Translation Research

Translational research is a relatively new term in medicine, and it varies distinctly from basic clinical research. Translational research is an interdisciplinary field that applies findings from various biomedical studies to the nursing practice with the intention of improving healthcare delivery (Robertson and Williams, 2009). In essence, basic research has been advanced to a whole new level because of the incorporation of new knowledge from other disciplines. For example, as a result, of translational research, new possibilities of preventing, diagnosing and treating diseases have been brought to light. The concept of translation of new knowledge is invaluable to the nursing practice, and it has contributed towards meaningful health outcomes since its adoption. This paper examines the importance of translational research in healthcare, how it has developed over time, the fundamental role played by doctors of nursing practice (DNPs) in research translation and the importance of teamwork in realizing the goals of translational research.

Background

For a long time, a vacuum has existed in the medical field in that the results of research carried out in hospitals are not put to any meaningful use (Hu, Mural and Liebman, 2008). This factor prompted scholars in the medical field to work towards the development of a multi-centric research model that uses findings from various surveys to improve the quality of healthcare services. Therefore, the need to translate scientific research results into the nursing practice intensified and experiments carried out in the laboratory were further adopted by clinics for trials. Clinical trials that proved successful became an important milestone in the development of point-of-care patient applications. Today, there are a variety of new drugs, equipment and treatment options for patients courtesy of the knowledge harnessed from translational research. Nevertheless, translational research remains a relatively new discipline whose success heavily relies on the combination of both aspects of basic science and clinical research.

The Goal of Translational Research

Theoretically, translational research came in to fill the gap created by the failure to implement research findings. The primary objective of this research is to significantly improve the global healthcare system regarding diagnosis, prevention and treatment of diseases by combining resources and expertise from the relevant disciplines. Translational research hopes to drive deeper discoveries in the global healthcare system by ensuring that scientific findings are applied to clinical practice. This research can also be looked at from the patients’ point of view because ultimately, it aims to improve patient care and promote public health.

The Development of Translational Research in Healthcare

As earlier established, translational research is a relatively new concept whose first application to healthcare can be traced back to the early 2000s. The Journal of the American Medical Association (JAMA) published in 2002 reiterated the need to translate the scientific knowledge acquired from other disciplines to the practice of nursing (Aronoff, 2011). Later in 2005, the Translational Research Working Group (TRWG) was created in the US. With the primary role of financing translational research. TRWG essentially set the stage of translational research and institutions of higher learning embraced the concept positively. For instance, in 2007, the University of Washington created the Institute of Translational Health Services (ITHS) that was tasked with strengthening genetic medicine (Aronoff, 2011). Since then, translational research has gained prominence in the nursing practice with many governments around the world assigning a significant portion of their healthcare budgets to translational research.

Importance of Translational Research in Healthcare

Translational research has not only improved the quality of patient care but also made it safer and more cost effective. Translating research findings into the practice of nursing has led to the development of new drugs and devices that have facilitated the process patient care. Previously unexploited medical resources have been explored, and the result is the invention of drugs that combat serious health hazards. The ultramodern equipment used by medical personnel significantly enhance the diagnostic process making results more precise. Patients have also benefited from the fruits of translational research since the costs associated with health care have considerably dropped. Furthermore, patients enjoy a pleasant experience with the nursing personnel while admitted to a hospital. Translational research remains important in as far as the provision of quality care is concerned because with subsequent research initiatives, the new knowledge acquired will have to be integrated into clinical nursing.

The Role of DNPs in Translational Research

It is worth noting that translating biomedical evidence into meaningful health outcomes is not an easy task. Implementing the research data requires the input of relevant stakeholders for an effective action-based learning. DNPs are integral elements of translational research because they possess the necessary clinical education needed for translating the knowledge. First, DNPs have to be trained in the various research designs, for example, participatory and iterative designs, which enable them accurately interpret research findings (Chesla, 2008). The training also ensures that the DNPs have a clear picture of the relevant pattern of stakeholders’ thought and behavior (. A diverse group of stakeholders is likely to have varying perspectives and trained DNPs can effectively assess the opinions and arrive at an agreeable conclusion. Another important role played by DNPs is that of coordinating team members in their respective collaborative learning communities, a factor that enhances translational productivity. Essentially, DNPs translate academic research into patient-oriented clinical practice.

