StemCell Therapy

The Ambulatory Healthcare IT Market report has been crafted carefully to provide the latest insights into the significant aspects of the Market. This Ambulatory Healthcare IT Market research report is the exhaustive analysis of the market across the world. It offers an overview of the market including its definition, key drivers, key market players and key segments. In addition, the study presents statistical data on the status of the market and hence is a valuable source of guidance for companies and individuals interested in the Industry. Market segmentations break down the key sub sectors which make up the market.

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Ambulatory care is also referred as outpatient care. It is a medical care given on outpatient criteria such as consultation, rehabilitation, observation, intervention, diagnosis, and treatment services. Ambulatory care involves emergency care, primary care, ambulatory services, and others. In this intervention and surgery, overnight hospital stay is not required.

The report highly involves chapter wise explanation for every aspect of the market wherein the drivers, trends, opportunities, leading and trending segments are discussed in detail with specific examples. Profiles of leading players are also discussed along with their business expansion strategies.

Few of the major market competitors currently working in the global ambulatory healthcare IT market are AmSurg Corp, Surgical Care Affiliates, Surgery Partners, Healthway Medical Group, SurgCenter, Trillium Health Partners, Medical Facilities Corporation, Nueterra Capital, Aspen Healthcare, Suomen Terveystalo Oy, IntegraMed America, Inc., SHERIDAN HEALTHCARE, NueHealth, Athenahealth, GENERAL ELECTRIC, Optum, Inc., Apria Healthcare Group, Inc., DaVita Inc., LVL Medical, Fresenius Kabi AG, Sonic Healthcare among others.

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The predictions featured in this report have been derived using proven research methods and standards. With this data, the research report serves as a source of information and analysis for every segment of the market, including but not restricted to: local markets, product, and application.

Global Ambulatory Healthcare IT Market By Type (Ambulatory Services, Primary Care Offices, Outpatient Departments, Emergency Departments, Surgical Specialty, Medical Specialty, Others), Modality (Hospital-affiliated, Freestanding), Surgery Type (Opthalmology, Orthopedics, Gastroenterology, Pain Management, Others), Application (Laceration Treatment, Bone Fracture Treatment, Emergency Care Service, Trauma Treatment)

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Ambulatory Healthcare IT Market Insights, Online Research With AmSurg Corp, Surgical Care Affiliates, Surgery Partners, Healthway Medical, SurgCenter,...

Kathi C. Huddleston PhD, RN, CNS, CCRC

Citation: Huddleston, K., (December 23, 2013) "Ethics: The Challenge of Ethical, Legal, and Social Implications (ELSI) in Genomic Nursing" OJIN: The Online Journal of Issues in Nursing Vol. 19 No. 1.

DOI: 10.3912/OJIN.Vol19No01EthCol01

Nurses have always been a cornerstone of healthcare literacy and education. It is essential that, in the complex and quickly changing world of genetics and genomics, they maintain this position. Genetics is the study of the function of a single gene; whereas genomics widens the view to include all genes, and their expression and effects on cell growth, utilizing DNA and bioinformatics (which is the use of biological knowledge to organize and analyze large amounts of data). Genomics includes the emerging fields of omics,such as proteomics (study of protein structures), metabolomics (study of chemical cellular metabolites), and transcriptomics (the study of RNA molecules).

Nurses will soon become as familiar with the omics as they are with vital signs. They will blend this new knowledge into their patient care, while continuing to address, with patients and community members, the ethical, legal, and social implications (ELSIs) of future health interventions. These ELSI implications will require basic genetic and genomic health literacy and an understanding of the expectations of the public. The need for the nurse to have baseline competencies in these areas has been well established (American Nurses Association, 2006; Calzone et al., 2012; Gelling, 2013). The multiple findings from studies that have explored health behaviors and attitudes towards genetic testing suggest that people want to know their genetic sequencing results, so as to better understand their personal health profiles (Haga et al., 2013; Hodgson & Gaff, 2013). The ever-expanding discoveries in genomics challenge the nurse to be competent in genomic medicine and knowledgeable in associated, and often difficult, ethical situations (Milton, 2012).

The genomic revolution began with the completion of the sequencing of the human genome in 2003. In the past 10 years, we have seen almost daily releases of studies and reports linking specific changes in genomes with diseases. New genomic discoveries are visible in every arena. Over the past two decades, there has been a growing realization of the complexity of disease and the pathogenesis of both acute and chronic illness (Hamilton, 2009; Lea, 2008). We now know that cancer is not one disease; rather it occurs in different forms with each form being a different disease. Our understanding of several common medical disorders now demonstrates that these disorders are anything but common; they differ in their predisposition, initiation, and path of progression. Something as prevalent as hypertension has proven to be a complex and confusing disorder with numerous etiologies and multiple triggers.

Currently, whole genome sequencing (WGS) serves primarily as a research tool, but that is rapidly changing. We are now seeing the use of WGS in the clinical diagnosis and treatment of complex illnesses (Tabor, Berkman, Hull, & Bamshad, 2011). The impact of genomics research on healthcare and society depends on our ability to deal with the complexity of the genomic revolution and the integration of knowledge to inform our ethical, legal, and social issues (Milton, 2013).

The concepts of autonomy, respect, beneficence, nonmalificence, and justice provide ethicists with a common language and a set of beginning assumptions upon which they can discuss the dilemmas presented to them. Although these concepts can frame the discussion, they are limited in providing answers to the new and complex questions raised by genomics. For example, the concept of autonomy would support the right of persons to obtain their genomic information, but it could also be used to defend their right to refuse such information. Consider a woman who had been found to have a BRCA1 (breast cancer susceptibility gene) variant during genetic testing for a different disorder, in light of the concept of autonomy. She may choose not to learn the results of this incidental finding that she had not consented to. She has the right to refuse that discovery information from her healthcare provider. If she does elect to learn her BRCA1 status, the question arises as to whether she has any obligation to share that information with her sisters or her mother who may have a 1:2 chance of also carrying the disease-causing gene. Does she have the right to test her child? Should the childs right to autonomy reign so that she delays involving her child until the child comes of age and consents to genetic testing? Every ethical question can be discussed and framed to defend or to counter any assumed correct decision.

Today, professional organizations are actively providing guidance and recommendations regarding these questions. The American Nurses Association (2006) has gathered important information about ethical challenges confronted by people receiving genetic- and genomic-based healthcare. Professional codes of ethics, including that of the American Nurses Association and those of professional organizations in other countries, such as Canada and the United Kingdom, provide guidance. These codes provide a framework for nurses who respond to the expansion of the science of genomics in fields such as genetics and genomics. Additionally, the American College of Medical Genetics and Genomics has recently posted a controversial recommendation for the reporting of incidental findings (Green et al., 2013). As the science advances, specialty organizations will also provide recommendations and guidance. To do this effectively, a basic framework is needed to understand the reason and the rationale for specific decisions so as to provide a consensus of leadership (Evans & Rothschild, 2012; Levenson, 2012).

