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JCO Precision Oncology Jan 2023With the growing number of available targeted therapeutics and molecular biomarkers, the optimal care of patients with cancer now depends on a comprehensive...
PURPOSE
With the growing number of available targeted therapeutics and molecular biomarkers, the optimal care of patients with cancer now depends on a comprehensive understanding of the rapidly evolving landscape of precision oncology, which can be challenging for oncologists to navigate alone.
METHODS
We developed and implemented a precision oncology decision support system, GI TARGET, (Gastrointestinal Treatment Assistance Regarding Genomic Evaluation of Tumors) within the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute. With a multidisciplinary team, we systematically reviewed tumor molecular profiling for GI tumors and provided molecularly informed clinical recommendations, which included identifying appropriate clinical trials aided by the computational matching platform MatchMiner, suggesting targeted therapy options on or off the US Food and Drug Administration-approved label, and consideration of additional or orthogonal molecular testing.
RESULTS
We reviewed genomic data and provided clinical recommendations for 506 patients with GI cancer who underwent tumor molecular profiling between January and June 2019 and determined follow-up using the electronic health record. Summary reports were provided to 19 medical oncologists for patients with colorectal (n = 198, 39%), pancreatic (n = 124, 24%), esophagogastric (n = 67, 13%), biliary (n = 40, 8%), and other GI cancers. We recommended ≥ 1 precision medicine clinical trial for 80% (406 of 506) of patients, leading to 24 enrollments. We recommended on-label and off-label targeted therapies for 6% (28 of 506) and 25% (125 of 506) of patients, respectively. Recommendations for additional or orthogonal testing were made for 42% (211 of 506) of patients.
CONCLUSION
The integration of precision medicine in routine cancer care through a dedicated multidisciplinary molecular tumor board is scalable and sustainable, and implementation of precision oncology recommendations has clinical utility for patients with cancer.
Topics: Humans; Precision Medicine; Medical Oncology; Gastrointestinal Neoplasms; Genomics; Molecular Diagnostic Techniques
PubMed: 36634297
DOI: 10.1200/PO.22.00342 -
Neurocritical Care Feb 2023Medicines have been developed and have become globalized at a pace faster than traditional medical education can keep up. Physicians, pharmacists, nurses, and advanced...
Medicines have been developed and have become globalized at a pace faster than traditional medical education can keep up. Physicians, pharmacists, nurses, and advanced practice providers learn the names and functions of these medications, but not how they are made and how they get to the bedside. The often economically driven intricacies behind these processes have a dramatic effect on patient care and outcomes. A staggering proportion of medications worldwide are reported to be substandard or falsified. This article explores one country's story of how medication gets to the bedside, describes how this process can go wrong, and outlines what providers can do to work toward the goal of equitable access to quality medications for all.
Topics: Humans; Counterfeit Drugs; Ecuador; Global Health; Physicians
PubMed: 36517662
DOI: 10.1007/s12028-022-01658-1 -
Journal of the American College of... Sep 2016Patients, hospitals, insurers, and the public rely on competent physicians. The definition and documentation of competency in cardiovascular training and practice... (Review)
Review
Patients, hospitals, insurers, and the public rely on competent physicians. The definition and documentation of competency in cardiovascular training and practice continues to evolve. New tools, such as the American College of Cardiology's in-training examination, restructured Core Cardiovascular Training Statement, curricular and lifelong learning competencies, and the Accreditation Council for Graduate Medical Education Milestones help define competent trainees and practitioners, and level the playing field. The American Board of Internal Medicine's Maintenance of Certification program is undergoing critical review, and a common vision of its future form and role are not yet clear. This paper explores present-day cardiovascular competency components, assessment tools, and strategies, and identifies challenges for the future.
Topics: Cardiology; Clinical Competence; Professional Practice
PubMed: 27634126
DOI: 10.1016/j.jacc.2016.05.097 -
British Journal of Clinical Pharmacology Feb 2020Medicines are a major component of modern healthcare delivery, both in resource consumption and as drivers of innovation. The ever-increasing application of... (Review)
Review
Medicines are a major component of modern healthcare delivery, both in resource consumption and as drivers of innovation. The ever-increasing application of digitalisation within day-to-day living and as part of our healthcare systems-with the resultant data generation-presents the opportunity to better define the populations exposed to medicines, and their benefits and harm in real world settings. This article outlines the development of the Scottish National Prescribing Information System (PIS) and describes how this capability is being used to support the safe and effective use of medicines, both nationally and internationally. Since 2009, PIS has included e-prescribed/e-dispensed and reimbursed medicines data, now totalling 976 million prescriptions, with codified structured data on dose instructions. A literature review, covering the period from January 2009 to March 2019, identified 40 full publications using PIS, the first occurring in 2014. The majority involved pharmacoepidemiology/drug-use studies (50%) in cancer and cardiovascular disease. Measuring the value and impact of PIS was extended beyond publication quantification by illustrating the translation of PIS outputs into the learning health system at scale. The developing Scottish capabilities add breadth and depth to the wider evolving international environment, and offer the potential to contribute collegiately to the global effort on medicine safety and effectiveness, including support for the World Health Organisation Global Patient Safety Challenge: Medication Without Harm.
