Future perspectives of personalized medicine in traditional Chinese medicine: a systems biology approach

Deconstruction of molecular pathways and advances in enabling technology platforms have opened new horizons for disease management, exploring therapeutic solutions to each individual patient beyond the one-size fits all practice. Application of personalized medicine paradigms aims to achieve the right diagnosis and right treatment for the right patient at the right time at the right cost. With the potential to transform medical practice across global communities, personalized medicine is emerging as the flagship of modern medicine. In recent years, the health care paradigm has shifted from a focus on diseases to a major hot of personalized traditional Chinese medicine (TCM) with holistic approach. TCM focuses on health maintenance, emphasizes on enhancing the body's resistance to diseases and especially showes great advantages in early intervention, personalized and combination therapies, etc. Systems biology, a new science of the 21st century, becomes practically available and resembles TCM in many aspects such as study method and design, and is current key component technologies that serves as the major driving force for translation of the personalized medicine revolution of TCM principles into practice, will advance personalized therapy principles into healthcare management tools for individuals and populations. Such system approach concepts are transforming principles of TCM to modern therapeutic approaches, enable a predictive and preventive medicine and will lead to personalized medicine. To realise the full potential of personalized TCM, we describe the current status of principles and practice of TCM integrated with systems biology platform. Some characteristic examples are presented to highlight the application of this platform to personalized TCM research and development as well as some of the necessary milestones for moving TCM into mainstream health care.     

Mechanistic understanding in clinical practice: complementing evidence‐based medicine with personalized medicine

In the last century, medicine has undergone an unprecedented wave of radical changes. From the implementation of surgery up to the development of single gene‐targeted therapies, clinical decision making has become increasingly complex to handle. Today, this complexity needs to be rethought in the light of two emerging paradigms: evidence‐based medicine (EBM) and personalized medicine (P‐Med). The new availability of diverse sources of scientific evidence raises significant issues concerning how clinicians will compare, evaluate and orient their decisions in front of a rapidly growing plethora of therapies, procedures, medical technologies and drugs. In this paper, we compare the background visions behind these two paradigms, evaluating their respective relevance for present and future clinical decision making. In particular, we argue that EBM and P‐Med are driven by two diverse modes of reasoning about ‘evidence making’ in medicine. EBM is grounded on statistical notions and epidemiological data, generally gathered through systematic meta‐reviews of randomized controlled trials; P‐Med, instead, is grounded on mechanistic explanations of molecular interactions, metabolic pathways and biomarkers. While both paradigms are epistemically sound, we argue that they cannot, and should not, be hybridized into a unique model. Rather, they ought to represent two compatible, but alternative ways of informing the clinical practice. Hence, we conclude that clinicians may expect to see their responsibility increasing as they will deal with diverse, but equally compelling, ways of reasoning and deciding about which intervention will qualify as the ‘best one’ in each individual case.     

The influence of power in the Canadian healthcare system

This article presents a review of the literature as it relates to the influence of the word power in the context of the Canadian healthcare system. The concept of power is used to explore issues of gender and the evolution of advanced nurse practice in the development of the Canadian healthcare system. Furthermore, issues related to the call for interprofessional collaboration are addressed. Healthcare workers, in particular nurses, are trusted in a society that seeks, promotes, and aspires for power and control. In addition, societal norms continue to shape our healthcare reform. As a consequence, the discussion centers on a call for true collaboration among our healthcare providers and concludes with implications for nursing.     

Health system drivers of hospital medicine in Canada: Systematic review

Objective

To identify the underlying systemic drivers of the development and ongoing expansion of hospitalist programs in Canada.

Data sources

MEDLINE and Google Scholar were searched using combinations of the terms hospitalist, hospital medicine, and Canada.

Study selection

All publications that addressed the study question, including review articles, original research, editorials, commentaries, and letters or news articles, were included in the review.

