Leo Nissola, MD

Digital health technologies: opportunities & challenges in rheumatology Daniel Solomon, MD MPH & Bob Rudin, PhD Abstract The past decade in rheumatology has seen tremendous innovation in digital health technologies, including the electronic health record, virtual visits, mobile health, wearable technology, digital therapeutics, artificial intelligence and machine learning. The increased availability of these technologies offers opportunities for improving important aspects of rheumatology, including access, outcomes, adherence and research. However, despite its growth in some areas, particularly with non-health-care consumers, digital health technology has not substantially changed the delivery of rheumatology care. This Review discusses key barriers and opportunities to improve application of digital health in rheumatology. Key topics include smart design, voice enablement and the integration of electronic patient-reported outcomes. Smart design involves active engagement with the end users of the technologies, including patients and clinicians through focus groups, user testing sessions and prototype review. Voice enablement using voice assistants could be critical for enabling patients with hand arthritis to effectively use smartphone apps and might facilitate patient engagement with many technologies. Tracking many rheumatic diseases requires frequent monitoring of #patientreportedoutcomes. Current practice only collects this information sporadically, and rarely between visits. #Digitalhealth technology could enable patient-reported outcomes to inform appropriate timing of face-to-face visits and enable improved application of treat-to-target strategies. However, best practice standards for digital health technologies do not yet exist. To achieve the potential of digital health technology in rheumatology, rheumatology professionals will need to be more engaged in the technology design process and provide leadership to effectively incorporate new tools into clinical care. Key points Digital health technology (DHT) offers enormous potential to improve rheumatology care but this potential has so far been largely unrealized. The #electronichealthrecord, virtual visits, mobile health, wearable technology, digital therapeutics, artificial intelligence and machine learning could all have a role individually and in combination to reshape rheumatology practice. Increased use of user-centred design in the development of #digitalrheumatology tools is needed and will facilitate electronic patient-reported outcomes becoming a cornerstone of rheumatology. https://lnkd.in/eEZCSEg7

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📢New article alert from the Journal of Comparative Effectiveness Research:   Title: Adverse event costs of systemic therapies for metastatic colorectal cancer previously treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy and biologics in the US   New research from Hernandez et al. compares adverse event management costs for fruquintinib, regorafenib, trifluridine/tipiracil (T/T), and T/T+bevacizumab for metastatic colorectal cancer patients previously treated with at least two prior lines of therapy. The article provides valuable insights for treatment, formulary and pathway decisions.   Authors: Victoria Federico Paly, N. Arvind Dasari, Joleen Hubbard, Tanios Bekaii-Saab, Thihan P. & Luis Hernandez Takeda Oncology, MD Anderson Cancer Center, Mayo Clinic   #Oncology #HealthEconomics #mCRC #PharmaResearch #OpenAccess   Link in the comments!

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From the last update of the #Spanish Society of Neurology consensus: "[C]onsidering early initiation of [high-efficacy] #DMTs can optimize clinical outcomes, delay disease progression, and improve the quality of life and long-term prognosis for [#MultipleSclerosis] patients. We join other voices advocating that initiating #heDMT early is the optimal strategy for achieving the most favorable long-term outcomes for individuals with MS. However, the decision to initiate heDMT early is complex and depends on several factors, such as the expertise of the neurologist with these therapies, long-term safety data, prognostic factors, the information that patients have and their preferences, availability of therapies and disease monitoring, local regulatory requirements, and national and international guidelines." https://lnkd.in/gvVu77Tj Celia Oreja-Guevara, Dr. José Meca Lallana

