Personalized medicine based on genomics
ScienceRoll has a post - Personalized Medicine: The Future is Now
which links to several news and announcement links.
{ Category Archives }
Bio-Tech
Steps to manage drug-resistant bacteria
Swabs in Hand, Hospital Cuts Deadly Infections
By Kevin Sack, The New York Times, Published: July 27, 2007
At a veterans’ hospital here, nurses swab the nasal passages of every arriving patient to test them for drug-resistant bacteria. Those found positive are housed in isolation rooms behind red painted lines that warn workers not to approach without wearing gowns and gloves.
Every room and corridor is equipped with dispensers of foamy hand sanitizer. Blood pressure cuffs are discarded after use, and each room is assigned its own stethoscope to prevent the transfer of microorganisms. Using these and other relatively inexpensive measures, the hospital has significantly reduced the number of patients who develop deadly drug-resistant infections, long an unaddressed problem in American hospitals.
The federal Centers for Disease Control and Prevention projected this year that one of every 22 patients would get an infection while hospitalized — 1.7 million cases a year — and that 99,000 would die, often from what began as a routine procedure. The cost of treating the infections amounts to tens of billions of dollars, experts say….
Dr. Richard P. Shannon, who championed a program to reduce catheter infections at Allegheny General Hospital in Pittsburgh, was able to show administrators that the average infection cost the hospital $27,000. He demonstrated that reimbursement payments for weeks of extended treatment were not keeping pace with actual costs. “I think it was assumed that hospitals didn’t mind treating these infections because they were getting paid for it,” Dr. Shannon said….
It is the screening and isolation of patients that draws the most debate. Screening presents an upfront cost for hospitals, and administrators worry that keeping patients in isolation will further clog emergency rooms and reduce the quality of care. Some researchers believe that improving hygiene and surgical practices alone may be equally effective.
In guidelines released last year, the centers recommended that other precautions be taken first and that hospitals resort to screening high-risk patients if they cannot otherwise reduce their infection rates. The guidelines are endorsed by the American Hospital Association, which believes that hospitals must be able to tailor plans to varying needs.
Others do not see the issue that way. Betsy McCaughey, who became a hospital infection crusader after serving as the New York lieutenant governor, said it was paradoxical that the centers encourage hospital screening for H.I.V. but not for bacterial infections, which are associated with seven times as many deaths. Ms. McCaughey said the agency “is largely to blame” for the failure to contain drug-resistant organisms.
“Their lax guidelines,” she said, “have given hospitals an excuse to do too little.”
There is an old saying, “You get what you measure.”
Fighting Hospital Infections a Stethoscope at a Time
Posted by Jacob Goldstein, The Wall Street Journal Health Blog, July 27, 2007
Here’s the thing about MRSA, the nasty, drug-resistant staph infection common among hospital patients: It’s insidious. Many patients carry the bug (pictured) without showing any signs at all, which makes it especially tough to tackle….
Better patient screening has been helped by rapid tests that allow hospitals to identify the bug within hours, the WSJ reported last month. A New Jersey intensive-care unit that started screening all its patients cut its rate of newly acquired MRSA infections nearly to zero….
I think we need universal health care. But it isn’t quality care by legislation or by flipping a switch. We need to carefully evolve from the complex system of incomplete incentives to perform well - to the system we think we mean by universal health care - with appropriate incentives for proper, top-of-the-game care.
Having indigent patients dumped in unpleasant parts of cities tells us we are not measuring well. We may think we have quality care available as needed, but we don’t give much thought to what behavior we encourage - by who, against the interests of who, at what social cost.
DNA - the YouTube video
Eye on DNA posts DNA Video: Gattaca
a YouTube video
“A beautifully done Gattaca music video. There were so many DNA motifs in the movie that I didn’t notice when I watched it many years ago.”
DNA stuff on 7/27/07
bbgm reports on
- “The PDB remediates”¹ and
- Perfect Storm -
e.g. Easy to use bioinformatics interfaces (1/2): BACAStarting a shameless self promotion exercise, I would like to present
two easy to use interfaces (with completely different target users and
objectives) in the field of Bioinformatics.
¹ RCSB PDB (Protein Data Bank) - from wwPDB
An Information Portal to Biological Macromolecular Structures
Remediated PDB Archive To Be Released on August 1, 2007
How-To Fund Eldercare Technology
Key to funding for eldercare technologies? Pilots
By Dawn Kawamoto , Staff Writer, CNET News.com, July 17, 2007
SAN FRANCISCO–Fighting the funding battle for eldercare technologies can come via large-scale pilots or highly successful small-scale ones, say health care companies.
No matter the size, a pilot not only serves as a means to vet whether an eldercare technology will work, but it also generates much needed data for insurance companies and government entities to weigh whether they might be willing to pay for such technologies, according to panelists Tuesday at the fourth annual Healthcare Unbound conference.
Northeast Health, an upstate New York health care provider that operates a wide range of services including independent and assisted care for seniors, has conducted several small-scale pilots with IBM, GE Global Research, as well as one on its own….
In one case, Northeast Health conducted a pilot with two patients of an insurance company to prove that remote, or “telehealth,” monitoring technology could save the insurance company money.
