Pat Stricker, RN

There are so many changes in healthcare that it is hard to keep up with all the new treatments, therapies, medications, procedures, and medical equipment that are being developed. Many of these are the result of new technologies, but others are innovative ways to use simple, known techniques in a new way to make significant changes. This article will review some of the current and future technologies that are changing or will change the healthcare landscape.  Hopefully you will find some that you were not aware of or some that might be helpful for some of you patients.

Now let’s take a look at what may be in store for us in the near future. The following are only a small list of some of the unbelievable  advances and innovations that are being worked on. As technology and computerization continue to advance there will be more amazing treatments and procedures available.

  • A promising Alzheimer’s drug – The use of Aducanumab resulted in less cognitive decline (about 15-27%) on memory and cognitive tests after 18 months of treatment. It is being re-studied and FDA approval will hopefully be obtained by early 2020.
  • A blood test to detect breast cancer – It screens for auto-antibodies produced in reaction to cancer cells and may be able to detect cancer up to 5 years before a lump is noticed or symptoms occur. The tests are less expensive and easier than mammograms. They are currently being studied in the U.K. and may be available within 5 years. A similar test is being studied in Scotland for lung cancer.
  • A new cystic fibrosis drugThis drug, Trikafta, provides “significant improvements” in lung function and respiratory health. It is now available to about 90% of the patients 12 or older with the most common cystic fibrosis mutation (about 27,000 people in the U.S.).
  • Crispr for Gene Modification—The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) gene-editing tool is the most advanced gene-editing technology. It works by harnessing the natural mechanisms of the immune system to then “cut out” infected DNA strands, giving it the power to potentially transform the way we treat disease. It allows DNA and genes to be modified in the early stages to study and treat sickle cell disease, multiple myeloma, sarcoma, cervical cancer, and non-Hodgkin’s lymphoma, as well as malaria, superbugs, and HIV. By modifying these genes, these threats could potentially be overcome in a matter of years. However, there are concerns about its use, mostly in relation to “playing God” and worries that gene-editing could produce “designer” babies. CRISPR is still a first-generation tool and its full capabilities are not yet understood.
  • Peanut Allergy Promise — A study using the antibody, Etokimab, has shown promise. People with severe peanut allergies were able to eat peanut protein within 2 weeks after just one injection of the antibody. A larger study is planned to determine dosing, timing and potential opportunities to treat other food allergies.
  • A Sickle Cell Breakthrough — A gene therapy, based on 20 years of research, uses infusions of a patient’s own bone marrow to produce normal red blood cells. Clinical trials are being conducted in various locations and patients have been symptom free after a year of treatment.

 

The following innovations are based on suggestions from a panel of doctors and researchers at Cleveland Clinics that identified medical innovations for 2019 that would transform the medical field and change healthcare.