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In managing chronic kidney disease (CKD), monitoring eGFR fluctuations is paramount, especially when initiating hemodynamically active therapies. - A reduction in eGFR of >30% on subsequent testing among CKD patients initiating hemodynamically active therapies exceeds expected variability and merits evaluation. - Hemodynamically mediated declines in eGFR (typically 10%-20%) may occur within the first 3 months of intensive blood pressure control. These are often transient and do not necessitate changes in therapeutic agents. - Initiating ACEi/ARBs or SGLT2i may lead to acute eGFR dips, reflecting hemodynamic changes. However, these are usually reversible and not indicative of drug toxicity. - Despite initial eGFR declines, therapies like SGLT2i still confer kidney benefits, particularly in patients with >10% initial drop in eGFR. By recognizing the nuances of eGFR changes and the effects of therapy initiation, healthcare providers can make informed decisions, optimize treatment strategies, and ensure the best possible outcomes for CKD patients. Link to the 2024 KDIGO Guidelines: https://lnkd.in/gDVT83EE #KDIGO2024 #ClinicalPracticeGuideline #ESRD #CKD #ESKD #Kidneydisease #RenalFailure #RenalReplacment #dialysis #hemodialysis #ChronicKidneyDisease #eGFR #CKDManagement #Nephrology #Healthcare #MedicalTreatment #KidneyHealth #PatientCare #TherapeuticAgents #HealthcareGuidelines #MedicalInsights

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Fascinating report on utility of cfDNA for detecting occult cancers by Amy E. Turriff et al. - Estelamari Rodriguez https://lnkd.in/eX4T8_ux #OncoDaily #Oncology #Cancer #Health #Medicine

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Wʜᴀᴛ ᴀʀᴇ ᴄʟɪɴɪᴄᴀʟ ᴛʀɪᴀʟꜱ? Health research has several layers… researchers may model molecular behaviours with computers (𝒾𝓃 𝓈𝒾𝓁𝒾𝒸ℴ), test compounds in cells growing in a dish (𝒾𝓃 𝓋𝒾𝓉𝓇ℴ), or mimic the whole pathology of a disease in a laboratory animal (𝒾𝓃 𝓋𝒾𝓋ℴ). The last test before a new medical, surgical, or behavioural intervention can be disseminated to everyone is a clinical trial conducted in 𝗽𝗲𝗼𝗽𝗹𝗲 𝘄𝗵𝗼 𝗵𝗮𝘃𝗲 𝘃𝗼𝗹𝘂𝗻𝘁𝗲𝗲𝗿𝗲𝗱 ➡ https://lnkd.in/d63y7XKq. Clinical trials are the primary way by which researchers determine if a new form of treatment or prevention, such as a new drug, diet, or medical device (for example, a blood sugar monitor implantable in patients with diabetes), is safe and effective in people ➡ https://lnkd.in/dv65Nizz. Often, the first aim of a clinical trial is to learn if 𝗮 𝗻𝗲𝘄 𝘁𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗶𝘀 𝗺𝗼𝗿𝗲 𝗲𝗳𝗳𝗲𝗰𝘁𝗶𝘃𝗲 𝗼𝗿 𝗵𝗮𝘀 𝗹𝗲𝘀𝘀 𝗵𝗮𝗿𝗺𝗳𝘂𝗹 𝘀𝗶𝗱𝗲 𝗲𝗳𝗳𝗲𝗰𝘁𝘀 𝘁𝗵𝗮𝗻 𝗲𝘅𝗶𝘀𝘁𝗶𝗻𝗴 𝘁𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁𝘀 ➡ https://lnkd.in/dUbbi_Pj. Read more on the value of standardizing health reporting on my brand new account Medium. https://lnkd.in/dBCiZNwm #clinicaltrials #reportingguidelines #academicpublishing #peerreview

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Chenchula, S., Atal, S. & Uppugunduri, C.R.S. A review of real-world evidence on preemptive pharmacogenomic testing for preventing adverse drug reactions: a reality for future health care. Pharmacogenomics J 24, 9 (2024). Image below was created using BioRender

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SGLT2 inhibitors benefit with or without GLP-1RAs. The best approach is both!

