Epigenetics in cancer therapy and nanomedicine

The emergence of nanotechnology applied to medicine has revolutionized the treatment of human cancer. As in the case of classic drugs for the treatment of cancer, epigenetic drugs have evolved in terms of their specificity and efficiency, especially because of the possibility of using more effective transport and delivery systems. The use of nanoparticles (NPs) in oncology management offers promising advantages in terms of the efficacy of cancer treatments, but it is still unclear how these NPs may be affecting the epigenome such that safe routine use is ensured. In this work, we summarize the importance of the epigenetic alterations identified in human cancer, which have led to the appearance of biomarkers or epigenetic drugs in precision medicine, and we describe the transport and release systems of the epigenetic drugs that have been developed to date.

The full article can be downloaded below.

Why precision medicines for oncology demands precision engagement

Life sciences companies overwhelmed with large volumes of information and data available - both in terms of therapies and patient-reported outcomes - must establish a more efficient, bi-directional communication model with care teams to succeed.

The full Med City News article can be viewed at this link.  

Opinion: How self-tracking biometrics influence patients, medicine and society

As a consequence of digitalisation, data acquisition related to different aspects of our daily life has become widely available. Monitoring of heart condition, mood or air quality is no longer the domain of specialised laboratories or hospitals, it can be done anytime, anywhere and by anybody. Self-knowledge and self-perception through numbers replace subjective narration based on frame of mind or intuition. Quantified-self phenomena not only revolutionise healthcare, but also promise to boost wellbeing. How will life change in a world where everything becomes measurable?

The full article from Mobie Health News can be viewed at this link.  

Continuing Patient Care During Electronic Health Record Downtime

This study documents the extent to which downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their downtime contingency plans need to find more effective methods to collect data during these times.

The full article can be downloaded below.  

Trends in Individuals’ Access, Viewing and Use of Online Medical Records and Other Technology for Health Needs: 2017-2018 

The access, exchange, and use of electronic health information is essential for individuals to better manage their health care needs and share information with their providers and caregivers. Many hospitals and physicians possess capabilities that enable patients to view and download their health information. However, additional steps are needed to make health information more accessible and useful to individuals. A majority of individuals have smartphones and use applications (apps) to help them manage various tasks. The 21st Century Cures Act emphasizes the importance of making patient health information more easily accessible and the need for greater education regarding patients’ rights to access their health information. This data brief uses the Health Information Trends Survey (HINTS), a nationally representative survey, to assess individuals’ access, viewing and use of their online medical records, and the use of smartphone health apps and other electronic devices in 2017 and 2018.

The full data brief can be downloaded below.  

How Big Pharmas Simultaneously Repel And Embrace Innovation

Pharmas are attractive for innovators pursuing approaches that are strongly endorsed by senior leadership and reasonably welcomed by the operational areas of the organization. The way some pharmas are working through the complex supply-chain logistics required for delivering CAR-T therapy or gene therapy at scale offer striking examples.

On the other hand, pharma organizations generally prioritize caution over agility, and incremental change over radical new approaches. Thus even innovation welcomed by the C-suite (like a lot of the original digital and data efforts) can run into the grindstone when those in the trenches can’t see the benefit, and experience only burden.

In general, large pharmas, like other big companies, are likely to remain generally resistant to profound innovation, though they will embrace and really go after specific opportunities they view as adequately validated or promising. Such traction requires explicitly endorsement and constant, active support from the top echelons of management if the approach is to even have a chance. Meanwhile, detached innovation initiatives reliably garner transient publicity but tend to achieve little durable organizational impact.

There’s likely a considerable opportunity to harness the many bottom-up innovative ideas to which pharma seems constitutively unable to respond; the robust startup ecosystem offers an attractive alternative or salvage pathway for some but not all of these promising approaches.

The full Forbes article can be viewed at this link.  