Synthesis

Constant comparative methodology was used to analyze and code the articles and to synthesize the identified codes into broader themes. Three broad categories were identified: physician-related drivers, health system–related drivers, and patient-related drivers. Within each category, we identified a number of drivers.

Conclusion

Many drivers have been cited in the literature as reasons behind the emergence and growth of the hospitalist model in the Canadian health care system. While their interplay makes simple cause-and-effect conclusions difficult, these drivers demonstrate that hospitalist programs in Canada have developed in response to a complex set of provider, system, and patient factors.     

Biomarkers research in Europe: focus on personalized medicine

The sixth annual European Biomarkers Summit took place in London, UK, on 18-19 May 2011. It was part of a larger event, organized by Select Biosciences, with meetings on molecular diagnostics, single cell analysis and theranostics for personalized medicine. The Biomarkers Summit featured 17 invited talks from academics and industry researchers, a number of poster presentations and exhibitions from several companies marketing biomarker-related technologies and consumables. The focus was broad, covering various aspects of biomarker discovery, qualification, and applications, and a variety of diseases including cancer, neurodegenerative conditions and infectious diseases. Gene-based, as well as protein-based, platforms for biomarkers identification and analysis were discussed.     

Iranian diabetic adolescent girls’ quality of life: perspectives on barriers

Scand J Caring Sci; 2010; 24; 463–471
Iranian diabetic adolescent girls’ quality of life: perspectives on barriers Introduction: Diabetes with permanent changes in a person’s life‐style has negative effects on adolescent quality of life (QoL) too. Diabetes may afflict men and women equally, but the suffering associated with the disease when it appears in an adolescent girl will have disastrous effects on her life. If we want to improve the QoL for girls with the disease, then being familiar with the barrier factors for a good QoL is important. Aim: To explore Iranian diabetic adolescent girls’ perspective on barriers of having a good QoL. Methods: A qualitative design using content analysis was applied in order to seek the purpose. Semistructured interviews were conducted with 20 adolescent girls with Type 1 diabetes. The participants were recruited by purposeful sampling of ‘West Azerbaijan Diabetes Association’ members as well as some patients in Uremia city hospitals. Findings: Qualitative content analysis demonstrated two original category from effective barriers on good QoL: (1) external world barriers on good QoL (problems in family, social perspective about diabetes and problems in school), (2) Individual barriers on good QoL (negative feeling toward treatment and care, negative effects of Diabetes and uncertainty about future). Also it was shown that, cultural believes, such more controls and limitations the various aspects of the behaviour and life of girls compared with boys sometimes had negative effects on QoL. Conclusion: As most paediatric teams are multidisciplinary, sharing the information regarding QoL barriers as part of ongoing clinical care is crucial and should help to tailor care to the needs of the adolescent with diabetes.     

Towards concordance in healthcare: perspectives of general practitioners,complementary and alternative medicine practitioners and pharmacists in Australia

Partnerships and concordance are desirable concepts for optimal healthcare. The concept of concordance is based on negotiation between equals in a therapeutic relationship, forming a therapeutic alliance between all partners. One field of healthcare in which concordant relationships may be particularly desirable is complementary and alternative medicine (CAM). CAM is increasingly used by consumers worldwide, and provider–patient relationships are important across the spectrum of CAM‐to‐conventional medicine; thus, it was considered useful to research CAM and concordance in parallel. The objective of this problem‐detection study (PDS) was to investigate practitioners’ (general practitioners’, pharmacists’ and CAM practitioners’) views on their relationships and reaching concordant partnerships with consumers in the areas of both conventional medicine and CAM. Focus groups and semi‐structured interviews guided the development of the PDS instrument. The questionnaire consisted of 36 items corresponding to seven thematic units deduced from the preliminary data. The differences in perceptions between the surveyed groups indicated that achieving concordance relies on mutual respect and communication and understanding of roles, responsibilities and limitations, and differences in opinion may be compromising the formation of partnerships. Potentially problematic issues identified by this research could be addressed by educational interventions and enhancement of communication between all parties involved, as information loses value when not shared, and may be prone to contradiction and confusion. Further research is warranted in order to facilitate positive changes in the health system.     