  • Alternative Therapies for Pain — Genetic testing is being used to predict an individual’s ability to metabolize drugs and identify drugs that work for a patient, thereby eliminating ineffective and unnecessary drugs and adverse reactions. This personalized approach to identify and prescribe appropriate medications for individuals has the potential to help end the opioid crisis.
  • Artificial Intelligence (AI) — Artificial intelligence is being used in decision-making support in patient triage, at the point of care, and in improving the analysis and accuracy of patient scans. AI is helping to make caring for patients quicker, easier, and more accurate. It will be responsible for major innovations in healthcare in the near future. AI has already significantly altered the healthcare landscape. It was used in a study to recognize forms of cancer. AI was taught to recognize forms of cancer by using algorithms that Google uses to identify objects online. It then found two forms of cancer in a tissue sample as accurately as a human could, but in just a matter of seconds. AI has also been used to model the precise dosage of a cancer drug to shrink tumors while causing only minimal toxic side effects.
  • Cardiac Percutaneous Valve Replacement and Repair — Many cardiac procedures performed percutaneously, via a catheter through the skin, have replaced open heart surgery. Examples include mitral and tricuspid valve replacements and repair that have shown very positive outcomes. This innovation has the potential for changing the future of cardiac care.
  • Immunotherapy for Cancer Treatment — Immunotherapy, a technique that uses the body’s own immune system to fight cancer, has been used for years, but new and innovative therapies are showing very promising results. It is hopeful that effective therapies will soon be available for all tumor profiles.
  • Robotic Surgery — Today minimally invasive robotized surgery provides precise and effective surgeries with improved outcomes. Robots are used in numerous routine surgeries and have resulted in the shortest and least invasive surgeries, with less recovery time and limited pain after surgery. They are also used in more complex procedures that are highly difficult or near-impossible. The robots will not take the place of a surgeon in the future, but rather assist and enhance a surgeons’ work.
  • RNA-Based Therapies — Ribonucleic acid (RNA) based therapies, which are similar to DNA-based gene therapies, provide the ability to intercept genetic abnormalities before they cause problems. These new therapies have shown immense potential and are being explored for rare genetic diseases such as Huntington’s, as well as cancer and other neurological conditions.
  • Robotic Support – Scientists are developing robotics that enfold and support like an exoskeleton for patients with severe mobility problems, such as partial paralysis. The devices are programmed to guide the body through motions, such as helping a stroke victim walk, by rebuilding posture and strength.
  • Acute Stroke Treatment Timeframe — A stroke can cause irreversible damage and disability due to a prolonged lack of blood flow, therefore a timely response is critical. However intervention has only been recommended within a limited timeframe. Now new stroke guidelines expand the timeframe for treatment, which will allow more future stroke patients to receive treatment, while improving recovery and reducing the risk of disability.
  • Prehospital Stroke Visor — Hemorrhagic strokes are responsible for nearly 40% of stroke deaths, even though they are less common than ischemic strokes. The uncontrolled bleeding from the ruptured blood vessel must be controlled as quickly as possible. A new hemorrhage scanning visor using low-energy frequency waves can be placed on a patient’s head and used in prehospital settings to quickly detect hemorrhagic strokes. The device is 92% accurate and has cut treatment time, thereby saving more lives.
  • 3D Printing – 3D printers are an amazing technology and have become one of the hottest topics. Prosthetics are increasingly popular because it provides unprecedented levels of comfort and mobility by matching an individual’s measurements down to the millimeter. This specificity also provides more advanced, specialized care, minimizes complications, and improves outcomes. 3D is primarily used currently for prosthetics, cranial and orthopedic implants and joints, and stents for narrowing airways. It has also been used in heart surgeries and a total face transplant. In April, 2019 the world’s first 3D “printed heart” with cells, blood vessels, ventricles and chambers, was produced at a lab in Tel Aviv. Fatty tissue from patients was reprogrammed into stem cells, which were then differentiated into cardiac and endothelial cells that make up the lining of blood vessels. The next step will be to train the printed heart to act like a human heart by transplanting them into animals and eventually, humans. It is the hope that “printed hearts” will eventually be able to be used to save patients who are waiting for a heart donor. Surgeons are also working on creating organs for transplant from stem cells. They have been able to create blood vessels, synthetic ovaries and even a pancreas. These artificial organs then grow within the patient’s body to replace original faulty ones. The ability to supply artificial organs that are not rejected by the body’s immune system would be revolutionary, saving thousands of patients that depend on life-saving transplants each year.  Burn victims are also finding relief with 3D “printed” skin created from production material from the patient’s own plasma and skin biopsies. 3D printing is also taking 2D x-rays and CT Scans and turning them into 3D models, providing more comprehensive views in order to better diagnose issues. 3D printing can also “print” pills that contain multiple drugs, which help patients with the organization, timing and monitoring of multiple medications.  3D printing is a truly amazing technology that seems to be able to do almost anything. It has great promise for numerous future applications.
  • An “EpiPen” for Spinal Cord Injuries — Immune cells typically work to clear out dead or damaged cells after an injury, as well as increase the body’s defense against infection. However an over-active immune response can sometimes occur, which can cause numbness and even paralysis in some cases. An “EpiPen” like device, using nanoparticles, is being studied to see if it can suppress immune cells without side effects common with pharmaceuticals. If this works it may be able to provide a quick, readily available treatment for spinal injuries, as well as other types of trauma, cancer, and inflammatory diseases.

