Community Development Foundation Group (CDFG)
Community Development Foundation Group (CDFG)

Advances in Medical Practice and Education in the New World:  Exploring the Trends and Issues in Medical Innovations and Patient Care in the 21st Century

 

Professor Dr Daniella E.C.C.O.H Kingsley, BSc(First Class Hons.), DMED, MMedSci, MSc, MMed, MD, PhD, DMedSci, FRSPH, FHEA, ILTM

 

INTRODUCTION

 

In the past years, we have seen constant advances, innovations and reforms in medicine, research, education and patient care. In line with this, patients have become more knowledgeable about their health and the healthcare delivery systems internationally. Hence these have raised demands and expectations, thereby bringing about the changing roles of doctors and healthcare workers in various communities globally.

 

Due to these changes, medical and healthcare workers now need to be more involved in teaching, research and innovative activities, as well as taking part in patient care. In addition, due to advances in medicine and new technology, people are living longer in society with chronic diseases and good prognosis. Equally, survival rates for people with genetic disorders have increased and life expectancy for people with different forms of cancers and other serious diseases are improving. In this review, we will explore some medical innovations that are being used to transform the ways we fight various diseases and undertake research and education as follows:

 

1. ADVANCES IN USING THE MICROBIOME TO PREVENT, DIAGNOSE AND TREAT DISEASE

 

When it comes to life-saving potential and market opportunities, the digestive system is an important area. Trillions of bacteria making up communities in our body – the microbiome – are unlocking mysteries at a rapid pace as the market scrambles to address the possibilities.

The crux of the discovery, made within the last decade is that our microbes have a mind of their own. The chemicals they emit interfere with the way food is digested, medicine is deployed, and even how a disease progresses.

 

Biotech companies once focused on the genomic market are pivoting to the potential of the microbiome to develop new diagnostics, new therapies, and “probiotic” products to prevent dangerous microbe imbalances.

With the National Microbiome Initiative accelerating research and development, experts believe 2017 is the year the microbiome cements itself as the healthcare industry’s most promising and lucrative frontier1,2.

 

2. ADVANCES IN DIABETES DRUGS THAT REDUCE CARDIOVASCULAR DISEASE AND DEATH

 

About ten years ago, a wave of new diabetes drugs hit the market with promises of lowering blood sugar. They fell far short of blunting the scariest statistics for type 2 diabetes patients: Half will die from complications from cardiovascular diseases, with the odds reaching 70% after their 65th birthdays.

 

In 2016, a couple of new medications began dropping the mortality rates considerably.  It was aregued that Empaglifozin proved to modify the progression of heart disease by working with the kidney, while liraglutide has a comprehensive effect on many organs3.

 

Given the positive results, experts predict that 2017 will mark a complete shift in the line up of medicines prescribed for diabetic patients, as well as a new wave of research into new avenues to target type 2 diabetes and its comorbidities. It is anticipated that with the contribution of these new drugs, more patients will live to see the benefits.

 

3. ADVANCES IN CELLULAR IMMUNOTHERAPY TO TREAT LEUKAEMIA AND LYMPHOMAS

 

It was predicted that in 2016, nearly 16,000 children and adolescents will be diagnosed with cancer, more than a quarter of them with leukaemia2,3. Yet there is good news coming for children, families and adults fighting the deadly battle with leukaemia, as well as with Non-Hodgkin lymphomas. One of the first cellular immunotherapies is about to hit the market, and early results suggest these diseases, even in advanced stages, may be curable.

 

Chimeric antigen receptor (CAR) T-cell therapies represent a type of immunotherapy where a patient’s immune system T-cells are removed and genetically reprogrammed to seek and destroy tumour cells. They seek out antigens, multiply, and attack and kill the foreign cancer cells, then often stick around to minimize chances of relapse.

 

Results of these cellular immunotherapies have been impressive. Some studies focusing on acute lymphoblastic leukaemia (ALL) have reported a remission rate of  90 %4,5.  The ground breaking treatment is expected to be presented to various licencing authorities  in 2017 for treatment of ALL, which could trigger a wave of approvals for other blood cancers and lymphomas.

 

It has been argued that cellular immunotherapy could one day replace chemotherapy and its lifetime of side effects. It gives a body a chance to prove resilience.

 

4. ADVANCES IN LIQUID BIOPSIES TO FIND CIRCULATING TUMOUR DNA

 

Oncologists have long dreamed of avoiding the subjective nature of reported signs and the hit-or-miss nature of biopsies. Their dreams maybe coming true because blood tests known as “liquid biopsies” uncover signs of actual DNA, or cell-free circulating tumour DNA (ctDNA), which is shed from a tumour into the bloodstream. The advantage is that ctDNA is more than 100 times more abundant in the blood than tumour cells.