As knowledge of genomics increasingly influences clinical care, the ethical, legal, and social implications of care decisions demand further inquiry and discussion within hospitals, medical practices, and communities. In my role as Director of Clinical Research at the Inova Translational Medicine Unit, I work with over 1500 families who have enrolled with their newborns to participate as a family in whole genome sequencing research. These families are participating in the exploration of molecular causes of prematurity and the longitudinal study of genomic correlations to childhood health outcomes. We are searching for genomic correlations as to causes of premature birth; but in the course of that research we may incidentally find a baby with a BRCA1 variant. This genetic variant is solely related to the adult onset of breast cancer. Should that result be reported to the mother and father? Would they make choices based on that knowledge that may affect the child? Should the child have the right to choose whether or not she wants to know this finding? What about other children? The question remains as to whether a mother should be told about that genetic susceptibility as it may relate to her reproductive health?

The ethical challenges in our genetic and genomic era regarding questions like these are intertwined with legal and social issues that lead to different interpretations of data privacy. The healthcare world has numerous privacy regulations. However, genomics is different because, although the genomic information belongs to an individual, it is relevant to the family. The patients parents, siblings, and children share roughly 50% of that genomic background, which is central their identity. Patients genetic information can change their perspective of who they are, who their parents are, their place in the world, and their time in the world.

All healthcare professionals must honor the principles of privacy and confidentiality. The technical challenges of coding protected health information through unique, unrelated, numbering systems that are read by computers, as well as the challenges of storing such grand-scale data on secure systems, are creating new markets and new requirements to support confidentiality, patient privacy, and choice. The risks to confidentiality related to genomic information have profound regulatory and insurance implications.

Ethical issues in informed consent have gained greater urgency because of the rapid advances in genomics. Genetic-informed consent is more than a signed document and more than a permission to perform genetic testing. It involves an interaction between the healthcare provider/research team member and the patient/participant. It requires listening and reviewing participants specific needs to ascertain their understanding. Some have even argued that it is not possible to provide informed consent for genetic research because knowledge is advancing so rapidly that we do not know what tests will be possible or what variants may be identified next week.

The increasing utilization of genomics in research and clinical care requires the development of a bioethical framework that considers the ethical, legal, and social implications necessary to advance healthcare and incorporate genomic information into health-related practices. With scientific breakthroughs emerging daily, for example the discovery of bacterial genomes and their interactions with human genomes as they affect health and disease, nurses are faced with more questions than answers. The translation of new knowledge and discoveries requires the integration of science into practice. There are no easy answers to these difficult ethical challenges. Science will continue to push our practice out in front of our comfort zone. Nurses need to develop guiding resources and recommendations, and establish educational competencies, to provide for the challenges of ethical, legal, and social implications in genomic nursing.

Kathi C. Huddleston PhD, RN, CNS, CCRCEmail: kathi.huddleston@inova.org

Dr. Huddleston currently serves as the Director for Clinical Research Projects at the Inova Translational Medicine Institute, Inova Fairfax Medical Campus, Falls Church, VA. She has over 30 years of nursing experience, working in pediatrics, critical care, surgery, and cardiac care. She has worked in childrens hospitals and has practiced in a variety of geographical areas, including Washington DC, Denver (CO), Fresno (CA), and Norfolk (VA). She has now returned turned home to the Washington DC area. Dr. Huddleston has always been interested in clinical outcomes research; and genomic research is a natural progression for her. She notes that one can argue whether genomics is the driver or the passenger in our advancing technologies, but there is no doubt that the genomics vehicle is in the race to the finish! She earned her PhD from George Mason University in Fairfax, VA, her MSN from the California State University in Fresno, and her BSN form the University of Maryland (Baltimore).

American Nurses Association. (2006). Essential genetic and genomic competencies. http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Genetics-1/Essential-Genetic-and-Genomic-Competencies-for-Nurses-With-Graduate-Degrees.pdf

Calzone, K.A., Jenkins, J., Yates, J., Cusack, G., Wallen, G., Liewehr, D.J., McBride, C. (2012). Survey of nursing integration of genomics into nursing practice. Image: The Journal of Nursing Scholarship, 28(2), 101-106.

Evans, J.P., & Rothschild, B.B. (2012). Return of result: Not that complicated? Genetics in Medicine, 14 (4), 358-60. doi: 10.1038/gim.2012.8

Gelling, L. (2013) Let's tap the patient potential. Nurse Researcher, 20(3), 3.

Green, R. C., Berg, J. S., Grody , W.W., Kalia, S.S., Korf, B. R., Martin, C. L., Biesecker, L.G. (2013). ACMG recommendations for reporting of incidental findings in clinical exome and genome sequencing. Genetic Medicine, 15(7), 565-574. Doi: 10.10.38/gim.2013.73

Hamilton, R. (2009). Nursing advocacy in a postgenomic age. Nursing Clinics of North America, 44(4), 435-446.

Hodgson, J., & Gaff, C. (2013). Enhancing family communication about genetics: Ethical and professional dilemmas. Journal of Genetic Counseling, 22(1), 16-21.

Lea, D. (2008). Genetic and genomic healthcare: Ethical issues of importance to nurses. OJIN: The Online Journal of Issues in Nursing, 13(1). doi: 10.3912/OJIN.Vol13No01Man04

Levenson, D. (2012). The tricky matter of secondary genomic findings: ACMG plans to issue recommendations. American Journal of Medical Genetics. Part A, 158(7), ix-x. doi: 10.1002/ajmg.a.35521

Milton, C.L. (2012). Ethical implications and interprofessional education. Nursing Science Quarterly, 25(4), 313-5. doi: 10.1177/0894318412457066

Milton, C.L. (2013) The ethics of research. Nursing Science Quarterly. 26(1), 20-23. doi: 10.1177/0894318412466740

Tabor, H.K., Berkman, B.E., Hull, S.C., & Bamshad, M.J. (2011). Genomics really gets personal: How exome and whole genome sequencing challenge the ethical framework of human genetics research. American Journal of Medical Genetics Part A. 155(12), 29162924. doi:10.1002/ajmg.a.34357

2013 OJIN: The Online Journal of Issues in Nursing Article published December 23, 2013

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Ethics: The Challenge of Ethical, Legal, and Social ...

A leading medical ethicist lists his top 5 ethical issues in medicine today and in the near future.

