Immuno-oncologic care during COVID-19: Challenges and opportunities for improving clinical care and investigation

The novel coronavirus disease 2019 (COVID-19) is a global pandemic that continues to sweep across the world, posing an urgent need for effective therapies and prevention of the spread of the severe acute respiratory syndrome related to coronavirus-2 (SARS-CoV-2). A major hypothesis that is currently guiding research and clinical care posits that an excessive and uncontrolled surge of pro-inflammatory cytokines (the so-called “cytokine storm”) drives morbidity and mortality in the most severe cases. In the overall efforts made to develop effective and safe therapies (including vaccines) for COVID-19, clinicians are thus repurposing ready-to-use drugs with direct or indirect anti-inflammatory and immunomodulatory activities. Speculatively, there are many opportunities and challenges in targeting immune/inflammatory processes in the evolving settings of COVID-19 disease because of the need to safely balance the fight against virus and aggressive inflammation versus the suppression of host immune defenses and the risk of additional harms in already compromised patients. To this end, many studies are globally underway to weigh the pros and cons of tailoring drugs used for inflammatory-driven conditions to COVID-19 patient care, and the next step will be to summarize the growing clinical trial experience into clean clinical practice. Based on the current evidence, anti-inflammatory drugs should be considered as complementary approaches to anti-viral drugs that need to be timely introduced in the management of COVID-19 according to disease severity. While drugs that target SARS-CoV-2 entry or replication are expected to confer the greatest benefits at the early stage of the infection, anti-inflammatory drugs would be more effective in limiting the inflammatory processes that drive the worsening of the disease.

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Psychosocial Challenges and Opportunities for Youth With Chronic Health Conditions During the COVID-19 Pandemic (Preprint)

10.2196/preprints.23057 ◽

2020 ◽

Author(s):

Anna Serlachius ◽

Sherif M Badawy ◽

Hiran Thabrew

Keyword(s):

Clinical Care ◽

Well Being ◽

Economic Stress ◽

School Closure ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Access To Health ◽

Increased Risk ◽

Challenges And Opportunities

UNSTRUCTURED School closures, altered access to health services, and economic stress during the COVID-19 pandemic have likely had an impact on the mental and physical well-being of youth worldwide, particularly among those with chronic health conditions (CHCs). A number of challenges and opportunities have emerged during the COVID-19 pandemic for youth with CHCs. Challenges include heightened anxiety, disrupted routines, academic and social stresses associated with school closure, increased risk of domestic violence and abuse, and reduced access to physical and psychosocial support. On the other hand, opportunities include reduced academic and social stress, increased time with families, reduced access to substances, easier access to health care using technology, and opportunities to build resilience. This viewpoint paper highlights both challenges and opportunities for youth with CHCs during the pandemic and offers recommendations for further research and clinical care.

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Health Care Social Work

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.176 ◽

2013 ◽

Cited By ~ 1

Author(s):

Shirley Otis-Green

Keyword(s):

Health Care ◽

Social Work ◽

Social Workers ◽

Clinical Care ◽

Research Education ◽

Challenges And Opportunities ◽

History Of ◽

Standards And Guidelines ◽

And Coping ◽

The Impact

Health social work is a subspecialization of social work concerned with a person's adjustment to changes in one's health and the impact this has on that person's social network. Social workers in every setting must be ready to assist individuals and families adjusting to illness and coping with medical crises. This entry provides a brief overview and history of health social work and describes the settings and roles where this work is practiced. Significant challenges and opportunities in clinical care, research, education, and policy are discussed. Standards and guidelines for quality practice are then noted.

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Clinical Tumor Sequencing: Opportunities and Challenges for Precision Cancer Medicine

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2015.35.e175 ◽

2015 ◽

pp. e175-e182 ◽

Cited By ~ 26

Author(s):

Senthilkumar Damodaran ◽

Michael F. Berger ◽

Sameek Roychowdhury

Keyword(s):

Genome Sequencing ◽

Clinical Care ◽

Point Mutations ◽

Genomic Testing ◽

Genomic Alterations ◽

Discovery Research ◽

Challenges And Opportunities ◽

Cancer Medicine ◽

Next Generation Sequencing Ngs ◽

Tumor Genome

Advances in tumor genome sequencing have enabled discovery of actionable alterations leading to novel therapies. Currently, there are approved targeted therapies across various tumors that can be matched to genomic alterations, such as point mutations, gene amplification, and translocations. Tools to detect these genomic alterations have emerged as a result of decreasing costs and improved throughput enabled by next-generation sequencing (NGS) technologies. NGS has been successfully utilized for developing biomarkers to assess susceptibility, diagnosis, prognosis, and treatment of cancers. However, clinical application presents some potential challenges in terms of tumor specimen acquisition, analysis, privacy, interpretation, and drug development in rare cancer subsets. Although whole-genome sequencing offers the most complete strategy for tumor analysis, its present utility in clinical care is limited. Consequently, targeted gene capture panels are more commonly employed by academic institutions and commercial vendors for clinical grade cancer genomic testing to assess molecular eligibility for matching therapies, whereas whole-exome and transcriptome (RNASeq) sequencing are being utilized for discovery research. This review discusses the strategies, clinical challenges, and opportunities associated with the application of cancer genomic testing for precision cancer medicine.

