Standardization and Personalized Medicine Using Quantitative EEG in Clinical Settings

2019 ◽  
pp. 155005941987494
Author(s):  
André W. Keizer
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Personalized Medicine ◽  
Treatment Effectiveness ◽  
Diagnostic Procedures ◽  
Quantitative Eeg ◽  
Clinical Settings ◽  
Validity And Reliability ◽  
Treatment Protocols ◽  
Normative Database

Two major trends have been dominant in health care in recent years. First, there is a growing consensus that standardization of health care procedures and methods can result in improved effectiveness and safety of treatments. Second, there is increased interest in “personalized medicine,” which refers to the tailoring of treatments to individual patients. Here I discuss how these trends apply to the field of quantitative EEG (qEEG), where de-artifacted resting state EEGs of individuals are compared with a normative database in order to assess clinically meaningful deviations, which can be used for diagnostic procedures, to guide personalized treatment protocols, and to assess treatment effectiveness. Standardized and automated de-artifacting procedures are increasingly being used in scientific research and in clinical practice. The advantages of these procedures over manual de-artifacting will be discussed. The results of a systematic comparison between 2 commonly used qEEG databases show that these databases produce very comparable results, illustrating not only the validity and reliability of both databases but also the opportunity to move forward to a standardized use of qEEG in clinical practice. Finally, the standardization of qEEG interpretation as both a diagnostic and treatment selection tool provides an example of how qEEG can merge both personalized medicine and standardization in the treatment of psychological disorders.

scholarly journals Implementing Personalized Medicine in COVID-19 in Andalusia: An Opportunity to Transform the Healthcare System

2021 ◽  
Vol 11 (6) ◽  
pp. 475
Author(s):  
Joaquín Dopazo ◽  
Douglas Maya-Miles ◽  
Federico García ◽  
Nicola Lorusso ◽  
Miguel Ángel Calleja ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Clinical Practice ◽  
Personalized Medicine ◽  
Local Level ◽  
Individual Variability ◽  
Response To Therapy ◽  
Control Measures ◽  
Response To Treatment ◽  
Specific Patient

The COVID-19 pandemic represents an unprecedented opportunity to exploit the advantages of personalized medicine for the prevention, diagnosis, treatment, surveillance and management of a new challenge in public health. COVID-19 infection is highly variable, ranging from asymptomatic infections to severe, life-threatening manifestations. Personalized medicine can play a key role in elucidating individual susceptibility to the infection as well as inter-individual variability in clinical course, prognosis and response to treatment. Integrating personalized medicine into clinical practice can also transform health care by enabling the design of preventive and therapeutic strategies tailored to individual profiles, improving the detection of outbreaks or defining transmission patterns at an increasingly local level. SARS-CoV2 genome sequencing, together with the assessment of specific patient genetic variants, will support clinical decision-makers and ultimately better ways to fight this disease. Additionally, it would facilitate a better stratification and selection of patients for clinical trials, thus increasing the likelihood of obtaining positive results. Lastly, defining a national strategy to implement in clinical practice all available tools of personalized medicine in COVID-19 could be challenging but linked to a positive transformation of the health care system. In this review, we provide an update of the achievements, promises, and challenges of personalized medicine in the fight against COVID-19 from susceptibility to natural history and response to therapy, as well as from surveillance to control measures and vaccination. We also discuss strategies to facilitate the adoption of this new paradigm for medical and public health measures during and after the pandemic in health care systems.

scholarly journals WEB PLOT DIGITIZER SOFTWARE: CAN IT BE USED TO MEASURE NECK POSTURE IN CLINICAL PRACTICE?