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In this new video, Laura Dormer, Editor of The Evidence Base®, speaks with Qianyi Zhang, Senior Research Scientist, Flatiron Health about the poster, “Evaluation of real-world response rate in clinical trial-aligned cohorts of patients with lung, colorectal, and breast cancer using machine learning,” presented at ISPOR—The Professional Society for Health Economics and Outcomes Research 2024 (May 6–8, 2024; Atlanta, GA, USA). #heor #healtheconomics #outcomesresearch #rwe #rwd #realworldevidence #realworlddata #healthdata #AI #artificialintelligence #machinelearning #lungcancer #breastcancer #colorectalcancer #oncology #clinicaltrials

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At ACR 2024, new data will be presented on clinical responses to an interleukin (IL)-17A inhibitor for different age groups and across disease domains. Join our two poster presentations at #ACR24 led by Dr. Sofia Ramiro and Dr. Laura Coates on post hoc analyses of the MEASURE 1-5 trials and FUTURE 2-5 trials. These studies evaluated clinical responses to an IL-17A inhibitor in patients with #AxialSpondyloarthritis (#axSpA) grouped by age, and evaluated time to response to an IL-17A inhibitor across key psoriatic arthritis domains in patients with #PsoriaticArthritis (#PsA). https://lnkd.in/ekuwqk7w

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A roadmap for actions towards increasing equity in screening and cancer care - Estelamari Rodriguez American Society of Clinical Oncology (ASCO) Florida Society of Clinical Oncology Sybil Green https://lnkd.in/eT6Y--4n #OncoDaily #Oncology #Cancer #Health #Medicine #CancerCare #CancerScreening

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This literature review seeks to compile and synthesize current insights on factors that influence #adherence, as well as explore potential methods for monitoring, evaluating, and improving its outcomes in #allergic #diseases and #asthma. https://lnkd.in/dhAwUaFQ

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Most viewed in the last 7 days from JAMA Oncology: This Review analyzes the heterogeneity of residual disease after neoadjuvant systemic therapy in patients with breast cancer. https://ja.ma/4gzYlMY

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Our article on the potential of using LLMs for translation between molecules and drug indications is published on Nature Scientific Reports! A drug molecule is a substance that changes an organism’s mental or physical state. Every approved drug has an indication, which refers to the therapeutic use of that drug for treating a particular medical condition. While the Large Language Model (LLM), a generative Artificial Intelligence (AI) technique, has recently demonstrated effectiveness in translating between molecules and their textual descriptions, there remains a gap in research regarding their application in facilitating the translation between drug molecules and indications (which describes the disease, condition or symptoms for which the drug is used), or vice versa. Addressing this challenge could greatly benefit the drug discovery process. The capability of generating a drug from a given indication would allow for the discovery of drugs targeting specific diseases or targets and ultimately provide patients with better treatments. https://lnkd.in/ehAwhseQ

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New zebrafish research from Miguel Godinho Ferreira shows us new information on the relationship between telomerase and the tumor suppressor gene TP53 in aging and cancer! To remind you, telomerase is the enzyme responsible for maintenance of the length of telomeres. In mammals telomeres "dictate" aging rate as they shorten every time cells divide. This study found that telomerase reduction in TP53 mutants is associated with lower cancer incidence and a longer lifespan! The team found surprising results in examining wild-type, telomerase-deficient, TP53 mutants, and double mutants. Notable effects were observed in male fertility, premature aging rates, tumor incidence and overall longevity. This study highlights the complex interaction between telomerase and TP53 in controlling aging and cancer processes. Read more in my highlight below: https://lnkd.in/eCanDwjh

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This article discusses the current landscape of CAR T therapies and highlights the potential of a novel BCMA-targeted #oncology treatment. #celltherapy #EPRTalks

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There has been so much stress about the reproducibility crisis in biomedical research in recent years. This crisis is largely self inflicted and imagined from the deterministic mindset of the dominant research paradigm for a long time. In this paper led by Ilya Shmulevich 22 years ago, we believe that gene regulations follow rule-based uncertainty. Now the most recent cancer hallmark paper published in Cell highlights the complexity of cancer systems. Approaches to address the complexity and uncertainty like Probabilistic Boolean Networks are the right strategies to interrogate and reveal the complexity and uncertainty of complex diseases like cancer. I am sharing this paper to celebrate the brilliant contributions to science by Ilya Shmulevich who recently passed away. #complexity #systemsbiology #cancer #generegulatorynetwork

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