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Challenges and Opportunities Faced by Biofield Practitioners in Global Health and Medicine: A White Paper

Global Advances in Health and Medicine ◽

10.7453/gahmj.2015.024.suppl ◽

2015 ◽

Vol 4 (1_suppl) ◽

pp. gahmj.2015.024. ◽

Cited By ~ 1

Author(s):

Erminia Guarneri ◽

Rauni Prittinen King

Keyword(s):

Interprofessional Education ◽

Core Competencies ◽

Clinical Care ◽

White Paper ◽

Current Status ◽

Integrative Health ◽

Team Care ◽

Challenges And Opportunities ◽

Definition Of ◽

Professional Licensure

Biofield therapies (BTs) are increasingly employed in contemporary healthcare. In this white paper, we review specific challenges faced by biofield practitioners resulting from a lack of (1) a common scientific definition of BT; (2) common educational standards for BT training (including core competencies for clinical care); (3) collaborative team care education in complementary and alternative medicine (CAM) and in integrative health and medicine (IHM); (4) a focused agenda in BT research; and (5) standardized devices and scientifically validated mechanisms in biofield research. We present a description of BT and discuss its current status and challenges as an integrative healthcare discipline. To address the challenges cited and to enhance collaboration across disciplines, we propose (1) standardized biofield education that leads to professional licensure and (2) interprofessional education (IPE) competencies in BT training required for licensed healthcare practitioners and encouraged for other practitioners using these therapies. Lastly, we discuss opportunities for growth and a potential strategic agenda to achieve these goals. The Academy of Integrative Health and Medicine (AIHM) provides a unique forum to facilitate development of this emerging discipline, to facilitate IPE, and to further increase the availability of BT to patients.

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Practice-Based Research Networks and the Mandate for Real-World Evidence

American Journal of Law & Medicine ◽

10.1177/0098858818789428 ◽

2018 ◽

Vol 44 (2-3) ◽

pp. 219-236 ◽

Cited By ~ 3

Author(s):

Elizabeth Hall-Lipsy ◽

Leila Barraza ◽

Christopher Robertson

Keyword(s):

Real World ◽

Clinical Care ◽

Observational Research ◽

Research Networks ◽

Real World Evidence ◽

Academic Hospitals ◽

Challenges And Opportunities ◽

Practice Based Research ◽

Research Findings ◽

Primary Care Clinicians

The 21st Century Cures Act encourages the Food and Drug Administration to consider “real-world evidence” in its regulation of the safety and efficacy of drugs and devices. Many have interpreted this mandate to focus on non-randomized observational research. However, we suggest that regulatory science must also move from rarefied academic hospitals to community-based settings, where the vast majority of patients in fact receive care in the fragmented U.S. healthcare system. This move is especially important if innovations are to reach, and be validated in, more diverse populations. A solution can be found in the 183 Practiced-Based Research Networks (“PBRN”), i.e., groups of primary care clinicians and practices in all 50 states working to improve clinical care and translate research findings into practice. This symposium contribution seeks to (1) describe some of the common shortcomings of clinical trials, (2) explore the opportunities and challenges posed by use of real-world evidence as a basis for drug and device regulation, (3) briefly describe the history and evolution of PBRNs, and (4) articulate the challenges and opportunities for using PBRNs to fulfill the 21st Century Cures Act mandate for real-world evidence.

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Personalized mathematical oncology: Challenges and opportunities

10.1101/2021.08.03.454882 ◽

2021 ◽

Author(s):

Michael C. Luo ◽

Elpiniki Nikolopoulou ◽

Jana Gevertz

Keyword(s):

Treatment Response ◽

Clinical Care ◽

Population Level ◽

Personalized Treatment ◽

Patient Specific ◽

Individual Treatment ◽

Specific Data ◽

Level Statistics ◽

Challenges And Opportunities ◽

The Individual

An outstanding challenge in the clinical care of cancer is moving from a one-size-fits-all approach that relies on population-level statistics towards personalized therapeutic design. Mathematical modeling is a powerful tool in treatment personalization, as it allows for the incorporation of patient-specific data so that treatment can be tailor-designed to the individual. In this work, we employ two fitting methodologies to personalize treatment in a mathematical model of murine cancer immunotherapy. Unexpectedly, we found that the predicted personalized treatment response is sensitive to the fitting methodology utilized. This raises concerns about the ability of mathematical models, even relatively simple ones, to make reliable predictions about individual treatment response. Our analyses shed light onto why it can be challenging to make personalized treatment recommendations from a model, but also suggest ways we can increase our confidence in personalized mathematical predictions.

