By Sara Hocker, MD; Shraddha Mainali, MD; and Andrew Naidech, MD
The fifth Neurocritical Care Research Conference, “The Future of Neurocritical Care Research: Looking for a Blue Ocean,” was held in Boca Raton, Florida, on Sept. 25, 2018. The primary aim of this interdisciplinary scientific symposium was to bring together scientists and healthcare professionals from diverse fields with a common interest in understanding and advancing research in neurocritical care and to set the agenda for the future direction of the Neurocritical Care Research Network (NCRN) and the Neurocritical Care Research Central (NCRC). The meeting had 125 registrants and 103 attendees from all parts of the world including the United States, Brazil, Israel, Canada, Colombia, Argentina, Chile, Japan, Italy, Germany, Austria and the UK. Attendees were 46 percent women, 39 percent minority and 28 percent junior members.
The conference opened with a review of the history and aims of the NCRN presented by Dr. Jose Suarez, followed by special lectures on the current status and innovative ideas in NCC research. The concept of using ideation techniques such as the blue ocean strategy to challenge the status quo was then introduced, and a lively discussion on the application of the concept to healthcare followed. Blue ocean is a concept from the business world developed by John Mullins and first published in 2005 by W. Chan Kim. It seeks to identify undiscovered markets, a “blue ocean.” Alternatively, a red ocean is an existing competitive workspace in which groups compete for the same customers. The Neurocritical Care Society is in fact, a blue ocean society, as its development created a new market space without existing competition. By comparison, the society journal, specialty certification, meetings and guidelines exist within red oceans because, while these are valuable and important products, there are many other societies and funding agencies pursuing similar concepts.
All participants were expected to read the book “Blue Ocean Strategy” and attend one of two webinars presented by Lawrence Aronhime, MBA, MS, an expert in ideation techniques, before the meeting. Three multiprofessional and multigenerational working groups (made up of five members each) were created and separately used the blue ocean strategy to answer questions posed within three broad topic areas, including: 1) NCRN driving the science, 2) NCRN driving research, and 3) NCRN driving the profession. These groups met regularly via teleconferences during the six months prior to the conference and drafted recommendations to be presented at the conference to a jury and all attendees. The five-member jury (Mike Diringer, Robert Stevens, Gisele Silva Sampaio, Lori Shutter and Claudia Robertson) was tasked with advising the NCRN leadership on which recommendations presented by the working groups should be most heavily considered.
A wide array of ideas was debated, resulting in the following conclusions:
- We have not fully defined our diseases.
- It is too soon to focus on implementation strategies given the limited number of evidence-based strategies to implement.
- There is a tension between protocolized medicine and precision medicine.
- A translational link from the lab to the patient is needed.
- Optimal research strategies in NCC have not been defined (e.g., randomized controlled trial, clinical accelerator, creative trial designs such as comparative effectiveness).
After deliberation, the jury proposed the following seven recommendations for the NCRN:
- Establish the right balance between game-changing scientific breakthroughs versus incremental discovery.
- Enable/support the backwards translation of fundamental research.
- Actively engage in new research methodologies such as big data, computational modeling and personalized/precision medicine.
- Support development of grant proposals.
- Partner with colleagues in other medical domains, basic science, engineering, government and the industry.
- Develop infrastructure to train the new generation of NCC investigators (e.g., online, embedded research time, mentorship, etc).
- Actively engage with partners in low-resource settings to conduct science and improve care.
Following the meeting, NCRN leadership met to discuss the recommendations generated in the meeting. The goal is to create a proposal for NCRN that will take NCS to the forefront of neurocritical care research and set a platform to address major problems faced by our patients.
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