“We said to one insurance company, ‘give us a couple of your most expensive patients, the ones who are always in and out of hospitals,’” said Lisa Gaudet, director of remote care technology and genetic services for Northeast Health. “They told us in one month we saved them $50,000 for one patient and $100,000 in a month for the other one.”…
The article goes on to cite other pilots that proved out other technologies - many using 35 or fewer participants. But if you save $50,000 to $100,000 per month per patient, you get some serious interest quickly from the party paying for it.
Biotech confusion - 07/01/07
A Challenge to Gene Theory, a Tougher Look at Biotech
By Denise Caruso, The New York Times, July 1, 2007
This article says
Last month, a consortium of scientists published findings that challenge the traditional view of how genes function. The exhaustive four-year effort was organized by the United States National Human Genome Research Institute and carried out by 35 groups from 80 organizations around the world. To their surprise, researchers found that the human genome might not be a “tidy collection of independent genes” after all, with each sequence of DNA linked to a single function, such as a predisposition to diabetes or heart disease.
But every biotech research presentation I’ve gone to included researchers who already knew that! That is one caution about any speedy conquest of a genetically related disease. In fact universities are forming Biomedical Informatics fields, in part, because:
Instead, genes appear to operate in a complex network, and interact and overlap with one another and with other components in ways not yet fully understood. According to the institute, these findings will challenge scientists “to rethink some long-held views about what genes are and what they do.”
Research includes the massive search through data to find correlations such as those suggested here.
To Soy or Not To Soy, that’s a new question
The Dark Side of Soy
Is America’s favorite health food making us sick?
—By Mary Vance, Terrain
Utne Reader July / August 2007 Issue
…Daniel and Bauman agree on the benefits of variety. “My experience as a clinical nutritionist is that people who have a varied diet tend not to get into trouble,” says Daniel….
The key is understanding what “varied” means in this context.
Health Affairs on GENOMICS: How Little We Know
It is by no means a coincidence that an explosion of knowledge about the human genome has occurred simultaneously with huge breakthroughs in computing capability and information technology. Sequencing the genome, after all, depended on being able to digitize the representation of the nucleotides in DNA. The genome’s mechanisms of operation involve intercellular messaging that has intriguing analogues in electronic communication. At a conceptual level, the genome and the computer operating system are by now firmly established as rich and relevant metaphors for each other.
So it was delightful but not altogether surprising to find amid last week’s extraordinary trove of new genomic research the use of computer “subroutines” as a metaphor to explain a body of emerging knowledge about “the complex patterns of dispersed regulation” that now challenge the scientific community’s understanding of what genes are and how they work….
has a number of links
Health Affairs - The Policy Journal of the Health Sphere
about Health Affairs
ran across this yesterday, you can subscribe to a table of contents email
Health Affairs is the leading journal of health policy thought and research. All papers are peer-reviewed, and the acceptance rate is 10–15 percent. Published since 1981, Health Affairs is nonpartisan and presents a wide range of timely research and commentary on health issues of current concern in both domestic and international spheres….
Web site - published and copyrighted by Project HOPE - The People-to-People Health Foundation, Inc.
circumstances - favorable, and not
Diagnosis
Full-Body Failure
By Lisa Sanders, M.D., The New York Times, June 17, 2007
“There’s a young woman sick as hell in the I.C.U. — if you have time,” read the note left on Dr. Steven Walerstein’s desk chair. It was late on a Friday afternoon and Walerstein, the medical director at Nassau University Medical Center in East Meadow, N.Y., was already going to be late for his weekly racquetball game. But he would come back. Stuck behind a desk far too much of the time, he was drawn to what promised to be a tough case.
It was early evening by the time Walerstein got to see the patient….
Walerstein was a general internist, admired for his broad knowledge of medicine. If he didn’t know the answer right off the bat, he was known to ask questions that would lead to the answer. And this young woman needed an answer, or she would die. Having examined the patient and her chart, Walerstein took a moment to step back and look for some kind of pattern buried in the chaotic assemblage of numbers and tests. Everyone else started with the bloody diarrhea. Maybe that was the wrong way to think about it. The fact that the patient’s blood was not clotting made Walerstein think that her liver was no longer working — the liver makes most of the protein that causes blood to coagulate. So she had liver failure. And her red blood cells were being destroyed. That combination stirred something in his memory….
Doctors inhabit a world of books and journals, but perhaps the most important way we learn clinical medicine, the medicine we use in the care of our patients, is through what we call pearls — pearls of wisdom. These are information couplets that link one or two clinical observations and an action. If this, then think or do that. Hippocrates, the father of medicine, published the first volumes of these practical aphorisms. The information has changed, but the delivery system has not….
[he figures it out]
But what would have happened if Walerstein had been out of town that day or hadn’t come back? Would this condition have been diagnosed? Would the patient have survived? Neither doctors nor patients like to consider how much of medicine depends on chance. Contingency and coincidence can be as important in the moments between life and death as knowledge and skill. No doctor knows everything. Hippocrates’s well-known aphorism expresses this ancient truth: “Life is short, the art, long . . . judgment is difficult. It is not enough for the physician to do what is necessary . . . the circumstances must be favorable.”