The Importance of Professional Collaboration and Teamwork

Medicine as a field is very broad with complex concepts that cannot be possibly understood by a single person. Therefore, it is important that healthcare providers embrace the spirit of teamwork positively since such professional collaborations will result in improved outcomes for patients. The importance of collaboration in healthcare cannot be underestimated because doctors, nurses and the other healthcare professionals have to work together towards the achievement of a common goal. Teamwork is highly recommended because it reduces medical error. A couple of nurses working on the same patient will easily notice a medical error as opposed to when the patient was being attended to by a single nurse. Patient safety is also significantly increased courtesy of teamwork since the welfare of an individual patient is addressed by a group of nurses.

Teamwork enhances problem-solving and serious medical problems in a particular field, say neurology, are tackled by a team of specialists belonging to that area. A lot of nurses have complained about exhaustion and being overworked in the past, an issue that can be addressed by embracing teamwork. A single nurse will no longer have to burn out because of being responsible for the health of several patients. On a lighter note, team building activities are normally effective in strengthening the bond among working colleagues. In fact, research has revealed that nurses who frequently experience team building programs are more satisfied with their jobs (Grady, 2010).

Conclusion

Indeed, translational research has made tremendous contributions to the health care system by integrating scientific research findings into clinical practice. The results are notable, and it is doubtless that the future of global healthcare looks bright as long as translational research is still exploited. Nevertheless, a wide gap still exists between the scientific community and the healthcare community and it is essential that this gap is bridged by forming partnerships between schools, healthcare services, and community organizations.

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Can Thrombotic Thrombocytopenic Purpura (TTP) be described as both a clotting disorder and a bleeding disorder?

Blood is fundamental for life. It consists of Plasma, Platelets, White blood cells and Red blood cells (Encyclopædia Britannica). Red blood cells carry oxygen and nutrients to every organ of the body and return carbon dioxide to the lungs. The white blood cells shield the body from infections while the platelets assist in coagulation process (blood clotting). A blood disorder occurs when one or more components of the blood are affected. Blood disorders bring a great deal of problems to human health (United States, 2008). Blood disorders are classified into four categories; clotting disorders, bleeding disorders, anemia and disorders of the bone marrow (United States, 2008). This essay seeks to establish whether Thrombotic Thrombocytopenic Purpura (TTP) can be described as both a clotting disorder and a bleeding disorder.

Thrombotic Thrombocytopenic Purpura is a blood disorder because it affects the platelet component of the blood. Thrombotic comes from the word thrombosis meaning coagulation of blood in a blood vessel; Thrombocytopenic is the drop in the platelet count in the blood while Purpura refers to the purple spots on the skin (Dictionary.com). Miller-Keane Encyclopedia (2003) defines TTP as a bleeding condition portrayed by oozing of blood under the skin, into the body tissues, and creating unstructured bruises (purpura) on the skin. It uses up platelets to form blood clots in small blood vessels in the entire body, leaving a small number of platelets in the blood. Kuter (2014) adds that the reduced number of platelets may be caused by very many platelets having been destroyed or the bone marrow being unable to make enough platelets. The blood clots formed, restrict the flow of blood to the vital organs of the body, putting a risk owing to lack of nutrients and oxygen.

