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• W4383303017 abstract "The road from a basic research discovery to widespread clinical implementation can be long. The journey has been said to involve three peaks and two intervening valleys (Figure 1) [4]. The first peak is the initial scientific discovery, typically made in a research laboratory and lacking immediate clinical significance. The second peak is the realization that a new scientific fact has clear medical significance, often following multiple correlative studies and sometimes a series of clinical trials. The third peak is creating the ability for a new clinical insight to achieve broad use to help patients equitably, which is enabled by national and international guidelines and resources. Between each peak is a “valley of death” (Figure 1). The first valley is crossed moderately frequently and is a key aspect of translational work by pathologists. The second valley is traversed far less often since it relies on teams of people to develop practical consensus-driven approaches and to consider and generate the resources needed to accomplish implementation. The approaches to getting to the third peak have been termed dissemination and implementation sciences [5]. Despite the best of intentions, however, humans often create obstacles that get in the way, usually in the form of idiosyncratic approaches and adherence to sometimes arbitrary rules. For example, recommending the assessment of mitoses in measured microscopic fields (e.g., mm2) rather than as ill-defined “high-power fields”—while eminently sensible from a scientific point of view and laudable as a goal—introduces a few practical challenges, creating an obstacle in the valley. In other words, when plotting a course, it is important to see the forest and not just the individual trees. An even more striking example of the difficulties of building consensus has been the recent generation of two separate international classifications in hematopathology [10]. In this sad situation, politics trumped [sic] long-term vision, creating needless complexity, controversy, and outright confusion that will persist at least until the next international classification effort (hopefully) rectifies this step backward. As is evident from the above, my convictions are that individuals must work sensibly and boldly in collectives (and across more than one collective) to achieve successful national and international implementation. My hope is that the next generation of brain tumor experts will take these messages to heart as they strive to uncover new biomedical facts, explore their clinical relevance, and eventually translate these findings into standard clinical practice. They must be practical in how far each step can go; there is an old quip that to be 10 feet ahead of a parade is to lead a parade, but to be 10 blocks ahead is not to be part of the parade at all. But they must also be purposeful to aim their sights far ahead; as the intrepid explorer and travel writer, Freya Stark, said, “Surely, of all the wonders of the world, the horizon is the greatest.” The author thanks Drs Jon C. Aster, David W. Ellison, Takashi Komori, Vani Santosh, Chitra Sarkar, and Pieter Wesseling for input on the manuscript. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study." @default.
• W4383303017 created "2023-07-07" @default.
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• W4383303017 date "2023-07-06" @default.
• W4383303017 modified "2023-09-26" @default.
• W4383303017 title "A <i>vade mecum</i> for crossing the second translational “valley of death” in brain tumor classification" @default.
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• W4383303017 doi "https://doi.org/10.1111/bpa.13183" @default.
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