Telehealth for the internal medicine resident: A 3-year longitudinal curriculum

Telemedicine and remote patient monitoring are an increasingly prevalent form of healthcare delivery. Internal medicine residents must be adept in caring for patients utilizing this technology. This curriculum was effective in improving resident comfort and self-efficacy in providing care through telehealth and provided residents with hands-on opportunities through supervised inclusion in remote patient-monitoring services. This curriculum model could be employed and evaluated within other internal medicine residency programmes to determine the feasibility at institutions with and without advanced telehealth centres.

The full article can be downloaded below.  

Epigenetics Analysis and Integrated Analysis of Multiomics Data, Including Epigenetic Data, Using Artificial Intelligence in the Era of Precision Medicine

To clarify the mechanisms of diseases, such as cancer, studies analyzing genetic mutations have been actively conducted for a long time, and a large number of achievements have already been reported. Indeed, genomic medicine is considered the core discipline of precision medicine, and currently, the clinical application of cutting-edge genomic medicine aimed at improving the prevention, diagnosis and treatment of a wide range of diseases is promoted. However, although the Human Genome Project was completed in 2003 and large-scale genetic analyses have since been accomplished worldwide with the development of next-generation sequencing (NGS), explaining the mechanism of disease onset only using genetic variation has been recognized as difficult. Meanwhile, the importance of epigenetics, which describes inheritance by mechanisms other than the genomic DNA sequence, has recently attracted attention, and, in particular, many studies have reported the involvement of epigenetic deregulation in human cancer. So far, given that genetic and epigenetic studies tend to be accomplished independently, physiological relationships between genetics and epigenetics in diseases remain almost unknown. Since this situation may be a disadvantage to developing precision medicine, the integrated understanding of genetic variation and epigenetic deregulation appears to be now critical. Importantly, the current progress of artificial intelligence (AI) technologies, such as machine learning and deep learning, is remarkable and enables multimodal analyses of big omics data. In this regard, it is important to develop a platform that can conduct multimodal analysis of medical big data using AI as this may accelerate the realization of precision medicine. In this review, we discuss the importance of genome-wide epigenetic and multiomics analyses using AI in the era of precision medicine.

The full article can be downloaded below.  

Applying bioethical principles for directing investment in precision medicine

The concept of precision medicine aims to tailor treatment based on data unique to the patient. An example is the use of genetic data from malignant tumours to select the most appropriate oncological treatment. The competing interests of utilitarianism and egoism create dilemmas for decisions regarding investment in precision medicine. The need to balance the perceived rights and needs of individuals against those of society as a whole is an on-going challenge in the distribution of limited health service resources. There is need for proper planning, organisation and investment into precision medicine to cope with the consequences of both direct-to-consumer and healthcare-directed genetic testing for genetic counselling, therapeutics and diagnostic networks. Consideration needs to be given to providing adequate time and training to allow for meaningful shared decision-making with patients and there is a strong case in support of a hub-and-spoke model to provide rapid, solid tumour genetic mutational analysis to prevent patients missing out on beneficial treatments.

The full article can be downloaded below.  

Long-term overall survival and prognostic score predicting survival: the IMPACT study in precision medicine

In conclusion, our data demonstrate that matched targeted therapy is associated with superior rates of objective response, PFS, and long-term OS compared to nonmatched therapy. The 3-year OS rate was 15% in the matched targeted group compared to 7% in the nonmatched group, and the 10-year OS rates were 6% and 1%, respectively.

Independent factors predicting shorter OS in multivariate analysis were used to develop a prognostic score to predict an individual patient’s risk of death. These factors were non-matched therapy, liver metastases, LDH > the upper limit of normal, and PI3k/ AKT/mTOR pathway alterations (score of 1 each), and performance status > 1 (score of 2). This prognostic model that includes molecular pathway abnormalities can be used to predict the expected OS of individual patients who are being considered for clinical trials.

Advances in technology and bioinformatics to identify driver molecular alterations; evolution of the global assessment of immune mechanisms and proteomic, transcriptomic, and epigenetic changes in individual patient tumor pathogenesis; and innovative, carefully designed clinical trials are expected to improve the implementation of precision medicine.