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A Path for Translation of Machine Learning Products into Healthcare Delivery

EMJ Innovation ◽

10.33590/emjinnov/19-00172 ◽

2020 ◽

Cited By ~ 4

Keyword(s):

Machine Learning ◽

Clinical Care ◽

Healthcare Delivery ◽

Clinical Decision ◽

Learning Models ◽

Electronic Health Record Data ◽

Challenges And Opportunities ◽

System Leaders ◽

Depth Study ◽

Machine Learning Models

Despite enormous enthusiasm, machine learning models are rarely translated into clinical care and there is minimal evidence of clinical or economic impact. New conference venues and academic journals have emerged to promote the proliferating research; however, the translational path remains unclear. This review undertakes the first in-depth study to identify how machine learning models that ingest structured electronic health record data can be applied to clinical decision support tasks and translated into clinical practice. The authors complement their own work with the experience of 21 machine learning products that address problems across clinical domains and across geographic populations. Four phases of translation emerge: design and develop, evaluate and validate, diffuse and scale, and continuing monitoring and maintenance. The review highlights the varying approaches taken across each phase by teams building machine learning products and presents a discussion of challenges and opportunities. The translational path and associated findings are instructive to researchers and developers building machine learning products, policy makers regulating machine learning products, and health system leaders who are considering adopting a machine learning product.

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Psychosocial Challenges and Opportunities for Youth With Chronic Health Conditions During the COVID-19 Pandemic

JMIR Pediatrics and Parenting ◽

10.2196/23057 ◽

2020 ◽

Vol 3 (2) ◽

pp. e23057 ◽

Cited By ~ 1

Author(s):

Anna Serlachius ◽

Sherif M Badawy ◽

Hiran Thabrew

Keyword(s):

Clinical Care ◽

Well Being ◽

Economic Stress ◽

School Closure ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Access To Health ◽

Increased Risk ◽

Challenges And Opportunities

School closures, altered access to health services, and economic stress during the COVID-19 pandemic have likely had an impact on the mental and physical well-being of youth worldwide, particularly among those with chronic health conditions (CHCs). A number of challenges and opportunities have emerged during the COVID-19 pandemic for youth with CHCs. Challenges include heightened anxiety, disrupted routines, academic and social stresses associated with school closure, increased risk of domestic violence and abuse, and reduced access to physical and psychosocial support. On the other hand, opportunities include reduced academic and social stress, increased time with families, reduced access to substances, easier access to health care using technology, and opportunities to build resilience. This viewpoint paper highlights both challenges and opportunities for youth with CHCs during the pandemic and offers recommendations for further research and clinical care.

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Teleneurology Teaching Service at a Rural Regional Campus

Journal of Regional Medical Campuses ◽

10.24926/jrmc.v4i3.3534 ◽

2021 ◽

Vol 4 (3) ◽

Author(s):

Anne-Taylor Beck ◽

Leeandra B. Cleaver ◽

Joshua D. Fuqua ◽

Katlyn B. Clark ◽

Rohit S. Nair ◽

...

Keyword(s):

Medical School ◽

Student Satisfaction ◽

Conflicts Of Interest ◽

Clinical Care ◽

Direct Interaction ◽

Rural Medicine ◽

Clinical Exposure ◽

Regional Campuses ◽

Challenges And Opportunities ◽

Regional Campus

Regional rural medical school campuses offer many opportunities for medical students to gain more hands-on experience, have more direct interaction with attending physicians, and cultivate a deeper understanding of challenges and opportunities specific to rural medicine. Some specialty services such as neurology are not available at these small regional campuses, and telemedicine technology can be a valuable tool to address this need. We report the implementation of teleneurology stroke consultation services as part of the third-year neurology clerkship at a regional medical school campus. We analyzed daily clinical notes and student satisfaction surveys. Students saw many common and important presentations of cerebrovascular events. Students worked as part of a multi-disciplinary care team while following these patients through their hospital course with effective instruction provided by remote stroke neurologists. All students strongly agreed that telemedicine was a positive component of the clerkship. We conclude that teleneurology is an effective way to provide inpatient neurology clinical exposure, especially when remote attendings have a strong screen presence and are enthusiastic about teaching. We believe these findings could be useful to other campuses considering similar teaching methods, as innovations in telemedicine continue to address challenges in medical education and clinical care. The authors have no conflicts of interest to report and the Baptist Health Madisonville Institutional Review Board found this study to be exempt.

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