No one knows exactly how many people are killed each year by medical errors, but it is in the hundreds of thousands in the United States and tens of thousands in the United Kingdom. Along with heart disease and cancer, it is a leading cause of death. Many more people are injured non-fatally by errors and the cost of payouts for clinical negligence claims in England in 2017/2018 was 2.23 billion.

Reducing the human and financial cost of medical errors is an ethical priority. The recent Bawa-Garba case, in which a junior doctor contributed to the death by sepsis of a 6-year-old-boy, highlighted the need to address both individual and systemic issues to reduce errors.

Reducing the human and financial cost of medical errors is an ethical priority. The recent Bawa-Garba case, in which a junior doctor contributed to the death by sepsis of a 6-year-old-boy, highlighted the need to address both individual and systemic issues to reduce errors.

Clinicians have an ethical obligation to be open about their medical errors but how do we encourage them to do so when the personal and professional consequences of honesty can be devastating? The reality is that some medical errors are never disclosed to patients, who are then deprived of compensation, and little is learnt from the mistakes.

The population is ageing and our ability to keep desperately sick people alive is ever-increasing. Should we help people who want to end their lives? If so, should it only be terminally ill patients or should it include those suffering from psychiatric disease, like Aurelia Brouwers, the 29-year-old Dutch woman who was so unhappy that she described her mental suffering as unbearable? She lawfully drank lethal poison in the Netherlands in January 2018. Parliament must urgently consider whether to create a law allowing clinicians to help patients die in certain circumstances.

Doctors have an obligation to keep their patients secrets but when can this be breached? If a person tells their GP that they have been a victim of domestic abuse but refuses to tell the police, should the doctor do so? What about the bus driver with epilepsy who continues to drive but withholds the diagnosis from the Driver and Vehicle Licensing Agency (DVLA)? If a patient has a serious genetic disease which a relative may also have, such as Huntingdons disease (a fatal, incurable condition which is passed on to children 50% of the time), should doctors tell the relative even if the patient refuses permission? Confidentiality is one of the most common issues raised by doctors when they contact the British Medical Associations Ethics Department.

How much money should the NHS receive from the government? Dr Richard Smith, a former editor of the British Medical Journal, recently argued that the NHS should not receive any more funds because 90% of health results from environment, genes and lifestyle and healthcare rapaciously swallows up funds that would do much for health if invested in education, housing, poverty reduction, the environment, community development.

Within the healthcare budget, how much should be given to each condition? Should acute conditions, such as brain haemorrhages, get more investment than long-term ones, such as diabetes?

Artificial Intelligence is infiltrating the field of medicine, with AI software already interpreting the scans of radiologists, making treatment plans, and assisting surgeons in the operating theatre. Over the next few years, the role of AI will continue to grow but ethical and legal issues are yet to be addressed. Who will be to blame, if anyone, if the AI proves malfunctions?

Over the next few years, the role of AI will continue to grow but ethical and legal issues are yet to be addressed. Who will be to blame, if anyone, if the AI proves malfunctions?

The developer, the manufacturer, the maintenance people, the hospital, the clinician? How can doctors obtain informed consent from patients if no one quite understands how the AIs self-learning algorithm works because it is too complicated, or when the error rate is unknown? And what if the algorithm contains or develops biases, discriminating against certain types of patients: the young, the old, the rich, the poor, men or women?

Several of these ethical issues are likely to be relevant to us at some point in our lives, whichever side of the stethoscope we stand. It is in our collective interest, therefore, to reflect on them and find practical solutions.

Daniel Sokol, PhD, is a medical ethicist and barrister at 12 Kings Bench Walk. His book Tough Choices: Stories from the Front Line of Medical Ethics is published in October 2018 and is available for pre-order.

Dr Daniel Sokol is a medical ethicist and clinical negligence barrister at 12 Kings Bench Walk, London.He has taught medical ethics and law at Keele, St Georges and Imperial College London, and sat on committees for the Ministry of Defence and the Ministry of Justice.He is the author of 3 books and over 250 articles on medical ethics and law.www.medicalethicist.net

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Top 5 ethical issues in medicine - The Hippocratic Post

The Science of Precision Medicine

GenomicInsightis our latest precision-based medicine test, and is a clinical DNA test that analyzes single-nucleotide polymorphisms (SNPs).

While all humans share a similar genome, individual differences occur from human to human. GenomicInsightidentifies the SNPs that represent these differences. Opus23 Explorer is an AI-powered informatics platform that allows practitioners to view over 5,000 SNPS that impact over a dozen areas of patient health using one comprehensive data file.

GenomicInsightallows practitioners to take personalized medicine and precision medicine to the next level. Curated reports identify what disease risks a patient may have, what nutraceutical or pharmacological drugs their genome will best react to, and what lifestyle factors can help prevent a harmful gene from expressing itself.

In the field of DNA testing and precision medicine, GenomicInsightis the most dynamic and comprehensive test available. Practitioners can now use the genome, unique to each patient, to influence critical areas of patient health, including methylation, hormone metabolism, aging, detoxification, HPA-Axis, and more.

Precision medicine practitioners are embracing the field of nutrigenomics. Nutrigenomics uses nutrition to influence a patients unique genome to treat or prevent disease. DNA testing and clinical understanding of the human genome is the epitome of personalized medicine.

Learn More About GenomicInsight

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Personalized Medicine | Diagnostic Solutions Laboratory

There is still some confusion surrounding the difference between precision medicine and personalized medicine. Some argue for a strict distinction between the two. For them, using the term precision medicine instead of personalized medicine offers a more accurate representation of practices involving the customisation of healthcare services.

Others have used the two interchangeably however. The public and mainstream media, as well as industry practitioners and non-profit healthcare and scientific organizations have used a degree of freedom in switching between the two terms.

A 2011 report prepared by a committee of the U.S. National Research Council suggested the use of the term precision medicine instead of personalized medicine. Note that NRC is the working arm of the United States National Academies responsible for shaping policies and advancing the pursuit of science, medicine, and engineering.

The report defines precision medicine as the tailoring of medical treatment to the individual characteristics of each patient. The report added, It does not literally mean the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment.

In explaining the difference between precision medicine and personalized medicine, the report said the latter is susceptible to misinterpretation. Some might regard personalized medicine as a concept that implies the design of unique treatments for each individual. This is not the actual case in practice as iterated in the definition of precision medicine.

An executive at Merck Research Laboratories and geneticist also explained the distinction between the two. In his blog article, Robert M. Plenge, MD, PhD, considered the term personalized medicine as synonymous with practices involving basic patient care. According to him, physicians generally make decisions about the best course of treatment based on patient preferences. This should be the actual and most basic definition of personalized medicine.