2018 ◽  
Vol 11 (14) ◽  
pp. 86 ◽  
Author(s):  
Suresh Mani ◽  
Shobha Sharma ◽  
Devinder Kaur Ajit Singh
Keyword(s):  
Clinical Practice ◽  
Neck Pain ◽  
Head Tilt ◽  
Future Research ◽  
Clinical Settings ◽  
Digital Photogrammetry ◽  
Validity And Reliability ◽  
The Past ◽  
History Of ◽  
Larger Sample

Objective : The aim of this study was to examine the use of WPD software to evaluate FHP using digital photogrammetry method.Method: A total of 15 adults with no history of neck pain for the past 6 months were recruited for the study. Using digital photogrammetry and sagittal head tilt, craniocervical and shoulder angles (SAs) were measured using a WPD, which is an open resource of web or Windows-based software.Result: Fifteen participants aged 17–40 years (mean 24.7±6.3 years) were examined. Sagittal head tilt and craniocervical angles were 16.35°±8.33° and 47.43°±7.97°, respectively. SA was 52.28°±12.46°.Conclusion: WPD may be used to evaluate FHP in the clinical settings. However, future research is required to determine the validity and reliability of WPD among patients with neck-related musculoskeletal disorders with a larger sample.

Challenges and Opportunities in Implementing Pharmacogenetic Testing in Clinical Settings

2021 ◽  
Vol 61 (1) ◽  
pp. 65-84 ◽  
Author(s):  
Wan-Chun Chang ◽  
Reo Tanoshima ◽  
Colin J.D. Ross ◽  
Bruce C. Carleton
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Drug Safety ◽  
Practice Guidelines ◽  
Genetic Variants ◽  
Clinical Settings ◽  
Drug Selection ◽  
Clinical Implementation ◽  
Pharmacogenetic Testing ◽  
Challenges And Opportunities

The clinical implementation of pharmacogenetic biomarkers continues to grow as new genetic variants associated with drug outcomes are discovered and validated. The number of drug labels that contain pharmacogenetic information also continues to expand. Published, peer-reviewed clinical practice guidelines have also been developed to support the implementation of pharmacogenetic tests. Incorporating pharmacogenetic information into health care benefits patients as well as clinicians by improving drug safety and reducing empiricism in drug selection. Barriers to the implementation of pharmacogenetic testing remain. This review explores current pharmacogenetic implementation initiatives with a focus on the challenges of pharmacogenetic implementation and potential opportunities to overcome these challenges.

scholarly journals Pharmacogenomic and Pharmacotranscriptomic Profiling of Childhood Acute Lymphoblastic Leukemia: Paving the Way to Personalized Treatment

Genes ◽  
2019 ◽  
Vol 10 (3) ◽  
pp. 191 ◽  
Author(s):  
Sonja Pavlovic ◽  
Nikola Kotur ◽  
Biljana Stankovic ◽  
Branka Zukic ◽  
Vladimir Gasic ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Acute Lymphoblastic Leukemia ◽  
Personalized Medicine ◽  
High Throughput ◽  
Prediction Models ◽  
Lymphoblastic Leukemia ◽  
Machine Learning Algorithms ◽  
Treatment Protocols ◽  
Childhood All ◽  
All Treatment

Personalized medicine is focused on research disciplines which contribute to the individualization of therapy, like pharmacogenomics and pharmacotranscriptomics. Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. It is one of the pediatric malignancies with the highest cure rate, but still a lethal outcome due to therapy accounts for 1%–3% of deaths. Further improvement of treatment protocols is needed through the implementation of pharmacogenomics and pharmacotranscriptomics. Emerging high-throughput technologies, including microarrays and next-generation sequencing, have provided an enormous amount of molecular data with the potential to be implemented in childhood ALL treatment protocols. In the current review, we summarized the contribution of these novel technologies to the pharmacogenomics and pharmacotranscriptomics of childhood ALL. We have presented data on molecular markers responsible for the efficacy, side effects, and toxicity of the drugs commonly used for childhood ALL treatment, i.e., glucocorticoids, vincristine, asparaginase, anthracyclines, thiopurines, and methotrexate. Big data was generated using high-throughput technologies, but their implementation in clinical practice is poor. Research efforts should be focused on data analysis and designing prediction models using machine learning algorithms. Bioinformatics tools and the implementation of artificial i Lack of association of the CEP72 rs924607 TT genotype with intelligence are expected to open the door wide for personalized medicine in the clinical practice of childhood ALL.

