CIRAR - Background and Strategic Directions

I. Royal Society Symposium Report on Innovative Mechanisms for Tackling Antibacterial Resistance

The global problem of antimicrobial resistance and innovative ways to respond to this problem are summarized in the proceedings of a recent symposium published by The Royal Society London, the independent academy of science in the UK. Download the entire report: Innovative Mechanisms for Tackling Antibacterial Resistance. The Royal Society Policy Document. July 2008.

Key points arising from the workshop were:

More efficient diagnostic tools must be developed to enhance the rapid identification of species of bacteria causing an infection as well as their resistance profile. This will enable appropriate and effective treatment to be given.
The potential for development of traditional antibiotics has not been exhausted. However, the development of antibacterial agents acting on/in bacteria in novel ways is vital. There are numerous scientific approaches that are promising and require investigation.
Venture capitalists, biotechnology companies and pharmaceutical companies need conditions that will encourage them to invest in antibacterial agents. This can be done by simplifying regulatory hurdles and enhancing financial returns of antibacterial agents.
Centres of excellence should be set up to promote the wide range of expertise needed throughout the expensive and lengthy research and development process and to train a new generation of experts in antimicrobial therapeutics.

II. Characteristics of Successful Research Collaborations^{1, 2}
Category	Characteristics
Structural	Comprised of a small number of multi-professional teams Standardized methods for planning, communicating, convening meetings and decision making and regularly scheduled meetings Formal agreements for data sharing and other collaborative activities Core administrative staff and structure External funding, often from multiple sources
Process	Clear and explicit shared research goals and objectives Clear articulation and agreement regarding research gaps Knowledge and experience with the change process Acceptance, validation, commitment, synergy among collaborators Strong and clear leadership Contributions made and recognized by all partners Minimal wasting of time, highly efficient work processes Participants exchange ideas outside of regular meetings Active involvement of students Team members receive formal training in interdisciplinary research Members understand the values and viewpoints of others
Outcomes	Measurable work products, including publications, dissertations, presentations and funded grants

III. Conceptual Underpinnings

Conceptual underpinnings for interdisciplinary research to reduce antimicrobial resistance.

CIRAR proposes to develop interdisciplinary research teams to build the foundation for long-term collaboration. The goal for the Consortium to be developed is that teams adopt a transdisciplinary approach in which they draw from the concepts and theories of the various disciplines to develop shared conceptual underpinnings. Over the past year, using an iterative process³, we have developed a model of interdisciplinary research to address the translational blocks described by Sung et al⁴. The focus is on research designed to improve individual clinical outcomes, systems of care delivery, and, ultimately, to influence health policy. This framework calls for the integration of health and risk communication, economics, informatics, epidemiology, and health services with the basic research and disciplinary expertise of the team members. While the research focus of CIRAR is on reducing antimicrobial resistance, we also have expertise and a strong success record of working with vulnerable populations. Often these populations are both outside the formal healthcare system without insurance and are likely to obtain and use antibiotics inappropriately.

IV. Examples of Potential Topics for Interdisciplinary Demonstration Projects
Example Demonstration Project	Required Disciplines
Developing early warning surveillance systems using informatics techniques for community or hospital outbreaks with multi-resistant organisms	Infectious diseases, molecular epidemiology, informatics, microbiology, community liaisons
Evaluating targeted health communication strategies for high risk subpopulations	Health and risk communication, education, informatics, epidemiology, health services research, multicultural expertise
Examining and comparing molecular markers of resistance in human populations	Genetics, molecular epidemiology
Testing promising rapid screening methods	Microbiology, infectious diseases, economics, epidemiology
Describing knowledge, attitudes, and practices regarding antibiotic use in immigrant populations	Epidemiology, health services research, risk communication, community liaisons
Intervention to improve judicious use of antibiotics in vulnerable / high risk groups	Clinical trials, risk communication, epidemiology, infectious diseases, policy
Assessing impact of real-time electronic microbiologic surveillance on development of nosocomial antibiotic resistance	Informatics, infectious diseases, epidemiology, microbiology, health policy
Cost-effectiveness of alternative targeting strategies for health communication; the impact of differential insurance types and status on use of antibiotics	Economics, informatics, health services, statistics, infectious diseases
Duration and impact of carriage of resistant gram-negative bacteria in patients after hospital discharge	Hospital and molecular epidemiology, microbiology, social scientists

Ovretveit J, Bate P, Cleary P, et al. Quality collaboratives: lessons from research. Qual Saf Health Care. 2002;11(4):345-351.
Bain P, Mann L, Pirola-Merlo A. The innovation imperative: the relationships between team climate, innovation, and performance in research and development teams. Small Group Research. 2001;32(1):55-73.
Peirce A, Cook S, Larson EL. Focusing research priorities in schools of nursing. J Prof Nursing. 2004;20(3):156-159.
Sung NS, Crowley WF, Jr., Genel M, et al. Central challenges facing the national clinical research enterprise. JAMA. 2003;289(10):1278-1287.

BACKGROUND AND STRATEGIC DIRECTIONS