The Translational Research Spectrum

What is the Translational Spectrum?

Translational research involves moving knowledge from basic science to proof-of-concept studies (T1),  clinical trials  (T2), medical practice (T3) and population health (T4). As shown in the table below, CTSI research has impacted health across the translational spectrum. We prioritize groups that  historically have been excluded from research, including older adults, children, and populations experiencing health disparities.

T1
Translation to Humans

  • Preclinical and animal studies

  • Proof-of-concept (POC)

  • Early-stage clinical trials

T2
Translation to Patients

  • Later phase clinical trials

T3
Translation to Practice

  • Health Services Research (HSR)
  • Dissemination and implementation
  • Studies in real-world settings

T4
Translation to Population Health

  • Interventions that improve population health
  • Social determinants of health

Across the CTSI:
Examples of projects and their impact

TL1
Population: Children

Supported by a CTSI Core Voucher Award, April Pyle, PhD, created functional skeletal muscle cells and used them in animal models of Duchene muscular dystrophy to restore dystrophin, the protein missing in the muscle-wasting disease that affects boys and young men.

Outcome. Her successful research was published in Nature Cell Biology [1].

Assisted by the CTSI’s study activation team in the CTRC, Noah Federman, MD, led UCLA’s participation in the multisite clinical trial of larotrectinib in children with bone and soft tissue sarcoma. 

Outcome. Results published in the NEJM led to FDA approval of the drug in children and adults with cancers that have an NTRK gene fusion, the second tissue-agnostic drug ever approved [2].

T2
Population: Children
T3
Population: Disparities

With assistance from CTSI pilot funds, the biostatistics core, research assistant support, and a health economist, the Los Angeles County Department of Health Services (DHS) implemented an intervention to conduct diabetic retinopathy screenings in primary care and transmit retinal images to optometrists for referrals to ophthalmologists, if necessary.

Outcome. The intervention eliminated the need for more than 14,000 visits to specialty eye-care professionals, increased annual rates of screening for diabetic retinopathy, and reduced wait times for screenings. The study was the first to evaluate the effect of a system-level intervention on improving access to eye care and definitive treatment for diabetic retinopathy in an urban medically underserved, or safety net, population [7].

With funding from a CTSI Safety-Net Innovation Award, Dong Chang, MD of Harbor, developed an intervention that brought families and patients into the decision-making process to reduce non-beneficial ICU care. 

Outcome. Based on these results, Dr. Chang and his team received a foundation award to conduct a wider study involving additional hospitals across the county [4].

T3
Population: Disparities
T3
Population: Disparities and Older Adults

Work by KL2 scholar John Mafi, MD, demonstrated that a multipronged nurse-led, quality-improvement initiative at a Los Angeles safety-net hospital was associated with sustained reductions in low-value preoperative testing for cataract surgery compared with a control safety-net site. 

Outcome. This work led to county-wide implementation and to an R01 to incorporate behavioral economics approaches in partnership with UCLA Anderson School of Management faculty [3].

As a KL2 Scholar, Joshua Pevnick, MD, of Cedars implemented a method to obtain accurate medication history for every high-risk patient upon admission. 

Outcome. His research contributed to passage of California Senate Bill 1254, which requires hospital pharmacy staff to obtain medication histories upon admission, enhancing patient safety [5, 6].

T4
Population: Older Adults

 

References

  1. Hicks MR, Hiserodt J, Paras K, Fujiwara W, Eskin A, et al. (2018) ERBB3 and NGFR mark a distinct skeletal muscle progenitor cell in human development and hPSCs. Nat Cell Biol, 20(1):46-57. Epub date: 2017/12/20 PMC5962356.
  2. Drilon A, Laetsch TW, Kummar S, DuBois SG, Lassen UN, et al. (2018) Efficacy of larotrectinib in TRK fusion-positive cancers in adults and children. N Engl J Med, 378(8):731-739. Epub date: 2018/02/22 PMC5857389.
  3. Mafi JN, Godoy-Travieso P, Wei E, Anders M, Amaya R, et al. (2019) Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system. JAMA Intern Med, 179(5):648-657. Epub date: 2019/03/26 PMC6503569.
  4. Chang D, Parrish J, Kamangar N, Liebler J, Lee M, et al. (2019) Time-limited trials among critically ill patients with advanced medical illnesses to reduce nonbeneficial intensive care unit treatments: Protocol for a multicenter quality improvement study. JMIR Res Protoc, 8(11):e16301. Epub date: 2019/11/26 PMC6902129.
  5. Pevnick JM, Nguyen C, Jackevicius CA, Palmer KA, Shane R, et al. (2018) Improving admission medication reconciliation with pharmacists or pharmacy technicians in the emergency department: a randomised controlled trial. BMJ Qual Saf, 27(7):512-520. Epub date: 2017/10/08 PMC5912995.
  6. Martinez C (2018) Pharmacy Chief’s Passion for Medication Safety Leads to New Law. Accessed April 10, 2020.
  7. Daskivich LP, Vasquez C, Martinez C, Tseng C, Mangione CM. Implementation and Evaluation of a Large-Scale Teleretinal Diabetic Retinopathy Screening Program in the Los Angeles County Department of Health Services. JAMA Intern Med. 2017;177(5):642–649. doi:10.1001/jamainternmed.2017.0204