First, there is a striking preponderance of clinical articles and journals in the cardiac literature: clinical journals dominate a larger area of the cardiac map than the cancer map. Of the 75 most active cardiac journals, a higher percentage have a clinical focus than in the corresponding set of cancer journals.
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With such a small presence of basic science journals, the basic research pole is actually formed of both the basic and clinical research journals. There is less intellectual distance, in some respects, between the extremes of the cardiac literature. In contrast to the cancer literature, where the most basic and most clinical cancer journals are fundamentally distinct, there is more common content across the cardiac journals.
Second, although links do exist between basic research and clinical research poles, a distinct translational interface has not yet appeared in cardiovascular medicine. While topics such as hypertension and atherosclerosis do have links between the clinical and research poles, they do not form a coherent third domain. The maps show that translational research is taking place in each field, but with important differences in the translational interfaces. There are many possible causes of this. In the case of cancer, despite the existence of different subspecialties defined by the anatomic site of the cancer e.
In cardiovascular medicine, in contrast, there appear to be distinct clinical domains e. There appears to be no distinct space in the cardiac domain for the kind of broad-reaching translational research seen in the cancer domain. Possible hypotheses can be assessed by evaluating the semantic content of the interfaces. The map has three distinct zones.
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Clinical journals e. Basic science and clinical research journals e. The translational interface from Cancer Science to Cancer Epidemiology includes two sets of terms. One set reflects specific tumor types e. The other set reflects specific translational techniques, with gene expression technologies on the left e. The network map was prepared as described for Figure 3. Clinical observation journals and concepts dominate the top half of the map. Distinct clusters can be seen for stroke on the left, surgery and electrophysiology on the top, and myocardial infarction, heart failure, and treatments e.
A small cluster of terms from molecular biology e. No clearly structured translational interface exists. Circulation , however, the sole clinical mix journal in the set, maintains links to both the clinical domain and the molecular biology domain. This journal plays a key role linking diverse research interests. Co-citation relationships of the most co-cited articles are mapped. The articles are arrayed along a chronological axis according to their publication date. The links between them show the co-citation relationships made by articles published in i.
Sheet 3A in Additional File 1 lists the articles plotted here.
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Circles were added to highlight specific clusters. The central portion of the plot is dominated by articles about cancer clinical trials Schiller , Hurwitz , Cunningham , looking back to the articles about relevant statistical methods Kaplan Meier , Mantel , Cox The largest recent node here Therasse provides guidelines about assessing treatment response. The cluster also includes papers on cancer staging e. An adjacent cluster focuses on epidemiology Jemal , Jemal , Jemal The next cluster to the left, reaching back to early work on angiogenesis Folkman , now includes articles on the molecular etiology of cancer, including oncogenes, P53, HF1, AKT pathways, and HPV Hanahan , Vogelstein , Vivanco Thus there is an overlap between the topic molecular etiology and the techniques needed to study it.
The cluster on the far left focuses on cancer diagnostics classification, prognosis, and prediction , from early papers on histopathological grading Elston , to the key papers on the molecular biology and genomic signatures of breast cancer Perou , Sorlie , van't Veer , Paik These overlap with articles on the bioinformatic methods needed to analyze microarrays and similar genomic tools Benjamini , Eisen , Tusher The bottom of the plot thus reveals a continuum from work on the molecular biology, especially of breast cancer, on the left to clinical trials of targeted therapies on the right, through research on molecular pathways and RCTs, and related statistical methods.
The network map was prepared as described for Figure 5. Sheet 3B in the Additional File lists the articles published here. The most recent articles are divided into distinct clusters by clinical topic. On the far left are articles about drug-eluting stents from Morice to Stone , adjacent to another thin cluster about clopidogrel and anti-platelet agents Yusuf , Mehta , Wivott The central cluster has concentrations of articles about cholesterol, atherosclerosis, and myocardial infarction Wilson , Libby , Yusuf , Hansson , then hypertension Dahlof , Chobanian , Mancia , and atrial fibrillation Haissaguerre , Go , Pappine , Fuster The right edge of the cluster has articles about echocardiography Nagueh , Ommen , Lang Finally, at the extreme right of the map sit articles about implanted defibrillators and biventricular pacing Moss , Bristow , Bardy , Chung As was seen in the cancer map, the most enduring articles all involve specific clinical or laboratory techniques, such as measurement of LDL Friedeweld or creatinine clearance Cockcroft , or standards, whether for grading coronary artery disease Austen or quantifying echocardiography Devereux , Schiller It is worth noting that the most cited articles in both lists include several different types of articles.
Some are research articles. Others, especially the older ones, are descriptions of widely used methods and techniques. One interesting set are the guidelines and criteria of various sorts seen in both the cancer plot Boland , Mountain , Therasse , Sobin and the cardiac plot Schiller , Chobanian , Lang , Mancia The prominence of such guidelines demonstrates the importance of standardization and regulatory tools for both research and clinical care[ 34 ]. Citation analysis also reveals evidence of ritual use of citations.
It is likely that many of the recent articles that cite the oldest articles e. The problem of citation mutation has received increasing attention recently[ 35 ]. Our findings demonstrate that systematic analysis of publication and citation data from tens of thousands of articles can capture important features of active fields of scientific research, in this case in both cancer and cardiac medicine.
The relational maps based on this data are well structured, stable over time, and accessible to interpretation. They reveal at a glance a polarization between clinical and basic research, as well as the structures that connect these poles.