Topics: Big Data; Drug Prescriptions; Humans; Pharmaceutical Preparations; Pharmacoepidemiology; Scotland
PubMed: 31758595
DOI: 10.1111/bcp.14184 -
Pulmonary Pharmacology & Therapeutics Dec 2022COVID-19 medicines, such as molnupiravir are beginning to emerge for public health and clinical practice. On the other hand, drugs display marked variability in their... (Review)
Review
COVID-19 medicines, such as molnupiravir are beginning to emerge for public health and clinical practice. On the other hand, drugs display marked variability in their efficacy and safety. Hence, COVID-19 medicines, as with all drugs, will be subject to the age-old maxim "one size prescription does not fit all". In this context, pharmacogenomics is the study of genome-by-drug interactions and offers insights on mechanisms of patient-to-patient and between-population variations in drug efficacy and safety. Pharmacogenomics information is crucial to tailoring the patients' prescriptions to achieve COVID-19 preventive and therapeutic interventions that take into account the host biology, patients' genome, and variable environmental exposures that collectively influence drug efficacy and safety. This expert review critically evaluates and summarizes the pharmacogenomics and personalized medicine aspects of the emerging COVID-19 drugs, and other selected drug interventions deployed to date. Here, we aim to sort out the hope, hype, and reality and suggest that there are veritable prospects to advance COVID-19 medicines for public health benefits, provided that pharmacogenomics is considered and implemented adequately. Pharmacogenomics is an integral part of rational and evidence-based medical practice. Scientists, health care professionals, pharmacists, pharmacovigilance practitioners, and importantly, patients stand to benefit by expanding the current pandemic response toolbox by the science of pharmacogenomics, and its applications in COVID-19 medicines and clinical trials.
Topics: Humans; Pharmacogenetics; Precision Medicine; Pandemics; COVID-19 Drug Treatment
PubMed: 36265833
DOI: 10.1016/j.pupt.2022.102172 -
Chinese Herbal Medicines Oct 2021Traditional medicine uses a multitude of plants to create medicinal formulations, some of which show antiviral properties that may be of benefit in treating emerging... (Review)
Review
Traditional medicine uses a multitude of plants to create medicinal formulations, some of which show antiviral properties that may be of benefit in treating emerging viral diseases, including Covid-19. Lanna, an ancient Kingdom in Northern Thailand, with a thriving culture that continues to this day and has a rich history of traditional medicine using local plants that is still practiced today. To find potential antiviral medicinal candidates, we examined ancient manuscripts, interviewed traditional healers practicing today, and inventoried current traditional medicines to catalogue 1400 medicinal formulations used in Lanna traditional medicine. We then narrowed this list to find those traditionally used to treat diseases that in their original use and descriptions most likely map to those we know today to be viral diseases. We identified the plants used in these formulations to create a list of 64 potential antiviral herbal candidates drawn from this ancient Lanna wisdom and matched these to the scientific literature to see which of these plants had already been shown to possess antiviral properties, generating a list of 64 potential antiviral medicinal candidates from Lanna traditional medicine worth further investigation for treating emerging viral diseases.
PubMed: 34567096
DOI: 10.1016/j.chmed.2021.09.006 -
Journal of Medical Internet Research Nov 2022Medicinal cannabis is increasingly being used for a variety of physical and mental health conditions. Social media and web-based health platforms provide valuable,... (Review)
Review
BACKGROUND
Medicinal cannabis is increasingly being used for a variety of physical and mental health conditions. Social media and web-based health platforms provide valuable, real-time, and cost-effective surveillance resources for gleaning insights regarding individuals who use cannabis for medicinal purposes. This is particularly important considering that the evidence for the optimal use of medicinal cannabis is still emerging. Despite the web-based marketing of medicinal cannabis to consumers, currently, there is no robust regulatory framework to measure clinical health benefits or individual experiences of adverse events. In a previous study, we conducted a systematic scoping review of studies that contained themes of the medicinal use of cannabis and used data from social media and search engine results. This study analyzed the methodological approaches and limitations of these studies.
OBJECTIVE
We aimed to examine research approaches and study methodologies that use web-based user-generated text to study the use of cannabis as a medicine.
METHODS
We searched MEDLINE, Scopus, Web of Science, and Embase databases for primary studies in the English language from January 1974 to April 2022. Studies were included if they aimed to understand web-based user-generated text related to health conditions where cannabis is used as a medicine or where health was mentioned in general cannabis-related conversations.