The full article can be downloaded below.  

Artificial intelligence has come to medicine. Are patients being put at risk?

Health products powered by artificial intelligence are streaming into our lives, from virtual doctor apps to wearable sensors and drugstore chatbots.

IBM boasted that its AI could “outthink cancer.” Others say computer systems that read X-rays will make radiologists obsolete. AI can help doctors interpret MRIs of the heart, CT scans of the head and photographs of the back of the eye, and could potentially take over many mundane medical chores, freeing doctors to spend more time talking to patients, said Dr. Eric Topol, a cardiologist and executive vice president of Scripps Research in La Jolla.

The full Los Angeles Times article can be viewed at this link.  

Money Can’t Buy You Health: Disconnection In U.S. Between Healthcare Spending And Population Health

Let me begin this sobering post by saying there are aspects of the U.S. healthcare system that are admirable, especially regarding the use of cutting-edge innovative medicines and medical procedures. In cancer care, in particular, the U.S. has been at the forefront of a number of advances which have delivered miraculous benefits to patients. Yet, on the whole, America’s healthcare system appears “woefully dysfunctional.”

The U.S.  spends about twice as much on healthcare as other Organization for Economic Cooperation and Development (OECD) countries, but ranks near the bottom in terms of life expectancy, and that gap has widened sharply in recent years.

The full Forbes article can be viewed at this link.  

FDA Finalizes Enforcement Policy on Unauthorized Flavored Cartridge-Based E-Cigarettes That Appeal to Children, Including Fruit and Mint

Amid the epidemic levels of youth use of e-cigarettes and the popularity of certain products among children, the U.S. Food and Drug Administration (FDA) today issued a policy prioritizing enforcement against certain unauthorized flavored e-cigarette products that appeal to kids, including fruit and mint flavors. Under this policy, companies that do not cease manufacture, distribution and sale of unauthorized flavored cartridge-based e-cigarettes (other than tobacco or menthol) within 30 days risk FDA enforcement actions.

The full HHS press office statement can be viewed at this link.  

What will 2020 bring for medicine and science? We asked 16 leaders for predictions

Last year, when we asked science and health care soothsayers to peek ahead to 2019, they told us that methamphetamine use would rise (it did), tumor organoids would near clinical use for personalizing cancer treatment and better targeting clinical trials (that’s happening), and price transparency wouldn’t bring lower health spending (that’s true, too). But nobody predicted the outbreak of lung injuries tied to vaping, the failure and attempted resurrection of Biogen’s Alzheimer’s drug aducanumab, or the restoration of cellular functions in pig brains after death.

We’re back with a new set of predictions for 2020. Let’s see how our experts do this time.

The full STAT article can be viewed at this link.  

In Rural Areas Without Pain Or Addiction Specialists, Family Doctors Fill In The Gaps

In many ways, rural communities like Necedah have become the face of the nation's opioid epidemic. Drug overdose deaths are more common by population size in rural areas than in urban ones. And rural doctors prescribe opioids more often by far, despite a nationwide decline in prescribing rates since 2012. Meanwhile, rural Americans have fewer alternatives to treat their very real pain, and they disproportionately lack access to effective addiction medication such as buprenorphine.

It used to be rare for primary care physicians outside of big cities to take on the challenges of opioid misuse, according to Dr. Erin Krebs, a professor of medicine at the University of Minnesota who researches chronic pain management. Now, Krebs says it's becoming increasingly common "out of necessity."

"We just have a lot of people who need this kind of care and they need it where they are," Krebs says.

The full NPR article can be viewed at this link.  

Precision medicine has a blind spot: children with cancer

Cancer, once a terrifying black box, is slowly being opened up. Thanks to advances in technology and genomics, we know significantly more today about what drives cancer.

Precision medicine, the concept of giving the right treatment to the right patient at the right time, is flourishing in cancer treatment. But there is a blind spot: children are not benefiting enough from the progress we’re making.

We need a full-scale renaissance in pediatric drug development and care. And we need it now.

The full STAT article can be viewed at this link.