Plenge also said that there are some burdens associated with personalized medicine. When the Human Genome Project was nearing it completion in 2000, people hoped that the identification of genetic markers would clearly differentiate patients between responders and non-responders. Personalized medicine was a buzzword around this time. This did not happen due to the polygenicity of complex traits.

Gary An, MD, and Yoram Vodovotz, MD, also trace the popularity of the term personalized medicine from the assumptions associated with the Human Genome Project. These assumptions revolved around using sequence data and information such as demography, medical histories, and responsiveness to medications to determine therapies that would work best for an individual patient. The assumptions never materialised however. An and Vodovotz said that precision medicine has become a more appropriate terminology to describe a healthcare approach involving the analysis of precisely defined subgroups of patients using genomic sequence data and metadata from existing therapies.

Others have used the terms precision medicine and personalized medicine despite some strict calls to use the former. This is evident in casual and formal discourse, as well as in scientific and non-scientific literatures.

During his 2015 State of the Union Address, President Obama announced an initiative centred on promoting precision medicine. His speech interestingly highlighted how some people use the term personalized medicine.

Publications from non-profit organisations have also switched the two terms with a high degree of liberty. For example, an article published online by the American Cancer Society featured personalized medicine in its headline. Author Elizabeth Mendes also mentioned that the definitions of precision medicine and personalized medicine seem to be merging.

The patient information website of the American Society of Clinical Oncologists has also used the terms interchangeably throughout its contents. In a specific info page about cancer treatment options, ASCO included personalized medicine in the list. However, some of its blog articles featured precision medicine in their headlines.

Note that personalized medicine seems an obsolete term based on the arguments by NRC and other physicians. However, organizations such as pharmaceutical companies and scientific communities are still using it in their publication. Companies such as Bayer and Pfizer, for instance, have made information webpages about personalized medicine. Pfizer describes the term as an approach involving the tailoring of drugs to match the genetic variability of diseases.

The Jackson Laboratory, a non-profit biomedical research institution, also uses personalized medicine as a term to describe tailoring of healthcare services based on genomics. Other organisations use precision medicine such as the National Health Institute and U.S. Food and Drug Administration.

Journals under the Nature Publishing Group and Public Library of Science have also featured articles using either the terms precision medicine or personalized medicine. There are even journals that are carrying the either of the two. Examples of these are the The Journal of Personalized Medicine of Molecular Diversity Preservation International, Personalized Medicine by Future Medicine, and the Personalized Medicine Universe by the Society of Personalized Medicine; as well as The Journal of Precision Medicine and Advances in Precision Medicine, among others.

However, PHG Foundation has concluded that the two terms have specific meanings. In their position paper, the UK-based health policy think thank suggested that personalized medicine is a more general or broader concept. Under this broad concept are specific concepts such as precision medicine, stratified medicine, and P4 medicine. PHG Foundation is still on the process of reviewing and analysing relevant literatures to come up with a more concrete suggestion as regards the use of these terminologies.

The concepts behind precision medicine and personalized medicine are hardly new. But there is a discord among stakeholders regarding their exact definitions and differentiations. One of the probable reasons behind this discord is that the actual application of each concept is relatively new. Another reason is that the overlaps between precision medicine and personalized medicine are very evident that their differences become negligible. Then there are those who consider the debate as nothing but a case of preferential difference.

Further readings: (1)An, Gary and Vodovotz, Yoram. 9 March 2015. What Is Precision Medicine And Can It Work? Elsevier Connect;(2)Mendez, Elizabeth. 3 April 2015. Personalized Medicine: Redefining Cancers And Its Treatment. ACS Research Updates. American Cancer Society;(3)National Research Council. 2011. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. ISBN: 978-0-309-22222-8;(4)PHG Foundation. n.d. Many Names For One Concept Or Many Concepts In One Name? PHG Foundation;(5)Plenge, Robert M. 16 March 2013. Personalized Medicine vs. Precision Medicine. Plenge Gen Blog

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Precision medicine vs. personalized medicine | Version Daily

Personalised medicine is a move away from a one size fits all approach to the treatment and care of patients with a particular condition, to one which uses new approaches to better manage patients health and targets therapies to achieve the best outcomes in the management of a patients disease or predisposition to disease.

We are all unique. Our health is determined by our inherent differences combined with our lifestyles and environment. By combining and analysing information about our genome, with other clinical and diagnostic information, patterns can be identified that can help to determine our individual risk of developing disease; detect illness earlier; and, determine the most effective interventions to help improve our health, be they medicines, lifestyle choices, or even simple changes in diet.

The concept of personalised medicine is not new. Clinicians have been working to personalise care, tailored to peoples individual health needs, throughout the history of medicine, but never before has it been possible to predict how each of our bodies will respond to specific interventions, or identify which of us is at risk of developing an illness. New possibilities are now emerging as we bring together novel approaches, such as whole genome sequencing, data and informatics, and wearable technology. It is the interconnections between these innovations that makes it possible to move to an era of truly personalised care.

Technological and scientific advances are already here and will continue to develop and improve medical practice; change is inevitable. For the NHS, we must consider not whether we should go down this path of personalised medicine, but instead how we can best respond and adapt, to ensure everyone benefits regardless of where people live, the illnesses they have, or where their care is provided.

We are on a journey towards embedding a personalised medicine approach into mainstream healthcare. NHS England is beginning a discussion about what we mean by personalised medicine, now and in the future, and the approach we will take, working with our partners, so that we can embrace new approaches, while ensuring that ethical, equality and economic implications are fully understood and addressed.

Through the 100,000 Genomes Project, a ground breaking and world leading initiative, the NHS is building partnerships with academia and industry to decode the human genome, in people with rare diseases and cancer. This will help to predict the future development of disease, to make a diagnosis where one has not existed previously and to identify treatments where possible. Please see the genomics page for further information.

Improving Outcomes through Personalised Medicine

If you have any queries regarding any aspect of personalised medicine please contact the Genomics Team at NHS England via:england.genomics@nhs.net

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NHS England Personalised medicine

Industry Insights

The global personalized medicine (PM) market size was estimated at USD 1.57 trillion in 2018 and is anticipated to expand at a CAGR of 10.6% during the forecast period. Personalized medicine promises a paradigm shift in diagnosis and care delivery as the treatment is based on data leveraged from a holistic view of an individual patient. Proliferation of sequencing methodologies, especially Next Generation Sequencing (NGS), due to rising cost of sequencing and development of Human Genome Project in genomics field is expected to drive the market.

