Category Archives: P4 Medicine Update

New MRI Analysis Useful in Predicting Stroke Complications Caused by Clot-Busters

Captured by Johns Hopkins

Johns Hopkins researchers have developed a new way of looking at standard MRI scans that more accurately measures damage to the blood-brain barrier in stroke victims, a process they hope will lead to safer, more individualized treatment of blood clots in the brain and better outcomes.

The blood-brain barrier is a unique shielding of blood vessels that limits the passage of molecules from the blood stream into the brain. Without it, the brain is open to infection, inflammation and hemorrhage. Ischemic stroke patients are at risk of bleeding into the brain when there is damage to the barrier. By more accurately identifying areas of damage, the researchers, in a report published in the journal PLOS ONE, say they hope to use their new tool to predict and reduce the risk of complications from clot-dissolving drugs used to treat this kind of stroke.

“A better characterization of blood-brain barrier damage opens the door to new approaches to treating stroke patients,” says study leader Richard Leigh, M.D., an assistant professor of neurology and radiology at the Johns Hopkins University School of Medicine. “We want to help patients, but we need to make sure our treatments don’t make things worse.”

In an ischemic stroke, a blood clot is stuck in a vessel, cutting off blood flow to a portion of the brain, which will begin to die the longer the clot remains. When patients come to the hospital within three-to-four hours of suffering an ischemic stroke, doctors quickly move to give them the intravenous clot-busting drug tPA, hoping that it will dissolve the clot without causing additional damage.

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Meditation Combined with Art Therapy Can Change Your Brain and Lower Anxiety

Captured by Thomas Jefferson University

Cancer and stress go hand-in-hand, and high stress levels can lead to poorer health outcomes in cancer patients. The Jefferson-Myrna Brind Center of Integrative Medicine combined creative art therapy with a Mindfulness-based Stress Reduction (MBSR) program for women with breast cancer and showed changes in brain activity associated with lower stress and anxiety after the eight-week program. Their new study appears in the December issue of the journalStress and Health.

Daniel Monti, MD, director of the Jefferson-Myrna Brind Center of Integrative Medicine and lead author on the study, and colleagues have previously published on the success of Mindfulness-based Art Therapy (MBAT) at helping cancer patients lower stress levels and improve quality of life.

“Our goal was to observe possible mechanisms for the observed psychosocial effects of MBAT by evaluating the cerebral blood flow (CBF) changes associated with an MBAT intervention in comparison with a control of equal time and attention,” says Monti. “This type of expressive art and meditation program has never before been studied for physiological impact and the correlation of that impact to improvements in stress and anxiety.”

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Patients with Diabetes May Not Receive Best Treatment to Lower Heart Disease Risk; One Size Doesn’t Fit All

Captured by University of Michigan Health System

For some people with diabetes, there may be such a thing as too much care.

Traditional treatment to reduce risks of heart disease among patients with diabetes has focused on lowering all patients’ blood cholesterol to a specific, standard level. But this practice may prompt the over-use of high-dose medications for patients who don’t need them, according to new research from the VA Ann Arbor Healthcare System (VAAAHS) and the University of Michigan Health System.

The study encourages a more individualized approach to treatment that adjusts treatment according to the patient in order to improve the quality of care. The findings appear in Circulation: Cardiovascular Quality and Outcomes.

Authors also suggest that blanket goals routinely used to lower heart attack risks may unnecessarily expose some patients to potential adverse side effects of high-dose medications. Researchers also note that when these standard goals are used to assess whether a health provider delivered high quality care, they may encourage overly aggressive treatment.

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Johns Hopkins Scientists Pair Blood Test and Gene Sequencing to Detect Cancer

Captured by Johns Hopkins Medicine

Scientists at the Johns Hopkins Kimmel Cancer Center have combined the ability to detect cancer DNA in the blood with genome sequencing technology in a test that could be used to screen for cancers, monitor cancer patients for recurrence and find residual cancer left after surgery.

“This approach uses the power of genome sequencing to detect circulating tumor DNA in the blood, providing a sensitive method that can be used to detect and monitor cancers,” says Victor Velculescu, M.D., Ph.D., professor of oncology and co-director of the Cancer Biology Program at Johns Hopkins.

