered research questions.

Patent Strategy and Management

This review reorganizes and reconceptualizes extant research on patent strategy, which has emerged from diverse roots in economics, law, and management. Accordingly, it is anticipated that this review will help provide structure and direction to what is currently a somewhat disparate and fractured field of study within management. The main proposed framework highlights two important themes within patent strategy research—generic patent strategies and the strategic management of patents. In addition, it is noted that research in each of these themes generally maps onto one or more of three key domains—rights, licensing, or enforcement—within which patent-related strategic actions are typically undertaken. Two summary tables of prior research are provided that juxtapose the three patent strategy domains with different theory lenses adopted in patent strategy research. Finally, the article highlights two promising areas whose connections with patent strategy are beginning to be addressed by research—firms’ overall appropriability strategies and value creation strategies. An overarching conceptual figure maps the different research areas reviewed in the article and highlights the relationships between these research literatures. The reconceptualization and reframing of prior research advanced in this review promises to advance scholarship on patent strategy by illuminating its many links with the broader management field and by identifying opportunities to address important unanswered research questions. It thus provides a useful roadmap to help stimulate and guide future management research in this vital area.

Viewpoint: The future of research in pediatric allergy: What should the focus be?

Allergic diseases have been increasing during the last three decades, and exact reasons for this are still debated. Despite intense ongoing research, a lot of aspects of allergic diseases are still poorly understood, resulting in limitations in current therapeutic approach to allergies. In this viewpoint, important unanswered research questions are raised mainly on novel therapeutic approaches to allergic children, and suggestions for future research are raised. Three aspects of pediatric allergy are distinguished: the prevention, control, and cure.

Insights into Melanosomes and Melanin from Some Interesting Spatial and Temporal Properties

Melanosomes are organelles found in a wide variety of tissues throughout the animal kingdom and exhibit a range of different shapes: spheres of up to approximately 1 mum diameters and ellipsoids with lengths of up to approximately 2 mum and varying aspect ratios. The functions of melanosomes include photoprotection, mitigation of the effects of reactive oxygen species, and metal chelation. The melanosome contains a variety of biological molecules, e.g., proteins and lipids, but the dominant constituent is the pigment melanin, and the functions ascribed to melanosomes are uniquely enabled by the chemical properties of the melanins they contain. In the past decade, there has been significant progress in understanding melanins and their impact on human health. While the molecular details of melanin production and how the pigment is organized within the melanosome determine its properties and biological functions, the physical and chemical properties of the surface of the melanosome are central to their range of ascribed functions. Surprisingly, few studies designed to probe this biological surface have been reported. In this article, we discuss recent work using surface-sensitive analytic, spectroscopic, and imaging techniques to examine the structural and chemical properties of many types of natural pigments: sepia melanin granules, human and bovine ocular melanosomes, human hair melanosomes, and neuromelanin. N 2 adsorption/desorption measurements and atomic force microscopy provide novel insights into surface morphology. The chemical properties of the melanins present on the surface are revealed by X-ray photoelectron spectroscopy and photoemission electron microscopy. These technologies are also applied to elucidate changes in surface properties that occur with aging. Specifically, studies of the surface properties of human retinal pigment epithelium melanosomes as a function of age are stimulating the development of models for their age-dependent behaviors. The article concludes with a brief discussion of important unanswered research questions in this field.

Fungal pathogenesis: Bridging the gap between the bedside and the bench

A meeting titled ‘Fungal Pathogenesis – Bridging the gap between the bedside and the bench’ was held at the University of Wisconsin, Madison in September 2004. The conference was sponsored by a generous unrestricted educational grant from Enzon Pharmaceuticals. This unique conference was intended to expose clinical and basic scientists and their trainees to the most recent advances and relevant questions in both clinical and laboratory medical mycology research. The meeting was predicated on the concept that crosstalk between basic and clinical researchers would facilitate discussions leading to collaboration and the development of new research questions and eventually important advances. Presentation topics included four fungal genera: Aspergillus, Candida, Cryptococcus, and Histoplasma. The state of research in both clinical disease and pathogenesis for each genus was presented sequentially. Each speaker was charged with not only presenting their research, but with the task of demonstrating application of new technical tools available to answer important questions, and lastly to speculate on the most important unanswered research questions. The four clinical presentations challenged the basic researchers to refocus current experimental approaches to address the most pressing clinical problems. The basic science talks demonstrated many of the tools now available to explore further the epidemiology, diagnosis, and therapy of these medical mycoses as well as molecular mechanisms of pathogenesis. A significant amount of time between sessions and during refreshment breaks allowed questions and discussion among the two groups and their trainees. The conference attracted more than 100 local and regional scientists and clinicians as well as a few international attendees.

Improving the quality of community care for the chronically mentally disabled: the role of case management.

This article draws upon an extensive case management literature in order to integrate a number of key concepts and findings that must be considered by those responsible for the planning, administration, and provision of effective community care to the chronically mentally disabled. A discussion of the reasons for the current popularity of the case management concept within human services is followed by a detailed presentation of the objectives, ideology, functions, and structural elements that characterize case management systems. A series of practical problems and issues that must be addressed to effectively implement a case management system are then identified and analyzed. Finally, a set of recommendations for those developing case management systems is offered, and a number of important unanswered research questions about the delivery and impact of case management services are identified.