Translational Medicine is a breakthrough in 21st century medicine that improves health prevention, speeds up the diagnosis of diseases, improves the quality of patient care and, last but not least, makes healthcare more cost-effective, while creating the right environment for high-quality clinical care. and basic science activities. In January 2016, the University of Pécs was the first in Hungary to create this new system in an innovative way, thus undertaking the development and launch of a completely unique patient care, education and science module.
The TM consists of four elements (TM HEALTHCARE, TM SCIENCE, TM KNOWLEDGE, TM EDUCATION AND COMMUNICATION) and the TM INTERDISCIPLINARY unit supporting it. Questions and current challenges must always be born at the bedside. Then we have to find the answers to our questions in one of the disciplines or in a combination of them. After that, the answers should be further developed into a unified knowledge. This is evidence-based medicine (EBM), the practical summary of which is the knowledge and guidelines for each disease, ie guidelines (EBM guideline). The knowledge organized in the EBM should be returned to patients, patient care participants, insurance companies, business leaders, industry partners and policy makers through educational and demonstration materials.
One of the biggest obstacles to quality and cost-effective patient care in Hungary is the significant lack of evidence-based medicine. Less than 5% of international guidelines are available in Hungarian, and a significant number of physicians use an “individual” protocol, which is not cost-effective and results in poorer recovery outcomes. We have national data in the field of acute pancreatitis and in 2014 we also made an evidence-based recommendation. Approx. 5050 patients are diagnosed annually in Hungary. From an analysis of data collected from 17 hospitals in the acute pancreatitis (AP) registry initiated and developed by our team, we know that the EBM guideline is followed in AP care in only half of the cases (EBM adherence = 50%). If we could reach 100%, we could reduce costs by 25% (which would save about HUF 0.5 billion) and save 116 lives a year. According to police data, there were 226 homicides in Hungary in 2017, which means that if we could achieve complete EBM adherence in only two disease groups, we could save more lives than if the police reduced the number of homicides in Hungary to zero. It is an important task of the TM HEALTHCARE units to formulate the scientific questions that will be forwarded to the TM SCIENCE.
We recommend that healthcare operate at three levels of progressivity.
An important challenge for the 21st century is to make the best possible use of scientific results. Questions from TM HEALTHCARE can be answered using basic, applied, and clinical research methods conducted in TM SCIENCE. Academic and university research teams would work closely together in this process. The development of TM HEALTHCARE and TM SCIENCE would be a huge attraction for pharmaceutical companies, the development of which could bring up to tens of billions to Hungary. The results of TM-SCIENCE would represent a major scientific advance in terms of both the quality and quantity of scientific publications. In the existing application systems, funding from science (eg NDP applications) could be used to increase the salaries of health care workers on a qualitative basis, which would reduce the attachment to parasolvency and offer an alternative to the suction effect of private health care.
Science (S) would operate in four coordinated areas:
One of the biggest obstacles to quality development is that scientific results are not recycled to the bedside, i.e. they are not utilized in patient care. Our serious shortcoming is the lack of a summary of scientific results. Every day, more than 10,000 new, peer-reviewed scientific publications appear on PUBMED, which stuck in the absence of a summary. All international EBM guidelines have been translated into Hungarian but only in pancreatic diseases.
The knowledge summary (T) should improve in the following areas:
T1-2, T4 would significantly increase our international publishing performance.
Of course, it is not enough to summarize the knowledge, but it also needs to be passed back to individual participants in the field. Knowledge can only be utilized if the latest knowledge is included in the education of medical staff (in the current medical education, a significant number of lecturers work with 10-20 years of educational materials and pass on their individual experience to students instead of knowledge materials. significantly worse than these outcomes of TM-KNOWLEDGE. In addition to doctors and professional staff, patients must be involved in education, and evidence-based educational and information materials must be compiled for policy, insurance, and pharmaceutical companies.
Education / information (O) routes should be passed on to the following target groups:
For the effective functioning of TM healthcare, TM science, TM knowledge, TM education, and TM communication, a closely coordinated operation of the disciplines that help each other and work closely together, i.e., interdisciplinary operation, is essential. IT professionals are essential in the development of multicenter registries and clinical trials, biostatisticians in data collection planning, inbound data analysis (our operating registers currently contain more than 2.6 million data). Important participants in data management are clinical research administrators who upload patient data and upload data quality monitors (data controllers). Today, large amounts of data are no longer enough, and quality is also essential to draw precise conclusions. Health economics experts can model and support the cost-effectiveness of system operation and interventions with accurate data and calculations. Dissemination of information to the public is also essential to increase prevention, with the help of the communication team. The medical management expert group provides the basic background for the planning and execution of registers, meta-analyzes and clinical trials. TM interdisciplinary tasks require an interdisciplinary center as well as smaller interdisciplinary groups established per university.
The interdisciplinary center would consist of the following groups.
The latter two groups are essential for national development.
Overall, only the combined operation of the above five units can lead to comprehensive and spectacular success in patient care, science and education.