The Changing Legal and Conceptual Shape of Health Care Privacy

2004 ◽  
Vol 32 (4) ◽  
pp. 680-691 ◽  
Author(s):  
Roger S. Magnusson
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Medical Care ◽  
Health Inequalities ◽  
Medical Technology ◽  
Clinical Settings ◽  
Social Forces ◽  
Health Law ◽  
Stage Of Development ◽  
Professional Codes

The contributions of Professor Bernard Dickens to health law and bioethics span the era in which these fields have emerged as distinct domains of teaching, scholarship and professional and public conversation. Neither field exists in a vacuum. The concerns of bioethics, like the content of health law, are a product of social forces. The bureaucratization of medical care, the possibilities and uncertainties created by developments in medical technology, not to mention glaring health inequalities, have been destabilizing forces in medicine. Writing in 1974, American sociologist Renée Fox noted that medicine had reached “a stage of development characterized by diffuse ethical and existential self-consciousness.” This new medical introspection was evidenced by intense engagement with issues of biomedical regulation, and with the growth of professional codes and processes for resolving value-laden issues within clinical settings.While sometimes described as a process or site for discussion and “engagement,” bioethics evolved rapidly into a domain of governance, with direct implications for clinical practice.

scholarly journals Is There a Research–Practice Dosage Gap in Aphasia Rehabilitation?

2021 ◽  
pp. 1-15
Author(s):  
Robert Cavanaugh ◽  
Christina Kravetz ◽  
Lillian Jarold ◽  
Yina Quique ◽  
Rose Turner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Treatment Effectiveness ◽  
The United States ◽  
Interquartile Range ◽  
Successful Implementation ◽  
Clinical Settings ◽  
Research Practice ◽  
Total Treatment ◽  
Episodes Of Care ◽  
Treatment Dosage

Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the translation and implementation of evidence-based aphasia interventions to clinical practice. Treatment dosage may be difficult to translate to clinical settings, and a mismatch between dosage in research and clinical practice threatens to attenuate intervention effectiveness. The purpose of this study is to quantify a potential research–practice dosage gap in outpatient aphasia rehabilitation. Method This study utilized a two-part approach. First, we estimated clinical treatment dosage in an episode of care (i.e., treatment provided from outpatient assessment to discharge) via utilization in a regional provider in the United States. Second, we undertook a scoping review of aphasia interventions published from 2009 to 2019 to estimate the typical dosage used in the current aphasia literature. Results Outpatient clinical episodes of care included a median of 10 treatment sessions and a mean of 14.8 sessions (interquartile range: 5–20 sessions). Sessions occurred 1–2 times a week over 4–14 weeks. The median total hours of treatment was 7.5 hr (interquartile range: 3.75–15 hr). In contrast, published interventions administered a greater treatment dosage, consisting of a median of 20 hr of treatment (interquartile range: 12–30 hr) over the course of 15 sessions (interquartile range: 10–24 sessions) approximately 3 times per week. Conclusions Results demonstrate a meaningful research–practice dosage gap, particularly in total treatment hours and weekly treatment intensity. This gap highlights the potential for attenuation of effectiveness from research to outpatient settings. Future translational research should consider clinical dosage constraints and take steps to facilitate intervention implementation, particularly with regard to dosage. Conversely, health care advocacy and continued development of alternative delivery methods are necessary for the successful implementation of treatments with dosage that is incompatible with current clinical contexts. Pragmatic, implementation-focused trials are recommended to evaluate and optimize treatment effectiveness in outpatient clinical settings. Supplemental Material https://doi.org/10.23641/asha.15161568

scholarly journals Safeguarding COVID-19 and cancer management: drug design and therapeutic approach

2021 ◽  
Vol 1 ◽  
pp. 77
Author(s):  
Nanasaheb Thorat ◽  
Sabrina Pricl ◽  
Abdul K. Parchur ◽  
Sandeep B. Somvanshi ◽  
Qifei Li ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Patients ◽  
Infection Risk ◽  
Data Driven ◽  
Clinical Settings ◽  
Treatment Protocols ◽  
Cancer Management ◽  
Clinical Cohort ◽  
Demographic Features ◽  
Overall Mortality

