As illustrated in figure 6, an exposure is identified that is believed to be associated with a specific outcome. The stronger an association, the more likely it is to be causal, and associations that are consistently reported in the literature are more likely to be causal. These investigators examined the first part of this proposed mechanism in the animal model, reporting that ethanol-fed rats have significantly decreased glutathione concentrations in lung tissue, lung lavage fluid, and alveolar type II cells. The last half century has yielded many basic discoveries. All Rights Reserved. - 222 - Padilha MI 23, No. “Research” is a broad stroke of a word, the verbal equivalent of painting a wall instead of a masterpiece. In clinical and translational research, scientific discoveries are moved along a virtual path from the laboratory into real-world practice, leading to improved human health.Translational research definitions courtesy of Harvard Catalyst and the Harvard Clinical and Translational Science Center, a Clinical and Translational Science Award (CTSA) member institution. For example, basic science investigators in our group developed a septic model to examine the effects of alcohol abuse in rats. The importance of collaboration between basic science and clinical researchers to determine the mechanisms responsible for epidemiological associations cannot be underestimated. It is therefore more accurate to discuss the effects of body position on VAP in relation to the presence or absence of enteral feeding as it is an effect modifier on the relationship between body position and the development of VAP. The discovery of mechanisms underlying these associations may lead to goal directed therapies that will ultimately improve the outcome of the critically ill patients we care for on a daily basis. Finally, avoid including variables in the causal pathway as potential confounders as they will mask risk factors that may be causal in a given disease state. All Rights Reserved. By Ellen L. Burnham, MD and Marc Moss, MD. The application of findings derived in basic science to the development of new understanding of disease mechanisms, diagnoses, and therapeutics in humans is known as translational research . Another model for translational research is bi-directional, where ideas flow from the bedside to the bench and back again. There are important distinctions among the three principal types of medical research — basic, clinical and translational. Our confounding variable of concern is smoking. Once a clinically important association has been identified, translation to the basic science laboratory is often necessary to determine the actual causal pathway or mechanism. In this model, epidemiological studies that capitalize on heterogeneity in a population identify clinically important associations, fueling basic science investigation and further clinical translational research. Quality of care is another component associated with acute illness. Some investigators have recommended new definitions of ICU syndromes based on biochemical criteria of inflammation, rather than clinical parameters to direct therapies at specific inflammatory components. With the development of diverse new technologies, remarkable advances have occurred in the understanding of the molecular and genetic bases of disease. The Meaning of Translational Research and Why It Matters. Weeding out failures earlier in the process can significantly decrease the overall cost of developing new products. Epidemiological studies can also be analytical, where determinants of variability in a disease are sought. An example from the recent literature is the relationship between body position (the primary exposure) and the incidence of ventilator-associated pneumonia (the outcome variable) . Heterogeneity in patient populations is a key concept in identifying clinically relevant associations that warrant further investigation. The authors reported a decreased frequency of ventilator-associated pneumonia in a semi-recumbent patient position (8%) than in a supine position (34%); however, the presence of enteral feedings was demonstrated to be an effect modifier. In summary, heterogeneity in the incidence of ARDS due to chronic alcohol abuse was initially observed in a clinical sample of patients with ARDS. A classic example of genetic factors affecting outcome was illustrated by Sorensen and colleagues , who studied causes of premature death in children who were adopted at an early age. Besides academic centers, foundations, industry, disease-related organizations, and individual hospitals and health systems have also established translational research programs and at least 2 journals (Translational Medicine and the Journal of Translational Medicine) are devoted to the topic.
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