A report describing the new approach appears in the Nov. 28 issue of Science Translational Medicine. To develop the test, the scientists took blood samples from late-stage colorectal and breast cancer patients and healthy individuals and looked for DNA that had been shed into the blood.

The investigators applied whole-genome sequencing technology to DNA found in blood samples, allowing them to compare sequences from cancer patients with those from healthy people. The scientists then looked for telltale signs of cancer in the DNA: dramatic rearrangements of the chromosomes or changes in chromosome number that occur only in cancer cells.

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Genomic and Personalized Medicine (2nd Ed.) Preps Doctors for Changing Reality

Captured by Duke Institute for Genome Sciences & Policy

An all-new edition of Genomic and Personalized Medicine promises to be a one-stop shop for doctors and other health professionals as they face the rapid growth of genetic and genomic testing in the clinic. The comprehensive resource volumes edited by the Duke Institute for Genomes Sciences & Policy’s Geoffrey Ginsburg and Huntington Willard are one solution to an increasingly obvious problem: the healthcare workforce on the whole lacks the background to make personalized medicine a reality for patients.

The two-volume set is now available for purchase from Elsevier and Amazon.com as either a hard copy or Kindle Edition. The books can also be purchased electronically in whole or as individual chapters (for just over $30 a piece) from Science Direct, with institutional bulk rates available.

“These books directly connect to our goal of making the genome relevant to our patients and to society,” Ginsburg said. “We took this project on because we saw a need to pull together all these bits of fragmented genomic information that could have a bearing on health and healthcare and put them in one place. There is nothing else like it.”

The first book in the two-volume set covers everything from essential genome technologies and approaches to their ethical and societal implications and their translation to personalized medicine in the clinic. The second volume presents the latest developments in disease-based genomic and personalized medicine, with sections dedicated to cardiovascular disease, cancer, metabolic disease, mental health, and infectious disease. It’s a soup-to-nuts resource intended for specialists in all medical disciplines, for research professionals, and for medical and graduate students alike.

“Once again, Ginsburg and Willard have recruited an impressive cast of geneticists and genomicists to contribute chapters spanning a wide spectrum of topics – from fundamentals in genomics research to key clinical areas that represent some of the ‘lowest hanging fruit’ in terms of opportunities to have genomics change medical practice,” writes Director of the National Human Genome Research Institute Eric Green in the foreword. “Together, these chapters provide unequivocal evidence about the current state of genomic and personalized medicine – that the opportunities are breathtaking, that the challenges are immense, and that the potential to improve health is nearly unlimited.”

“This is the definitive textbook providing the content for a new era of medicine – an era where disease is defined at the molecular level rather than the anatomic level; where therapies are individualized and targeted rather than uniformly applied across a population,” said Dietrich Stephan, President and CEO of Silicon Valley Biosystems and Co-Founder of Navigenics. “We have an opportunity with this text to improve patient outcomes using new tools and strategies, which is certainly an exciting prospect for each of us. This text should be mandatory reading for every physician, or physician in training.”

 

 

From Virus to Viral: Researchers Explore Social Media as Preventative Method for Infectious Diseases

Captured by Kansas State University

When it comes to stopping illness, social media posts and tweets may be just what the doctor ordered.

A Kansas State University-led research team is looking at social media as a tool to reduce and prevent diseases from spreading. Researchers are studying whether a well-timed post from a public authority or trustworthy person could be as beneficial as flu shots, hand-washing or sneezing into an elbow.

“Infectious diseases are a serious problem and historically have been a major cause of death,” said Faryad Sahneh, Kansas State University doctoral candidate in electrical engineering who is modeling the spread of epidemics in an effort to reduce them. “During the last decades there has been a huge advancement in medication and vaccination, which has helped save many peoples’ lives. But now there also has been a revolution in communication and information technology that we think could be used to develop an even more robust preventative society against infectious diseases.”

