Pandemic Preparedness

In their article on "Navigating the Field of Implementation Science Towards Maturity: Challenges and Opportunities," Chambers and Emmons describe the rapid growth of implementation science along with remaining challenges. A significant gap remains in training and capacity building. Formats for capacity building include university degree programs, summer training institutes, workshops, and conferences. In this letter, we describe and amplify on five key areas, including the need to (1) identify advanced competencies, (2) increase the volume and reach of trainings, (3) sustain trainings, (4) build equity focused trainings, and (5) develop global capacity. We hope that the areas we highlight will aid in addressing several key challenges to prioritize in future efforts to build greater capacity in implementation science.

BackgroundOrganizations implement innovations to disrupt the status quo and create value. Within sectors such as healthcare, innovations need to navigate large scale system and organizational factors to succeed. This research explores the implementation of a global innovation- Project ECHO®. Project ECHO® is a validated virtual communities of practice model organizational teams implement to build workforce capacity and capability. Project ECHO® has experienced broad global adoption, particularly within the healthcare sector, and is experiencing growth across other sectors. This study sought to examine the state of implementation success for Project ECHO® globally, to understand how these implementations compare across geographic and sectoral contexts, and understand what enablers/barriers exist for organizational teams implementing the innovation.MethodsAn empirical study was conducted to collect data on 54 Project ECHO® implementation success indicators across an international sample. An online survey questionnaire was developed and distributed to all Project ECHO® hub organizations globally to collect data. Data was analyzed using descriptive statistics.ResultsThe 54 implementation success indicators measured in this survey revealed that the adoption of Project ECHO® across 13 organizations varied on a case-by-case basis, with a strong rate of adoption within the healthcare sector. Implementation teams from these organizations successfully implemented Project ECHO® within 12-18 months after completing Immersion partner launch training and operated 51 ECHO® Networks at the time of data collection. Implementation teams which liaised more regularly with ECHO® Superhub mentors often went on to launch a higher number of ECHO® Networks that were sustained over the longer term. This suggests that these implementation teams better aligned and consolidated their Project ECHO® pilots as new innovations within the local context and strategic organizational priorities. Access to research and evaluation capability, and a more automated digital client relationship management system were key limitations to showcasing implementation success outcomes experienced by the majority of implementation teams.ConclusionsThese findings make a valuable contribution to address a knowledge gap regarding how a global sample of organizations adopting Project ECHO® measured and reported their implementation successes. Key successes included pre-launch experimentation and expansion, Superhub mentorship, stakeholder engagement, and alignment to strategic priorities.

BackgroundIn this priority-setting exercise, we sought to identify leading research priorities needed for strengthening future pandemic preparedness and response across countries.MethodsThe International Society of Global Health (ISoGH) used the Child Health and Nutrition Research Initiative (CHNRI) method to identify research priorities for future pandemic preparedness. Eighty experts in global health, translational and clinical research identified 163 research ideas, of which 42 experts then scored based on five pre-defined criteria. We calculated intermediate criterion-specific scores and overall research priority scores from the mean of individual scores for each research idea. We used a bootstrap (n = 1000) to compute the 95% confidence intervals.ResultsKey priorities included strengthening health systems, rapid vaccine and treatment production, improving international cooperation, and enhancing surveillance efficiency. Other priorities included learning from the coronavirus disease 2019 (COVID-19) pandemic, managing supply chains, identifying planning gaps, and promoting equitable interventions. We compared this CHNRI-based outcome with the 14 research priorities generated and ranked by ChatGPT, encountering both striking similarities and clear differences.ConclusionsPriority setting processes based on human crowdsourcing - such as the CHNRI method - and the output provided by ChatGPT are both valuable, as they complement and strengthen each other. The priorities identified by ChatGPT were more grounded in theory, while those identified by CHNRI were guided by recent practical experiences. Addressing these priorities, along with improvements in health planning, equitable community-based interventions, and the capacity of primary health care, is vital for better pandemic preparedness and response in many settings.

ImportanceCurrent colorectal surveillance guidelines emphasize adenoma characteristics but overlook temporal, racial, and sex-based heterogeneity in recurrence risk, a gap that limits equitable and personalized care.ObjectiveTo evaluate the associations of demographic factors, obesity, and adenoma features with recurrence risk over time in a large longitudinal surveillance cohort.Design, setting, and participantsThis retrospective cohort study included adults who underwent their first colonoscopic polypectomy between January 1990 and July 2024 at a tertiary medical center.ExposuresDemographic variables included race and ethnicity, sex, obesity (body mass index >30), family history of colorectal cancer (CRC) or polyps, and age at adenoma onset (Main outcomes and measuresThe primary outcome was recurrence-free survival, defined as time from initial polypectomy to histologically confirmed recurrence. Time-varying coefficient Cox models were fitted to handle the nonconstant associations of exposure over the follow-up time. The follow-up time was categorized into 3 periods (less than 5 years, 5 to 10 years, and 10 or more years). The heterogeneity of exposure associations across the 3 follow-up periods was assessed with likelihood ratio tests.ResultsAmong 59 667 patients (mean [SD] age, 60 years [11.2]; 29 401 [49.3%] female; 1007 [1.7%] Asian and Pacific Islander, 646 [1.1%] Hispanic, 5972 [10.0%] non-Hispanic Black, and 52 042 [87.2%] non-Hispanic White; median [IQR] follow-up, 4 [1-9] years), 17 596 (29.5%) experienced overall recurrence within 5 years. High-grade dysplasia demonstrated the largest early phase association (adjusted hazard ratio [aHR], 4.00; 95% CI, 3.56-4.50) with complete midterm and late attenuation, while villous histology exhibited biphasic patterns with early elevation (aHR, 2.89; 95% CI, 2.63-3.18) and late-phase (>10 years) reemergence (aHR, 2.71; 95% CI, 2.15-3.41). Obesity conferred persistent risk across all surveillance intervals (early: aHR, 1.16; 95% CI, 1.11-1.21; late: aHR, 1.22; 95% CI, 1.09-1.35). Female patients with high-risk adenomas exhibited marked late-term (>10 years) elevation exceeding male patients (female patients: aHR, 1.73; 95% CI, 1.43-2.08 vs male patients: aHR, 1.29; 95% CI, 1.06-1.58).Conclusions and relevanceBoth histopathologic features and demographic factors demonstrated distinct time-dependent patterns in adenoma recurrence, underscoring the need for surveillance strategies that account for temporal variation and population-specific risk profiles.