NGS technology delivers the data related to the genetic makeup of the patient and response of drugs on patient, thereby fostering the development of precision medicineto treat diseases. Moreover, NGS combined with Companion Diagnostics (CDx) is expected to play a major role for advancement of personalized diagnostics and therapeutics over the forthcoming years. Advent of novel CDx and biomarkers for non-oncology therapeutic applications have forced companies to improve their precision medicine portfolio; focusing oninfectious diseases and Cardiovascular Diseases (CVDs).

This generates a strong impetus for scaling up the CDx tests to form PM for non-oncology cases. Increasing prevalence of cancer, which boosts demand for personalized cancer diagnostics and therapeutics, is also one of the key factors responsible for the growth of the market. As per data GLOBOCAN 2018, the global burden of cancer has increased to 18.1 million new cases in 2018. Growing cancer-related spending is also amongst the drivers for growth.

Key companies in the personalized medicine market are involved in several investment programs pertaining to the precision medicine. This has resulted in an increased commitment of leading pharma competitors toward this sector. Furthermore, companies providing molecular decision support system are combining genomic data with clinical data to minimize the gaps in precision medicine practice.

Personalized nutrition & wellness was the largest product segment in 2018. Availability of a wide range of nutrition & wellness products and increased Over The Counter (OTC) sale of these productsplay a significant role in boosting the segment growth. Companies are undertaking several initiatives for sustaining market competition. For instance, in March 2018, DSM partnered with Mixfit to provide personalized nutrition solutions by combining Artificial Intelligence (AI) technology.

This strategic partnership was targeted towards offering consumers a personalized approach regarding nutrition. PM therapeutics includes pharmaceuticals, genomic medicine, and medical devices for personalized therapies and it is anticipated to witness the highest CAGR during the forecast period. Advent of high-capacity rapid sequencing platforms and reducing cost of sequencing whole human genome plays a major role in the segment development.

Genomic medicine has emerged as a significant segment in PM therapeutics. Availability of large databases of genomic data enables researchers to develop accurate and effective therapeutic products for several medical conditions. Consequently, this results in high utilization of human genome sequencing techniques for genomic medicine.

Led by U.S., North America was the dominant regional personalized medicine market in 2018. Increasing adoption of NGS methods and healthcare IT systems in clinical workflow along with supportive government policies and funding drives the regional market.

For instance, in September 2018, the All of Us Research Program initiated by the National Institutes of Health (NIH) awarded funds of USD 28.6 million to three genome centers of the U.S. This funding supported the generation of genomic data from biosamples by these centers, which is a critical component of precision medicine discoveries.

However, Asia Pacific is projected to witness the highest CAGR over the forecast period owing to low cost of clinical trialsof newly developed precision medicines and diagnostic products. Moreover, rising disposable income levels and growing economy of emerging countries will boost the market further.

Some key companies in this market include GE Healthcare; Illumina, Inc.; Asuragen, Inc.; Abbott Laboratories; Dako A/S; Exact Science Corporation; Danaher Corporation (Cepheid, Inc.);Decode Genetics, Inc.;Genelex Corporation; Exagen Diagnostics, Inc.; Precision Biologics, Inc.; QIAGEN; Celera Diagnostics LLC; and Biogen, Inc.

These companies invest in personalized products-focused innovations and developments for business expansion. For instance, in April 2018, Ilumina helped various startup companies by offering them financial support. One of such startups, TruGenomix Health, Inc. focused on individualized treatment options, thereby advancing personalized therapies.

Attribute

Details

Base year for estimation

2018

Actual estimates/Historical data

2014 - 2017

Forecast period

2019 - 2025

Market representation

Revenue in USD Million and CAGR from 2019 to 2025

Regional scope

North America, Europe, Asia Pacific, Latin America, and MEA

Country scope

U.S., Canada, Germany, U.K., Japan, China, Brazil, and South Africa

Report coverage

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This report forecasts revenue and volume growth at global, regional, and country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2014 to 2025. For the purpose of this study, Grand View Research has segmented the global personalized medicine (PM) market report on the basis of product and region:

Product Outlook (Revenue, USD Million, 2014 - 2025)

Regional Outlook (Revenue, USD Million, 2014 - 2025)

Continued here:
Personalized Medicine Market Size & Forecast | Industry ...

In the United States, despite high hopes, our health-care system still generally operates as a one-size-fits-all model. Some refer to this as a population model. This paradigm suggests that in the majority of people, an ailmentbe it a common cold or cancerhas a common predicted trajectory, and most people will benefit from a homogeneous course of treatment. If a particular treatment does not work, then the second-most likely successful treatment plan is prescribed.

This continues until the ailment is relieved. Treatments are set based on available population statistics, and trial and error is used until the patient is well. In this model of medicine, personal characteristics, risk factors, lifestyle choices and genetics are rarely considered. Therefore, the treatment approach will not be ideal in all cases, failing those who do not fit with average parameters.

Personalized medicine, on the other hand, advocates the customization of health care. It aims to prevent diseases, as well as tailor treatments to an individual so a disease or illness can be targeted in a way that promises the highest chance of success based on the attributes of the individual. An underlying assumption of this approach is personalized medicine (PM) takes into account that drugs and interventions will have varying efficacy based on the person being treated.

Now that science possesses a complete map of all the genes in the body, personalized medicine is manifesting as a reality.

Angelina Jolies public disclosure about carrying a BRCA1 gene mutation, which puts her at high risk of breast cancer and ovarian cancer, brought some of these concepts to the publics attention. Making choices based on gene type might not yet be the norm in everyday health-care practice, but it is becoming more prevalent.

Oncology is an area of medicine where DNA sequencing technology has a lot of potential. For example, for lung cancer, there are many personalized treatment options now available based on different lung cancer biomarkers. If there is a medical indication, genetic tests can often be covered by insurance, especially if there is an FDA-approved drug or treatment that is tied to a genetic mutation.

Recently, researchers have also used DNA sequencing to establish the connection between bovine leukemia virus (BLV) and breast cancer. It was previously believed that this cattle virus cannot infect humans. However, a study conducted by the University of California, Berkeley, and the University of New South Wales, Sydney, showed that BLV can be present in human tissue three to 10 years before cancer gets diagnosed, indicating a strong correlation.

Genome-driven medical care is becoming increasingly utilized due to the development of next-generation sequencing (NGS) technologies.

According to The National Human Genome Research Institute, whole genome sequencing can now be performed in less than 24 hours for under $1,000. The genetic services have become more accurate and affordable and are now used in both public and private institutions. However, numerous challenges still need to be tackled. For instance, many doctors may lack training opportunities and are unfamiliar with the emerging technologies. Some experts also warn that there needs to be a balance between hope and hype and that ethical issues should be strictly monitored.