Promoting self-care in heart failure: state of clinical practice based on the perspectives of healthcare systems and providers

Patient adherence to self-care is an important theme discussed in evidence-based consensus treatment guidelines, although the level of evidence reflects only expert opinion. This article summarizes what is known about self-care from the perspective of healthcare system personnel and healthcare providers. This perspectives of these two groups may influence patients abilities to perform self-care and may sway treatment guideline or performance measure recommendations. No performance measures address patient adherence to any aspect of self-care in the hospital or ambulatory care setting. Likewise, education and demonstration of self-care interventions that might aid patients to adhere to the heart failure plan of care are not systematically applied in healthcare systems or by providers. Thus, we remain unsure if the intervention methods used are effective or if the breadth and depth of education provided are sufficient. This article discusses the current state of clinical practice aimed at promoting patient adherence to self-care and how healthcare systems and healthcare providers contribute to reaching self-care goals.     

Predictors of children's healthcare use: the value of child versus parental perspectives on healthcare needs

OBJECTIVE: The objective of this study was to examine the relationship between healthcare use and children's healthcare needs as assessed from the perspectives of children themselves, parents, and healthcare practitioners. RESEARCH DESIGN: We conducted a prospective cohort study in which service use was monitored for the 12 months before and after administration of a health survey. SUBJECTS: We studied 384 parents and children aged 6 to 11 years enrolled for 2 years in a northern California health maintenance organization or a Medicaid managed care program in Rhode Island. MEASURES: Child and parent perspectives on needs were determined using the Child Health and Illness Profile, Child Edition (CHIP-CE). Plan administrative data were used to develop a treated morbidity index, which was based on diagnosis codes recorded by practitioners during the year before the survey and to obtain prospective measures of service use. RESULTS: For both child- and parent-respondents, low satisfaction and comfort scale scores from the CHIP-CE were significant predictors of number of visits. CHIP-CE domain scales unrelated to future use were risk avoidance, resilience, and achievement. Multivariable regression using CHIP-CE information collected from children explained more variation in total physician visits than models that used parent-respondent data. The treated morbidity index was a weaker predictor of physician visits than the CHIP-CE scale scores. None of the domain scales were significant predictors of any emergency department use or any specialist use; however, the treated morbidity index was associated with any specialist use. CONCLUSIONS: A child's sense of well-being and burden of symptoms predict future use. Perceived healthcare needs, as assessed by the CHIP-CE, is a better predictor of children's service use than evaluated needs as assessed by physician-diagnosed disorders. Our results support the validity of using the responses of children aged 6 to 11 years as a measure of need for future health care.     

Health care system and laboratory medicine in Austria: present status and future perspectives

In the recent past, the role of laboratory medicine has changed from merely supplier of analytical data to supplier of results together with clinical interpretation. In addition, the role of medical laboratories as important partners of health care management by providing data for management functions and decisions is rapidly growing. The article has the purpose of giving an overview of Austria's population, the governmental system and Austrian health politics in context with European health care. The existing health care system with its historical development, to-date status and recent changes due to socio-economic pressure are outlined. Special emphasis is given to the present situation of medical laboratories in Austria. Furthermore, hospital management strategies and some adjustment processes in the authors' clinical-medical laboratory to alleviate the ongoing economic pressure are described. As far as possible, an attempt of forecasting future scenarios is made.     

Implications of end‐of‐life home care compared with hospital‐based care during the COVID‐19 pandemic: A case report

Restriction on hospital visits for COVID‐19 infection control continues to have a significant negative impact on patients and their families. For a patient receiving palliative care, this social isolation may deteriorate their mental health. In such situations, home care could be a viable solution to this problem.