 

While studies are still underway, the market is adjusting to make way for this revolutionary cancer test. Annual sales are forecast to be about £7 billion, and several companies are developing testing kits to hit the market from 2017.

 

The frontier of the liquid biopsy is wide open.  It’s being hailed as a flagship technology of the United States of America (USA) Federal Government’s Cancer Moon shot Initiative, and this is spreading elsewhere around the World. Experts believe that it is only a matter of time before catching and treating cancer is as routine as one’s annual medical check up.

 

5. ADVANCES IN AUTOMATED CAR SAFETY FEATURES AND DRIVERLESS CAPABILITIES

 

With many fatal car crashes in recent years, automobile accidents remain a leading cause of death and disability Worldwide, not to mention a major expenses associate with them. Hence intervention is needed in this area.

 

New, automatic safety features promise to make a dent in dangerous car accidents. These range from collision warning systems to drowsiness alerts to adaptive cruise control. More are coming. Safety technology is expected to increase in 2017.

 

Meanwhile, there is a grander notion to remove all human error from vehicle transportation. In the USA, biggest software, private transportation, and auto manufacturing companies are making huge investments into driverless cars, and this is also being considered in other parts of the World.  Safety and legal questions remain, but 2017 is expected to be the year that driverless cars take a spin into the mainstream.

 

6. ADVANCES IN FAST HEALTHCARE INTEROPERABILITY RESOURCES

 

The inefficiencies of doctors’ appointments and hospital stays have been healthcare management problems for decades. While sorting through bills or waiting on hold with insurance companies, patients are likely to ask, “Why can’t these offices talk with each other?” or “Why can’t the machines in the same hospital talk to each other?”

 

The answer for too many years has been, “It’s complicated.” It is contended that in 2017, that excuse will not be acceptable.

 

Digital interoperability is complex in healthcare, which must weigh privacy, security and accuracy concerns. However in-house systems have become so diverse and convoluted to the extent that it is hard for different systems to communicate and nearly impossible for new software companies to penetrate the industry.

 

It is believed that 2017 will mark the year that we finally make sense of the tangled web that healthcare has woven.  Fast Healthcare Interoperability Resources (FHIR) is a new tool soon to be released by an international committee called HL7. It will essentially function as an interpreter between two healthcare systems or offices that have developed their own languages. The first release will focus on clinical data, like images and medications, while the second will focus on administrative data, like billing and demographics.

 

There are huge implications for healthcare beyond the interoperability of their systems. Innovators and entrepreneurs everywhere can finally take a crack at building smart, data-driven technologies that can be built to a FHIR standard, allowing new technologies to be adopted anywhere.

It is anticipated that FHIR will not only marks a potential end of the frustration, it will pave the way for a surge of life-saving health information technology.

 

7. ADVANCES IN KETAMINE FOR TREATMENT-RESISTANT DEPRESSION

 

It is widely accepted that a loss of hope is a classic symptom of depression. Drugs and therapies have been developed to help balance or trigger serotonin, norepinephrine and other neurotransmitters. However, for one-third of depressed patients, the medications don’t really work. Alternatives include electroconvulsive therapy or other intensive treatment options.  Sadly, too often, the last resort is suicide.

 

In 2013, ketamine, a drug commonly used for anaesthesia – and known in the 1960s as a party drug – was studied for its ability to target and inhibit the action of N-methyl-D-aspartate (“NMDA”) receptors of nerve cells. The results were overwhelmingly favourable. Initial studies indicated that 70% of treatment-resistant-depression (“TRD”) patients saw an improvement in symptoms within 24 hours of being injected with a low dose of ketamine. For the first time, there was a fast treatment for the severely depressed.

 

The studies triggered fast approval for the development of a new NMDA-receptor-targeting medications based on the ketamine profile. Some, like esketamine, received official approvals in the USA and elsewhere, enhancing the probability that these new drugs will be available to patients in 2017.  With many suicides a year around the World, the need for effective treatment is needed.

 

8. ADVANCES IN 3-D VISUALIZATION AND AUGMENTED REALITY FOR SURGERY

 

For years, surgeons have relied on microscope oculars or other camera systems to operate. Even so, they typically depend on their own eyes and interpretations to execute the most precise of tasks with their heads down, peripheral vision limited, back and neck muscles strained. 