Perhaps one of the most sensational innovations in the area of personalized medicine is printing 3-D organs from ones own cells. It is predicted that in about 10 to 15 years, organs will routinely be produced from cells harvested from patients themselves using 3-D bioprinting technology. In the future, organ transplantations might eventually be replaced by customized organ-growing.

Anthony Atala, M.D., the Director of the Wake Forest Institute for Regenerative Medicine (WFIRM), has already demonstrated that transplantable kidneys can be produced using such a technique, helping to curb a crisis resulting from organ shortage. Currently, scientists at WFIRM are engineering over 30 different tissues and organs that could be used as replacement organs. Organovo, a company working on personalized bioprinted human tissue, has so far produced 3-D liver models that stay functional and stable for up to 60 days, which is an improvement from the previously established functionality of 28 days. The printed liver tissue can be used for drug testing, offering an alternative to animal and in vitro experiments. It also offers new hope to people with various genetic conditions who could benefit from a transplant. In 2016, Chinese scientists successfully printed a part of the hearts left atrium (left atrial appendage). Occlusion of this part can play a role in preventing stroke in patients with atrial fibrillation. It appears that 3-D technology can offer an improved presentation of an individuals left atrial appendage compared to conventional imaging methods. This is essential for surgeons as they need an accurate preoperative reference before they start with the occlusion procedure.

Eric Topol, the Director and Professor of Genomics at Scripps Translational Science Institute, describes the now-ubiquitous smartphones as the hub of future medicine. Mobile phones and mobile peripherals can be used as biosensorsmeasuring blood pressure, heart rhythm, blood sugar levels and even brain wavesas well as functioning as a personal scanner such as an otoscope or ultrasound. People can now perform many measurements by themselves, when they want and where it is most convenient for them. They can view and interpret their data without having to visit the doctor, making health care increasingly more personal and individual-based.

Since the dawn of personalized medicine, several limitations of this approach have been discussed. Some experts argue that it carries a risk of reducing medicine to molecular profiling. A properly executed traditional medicine practice should already include a degree of personalization by looking at your unique characteristics, medical history and social circumstances. Many social scientists and bioethicists believe that the label personalized medicine could involve a radical shift of responsibility toward the individual, potentially dismissing other socioeconomic factors that are important to examine as well. The approach might in some cases contribute to the culture of blaming the victim, creating stigmatization of certain groups of people and taking the public health resources away from initiatives that try to address the social disparities and inequity that also affect health.

An article published by the Hastings Centera research institute that addresses ethical and social issues in health care, science, and technologyhighlighted that there might be some erroneous expectations surrounding personalized medicine. It is very unlikely that in the future, you will be able to receive a unique prescription or a treatment specific to you alone. Personalized medicine is more about classifying people into groups based on genomic information and looking at your health risks and treatment responses in the context of that genetic group.

Many people are concerned that being classified as a member of a certain subgroup could, for example, increase your insurance rates or make you a less desirable job candidate. These considerations are not unfounded. Personalized medicine goes hand in hand with increased data accumulation, and data security remains a challenge. Moreover, being in a certain subgroup might oblige you to participate in screening programs as a matter of social responsibility somewhat reducing the freedom of personal choice.

There are also potential ethical implications for doctors handling genomic information. For instance, doctors might need to contemplate withdrawing some pieces of information that have no medical utility. The disclosure process would require some careful editing to prevent confusing or scaring the patient further. However, this could signal the return to paternalistic medicine where the doctor decides what is best for you and what you should be told. There is clearly a need for a solid ethical framework in this field, as well as a need for careful monitoring to ensure concerns are balanced with benefits.

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Moving from Population Medicine to Personalized Medicine

Molecular profiling has emerged to play a pivotal role in personalized medicine, classifying tumors based on genetic profiles for the purposes of cancer diagnosis or treatment,or predicting response to therapy. Innovative technologies, including next generation sequencing (NGS), can now clinically identify an extensive panel of actionable and exploratory genetic alterations.

In the US, Sarah Cannon physicians identify and order the most appropriate molecular test(s) from a number of best in class commercial laboratory service providers, such as Foundation Medicine,PathGroup, or Caris Life Sciencesaccredited from the Commission on Laboratory Accreditation of the College of American Pathologists (CAP). The NGS panels that are ordered target 35 to over 400 genes that are currently known to be altered in solid tumors or blood cancers. The appropriate molecular test and/or NGS panel is chosen based on tumor characteristics.

In the UK, Sarah Cannon is working withUniversity College London - Advanced Diagnostics (UCL-AD), a CPA-accreditedmolecular profiling laboratory, to develop novel technologies and assay menus and provide a clinical service to the private sector and the NHS, as well as a comprehensive research platform to the pharmaceutical industry.

With access to thousands of patients with different tumor types and access to the latest technologies used for molecular profiling, we are able to rapidly identify eligible patients for early and late-phase clinical trials and explore novel biomarkers that predict response to specific treatments.

The rest is here:
Personalized Medicine | Sarah Cannon

Fact Sheets about Genomics | NHGRI Skip to main content

The National Human Genome Research Institute (NHGRI) has produced this series of fact sheets to explain complex concepts in genomics research to a non-scientific audience. Teachers, students and the general public alike will find the materials clearly written and easy to understand.

A biological pathway is a series of actions among molecules in a cell that leads to a certain product or a change in the cell.

Genomics is the study of all of a person's genes (the genome), including interactions of those genes with each other and with the person's environment.

Chromosomes are thread-like structures located inside the nucleus of animal and plant cells.

Cloning describes a number of different processes that can be used to produce genetically identical copies of a biological entity.

Comparative genomics is a field of biological research in which researchers compare the complete genome sequences of different species.

DNA sequencing determines the order of the four chemical building blocks - called "bases" - that make up the DNA molecule.

Epigenomics is a field in which researchers chart the locations and understand the functions of all the chemical tags that mark the genome.

Genetic mapping offers evidence that a disease transmitted from parent to child is linked to one or more genes and clues about where a gene lies on a chromosome.

A knockout mouse is a laboratory mouse in which researchers have inactivated an existing gene by replacing it or disrupting it with an artificial piece of DNA.

Newborn screening tests use a dried blood sample collected during the first week after birth to measure the presence of disease biomarkers.

Data used to estimate the cost of sequencing the human genome over time since the Human Genome Project.

The X chromosome determines your sex, gives some females super color vision and lends its magic to a certain breed of cat.

The Y chromosome of all living men is related through a single male ancestor who lived over 100,000 years ago.

Genetics refers to the study of genes and their roles in inheritance. Genomics refers to the study of all of a person's genes (the genome).

