Research on emerging infectious diseases continues to grow; however, some practitioners feel that a focus on knowledge acquisition has overshadowed the distribution of that knowledge to the frontline providers who need it most.
“He who hesitates is lost.”
Cliché though it may be, the rule definitely applies to the implementation of new research findings into clinical practice, particularly in the face of global disease outbreaks—eg, Zika virus infection—according to a commentary published in the New England Journal of Medicine (NEJM). As the Houston-based authors of the NEJM commentary note, although rapidly adding to the knowledge base on emerging infectious diseases such as Zika is “critical” and “should continue,” they express concern that the “focus on knowledge acquisition has overshadowed” the dissemination of that knowledge to clinicians in the field.
“Previous research has estimated that it takes roughly 17 years for research evidence to reach clinical practice,” Stephanie Morain, PhD, MPH, Assistant Professor, Center for Medical Ethics and Health Policy, Baylor College of Medicine said in a statement released by the school in conjunction with the publication of the NEJM commentary. “In the case of a virus, like Zika… the need for concise translation of research findings to the clinic is much more immediate.”
As an example of how the bench-to-bedside disconnect manifests itself in the field, Dr. Morain and her colleagues highlight the fact that, despite Centers for Disease Control and Prevention (CDC) recommendations that infants born to mothers who had laboratory evidence of Zika during pregnancy undergo a comprehensive physical exam, head ultrasound, and laboratory testing for the mosquito-borne virus, only 25% of such infants actually have brain imaging and only 65% have appropriate lab testing, according to research published in the CDC’s Morbidity and Mortality Weekly Report.
Dr. Morain et al suggest that there are several ways for the scientific and medical communities to address these “translational gaps” and overcome the common barriers to implementation, such as resource and cost constraints. They urge societies such as American Academy of Pediatrics (AAP) and the American Congress of Obstetricians and Gynecologists to “expand the reach of their educational programming and increase their coordination efforts” by making resources available to wider audiences. At present, they note, many of these programs are available only to paying society members, meaning they “may reach only a fraction of the providers in a given specialty or geographic area.”
Societies can overcome these educational gaps, they suggest, through strategic partnerships with groups in Zika-affected areas. Such partnerships could also foster enhance “peer-to-peer learning opportunities,” empowering providers in regions lacking sufficient medical personnel (eg, nurse practitioners and physician assistants) by providing them with the knowledge necessary to interpret Zika test results and implement the latest diagnostic criteria. One successful example of this is Project ECHO (Extension for Community Healthcare Outcomes) Zika, a “telementoring” platform established by the AAP and the US Department of Health and Human Services that links community providers to each other and to academic specialists.
“Many rural counties in Texas do not have convenient access to physicians or obstetricians, so engaging a wide network of primary care providers is crucial in treating Zika in these areas that have seen active transmission, but may not have the knowledge or resources to screen or refer patients,” Dr. Morain said in the Baylor release. “Zika is a relatively new epidemic, but this challenge of translating clinical recommendations is not. There is such a crucial need to not only conduct rapid clinical and scientific research but also to circulate and implement these findings in the clinic… We need not only to learn, but also to do.”
Of course, as helpful as the commentary authors’ recommendations could be in improving outbreak response, they may not be sufficient to overcome another notable Zika-related delay—that being Congress’ lateness in providing necessary federal funding for dealing with the disease.
Then again, to use another cliché, “Rome wasn’t built in a day.”
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.