Medication adherence influencing factors—an (updated) overview of systematic reviews

Non-adherence negatively affects the efficacy, safety and costs of therapies. Non-adherence is a multifactorial problem. This systematic review (SR) of SRs (overview) aims to identify factors that can influence the adherence of adult patients with chronic physical diseases. We performed a systematic literature search in MEDLINE and Embase on June 13, 2018. We included SRs on the factors that can influence adherence in adult patients taking oral medications for treating physical chronic diseases. Two reviewers independently selected studies according to pre-defined inclusion criteria. Two reviewers independently assessed the risk of bias with the ROBIS tool. Data were extracted in standardized tables previously piloted by one reviewer and verified by a second reviewer. We synthesized data in tables in a structured narrative manner. We included 21 SRs on eight different conditions. We rated eight SRs to be at low risk of bias and 13 to be at high risk of bias. Although higher education, employment, higher financial status and marriage/partnership mostly showed a positive effect on adherence, the impact was unclear because of the high uncertainty of the underlying evidence. The evidence indicates that socioeconomic status and social support might have a positive impact on adherence and that belonging to an ethnic minority might have a negative impact on adherence. Therapy-related factors (e.g., intake regime) and disease-related factors (e.g., duration) mostly showed no impact on adherence. Analysis of gender showed inconsistent results. Age might have a concave relation to adherence, i.e., adherence is lowest in very young and very old people. Depression has a negative impact on adherence. Impacts of other mental and physical comorbidities were uncertain. Co-payments (any or higher) have a negative impact on adherence. In contrast, the impacts of medication costs and insurance status were uncertain. This overview analyses factors that might impact adherence to oral therapies in adult patients with physical chronic diseases. Our overview suggests that there is a social gradient in adherence. However, for most factors, the evidence was not conclusive due to the risk of bias, inconsistency or imprecision.

The full article can be downloaded below.  

Integrated cancer tissue engineering models for precision medicine

Tumors are not merely cancerous cells that undergo mindless proliferation. Rather, they are highly organized and interconnected organ systems. Tumor cells reside in complex microenvironments in which they are subjected to a variety of physical and chemical stimuli that influence cell behavior and ultimately the progression and maintenance of the tumor. As cancer bioengineers, it is our responsibility to create physiologic models that enable accurate understanding of the multi-dimensional structure, organization, and complex relationships in diverse tumor microenvironments. Such models can greatly expedite clinical discovery and translation by closely replicating the physiological conditions while maintaining high tunability and control of extrinsic factors. In this review, we discuss the current models that target key aspects of the tumor microenvironment and their role in cancer progression. In order to address sources of experimental variation and model limitations, we also make recommendations for methods to improve overall physiologic reproducibility, experimental repeatability, and rigor within the field. Improvements can be made through an enhanced emphasis on mathematical modeling, standardized in vitro model characterization, transparent reporting of methodologies, and designing experiments with physiological metrics. Taken together these considerations will enhance the relevance of in vitro tumor models, biological understanding, and accelerate treatment exploration ultimately leading to improved clinical outcomes. Moreover, the development of robust, user-friendly models that integrate important stimuli will allow for the in-depth study of tumors as they undergo progression from non-transformed primary cells to metastatic disease and facilitate translation to a wide variety of biological and clinical studies.

The full article can be downloaded below.  

The law of genetic privacy: applications, implications, and limitations

Recent advances in technology have significantly improved the accuracy of genetic testing and analysis, and substantially reduced its cost, resulting in a dramatic increase inthe amount of genetic information generated, analysed, shared, and stored by diverse individuals and entities. Given the diversity of actors and their interests, coupled with the wide variety of ways genetic data are held, it has been difficult to develop broadly applicable legal principles for genetic privacy. This article examines the current landscape of genetic privacy to identify the roles that the law does or should play, with a focus on federal statutes and regulations, including the Health Insurance Portability and Accountability Act (HIPAA) and the Genetic Information Nondiscrimination Act (GINA). After considering the many contexts in which issues of genetic privacy arise, the article concludes that few, if any, applicable legal doctrines or enactments provide adequate protection or meaningful control to individuals over disclosures that may affect them. The article describes why it may be time to shift attention from attempting to control access to genetic information to considering the more challenging question of how these data can be used and under what conditions, explicitly addressing trade-offs between individual and social goods in numerous applications.

The full article can be downloaded below.  

Penn Medicine Launches Self-Service Machine Learning System

The Penn Medicine Institute for Biomedical Informatics has released a free, open-source automated machine learning system for data analysis.

The team developed the system so that anyone can use it, from high school students to biomedical researchers, on any computer or laptop. The first widely available tool of its kind, PennAI aims to eliminate barriers for entry into artificial intelligence. Users can bring in their own datasets or use the several hundred available for download within the system.

PennAI is also designed to learn as it goes, eventually making analysis suggestions based on the experience it gains through use. Because PennAI is an automated machine learning system, the artificial intelligence engine behind it can work through different analyses with different variables and methods on its own, without human input.

The full Health IT Analytics article can be viewed at this link.