Citations

Barriers to incorporating pharmacogenetics into routine clinical practice in the United States are well documented. Initial surveys by the Clinical Pharmacogenetics Implementation Consortium (CPIC) in 2009 and 2010 identified barriers across four key domains that have hindered the widespread adoption of clinical pharmacogenetic testing. These are presented verbatim as: (i) absence of a definition of the processes required to interpret genotype information and to translate genetic information into clinical actions; (ii) need for recommended drug/gene pairs to implement clinically now; (iii) clinician resistance to consider pharmacogenetic information at the bedside; and (iv) concerns about test costs and reimbursement. Over time, many of these challenges have been overcome, and clinical pharmacogenetic testing has subsequently reached broader implementation. Despite this progress, several barriers remain that block further adoption. This narrative review used authors' expertise and experience to identify and describe current barriers to pharmacogenetic implementation across seven domains in the United States: equity and inclusion; guidelines and supporting evidence; regulatory agency oversight; payer coverage and insurance; availability of quality pharmacogenetic tests; electronic health records; and provider and patient education. Within each domain, it revisits past successes and challenges and explores remaining barriers. We also propose solutions to address ongoing challenges across these domains, including further expansion of recommendations beyond pharmacogenetic‐specific guidelines, standards for designing clinical decision support tools, and broader pharmacogenetics education. Addressing these remaining obstacles directs work to enable broader adoption of clinical pharmacogenetic implementation to ultimately improve patient outcomes.

ABSTRACT Background A novel individualized antitachycardia pacing (IATP) algorithm using the post‐pacing interval for real‐time control has been introduced. Performance information is limited to a small safety and feasibility study with additional single‐center and case studies. A larger‐scale analysis is needed to better understand algorithm performance. Methods Deidentified remote monitoring transmissions from devices with the IATP therapy applied were randomly selected. Rhythms were classified and effects of the novel algorithm were assessed. For monomorphic ventricular tachycardias (MVTs) proportions of successful therapy, shock‐free episodes, and acceleration were calculated using generalized estimating equations to correct for multiple episodes and compute statistics of the algorithm's performance. Results There were 2259 MVT episodes in 336 patients. IATP succeeded in 87.1% of MVT episodes with 89.9% of MVT episodes ultimately free of shock therapy. Based on multivariate analysis, significant factors in therapy success were programming of at least the recommended number of sequences (90% at least recommended vs 73%, p = 0.00088) and female sex (95% for females vs 86%, p = 0.002). A trend to higher success was found for MVT with a cycle length of 320 ms or greater (90% vs. 83%, p = 0.10). The IATP accelerated 3.6% of MVT episodes. None of the available factors was significantly associated with acceleration in the multivariate analysis. Conclusions The IATP algorithm succeeded in a large proportion of MVT episodes and with low acceleration in patients randomly selected from remote monitoring transmissions. Using at least the recommended number of sequences had the strongest association with successful therapy.

Abstract Medical devices that use electromagnetic fields for diagnostic and therapeutic purposes are rapidly evolving. Understanding the interactions between electromagnetic signals and biological tissue is fundamental to developing safe, novel diagnostic and therapy treatments. This study characterizes the dielectric properties of porcine hearts from 10 male and 10 female animals. Dielectric properties are measured using an open-ended coaxial probe dielectric spectroscopy method over a frequency range of 0.5 to 20 GHz. Scatter parameters (S11) collected from various anatomical cardiac locations (LA, RA, LV, RV, SA, IAS, IVS) are converted into frequency-dependent complex permittivity. The calculated dielectric properties vary regionally within the heart, indicating heterogeneity in tissue properties observed at microwave frequencies.

Abstract The accurate measurement of wrist range of motion (ROM) is crucial for assessing functional impairments and monitoring recovery in clinical and rehabilitation settings. Traditional methods, such as Goniometric measurement, while effective, require clinician involvement and provide limited dynamic data. Recent advancements in wearable and smartphone-based technologies offer promising alternatives, enabling remote self-monitoring and dynamic assessments. This paper presents a novel smartphone-based application for measuring wrist ROM, leveraging built-in accelerometers and gyroscopes to capture joint motion with high accuracy. The app provides real-time feedback through visualizations and haptic or auditory cues, enhancing usability and ensuring accurate measurements without clinician supervision. By focusing on accessibility, affordability, and ease of use, the proposed app aims to bridge the gap between clinical and home-based care, offering a scalable solution for remote rehabilitation and continuous care. This paper discusses the current state of ROM measurement technologies, the design of the app, and its potential to improve patient engagement and outcomes in both clinical and home settings.