 

Other innovations that are on the horizon to revolutionize medicine include:

  • Bionic Prosthetics — A 3D printer can create a bionic eye within an hour. While it is not fully designed and working yet, the promise of seeing a prosthetic bionic eye is much closer to reality.
  • Contact Lenses That Track Glucose Levels – Researchers have been able to attach transparent, flexible electronics to contacts so that glucose levels can be checked, using tears, and then wirelessly relaying the results back to a computer program or app. And none of the electronics or sensors block the vision.
  • A Patch that Measures Blood Pressure — A patch, smaller than a postage stamp, can be worn and it can measure blood pressure deep within the body by emitting ultrasonic waves that pierce the skin and bounce off tissues and blood. The blood pressure data can then be sent back to a laptop.
  • A Musical Milestone — In Geneva Switzerland music is folded into the care plan for some preemies. This NICU music program features 3 specific songs, which babies listen to through special headphones. This ongoing study’s goals are to understand how music affects a preemie’s brain and how well it can recognize melody, tempo, and pitch-skills related to language processing. The songs were composed to help the infants fall asleep, wake up, and interact. MRIs are taken of the babies’ brains as they listen to the music, comparing it to babies who were not exposed to the music. The MRI scans reveal improved brain connectivity and the songs appear to support the daily rhythm of sleeping and waking, which is key to thriving in a noisy NICU.
  • Deep Brain Stimulation — Electrodes implanted in the brain deliver deep brain stimulation (DBS). These “brain pacemakers”, which have been used to effectively treat conditions like obsessive/compulsive disorders and Parkinson’s disease, are being tested in Alzheimer’s patients to improve focus, memory, and judgment. Another stroke recovery study has shown promising results, allowing a woman who was paralyzed on her left side to regain function after months of physical and occupational therapy and DBS.
  • Identifying Jaundice — A smartphone app is able to check the whites of our eyes for signs of jaundice. This could help diagnose pancreatic cancer by identifying elevated bilirubin levels.

·         Smart Inhalers – Inhalers, if used correctly, are effective for 90% of patients however research shows that as many as 94% of patients do not use their inhalers properly and only about 50% of patients have their condition under control. Bluetooth-enabled smart inhalers have been developed to help patient gain better control over their condition. A small device attached to the inhaler records the date and time of each dose and whether it was correctly administered. It then sends that data to the patient’s smartphone so they can track and manage their condition. Patients who used this device used less medication and had more reliever-free days.

·         Wireless, Absorbable Brain Sensors – Bioabsorbable electronics can be placed in the brain to measure brain temperature and pressures and then dissolve when they are no longer needed, thereby eliminating the need for another surgery to remove them.

  • Precision Medicine – Pharmaceuticals are becoming much more personalized to individual patients with the advent of gene therapy. The trend is moving away from having one standard, general way to approach treatment protocols and moving towards providing personalized treatment and prevention based on each individual’s genetics, lifestyle, and environment. Treatment is determined based on diagnostic and molecular genetic testing. Physicians can now select specific medicines and therapies to treat diseases, such as cancer or rheumatoid arthritis, based on an individual’s genetic make-up. This provides a more effective treatment plan since it attacks tumors based on the patient’s specific genes and proteins, causing gene mutations which make it easier to destroy the cancer cells. Precision medicine has shown many early successes and will be an ever-increasing concept in tomorrow’s healthcare environment.