Sahneh is working on the project with Kansas State University researchers Caterina Scoglio, associate professor of electrical and computer engineering and expert in complex network modeling; Gary Brase, associate professor of psychology who studies how people make decisions; and Walter Schumm, professor of family studies and human services who studies family dynamics.

Collaborators also include Daniel J. Kruger, a public health scientist at the University of Michigan’s School of Public Health; Fahmida N. Chowdhury, an expert in dynamical systems theory and control at the National Science Foundation; and Michael L. Parchman, director of the MacColl Center for Health Care Innovation.

According to Scoglio, having research collaborators from a wide range of relevant disciplines helps the team develop more comprehensive and accurate models that account for realistic human behavior.

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Gene that Causes Tumor Disorder Linked to Increased Breast Cancer Risk

Captured by Johns Hopkins Medicine

New Johns Hopkins research showing a more than four-fold increase in the incidence of breast cancer in women with neurofibromatosis-1 (NF1) adds to growing evidence that women with this rare genetic disorder may benefit from early breast cancer screening with mammograms beginning at age 40, and manual breast exams as early as adolescence.

In a small study of 126 women with NF1 at the Johns Hopkins Comprehensive Neurofibromatosis Center, the Johns Hopkins scientists identified four cases of breast cancer. The study showed a four-fold increased risk for breast cancer in women with NF1 compared to the general population of women under the age of 50. NF1 is characterized by the uncontrolled growth of mostly non-cancerous tumors along the body’s nerves, often resulting in pain and disfigurement.

Beyond their implications for breast cancer screening guidelines for women with NF1, the findings may also shed light on the origins and nature of breast cancer in those without the syndrome, the researchers say, because other recent studies suggest that some women without neurofibromatosis-1 had breast cancers fueled primarily by an NF1 mutation. A recent study, for example, described in the journal Nature, estimated that 3 percent of all breast cancers in the general population are caused by NF1 mutations that arise spontaneously.

“When we study rare populations intensively, we learn things that also may be factors in very common diseases, like breast cancer,” says Jaishri Blakeley, M.D., an assistant professor of neurology, neurosurgery and oncology at the Johns Hopkins University School of Medicine, and leader of the new study described online in the American Journal of Medical Genetics. “What we learn from this population will help us learn more about the subtleties of different types of breast cancers.”

The major implication of their study, Blakeley says, is the need for medical specialty societies to develop guidelines recognizing NF1 patients under the age of 50 as a group at increased risk for breast cancer. Guidelines developed by medical societies would change clinical practice and, just as importantly, encourage insurance companies to pay for potentially lifesaving screening in younger women with the debilitating disease, the researchers add.

“There are guidelines for how to care for women at high risk for breast cancer because of a family history of the disease, or because they have the BRCA genetic mutations, but there are no guidelines for women with NF1,” Blakeley says. “Women with NF1 haven’t even been on the radar as a high-risk population. Now that we increasingly understand the risk, we have to make sure doctors are talking to their patients about the benefits and risks of early screening.”

Blakeley, director of the Johns Hopkins Comprehensive Neurofibromatosis Center, says she recommends that her NF1 patients get a manual breast exam from a physician annually, beginning in their teens. She recommends mammograms beginning at age 40, 10 years earlier than current National Cancer Institute guidelines for the general population. Research has not yet determined the ideal time for NF1 patients to get their first mammograms; some physicians suggest age 30, the age recommended for women with BRCA mutations. Blakeley says that because radiation exposure can sometimes trigger benign tumors to change to malignant tumors in NF1 patients, she worries about an extra 10 years of radiation exposure due to mammography.

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Scanning Innovation Can Improve Personalized Medicine

Captured by Virginia Tech

New combinations of medical imaging technologies hold promise for improved early disease screening, cancer staging, therapeutic assessment, and other aspects of personalized medicine, according to Ge Wang, director of Virginia Tech’s Center for Biomedical Imaging, in a recent paper that appeared in the refereed journal PLoS One.

The integration of multiple major tomographic scanners into a single framework “is a new way of thinking in the biomedical imaging world” and is evolving into a “grand fusion” of many imaging modalities known as “omni-tomography,” explained Wang, the lead author of the article.

