Stakeholder engagement analysis - a bioethics dilemma in patient-targeted intervention: patients with temporomandibular joint disorders

Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project

BACKGROUND

Designing intervention and implementation strategies with careful consideration of context is essential for successful implementation science projects. Although the importance of context has been emphasized and methodology for its analysis is emerging, researchers have little guidance on how to plan, perform, and report contextual analysis. Therefore, our aim was to describe the Basel Approach for coNtextual ANAlysis (BANANA) and to demonstrate its application on an ongoing multi-site, multiphase implementation science project to develop/adapt, implement, and evaluate an integrated care model in allogeneic SteM cell transplantatIon facILitated by eHealth (the SMILe project).

METHODS

BANANA builds on guidance for assessing context by Stange and Glasgow (Contextual factors: the importance of considering and reporting on context in research on the patient-centered medical home, 2013). Based on a literature review, BANANA was developed in ten discussion sessions with implementation science experts and a medical anthropologist to guide the SMILe project's contextual analysis. BANANA's theoretical basis is the Context and Implementation of Complex Interventions (CICI) framework. Working from an ecological perspective, CICI acknowledges contextual dynamics and distinguishes between context and setting (the implementation's physical location).

RESULTS

BANANA entails six components: (1) choose a theory, model, or framework (TMF) to guide the contextual analysis; (2) use empirical evidence derived from primary and/or secondary data to identify relevant contextual factors; (3) involve stakeholders throughout contextual analysis; (4) choose a study design to assess context; (5) determine contextual factors' relevance to implementation strategies/outcomes and intervention co-design; and (6) report findings of contextual analysis following appropriate reporting guidelines. Partly run simultaneously, the first three components form a basis both for the identification of relevant contextual factors and for the next components of the BANANA approach.

DISCUSSION

Understanding of context is indispensable for a successful implementation science project. BANANA provides much-needed methodological guidance for contextual analysis. In subsequent phases, it helps researchers apply the results to intervention development/adaption and choices of contextually tailored implementation strategies. For future implementation science projects, BANANA's principles will guide researchers first to gather relevant information on their target context, then to inform all subsequent phases of their implementation science project to strengthen every part of their work and fulfill their implementation goals.

Drug Discovery for Coronary Artery Disease

Cardiovascular disease is the number one cause of human morbidity and mortality worldwide. Although cholesterol-lowering drugs, including statins and recently approved PCSK9 inhibitors, together with antithrombotic drugs have been historically successful in reducing the occurrence of coronary artery disease (CAD), the high incidence of CAD remains imposing the largest disease burden on our healthcare systems. We reviewed cardiovascular drugs recently approved or under clinical development, with a particular focus on their pharmacology and limitations. New agents targeting cholesterol/triglyceride lowering bear promise of further cardiovascular risk reduction. Some new antidiabetic agents show cardiovascular benefit in patients with diabetes. Improved antithrombotic agents with diminished bleeding risk are in clinical development. The recent clinical success of the IL-1β antibody in reducing atherothrombosis opens a new era of therapeutic discovery that targets inflammation. Chinese traditional medicine and cardiac regeneration are also discussed. Human genetics studies of CAD and further delineation of key determinants/pathways underlying the residual risk of CAD under current standard therapy will continue to fuel the pipeline of cardiovascular drug discovery.

Ethical Aspects of Translating Research with Human Pluripotent Stem Cell Products into Clinical Practice: A Stakeholder Approach

Experimental therapies with embryonic stem cells (hESCs) and, more recently, human induced pluripotent stem cells (hiPSCs) are steadily gaining ground in clinical practice. The implementation of such novel high-risk/high-potential treatments calls for proper safeguards for the interests of the public and, most importantly, of research participants directly affected by the design and outcomes of trials. We argue that the active involvement of stakeholders in decision-making is ethically required. Public and patient involvement is a necessary prerequisite for dealing responsibly with high-risk/high-potential clinical research such as stem-cell research. Moreover, there is an urgent need for public debate, regionally and globally, about the present and future value of such types of research. A stakeholder approach that pays attention to all of the people and institutions involved, including patients and their organizations, will guide the translational process and maintain the public's trust in such a rapidly evolving scientific field.