Last updated: November 9, 2015

Follow this link:
Fact Sheets about Genomics | NHGRI - genome.gov

For the most comprehensive take on all of David Sinclairs recommendations and the best ideas on optimizing healthspan, check out The Table of Longevity | The 5 Pillars to Optimize for Increasing Healthspan and Living Your Best LifeKey Takeaways

NAD+ is responsible for hundreds of critical biological processes, including creating energy, regulating sleep/wake cycles, and maintaining healthy DNA. Heres the problem: NAD+ declines with age no matter how much you exercise and how well you eat. So what can you do? You have a few options, but the most promising is supplementing with the oral NAD+ precursor, NR (nicotinamide riboside). For us at Podcast Notes, hands down, when it comes to a brand of NR, we cant recommend Elysium Basis enough (use the code podcast45 at checkout to receive $45 off a semi/annual subscription). We, Matt and Yoni, have been researching the company and trying Basis out for the past 3 months. Basis is a proprietary formulation of crystalline NR and pterostilbene that supports cellular health by increasing and sustaining NAD+. Long-term health starts at the cellular level. If you want to improve your healthspan and increase your energy, replenish your NAD+ levels in the most efficient way possible with Elysium Basis.

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David Sinclair, Ph.D. - The Joe Rogan Experience #1349 ...

First test plate of the Ishihara CVD test.

The original Ishihara color blindness test was introduced in early last century and since then, it is by far the most well known color vision deficiency test all around the world. Dr. Shinobu Ishihara from Japan produced three different test sets which are widely used and which all based on the same pseudoisochromatic plates.

This test is actually designed to be used in a booklet and is usually executed by an eye doctor.But I have made an onlince version of the test, available right here on Colblindor.

The online test is based on the 38 plates edition and will give you a little feedback at the end of the test.

As this test is only made to check for red-green color blindness, any other form of CVD can not be detected. And at the endif you likeyou can even share your test result with your friends.This way they can see how you performed and try the test themselves if they like to.

Be aware: This test consist of scanned plates. The colors are not exactly the same as in the original version. You also have to consider, that every computer screen has different color settings and therefore the test results might alter between different trials.

If you would like to see all the 38 plates in an overview, you can find them at Ishihara Test for Colour Deficiency 38 Plates Edition.

Read more here:
Ishihara 38 Plates CVD Test - color-blindness.com

What is Integrative Medicine?

Integrative medicine is an approach to health care that takes into account the whole person, addressing the full range of physical, emotional, mental, social, spiritual and environmental influences that affect an individuals health. Integrative medicine is informed by evidence, makes use of all appropriate therapies, and emphasizes that the patient and holistic doctor or provider are partners in the healing process.

At UH Connor Integrative Health Network, we offer integrative medicine therapies and services that work together with traditional medical treatments to heal the mind, body and spirit. Employing a personalized strategy that considers the patients unique circumstances, we use the most appropriate holistic medicine interventions from an array of scientific disciplines to heal illness and disease and help people attain optimum health.

Learn more about the health benefitsof integrative medicine.

The Connor story: Learn more about the Connor family and the story behind the creation of UH Connor Integrative Health Network.

Words cannot begin to explain the gratitude I feel for this organization. Integrative medicine has changed my life when no one else could. This is the future of medicine.

UH Connor Integrative Health patient

Our dedicated health care professionalsalso include acupuncturists, massage therapists, meditation guides, yoga instructors and life coaches. All of our practitioners are experts with the highest credentials, whether in conventional medicine, integrative health, medical massage, exercise or Traditional Chinese Medicine. They will work closely with your primary care or specialty physicians to ensure that all the care you receive is coordinated and safe.

While there are many practitioners of complementary services throughout our community, availing yourself of services in a medical setting provides the certainty that those who are providing your healing therapy are highly trained and experienced, and follow the best practices model in health care. They are familiar with the most recent scientific research in their specialties, and they are rigorous about maintaining and enhancing their education in the field of integrative medicine. Integrative medicine happens not outside the parameters of medical specialties and departments, but within them. UH Connor Integrative Health Network is a place where compassionate, innovative and research-minded experts join together in a collaborative spirit.

For a national perspective on integrative medicine, we offer comprehensive information on evidence-based integrative medicine therapies. A broad and deep look at the many aspects of integrative medicine can be found at the National Center for Complementary and Integrative Health.

To request an appointment with an Integrative Medicine specialist at University Hospitals call 216-250-9520.

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Integrative Medicine | Providing Functional Medical ...

UH Connor Integrative Health Network, a system-wide initiative at University Hospitals, offers acupuncture treatments for patients suffering from pain caused by a variety of medical conditions.

My experience with UH Connor has been nothing short of amazing, from the friendly staff to the unmatched care from Megan. This is my first experience with acupuncture and I was not sure what to expect. From my first appointment I knew I made the right choice.

Bob Wagner, acupuncture patient

Acupuncture is one of the eight branches of Traditional Chinese Medicine (TCM), which has been practiced for over 3,000 years. It is one of the oldest and most commonly used treatments in the world.

According to TCM, natural energy, or qi (pronounced chi) travels along 14 pathways or meridians throughout the body in a way that is similar to how blood flows through the veins and arteries.

The meridians are all connected to specific organs or bodily functions, and when they are blocked or thrown off balance, symptoms or illness may result.

Acupuncturists stimulate certain points by inserting hair-thin, metallic needles to remove energy blocks and restore balance and flow in the body, which restores health.

The World Health Organization (WHO) and the National Institutes of Health (NIH) recommend acupuncture for the treatment of chronic pain and over 40 other conditions, including:

Women and men who are struggling with infertility may find help through the use of acupuncture, which can help balance hormones, decrease stress, improve blood flow to the uterus, improve the bodys response to in-vitro fertilization, and more.

Learn more about Connor Integrative Health Networks approach to acupuncture for fertility.

For more information, or to schedule an acupuncture appointment call 216-250-9765.

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Acupuncture l Services l Integrative Medicine l University ...

Cloning suggests the possibility of growing or cultivating human beings in the future.

Cloning has been around since 1952 when Robert Briggs and Thomas King externally fertilized and developed a leopard frog using somatic cell nuclear transfer. Though scientists had discussed the need for communication about the ethical ramifications of cloning since as early as 1972, it was not until the successful cloning of a sheep named Dolly in 1997 that cloning came to the forefront of scientific and societal discussion. As a result of the continuity of fast-paced scientific discovery, the issues surrounding cloning of both animals and humans remain a hot topic, with people divided on both sides of the controversy.

