Review Article
Translational research: understanding the continuum from bench to bedside

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The process of translating basic scientific discoveries to clinical applications, and ultimately to public health improvements, has emerged as an important, but difficult, objective in biomedical research. The process is best described as a “translation continuum” because various resources and actions are involved in this progression of knowledge, which advances discoveries from the bench to the bedside. The current model of this continuum focuses primarily on translational research, which is merely one component of the overall translation process. This approach is ineffective. A revised model to address the entire continuum would provide a methodology to identify and describe all translational activities (eg, implementation, adoption translational research, etc) as well their place within the continuum. This manuscript reviews and synthesizes the literature to provide an overview of the current terminology and model for translation. A modification of the existing model is proposed to create a framework called the Biomedical Research Translation Continuum, which defines the translation process and describes the progression of knowledge from laboratory to health gains. This framework clarifies translation for readers who have not followed the evolving and complicated models currently described. Authors and researchers may use the continuum to understand and describe their research better as well as the translational activities within a conceptual framework. Additionally, the framework may increase the advancement of knowledge by refining discussions of translation and allowing more precise identification of barriers to progress.

Section snippets

Importance of Translation

Although translation has been discussed for more than 30 years,1 the process recently has become a major focus in biomedical research. In the 2001 Crossing the Quality Chasm report, the Institute of Medicine (IOM) identified the importance and difficulty of translating basic scientific knowledge to patient care.2 In that same year, the editors of The Journal of the American Medical Association published a call for papers discussing TR, identifying this work as vital to the progress of

The Translation Lexicon

To discuss translation, it is necessary to understand a new lexicon that has developed in the literature and may be difficult to interpret without the appropriate background. The IOM Clinical Research Roundtable first described the current terminology and model of TR in 2003. They described a 2-phase process of research progressing from (1) basic science to clinical science, then (2) from clinical science to public health impact. In their framework, they identified “translational blocks”

The Biomedical Research Translation Continuum

We reviewed the evolution of translation through a detailed evaluation of the published literature. This review begins with an editorial from the New England Journal of Medicine in 1974, progresses to the first workable definition by Dr. Thomas A. Waldmann in the early 1990s, and ends with the current model from Blue Highways and the “3 T’s” Road Map.1, 11, 12, 16 Noting that obscurity exists in the current terminology and model of translation, we then created a framework to describe the

Conclusions

The loss of scientific discoveries along the Biomedical Research Translation Continuum is a major public health problem. Despite multibillion dollar research funding and considerable laboratory productivity, only a fraction of promising basic science discoveries result in applied clinical practices and health gains.7 As a result, immense research budgets, a wealth of scientific knowledge, and significant public health benefits are lost in translation. Therefore, it is vital that we understand

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