 

The following are cutting-edge medical super-tools that were included in “2019 Medical Breakthroughs: Move Easier, Feel Better, Live Longer” article by Jacqueline Detwiler that was in the October/November, 2019 issue of the AARP Magazine, page 44. They are arranged in groups of like-topics.

Bone Grafts — Researchers have found a way to add calcium-rich eggshells to a hydrogel mixture that allows them to form a frame where new bone can develop from bone cells, making bone grafts more effective in treating osteoporosis and other skeletal damage.

Cancer

  • Prostate Urine Risk (PUR) Test — Researchers in the U.K. have developed a Prostate Urine Risk test that can identify patients who will require treatment for prostate cancer within the first 5 years after diagnosis. This test could eliminate the need for biopsies and lessen the risk of impotence or incontinence.
  • Skin Cancer Diagnosis Using Infrared Light — Infrared light is being used to map a potential skin cancer by blasting it with sound waves to measure its density and stiffness as a way to diagnose cancer with doing a biopsy. Researchers expect FDA approval next year.
  • Some cancers live by the same daily clock as we do. Understanding this rhythm helps physicians determine when it’s most susceptible to treatment. Researchers used a protein that makes fireflies glow to light up glioblastoma cancer cells whenever they were active. They discovered that oral anti-cancer drugs could be more effective if they hit the tumor at that exact time. Participants are being treated at different times of the day to identify the best times for attacking the cancer.

Chronic ConstipationThis condition may be treated in the future with pills that vibrate while moving through the GI tract. The vibrating pills induce natural peristalsis, moving stool through the body without chemical action.

Circadian-Rhythm Tests and Treatments

Circadian rhythms affect us and our bodily functions more than we realize, as evidence by some of the following studies on mood, sleeping, activity, eating, taking medications, the importance of light, etc. There is now a cell phone app called myCircadianClock that can help you identify your circadian rhythm and how to synchronize your body clock with the outside world. Check it out at mycircadianclock.org.

  • Circadian Rhythm Blood Test — During a 24-hour period about ½ of your genes are activated. Researchers have developed a blood test that measures your personal internal rhythms and determines a “time signature” that allows them to identify the absolute best times for you to eat, exercise, work and receive medications or other therapies when your body is most receptive.
  • Body Clock Tune-Ups — Circadian clocks are weakened by difficulty sleeping through the nights and daytime sleepiness often associated with Parkinson’s. Researchers have found that exposing subjects to bright light twice a day can reset sleep patterns and reduce early symptoms.
  • Adjust Your Daily Clock — The toxic effects of late night eating and all-day snacking is similar to those of “lead and asbestos”. Almost all genes, hormones, brain chemicals, neurotransmitters, digestive juices, and enzymes are programmed to turn on and off, or go up or down, every 24 hours. Eating when the stomach, pancreas, liver, and other organs are unprepared leaves the body less time to repair itself. Over time this can lead to chronic diseases. Re-establishing your circadian rhythm can fix these problems. Not eating at night and getting morning sunlight can help synchronize our body clocks with the outside world. New science shows that food should be eaten within an 8-12 hour window each day, beginning about an hour after you wake up. Researchers found that when overweight people restricted their eating to a 10-hour window they lost 4% of their body weight in four months without any changes in their diet.
  • Circadian Rhythm Lighting — Companies have developed lighting for hospitals and elder care facilities that mimics the movement of the sun, with light that grows gradually brighter toward midday and darker as sunset arrives. This helps counteract the effects of continuous fluorescent lights and the disruption of normal daily rhythms.

Depression:  A Mood Adjusting Spray Depression treatments frequently work for a time and then stop or are less effective as time goes by. A nasal spray called Spravato (Esketamine), recently approved by the FDA, can be used with an oral anti-depressant for patients with treatment-resistant depression. Some participants have found that there was no “off” time and it is still working after 2 years.