Blood is destined to clot. When there is an injury, blood oozes out a little and then coagulates. In a normal haemostasis, the platelets assemble at an injury spot, attach themselves to the inside layer of the affected blood vessel and create a platform on which blood clotting can take place. Barlow-Stewart, Emery and Metcalfe (2007) assert that the clotting happens outside the body, and if it does happen inside, then there is something wrong. A person is said to have clotting disorder if his/her blood clots very easily within the body. According to a United States publication (2008, p.107) such blood clots take place in the veins and occasionally in the arteries. A blood clot may remain in one part of the blood vessel. It causes deep venous thrombosis or DVT, or it may circulate through the blood stream to the vital organs of the body causing venous thromboembolism (Barlow-Stewart, Emery and Metcalfe, 2007, p.1)

Bleeding disorders occur when there is abnormal blood clotting or when bleeding takes too long to stop. Journeycake and Buchanan (2003) emphasize that if the following three signs appear, then consider it a bleeding disorder. The first one is if there is persistent or severe bleeding. Secondly, if there is blood seeping out from more than one site and finally when medical intervention is essential such as blood transfusion. Irish Haemophilia Society (2010, p.2) argues that there are well known and common bleeding disorders such as the von Willebrand disease, Haemophilia A and Haemophilia B but insists that there also exists a big number of bleeding disorders that have something to do with both the platelets and coagulation factors. Israels, Schwetz, Boyar and Mcnicol (2006) add that what hampers haemostasis are abnormalities that are either acquired or inherited. Too much bleeding can arise from platelet deficiency, blood vessel fragility/dysfunction, derangement of clotting, or a combination of all.

What causes TTP is unclear; however it is argued (Levy et al. 2001) that it is caused by the absence of ADAMTS13 gene that controls the protein that helps in blood clotting. Vesely et al. (2003) agrees that the deficiency of the gene causes TTP. Gerritsen et al. (1999) says that people with TTP have been found to have a deficiency of von Willebrand factor (vWF). Von Willebrand factor is not an enzyme, but it is a cleaving protease. Its main role in the blood is binding to other proteins enhancing blood coagulation. Therefore, its deficiency leads to a bleeding tendency. ADAMTS13 enzyme mediates the catabolism (biological breakdown) of vWF hence its deficiency leads to decreased breakdown of the ultra-large multimers of vWF.

In TTP, platelets use vWF molecule to stick themselves together in form of clots. When the vWF become very long, the platelets will form clots even when they are not supposed to. The body normally keeps vWF in the right length using enzyme ADAMTS13. If the body is unable to keep vWF short enough to prevent abnormal clot and destruction to the blood vessels of the body, then TTP occurs. When blood clots in the blood vessels throughout the body, a few platelets are left such that in the event of an injury, bleeding continues for long, and internal bleeding occurs. The blood clots form and circulate in the entire body ending up in the vital organs such as kidneys and the brain.

The minute clots have two key effects. First, by circulating throughout the body, they can block the blood veins preventing blood from reaching the vital organs of the body. This restriction can compromise their performance (Kuter, 2014). Second, the small blood clots can use up numerous platelets. This results to blood being unable to clot when it is required to. For this reason in the event of an injury, bleeding continues for long. Since TTP is a deadly disease of abrupt start and unclear cause (LEVY et al., 2001), it is unpreventable.

From the descriptions of both the blood disorders and clotting disorders, it is evident that Thrombotic Thrombocytopenic Purpura can comfortably be described as being both a blood disorder and a bleeding disorder. It is a bleeding disorder because firstly, blood seeps out through the skin due to reduced number of platelets in the blood. Secondly, blood oozes out from more than one site. Thirdly, the bleeding continues for a long time. Lastly, bruising occurs on the skin (Miller-Keane Encyclopedia, 2003), and the disease is fatal if no immediate medical intervention is taken (George, 2006). On the other hand, TTP is a clotting disorder because the disease occurs due to abnormal clotting of the blood. Blood clots form within the blood vessels instead of outside the body at an injury spot. Blood clots form easily and circulate in the blood throughout the body even to the vital organs like the kidneys and the brain.

In conclusion, Thrombotic Thrombocytopenic Purpura is an uncommon medical emergency of the blood whose cause is unknown. It affects mainly adults (George, 2006). It is potentially fatal (Rock et al., 1991 p.393) due to the formation of microscopic blood clots throughout the body putting a risk to the critical organs of the body such as the heart, kidneys and brain (Byrnes and Khurana, 1977). Life-threatening bleeding occurs due to both internal and external bleeding. TTP is both a bleeding and clotting disorder since it has the characteristics of both.

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