 

This past year, two of the most intricate surgical practices, ophthalmology and neurology, began experimenting with technology that keeps surgeons’ heads up while immersing them in a high resolution, 3D visual representations of their subject. These stereoscopic systems also use data to generate visual templates for surgeons to execute certain tasks within a surgery. Experts and surgeons who have piloted the technology say the added comfort and visual information allow surgeons to operate more efficiently and effectively. In addition, trainees have a clearer picture of what the surgeon is seeing and doing.

 

Along the same lines, software companies are building augmented reality glasses that display holographic images of human anatomy. Medical schools may see the end of cadaver laboratories.

While the market is still growing and imaginations running wild, several hospitals will be adopting virtual reality tools in 2017, pushing the boundaries of surgical reality.

 

9. ADVANCES IN SELF-ADMINISTERED HPV TEST

 

Around the World, for example, in the mountains of Ecuador, over the rough terrain of Tanzania, or even in the rural communities in the USA, there are women at significant risk of dying of cervical cancer and have no idea. Even worse, they have no real way of finding out.

Most sexually active woman contract the Human Papilloma Virus (HPV). Certain strains of HPV are responsible for 99% of cases of cervical cancer, the most common malignancy in women aged 35 years or younger.

 

Despite great strides in HPV prevention and treatment, the benefits are restricted to a narrow population – women with access to HPV tests and vaccines.

 

In 2017, an ambitious approach to expand the care will be launched. Scientists have developed self-administered HPV test kits that include a test tube, a swab, and a mail-in box. The idea is that women can administer their own test, mail a sample back to a laboratory and be alerted to dangerous strains of HPV.

 

Cervical cancer prevention is a “Millennium Development Goal” of the United Nations. Experts believe that 2017 will be the year these tests are deployed on a large scale, representing the largest scale prevention strategy for cervical cancer to date.

 

10. ADVANCES IN BIOABSORBABLE STENTS

 

Every year, 600,000 people have metal coronary stents put into their chests to treat coronary artery blockage. Most of the time, that stent stays there forever, long after its mission is complete. The stents may inhibit natural blood flow and cause other complications, like blood clots.

 

But what if the stents could just disappear? That is a long-sought goal researchers have finally met. In July 2016 the first bioabsorbable stent was approved in the USA. Made of a naturally dissolving polymer, the stent widens the clogged artery for two years before it is absorbed into the body in a manner similar to dissolvable sutures. The disappearing stent leaves behind a healthy natural artery. The patient is free to go off blood clotting medication and qualifies for a broader range of medical treatments.

 

Only one version of an absorbable stent has been approved in the USA and elsewhere,  but more are coming. Experts believe that the market potential will approach £1 billion in six years. While the full impact of vanishing stents is yet to be seen, 2017 is the year the technology becomes a game changer.

 

CONCLUSION AND NEW CHALLENGES IN THE 21ST CENTURY

 

With the advances in medical practice and innovations stated above come increasing internal and external pressures to improve the quality of patient care, healthcare delivery, education and research performances of health professionals. These factors also bring with them various challenges in the changing World.

Hence the Community Development Foundation Group (CDFG) and its collaborators has organised a conference which will embrace many topics on the various issues affecting medical innovation, advances in medical practice, research  and education in changing World.  The event will take place at Plovdiv Medical University, Vasil Aprilov 15-A, 4002 Plovdiv, Bulgaria, Europe, from 24 to 27 November 2017. 

 

More information about the conference can be obtained from:  http://www.cdfg.org.uk/conferences-and-courses/combined-combined-bulgarian-medical-conference-two/ or contact the conference organisers at: conferences@cdfg.org.uk

 

 

REFERENCES

 

  1. Kingsley D. The Future of Medical Innovation: Evaluation of the Trends.  London: AHCP Occasional Papers Publications, 2015.
  2. Medical Innovations.  Bristol: Research Innovation 2015
  3. Kingsley D. Medical Innovation for the future and beyond.  London: AHCP Occasional Papers Publications, 2016.
  4. Medical Innovations.  Bristol: Research Innovation 2016
  5. Medical Innovations.  Bristol: Research Innovation 2016
  6. Kingsley D. Medical Innovation for the future and beyond.  London: AHCP Occasional Papers Publications, 2017.

 

ABOUT THE AUTHOR

 

Professor Dr Daniella E.C.C.O.H. Kingsley is the Editor-in-Chief of the International Journal of Medicine (IJM)  and many other publications, Professor and Medical Advisor for the Community Development Foundation Group.  For more information about Professor Kingsley, please visit: http://www.ijmjournal.org.uk/editorial-board-members-profiles/professor-dr-d-c-o-kingsley/ . Email: info@cdfg.org.uk

 

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