RESULTS
We included 42 articles in this review. In these articles, Twitter was used 3 times more than other computer-generated sources, including Reddit, web-based forums, GoFundMe, YouTube, and Google Trends. Analytical methods included sentiment assessment, thematic analysis (manual and automatic), social network analysis, and geographic analysis.
CONCLUSIONS
This study is the first to review techniques used by research on consumer-generated text for understanding cannabis as a medicine. It is increasingly evident that consumer-generated data offer opportunities for a greater understanding of individual behavior and population health outcomes. However, research using these data has some limitations that include difficulties in establishing sample representativeness and a lack of methodological best practices. To address these limitations, deidentified annotated data sources should be made publicly available, researchers should determine the origins of posts (organizations, bots, power users, or ordinary individuals), and powerful analytical techniques should be used.
Topics: Humans; Cannabis; Medical Marijuana; Social Media; Medicine; Mental Disorders
PubMed: 36383417
DOI: 10.2196/35974 -
European Review For Medical and... Nov 2023The objective of this study was to systematically evaluate the application of Chinese medicine in the treatment of neck and low back pain. The goal was to assess the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The objective of this study was to systematically evaluate the application of Chinese medicine in the treatment of neck and low back pain. The goal was to assess the efficacy, analgesic effect, and safety of Chinese medicine using Cochrane system evaluation standards and conduct a meta-analysis to provide high-quality, evidence-based medical data for clinical practice decision-making.
MATERIALS AND METHODS
A comprehensive search was conducted in Chinese and English databases, including CBM, CNKI, Wanfang Data Knowledge Service Platform, VIP Chinese Science and Technology Periodical Database, Pubmed, Embase, and the Cochrane Library. The search encompassed randomized controlled trials on the use of Chinese medicine for pain treatment, with a time range from the establishment of each database to October 1, 2021. We have added the referred literature from the online databases for this research. Two researchers independently reviewed the literature, gathered data, and assessed the methodological quality of the included studies using the Cochrane Assistance Network risk of bias tool. Safety, reaction rate, and VAS pain score were of interest. To evaluate Chinese medicine's curative and analgesic benefits for pain illnesses, RevMan 5.4 and Stata 15.1 were used to analyze selected literature using forest plots, funnel plots, Egger and HarbORd linear regression plots, and star charts.
RESULTS
Chinese medicine treated pain in 57 investigations. The analysis yielded (1) a curative effect: Chinese medicine outperformed Western medicine, with no publication bias. The sensitivity analysis matched the meta-analysis that has been performed in this work, and it shows that Chinese medicine treated low back pain better than Western medicine. (2) Analgesic effect: Chinese medicine outperformed Western medicine in analgesia, although the literature is limited for such a claim. Chinese medicine was also more analgesic than Western medicine. (3) Safety: No major side effects were reported in 20 investigations on Chinese medicine's safety.
CONCLUSIONS
This study provides evidence that Chinese medicine can achieve better clinical efficacy and analgesic effects when comparing Chinese and Western medicine in the treatment of neck and low back pain. Furthermore, Chinese medicine demonstrated a favorable safety profile. However, further research is required to explore the use of Chinese medicine specifically for neck pain and to enhance the evidence base for clinical decision-making in pain management.
Topics: Humans; Low Back Pain; Medicine, Chinese Traditional; Treatment Outcome; Medicine; Analgesics; Drugs, Chinese Herbal
PubMed: 37975353
DOI: 10.26355/eurrev_202311_34304 -
JCO Global Oncology May 2021
Topics: COVID-19; Global Health; Humans; Medical Oncology; SARS-CoV-2
PubMed: 34077258
DOI: 10.1200/GO.21.00078 -
Drug Discovery Today Dec 2017Drug development requires physiologically more appropriate model systems and assays to increase understanding of drug action and pathological processes in individual... (Review)
Review
Drug development requires physiologically more appropriate model systems and assays to increase understanding of drug action and pathological processes in individual humans. Specifically, patient-derived cells offer great opportunities as representative cellular model systems. Moreover, with novel label-free cellular assays, it is often possible to investigate complex biological processes in their native environment. Combining these two offers distinct opportunities for increasing physiological relevance. Here, we review impedance-based label-free technologies in the context of patient samples, focusing on commonly used cell types, including fibroblasts, blood components, and stem cells. Applications extend as far as tissue-on-a-chip models. Thus, applying label-free technologies to patient samples can produce highly biorelevant data and, with them, unique opportunities for drug development and precision medicine.
Topics: Animals; Biological Assay; Cells; Drug Discovery; Humans; Precision Medicine
PubMed: 28778587
DOI: 10.1016/j.drudis.2017.07.015