FABP4 as a key determinant of metastatic potential of ovarian cancer

The standard treatment for high-grade serous ovarian cancer is primary debulking surgery followed by chemotherapy. The extent of metastasis and invasive potential of lesions can influence the outcome of these primary surgeries. Here, we explored the underlying mechanisms that could increase metastatic potential in ovarian cancer. We discovered that FABP4 (fatty acid binding protein) can substantially increase the metastatic potential of cancer cells. We also found that miR-409-3p regulates FABP4 in ovarian cancer cells and that hypoxia decreases miR-409-3p levels. Treatment with DOPC nanoliposomes containing either miR-409-3p mimic or FABP4 siRNA inhibited tumor progression in mouse models. With RPPA and metabolite arrays, we found that FABP4 regulates pathways associated with metastasis and affects metabolic pathways in ovarian cancer cells. Collectively, these findings demonstrate that FABP4 is functionally responsible for aggressive patterns of disease that likely contribute to poor prognosis in ovarian cancer.

Evidence-Based Dentistry: Two Decades and Beyond

BACKGROUND

In 1999, the American Dental Association proffered a definition of the term evidence-based dentistry, which is still very much used to this day. It stated that "… evidence-based dentistry is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences." Concerted research during the past 2 decades have defined and characterized the protocols that obtain the qualitative and quantitative consensus of the best evidence base. This component of evidence-based dentistry, which is referred to as evidence-based dental research, is brought about as comparative effectiveness research with the research synthesis design. The best evidence base is judiciously used to generate evidence-based clinical practice guidelines, which in turn inform evidence-based dental practice.

DISCUSSION

At this juncture, the complexity of the construct of evidence-based dentistry dictates several avenues of current and future inquiry and development. The most urgent and important of these is undoubtedly to craft and validate novel didactic and practical methodologies to teach evidence-based dentistry-both research and practice-to the next generation of dental researchers and clinical dentists and to optimize the integration of evidence-based dentistry in the dental curriculum. Secondarily, but certainly not of lesser importance, is the need to open and expand new research opportunities in subdomains critical to successful evidence-based dental practice, such as stakeholder engagement, teledentistry, patient-centered care, individual patient data analysis, and health literacy of the patients and caregivers.

CONCLUSIONS

The course that has led evidence-based dentistry from its infancy in 1999 to a state of relative recognition, if not acceptance across academic and private clinical dentistry in the United States and abroad that the field enjoys today, has been arduous. The concerted efforts by researchers and clinicians were aided considerably by the political environment, which, during the years, proffered funding to the Agency for Healthcare Research and Quality and the Patient-Centered Outcome Research Institute. These have been significant catalysts of the field of comparative effectiveness research and evidence-based research in medicine and dentistry and have fostered and defended the pursuit of evidence-based endeavors in translational health care. The road ahead does not promise to be easier in next 2 decades. In fact, it has become all the murkier and more complicated now as phrases such as science based and evidence based have presently been banned and declared politically incorrect.

Lubricin: A Principal Modulator of the Psychoneuroendocrine - Osteoimmune Interactome - Implications for Novel Treatments of Osteoarthritic Pathologies

Lubricin is a synovial glycoprotein that contributes to joint lubrication. We propose the hypothesis that lubricin is a key modulator of the psychoneuroendocrine-osteoimmune interactome, with important clinical relevance for osteoarthritic pathologies. We consider a variety of neuroendocrine-immune factors, including inflammatory cytokines and chemokines that may contribute to the modulation of lubricin in rheumatic complications. Based on our preliminary immunocytochemistry and fractal analysis data, and in the context of translational research of modern healthcare, we propose that molecular lubricin gene expression modification by means of the novel CRISPR/Cas system be considered for osteoarthritic therapies.

Testing patient targeted therapies in patients with temporomandibular joint disorder with the arthrokinetic reflex: individual patient research

Traditional research in the health sciences has involved control and experimental groups of patients, and descriptive and inferential statistical analyses performed on the measurements obtained from the samples in each group. As the novel model of translational healthcare, which integrates translational research and translational effectiveness, becomes increasingly established in modern contemporary medicine, healthcare continues to evolve into a model of care that is evidence-based, effectiveness-focused and patient-centered. Patient-centered care and patient-targeted therapies require the timely and critical development and validation of a new research paradigm, individual patient research (IPR), as opposed to the customary group research approach. Here, we propose a model of individual patient research to define and characterize the effectiveness of a novel therapeutic intervention for temporomandibular joint disorder. The intervention must be tailor-made for each individual patient, and the data from each patient must be analyzed individually. We propose that this endeavor is best achieved by means of an adaptive cluster randomized stepped wedge blinded controlled trial, because it permit individual patient outcomes research and analysis, ensures equipoise, and maintains adequate power. The patient targeted therapies section of the Journal of Translational Medicine must endeavor to facilitate the dissemination of studies that focus broadly on translational research for the ultimate benefit of individual patients.