Abstract Femtech, a sector dedicated to the development of technologies addressing women's health issues, holds significant potential to revolutionize healthcare for women. This study provides an overview of current Femtech solutions tailored to meet the unique needs of women. It analyzes the present landscape, highlighting key areas where artificial intelligence (AI) and generative technologies have made substantial impacts. Furthermore, the study explores strategies to foster future growth and broader adoption of Femtech within the healthcare sector with a glance at Artificial Intelligence. The ultimate objective is to advance the development of more effective, personalized, accessible, and equitable healthcare solutions for women. The study will review and categorize 56 women’s health-related applications and devices currently available on the US market, identifying existing gaps and areas for potential improvement.

Abstract Introduction The objective of the study was to investigate the characteristics of patients who underwent surgery for dysplasia detected during chromoendoscopy (CE) surveillance for inflammatory bowel disease (IBD) and the incidence of cancer in the surgical specimen. Methods A retrospective review of medical records of all patients with dysplasia on a background of underlying IBD diagnosed through CE was carried out at a tri-site enterprise tertiary referral center between 2006 and 2019. We aimed to assess the clinical characteristics of patients requiring surgery for dysplasia and the incidence of cancer in the surgical specimen. Results Out of 219 patients with dysplasia on CE, 35 underwent surgery for dysplasia (16%). Indications for surgery were multifocal disease (n = 6), endoscopically unresectable lesions (n = 13), visible HGD (n = 7) and unifocal invisible LGD (n = 9). Out of 35 patients requiring surgery, 5 were found to have adenocarcinoma, one of whom with stage IIIB disease received postoperative chemotherapy. No patient with a pathologic diagnosis of adenocarcinoma had any evidence of recurrent disease after a mean postoperative follow-up of 32 months. Conclusions While the incidence of cancer at the time of surgery for IBD-related dysplasia is not negligible, the rate of node-positive disease is low.

Point-of-care ultrasound (POCUS) is increasingly becoming integral to clinical practice across many subspecialties. Its value in diagnostics and therapeutics has been validated across various disorders. It is becoming evident that the integration of POCUS in our intensive care units is becoming essential in early diagnostics and interventions that impacts patient outcomes. Therefore, we must train our next generation of intensivists, guided by several established recommendations from multiple societies. To achieve this task, we propose that at least four crucial elements, with full support from the institutional leadership, must be established. These include sufficient number of trained staff, a comprehensive curriculum, an educational platform, and a continuous professional development program. In establishing such a program, the potential harm of misinterpretation leading to mismanagement should be mitigated.

Objective To describe the potential applications of awake cochlear implantation (CI). Patients Adult patients with sensorineural hearing loss who qualify for CI. Interventions CI under local anesthesia, without any form of systemic analgesia or anesthesia. Main Outcome Measures Acoustic hearing preservation, subjective patient report of cochlear implant pitch matching, and subjective patient report of cochlear implant sound quality. Results Four illustrative cases are presented, highlighting the potential uses of CI performed under local anesthesia for optimizing outcomes in hearing preservation, implant pitch matching, and implant sound quality. Conclusions CI under local anesthesia allows surgeons to use real-time patient feedback during electrode array insertion to minimize intracochlear trauma, particularly in cases where hearing preservation is a goal of CI, and to potentially improve implant performance by optimizing pitch matching and sound quality.

PURPOSE Initial reports indicate that access to contemporary therapies currently used in North America for the treatment of multiple myeloma (MM) varies internationally. No studies have quantitatively reported the extent of disparities in the access to MM therapies worldwide, with a goal to investigate access to MM therapies and barriers globally. METHODS From June 18 to July 15, 2023, an electronic survey was distributed to 176 oncologists treating MM outside the United States. MM drugs were categorized by accessibility, with the cutoff for adequate access set at 60% of respondents affirming easy/moderate access. RESULTS Ninety-five (54%) respondents from 33 countries completed the survey. Fifty-one percent of the respondents were from university-based academic programs, and 17% of the responders treated only plasma cell disorders. Most respondents had adequate access to noncellular MM therapies, except for isatuximab, ixazomib, selinexor, and elotuzumab. Among the cellular therapies, 17% had access to Chimeric Antigen Receptor T-cell therapy, whereas 23% had access to approved T-cell engagers (TCEs). Financial stress on patients and health care systems has emerged as a primary barrier to global inaccessibility of treatment drugs. CONCLUSION Global access to novel MM therapies remains challenging, and we have identified barriers and suggested strategies to bridge this gap.