As you may recall from Part 1 of my “Top Ten 2018 Medical Innovations” article, the Cleveland Clinic announced the Top 10 Medical Innovations of 2018 last year in Ohio to close their Medical Innovation Summit, held October 23-25, 2017.
Ranked by expected importance, the second set of five winners were:
Right now, it takes an investment of about $200 million and a minimum of 10 years to develop a single vaccine. Fast-moving viruses like Ebola and Zika require solutions that can be produced much more quickly.
Traditionally, viruses are incubated on chicken eggs. Vaccine developers are now turning to tobacco plants, insects, and nanoparticle systems to speed research and save millions of dollars in development costs.
A second goal for vaccine makers is to speed up delivery to large populations (millions of people) in order to prevent an epidemic.
Freeze drying vaccines is being explored as a way to ensure timely delivery and longer shelf life when stored. This will also reduce wasted vaccines which are discarded once they are deemed unusable.
Finally, because a lot of people do not like being poked with a needle, vaccine manufacturers are looking at alternatives. The Cleveland Clinic reported:
“This past year an oral form of the rotavirus vaccine announced positive Phase III results. Edible vaccines, mucosally delivered vaccines, intranasal vaccines, and vaccine chips are also all under development for other viruses. In 2018, a band-aid sized patch for the flu vaccine is expected to be marketed to kids and adults alike.”
Breast cancer kills over 40,000 American women each year. Traditional treatment methods include hormone therapy, chemotherapy, and radiation. Each of these can lengthen life but often fail to destroy the carcinoma. Furthermore, the side effects can be severe and quite unpleasant.
Therefore, news that researchers are making gains in alternative therapies is very encouraging. These innovative treatments may make other treatments obsolete:
“Experts believe the cumulative results from a variety of studies are pointing to an increasing survival rate, and perhaps the eventual end of chemotherapy for a significant population of breast cancer patients,” says the Cleveland Clinic about several very promising breast cancer therapies.
Breast cancer patients that are BRCA1 or BRCA2 positive may benefit from PARP inhibitors, which are already proving successful against ovarian cancer. The Cleveland Clinic explains how this therapy can be used to offset one important negative side effect of chemotherapy:
“While first-line cancer DNA-creating proteins are often dismantled by chemo, BRCA genes have a backup up plan to repair that DNA, carried out by poly-ADP-ribose polymerases (PARPs).”
Another new therapy is showing positive results when combined with chemotherapy. “HER2-positive breast cancer is named for an overabundant protein that promotes the growth of cancer cells.”
20 percent of breast cancer patients experience this overabundant protein which often resists traditional treatments. One study indicated long-term remissions for a small patient group.
Three CDK4/6 inhibitors introduced in 2018 are expected to bring relief to women with ER-Positive/HER2-negative breast cancer. The new inhibitors interfere with a cell’s ability to synthesize DNA in preparation for its own division.
All told, breast cancer patients may soon be able to bypass chemotherapy or at least minimize its negative effects.
Physicians see the need to update their post-surgery strategies as hospital readmissions have soared (Medicare paid $528 million in 2016 and more than $100 million in 2015). Opioid addiction is also attributed to pain medications prescribed postoperatively.
Trending now among health care facilities is the new ERAS (Enhanced Recovery After Surgery) methodology which puts post-op recovery on the fast track. ERAS is reducing blood clots, nausea, infection, muscle atrophy, and length of hospital stay.
ERAS allows patients to “eat before surgery, limits opioids by prescribing alternate medications, and encourages regular walking reduces complication rates and accelerates recovery after surgery.”
ERAS patients follow a postoperative nutrition plan to speed recovery and physicians are substituting multi-modal analgesia to limit the use of narcotics.
One ERAS program reported that surgical complications fell by one-third. The same program lowered its opioid prescriptions by a whopping 21 percent.
Other studies have shown a decrease in mortality in colorectal resection patients, more hip-fracture patients being discharged to their homes instead of skilled nursing facilities, and cost reductions of more than $6,500 per patient.
Best of all, the new protocol is keeping patients from returning for further treatment after a surgery:
“Employing ERAS, we’ve shown that patients going home within two or three days of surgery have extremely low readmission rates of 2 percent,” said Conor Delaney, MD, PhD, Chair of the Digestive Disease & Surgery Institute at Cleveland Clinic.
The health care community is celebrating a “new era of surgical recovery.”
A typical hospital nursing station resounds with beeps, boops, and other alarms from patient monitoring systems. There are so many cautionary sounds that nurses can experience “alarm fatigue” where they basically tune out most of the noise. Small wonder when “less than 10 percent of alerts are immediately clinically relevant,” according to the Cleveland Clinic.
The American Heart Association claims that fewer than one in four patients (25 percent) survive a cardiac arrest which happens at the hospital. As many as 44 percent – almost half – of inpatient cardiac arrests are “not detected appropriately.”
The proposed solution is a command center which features centralized monitoring. The idea is that off-site personnel can monitor blood pressure, heart rate, heart rhythm, respiration, pulse oximetry and more by means of advanced equipment like sensors and high-definition cameras.
In addition, computer algorithms that calculate risk from complex data “automatically generate alerts triggering on-site intervention, while filtering out many unimportant alarms.”
The results are very encouraging. Out of 100,000 patients monitored by a CMU (centralized monitoring unit), on-site staff were alerted to serious problems and accurately notified in advance of 79 percent of the incidents. The survival rate for cardiopulmonary arrest patients rose to 93 percent because the CMU gave effective advance warnings.
The goal of the CMU is to “double the number of monitored patients per technician, improve clinical outcomes, and decrease communication transit times.” What’s not to like?
Hair loss from chemotherapy can be devastating, especially to women suffering from breast cancer.
Scalp cooling lowers the temperature by a few degrees on the scalp of a patient receiving chemotherapy – before, during, and after.
Half of the women in one clinical trial who were receiving neoadjuvant or adjuvant chemotherapy for early-stage breast cancer kept their hair rather than losing it. Study participants wore “a cap or helmet with circulating cooling fluid for half an hour before chemotherapy, during chemotherapy administration, and for 90 minutes after the completion of chemotherapy,” according to the Cleveland Clinic.
“The hair loss prevention system in this study uses cooling fluid to keep the helmet and scalp cold, causing cutaneous vasoconstriction, also potentially resulting in reduced biochemical activity.”
In May 2017, the U.S. Federal Drug Administration (FDA) approved scalp cooling. However, this new procedure has been shown to be useful for every patient and should not be used with certain chemotherapy drugs.
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As we have noted before, time and technology march on. 2018 is proving to be an exciting year for medical innovations. What future horizons await to improve health care here and abroad? Prepare to be amazed!