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They also reveal clear differences in the relationships of journals in oncology and cardiac medicine. Do these differences arise from the nature of the clinical problems and the research they require? For most of the late twentieth century, cancer was seen as a problem of cellular pathology, with research focused on the cellular and molecular basis of the disease. These methods and concepts could be applied to most cancers, regardless of their cell of origin. Cardiac researchers, in contrast, focused longer on problems of organ pathology and physiology e.
Only in specific areas -- notably the biology of hypertension and atherosclerosis -- did molecular biology take root early, and these are exactly the areas where the translational domain is clearest. The maps also identify areas where the connections are not as strong. Surgical research, in both cancer and cardiac care, is on the periphery of the plots, less strongly connected to translational and basic research than other areas in the fields.
On the cardiac map some links do appear between the surgical journals and Shock ; surgical oncology journals may also be linked to molecular biology through adjuvant and neo-adjuvant trials. Areas where links are less clear suggest possible targets for research investment. The recent increase in interest in efforts to engineer and grow vascular tissues for use as conduits in surgical reconstruction, for instance, may eventually fill this gap in the cardiac literature.
The distinct structures in cardiac and cancer publishing require explanation. Are the differences intrinsic to the science of the field itself, or are they produced by institutional structures, policy initiatives, or clinical concerns? Developments in cancer research in the s, including rapid advances in understanding of cancer genetics and increasing use of surface antigens to characterize cell types, yielded a hybrid of applied and basic research with clear relevance for clinical oncology. Cardiac therapeutics, in contrast, have remained less unified, with clusters of clinicians and associated researchers working on distinct topics such as coronary revascularization or management of hypertension, heart failure, or arrhythmias.
It may be that the clinical problems in cardiac medicine are so distinctive that no broad translational interface should be expected. But this also raises important questions. Does the current structure of each field reflect the internal cognitive or epistemological content of the field? Or does the current structure reflect past policy decisions that directed resources to certain kinds of clinical and research questions? Presumably both sets of factors contribute. Further insight into these questions could be gained through a range of different bibliometric analyses.
We analyzed and presented data at a high level of aggregation i. Other analyses could be performed, for instance based on the institutional affiliations of authors, the countries where research takes place, or on co-authorship relationships. We looked briefly at some of these analyses but found the ones described in detail here to be more fruitful. Assessing the relative importance of substantive content and policy initiative for the structure of scientific fields has consequences for the prospects of current policy decisions.
Policy makers today have argued that by providing funding, incentives, and infrastructure support it will be possible to integrate basic and clinical research and foster translational research[ 1 , 3 , 6 , 7 , 10 ]. This history provides a test case. Were there differences in research policy between cancer and cardiovascular research that account for the different outcomes in those two fields?
Further analysis of these questions is needed to provide a firm baseline for policy interventions that seek to overcome the translational divides that exist in medical research today. Even though we cannot offer definitive explanations for why the structures and differences exist -- experts in the respective fields will have to fill in this history and derive appropriate policies -- we do offer a set of relevant parameters and tools that can be used to study the on-going efforts to strengthen translational research in health care.
We would like to thank Dr. Grant Lewison Evaluametrics Ltd. None of the funders had any role in study design, collection, analysis, interpretation, writing, or decision to submit the manuscript for publication. This article is published under license to BioMed Central Ltd. Skip to main content Skip to sections. Advertisement Hide. Download PDF. Journal of Translational Medicine December , Cite as. Detection and characterization of translational research in cancer and cardiovascular medicine.
Open Access. First Online: 11 May Background Scientists and experts in science policy have become increasingly interested in strengthening translational research. Methods We downloaded bibliographic and citation data from all articles published in in the 75 leading journals in cancer and in cardiovascular medicine roughly 15, articles for each field. Results Network analysis and mapping revealed polarization between basic and clinical research, but with translational links between these poles. Conclusions These techniques can be used to monitor the continuing evolution of translational research in medicine and the impact of interventions designed to enhance it.
Engineering also enables the development of new faster and better means to study cardiovascular diseases and conditions, interpret them and analyze them. This special issue of the ASME Journal of Engineering and Science in Medical Diagnostics and Therapy will focus on truly new and emergent approaches with transformative potential in patient-specific treatment.
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Topics to be covered in the special issue will include cardiovascular medicine, medical devices, and therapeutic interventions. The editors for this special issue are Dr. Before contrast, A significant impact on management was observed: additional diagnostic procedures were avoided in Reference: J Am Coll Cardiol. Comment: This study was the first to prove the value of MCE in identifying aetiology ischaemic vs non-ischaemic in patients presenting for the first time with heart failure.
Reference: Circulation ; 11 Comment: This was the first study to show that perfusion assessment has incremental benefit over wall motion analysis in detecting CAD. Comment: The first paper to show that delayed imaging is the technique of choice for detecting myocardial viability. MCE was performed at baseline using triggering intervals of early and delayed cardiac cycles.
Delayed imaging had superior positive and negative predictive value for recovery of systolic function. The authors concluded that delayed triggered MCE can independently detect myocardial viability early after AMI and that delayed triggered imaging is superior to early triggered imaging. Reference: J Am Coll Cardiol ; 38 1 Reference: J Am Coll Cardiol ; 37 3 ; Comment: Landmark study which proved, for the first time, that capillaries play a crucial role in regulation of coronary blood flow CBF.
A canine model of the coronary circulation with three compartments was created arterial, capillary, venous.