Diabetes

  • An Operation That Improves Blood Sugar — A study for diabetics in Holland included diet and lifestyle recommendations but also an outpatient procedure known as duodenal mucosal resurfacing (DMR) that used heat to destroy the topmost layer of the duodenum, the first portion of the small intestine. The idea was to destroy the layer of cells that prevent insulin from functioning optimally and replacing them with regenerated, healthy cells. Six months later, 85% of the patient had better blood sugar control and were no longer using insulin. The study is now being replicated in the U.S.
  • Afternoon Exercise for Type-2 Diabetes — A study showed that high-intensity interval training helps control blood sugar in people with type-2 diabetes, especially when it is done in the afternoon. In fact, it was not only better than exercising in the morning after breakfast, but the two patterns actually had different effects. When exercising after breakfast the participants’ blood sugar spiked, but the blood sugar remained lower throughout the day for those who exercised in the afternoon.

Exercise Can Help Prevent a Second FallA study of 345 men and women 70 and older showed that participants cut their risk of a second fall by 36% by following the Otago Exercise Program, a series of 5 strengthening and 12 balance moves with increasing levels of difficulty. The program focuses on knee, hip, and ankle strengthening and overall balance.

Heart Disease: A Whole-Life Longevity PlanA program developed by Dean Ornish, the developer of the Ornish Diet, has created a holistic 9-week lifestyle intervention course to help people reverse serious heart disease. It includes four rules: eat a low-fat, plant-based diet; get regular exercise; manage stress with yoga and meditation; and maintain love and intimacy. Within one month of completing the pilot study, the ten participants showed cardiac function improvement. One, who had been evaluated for a heart transplant, had a 27% reduction of his blocked arteries and has made amazing overall progress. The program is available in 18 states and is being approved by some insurance companies.

Light Therapy

  • Blood Pressure Light — Patients in a study were exposed to 30 minutes of whole-body blue light, a dose comparable to daily sunlight. The light reduced the systolic blood pressure by almost eight points, similar to what is seen with blood pressure lowering drugs.
  • Light-Box Therapy — Light-box therapy has been used for years to treat seasonal affective disorder, which leads to a low mood in the winter. Now the same therapy is being used to treat depression, including treatment-resistant depression and bipolar depression. Patients sit near a light box during morning hours to reset their circadian rhythm, resulting in improved mood. A study also showed that patients hospitalized for depression who had rooms that faced the southeast (more sunlight each day) were discharged an average of 30 days earlier than those in rooms facing the northwest (less sunlight each day).

More Comfortable MammogramsNew mammogram machines allow patients to control the compression of their own breasts, which can result in clearer pictures with less stress and pain. One study showed that 91% of the patients gave themselves equal or greater compression over the previous year’s scan, which improved the images.

Parkinson’s – Less Invasive Treatment for Tremors  — Deep brain stimulation, the gold standard for treatment of patients with Parkinson’s tremors that don’t respond to medication, is effective about 90% of the time. However, it requires a surgery to implant the electrodes in the brain. Last year the FDA approved a safer, noninvasive MRI Exablate Neuro treatment that guides ultra-sound waves directly to the most affected areas of the brain and destroys misfiring cells without requiring surgery.

Robotic UndergarmentsAn undergarment with robotic muscles that was originally designed to enhance soldiers’ endurance, can augment core strength by about 25%. Each garment is customized to fit an individual’s lifestyle and issues, providing support to core muscles, legs and hips, and back. They are available in the Seattle area and some elderly communities and companies are providing them to members and employees to lease for $1,000 to $1,500.

10,000 Steps a DayThe standard goal of 10,000 steps a day isn’t based on science. It was related to a 1964 Tokyo Olympics marketing effort. Researchers worked with 17,000 women (average age: 72) to determine how many steps are needed in older adults to lower their risk of dying from all causes. They were asked to record their steps for at least 10 hours a day, four days a week. They found that mortality rates began to drop at 4,400 steps and leveled off at 7,500 steps. So you can rest a little and not feel like you have to push yourself to get to 10,000 steps – 7,500 may be enough.  However, the more you do, the better it is for your health.