Wang has a history of “firsts” in the imaging world, including the first paper on spiral multi-slice/cone-beam (computed tomography) CT in 1991, on bioluminescence tomography in 2004, and on interior tomography in 2007.

“The holy grail of biomedical imaging is an integrated system capable of producing tomographic, simultaneous, dynamic observations of highly complex biological phenomena in vivo,” Wang said.

Currently, dual-modality imaging such as a positron emission tomography and magnetic resonance imaging (PET/MRI) is “a powerful example of the synergy provided” by using the two as a hybrid technology when assessing concerns in oncology and cardiology, Wang said. “There are no longer any lone PET scanners. Today all are coupled with computed tomography scanners,” added Wang.

For the past decade, Wang and his colleagues have investigated approaches to fusing the various scanning techniques. Recently, they became interested in going beyond the dual-mode imaging, and found that the enabling technology for omni-tomography is “interior tomography” that allows for the integration of multiple major tomographic scanners into one architecture.

He explained that many of the real-world problems in cancer or heart disease are localized or often observed in a relatively small region of interest (ROI) in a human body. In order to obtain a theoretically exact reconstruction of this small area, Wang and others have shown that by using some prior knowledge and common properties on an ROI, they can precisely reconstruct the ROI from data collected with a narrow X-ray beam just covering the ROI.

“We call this novel approach `interior tomography’,” Wang added. “In our latest work, we elevated interior tomography from its origin in X-ray CT to a general tomographic imaging principle, and demonstrated its validity for different tomographic modalities including single-photon emission computed tomography (SPECT), MRI, and phase-contrast tomography,” Wang said.

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Wash U. Medical School Receives $50 Million Grant from Federal Government

Captured by St. Louis Business Journal

Washington University School of Medicine in St. Louis was awarded a $50 million grant from the National Institutes of Health (NIH) to turn scientific discoveries into something meaningful for patient’s by improving their health.

The grant will support the School of Medicine’s Institute of Clinical and Translational Sciences (ICTS) over the next five years to drill down on three areas that are likely to yield results. Those will include finding ways to share information from research findings so they become a part of medical practice from areas like genetics and genomics to new therapeutics, the university reports.

ICTS Director and Dr. Bradley Evanoff said in a statement, “The ICTS is not built around one specific disease or clinical specialty. We are charged with speeding the application of research findings in prevention, diagnosis and treatment across a wide spectrum of health conditions and research disciplines.”

Boston Medical Center’s Pantry-by-Prescription Program Recognized with National Award

Captured by The Boston Globe

Food is medicine. That’s the basic premise behind the Preventive Food Pantry at Boston Medical Center.

Doctors at the hospital can write prescriptions for patients to visit the pantry twice a month. Just as for insulin or blood pressure medications, the prescription becomes part of the patient’s medical record, allowing them to return to the pantry to stock up on fresh vegetables and canned goods. A chef provides lessons in a demonstration kitchen about how to prepare healthy food.

The program, which assisted more than 80,000 people last year, is being recognized with the James W. Varnum National Quality Health Care Award from Dartmouth-Hitchcock, named for the health system’s long-time president.

The pantry is supported by donations and is only available to people who have been referred by their doctor. Many of the patients served have diabetes, unhealthy weight, or food allergies directly affected by eating habits.

“The creative approach taken by BMC in making nutritious food and education readily available to patients is a terrific example of providing value at relatively low cost, putting patients on the road to a healthier lifestyle and helping prevent costlier care later in their lives,” said Dr. George T. Blike, Dartmouth-Hitchcock’s chief quality officer.

The pantry is one of several programs at the Boston hospital focused on prescribing services that go beyond traditional medicine. With Health Leads , a program founded in the Boston Medical Center pediatrics department and now a nonprofit working in six cities, doctors write prescriptions for a family to visit volunteers who can connect them to home heating assistance, for example.

The award is given every two years and will be presented Nov. 27 at Dartmouth-Hitchcock Medical Center in Lebanon. A video about the program will be presented to Boston Medical Center, as part of the award, to help publicize it.