Recent clinical cohort studies have highlighted that there is a three-fold greater SARS-Cov-2 infection risk in cancer patients, and overall mortality in individuals with tumours is increased by 41% with respect to general COVID-19 patients. Thus, access to therapeutics and intensive care is compromised for people with both diseases (comorbidity) and there is risk of delayed access to diagnosis. This comorbidity has resulted in extensive burden on the treatment of patients and health care system across the globe; moreover, mortality of hospitalized patients with comorbidity is reported to be 30% higher than for individuals affected by either disease. In this data-driven review, we aim specifically to address drug discoveries and clinical data of cancer management during the COVID-19 pandemic. The review will extensively address the treatment of COVID-19/cancer comorbidity; treatment protocols and new drug discoveries, including the description of drugs currently available in clinical settings; demographic features; and COVID-19 outcomes in cancer patients worldwide.

scholarly journals Role of Artificial Intelligence Applications in Real-Life Clinical Practice: Systematic Review (Preprint)

2020 ◽  
Author(s):  
Jiamin Yin ◽  
Kee Yuan Ngiam ◽  
Hock Hai Teo
Keyword(s):  
Artificial Intelligence ◽  
Health Care ◽  
Clinical Practice ◽  
Risk Analysis ◽  
Early Stage ◽  
Controlled Trial ◽  
Real Life ◽  
Disease Diagnosis ◽  
Clinical Settings ◽  
Clinical Implementation

BACKGROUND Artificial intelligence (AI) applications are growing at an unprecedented pace in health care, including disease diagnosis, triage or screening, risk analysis, surgical operations, and so forth. Despite a great deal of research in the development and validation of health care AI, only few applications have been actually implemented at the frontlines of clinical practice. OBJECTIVE The objective of this study was to systematically review AI applications that have been implemented in real-life clinical practice. METHODS We conducted a literature search in PubMed, Embase, Cochrane Central, and CINAHL to identify relevant articles published between January 2010 and May 2020. We also hand searched premier computer science journals and conferences as well as registered clinical trials. Studies were included if they reported AI applications that had been implemented in real-world clinical settings. RESULTS We identified 51 relevant studies that reported the implementation and evaluation of AI applications in clinical practice, of which 13 adopted a randomized controlled trial design and eight adopted an experimental design. The AI applications targeted various clinical tasks, such as screening or triage (n=16), disease diagnosis (n=16), risk analysis (n=14), and treatment (n=7). The most commonly addressed diseases and conditions were sepsis (n=6), breast cancer (n=5), diabetic retinopathy (n=4), and polyp and adenoma (n=4). Regarding the evaluation outcomes, we found that 26 studies examined the performance of AI applications in clinical settings, 33 studies examined the effect of AI applications on clinician outcomes, 14 studies examined the effect on patient outcomes, and one study examined the economic impact associated with AI implementation. CONCLUSIONS This review indicates that research on the clinical implementation of AI applications is still at an early stage despite the great potential. More research needs to assess the benefits and challenges associated with clinical AI applications through a more rigorous methodology.

scholarly journals Motivations and Experiences of Canadians Seeking Treatment for Lyme Disease Outside of the Conventional Canadian Health-Care System

2017 ◽  
Vol 5 (2) ◽  
pp. 120-126 ◽  
Author(s):  
Corinne R Boudreau ◽  
Vett K Lloyd ◽  
Odette N Gould
Keyword(s):  
Health Care ◽  
Lyme Disease ◽  
Health Care System ◽  
Diagnostic Procedures ◽  
Advocacy Groups ◽  
Treatment Protocols ◽  
Canadian Health Care System ◽  
Canadian Health ◽  
Canadian Health Care ◽  
Care System

Objective: We aimed to describe the experiences of Canadians who seek diagnosis and treatment for Lyme disease outside of the conventional Canadian health-care system. Methods: Forty-five individuals who had sought treatment for Lyme disease outside of the conventional Canadian health-care system were recruited from Lyme support and advocacy groups across Canada to answer open-ended questions about their experiences. Results: Respondents sought treatment outside of the conventional medical system due to extensive diagnostic procedures and treatments that did not resolve symptoms. Escalating health concerns, lack of effective treatment, and stigma produced a sense of abandonment and desperation. Respondents accessed alternative forms of care based on the recommendations of peers, yet considerable financial and emotional stress was experienced. Conclusions: Many individuals with Lyme or Lyme-like diseases are deeply dissatisfied with the care received within the conventional Canadian health-care system and therefore felt both pushed and pulled to seek treatments either from international physicians using different treatment protocols or from alternative medicine providers in Canada.

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