From the production of vaccines to organ regrowth for transplantation, cloning from stem cells can improve people's health. In regards to the cloning of whole organisms, however, the benefits are largely found in increasing nutrition derived from food. In the United States, you frequently see whole organism cloning in the genetically modified foods you eat, which are FDA approved and not limited to plants but also to animals such as cloned pigs modified to be a source of omega-3 fatty acids that usually come from fish and certain seeds. Additionally, the replacement of dead or dying household pets and children with genetic disorders, termed ''reproductive cloning,'' has become a social argument in favor of cloning. In fact, in 2004 a company devoted solely to the cloning of household pets opened, and though it closed after only a short, two-year stint, some people continue to see this as a valuable route for cloning research.

From a religious standpoint, many argue that the act of cloning makes humans God, an equality not viewed as appropriate as humans lack omniscience. Morally, the arguments are more broad. The ethics of animal research come into play, where many, such as the moral philosopher Peter Singer, believe that all animals are created equal, suggesting animal testing in science should be completely eliminated. The possibilities of unforeseen health risks in cloned organisms and potential negative effects of decreased genetic variation on the human gene pool are seen as ethical causes for concern in addition to the mixed ethical and social consideration of increasing population sizes when worldwide resource availability is a problem.

The social issues of cloning tend to focus on human clones in terms of both availability of cloning technology and integration of clones into society. Reproductive cloning raises the question of cost and who should have access. However, the biggest social argument is that cloning negates a person's right to individuality and ignores the potential psychological effects of such a parentless and de-individualized identity.

Legally, funding has always been a concern for cloning research. Many believe the government and taxpayer money should not support research not agreed upon by a clear majority, and in this respect, the U.S. Congress has continued to prohibit use of taxpayer dollars for any research that may result in the death of human embryos. However, reproductive animal cloning continues not just in the U.S., but around the world. The biggest legal issues concerning animal clones are who should be responsible for and at what depth there should be oversight and accountability, as well as the legal right to patent live organisms.

See the rest here:
The Ethical, Social & Legal Issues of Cloning Animals ...

Does stem cell therapy for back pain actually work? If so, can stem cell therapy work for degenerative disc disease? What kinds work better than others? Is stem cell therapy covered by insurance? And does Stem Cell Therapy Work for Back Pain? Lets dig in.

Back in 2005, I was one of the first humans on earth to inject stem cells into a human disc. In the past almost two decades Ive published and learned much about what works and doesnt work. My goal here is to make sure that I transfer that wisdom to you to keep you from getting scammed.

Before we jump into stem cell therapy for back pain, its critical to review what the targets for the therapy would be. Meaning, what causes back pain? Lots of things:

Its critical when looking for the right stem cell therapy for back pain that you follow the Who, What, and Where method. If you dont, youre more likely than not to get scammed. So how does that work?

Who will perform the stem cell therapy for back pain is critical. Given that the stem cells need to be placed into specific spots that are causing pain and this requires advanced imaging guidance and training to do safely, getting this injection procedure done by a nurse or physicians assistant or even a non-specialist family physician just isnt a viable option. You need a spine specialist who can perform precise injections using an x-ray technology known as fluoroscopy.

What will be injected is also critical. As an example, a common message youll hear at seminars is that the clinic uses young and vibrant stem cells from amniotic fluid or umbilical cords! Theres just one problem with that message and its called reality. Meaning multiple studies have now shown that the products used by these clinics contain no live and viable stem cells, in fact, these preparations theyre using are all dead tissue (1-3). In fact, the only stem cell therapy out there right now that can be performed in the United States is Bone Marrow Concentrate (BMC) from the same patient, which contains many live and viable mesenchymal stem cells (4). BMC is obtained from a bone marrow aspirate at the back of the pelvis, centrifuged to concentrate the stem cell fraction, and then reinjected. Other possibilities include using cells that are cultured and grown to bigger numbers.

Where will the stem cells be reinjected? As discussed above, that could be many different areas from into the disc, around the nerves (epidural), into the facet joints, ligaments, muscles, etc Injecting stem cells into the wrong area will provide no results, so being able to diagnose where cells should go and then getting the cells to that specific area is critical.

Want to learn more about choosing a good stem cell clinic using this who, what, and where system? Click on the cover below to read that short mini-book:

Has medical research demonstrated that stem cell therapy for back pain is effective? Does Stem Cell Therapy Work for Back Pain? To answer that question, Ill include all regenerative medicine therapies, such as platelet-rich plasma (concentrated platelets from the patients own blood), bone marrow concentrate, and cultured stem cells (not available in the United States).

Theres pretty good research that platelet-rich plasma (PRP) can help various causes of back pain. For example, there is a high-level study showing that PRP can help painful low back discs (9). We published a research study on using a type of PRP called platelet lysate to help sciatica caused by bulged and herniated discs (10). In addition, PRP has been shown to help reduce the atrophy of low back stabilizing muscles as well (11). Finally, PRP has also been used to treat sacroiliac joint problems and was shown to better than steroid shots (12).

Next up is bone marrow concentrate. This has been used successfully to treat painful discs through injection (13). Practically, we have also used it to treat damaged facet joints, sacroiliac joint instability/pain, as well as degenerative disc disease. However, the sweet spot appears to be in treating painful disc tears that often reduce the ability of the patient to sit for any prolonged period of time.

While not legal in the United States, in other countries, the patients bone marrow stem cells can be cultured and grown to larger numbers. We have published on injecting these types of cells to treat bulging discs causing nerve root impingement (14, 15). There are a few others who have also published on a smaller number of patients.

Notice what you dont see in this section. There are no human studies on using amniotic or umbilical cord products in the spine. There is also nothing published in human patients where exosomes were used (a type of therapy beginning to be offered). Hence, if you go to a seminar that claims that there is copious research showing these things work well in real patients, then run.

One of the more common questions I get from patients on stem cell therapy for back pain is whether it can regrow a collapsed low back disc. The discs in the spine are cushions that sit between individual backbones (vertebrae). In DDD the disc collapses and this causes degenerative instability which can lead to facet joint arthritis, irritated nerves, and over the long run, stenosis.

So can stem cell therapy for back pain regrow a degenerated disc? There was a real promise that this would happen, as in animals like rabbits, this is easy to do (16). However, to date, in humans, reliable disc regeneration has remained elusive. Meaning that it is very unlikely that if you have a collapsed disc, injecting stem cells will grow you a new plump disc.

I created a little video on this topic, so please watch this for more information:

In addition, I wrote a whole book on this topic of stem cells for spine problems, click on the cover below to download a copy:

Regrettably, for most patients, stem cell therapy for back pain is not covered by major health insurers, Medicare, or Medicaid. However, Regenexx has had success in getting full coverage from various self-funded health plans. Click here to learn more about getting your employer to cover these procedures.

The upshot? Stem cell therapy for back pain is a promising alternative to surgery. However, making sure you actually get the real deal versus treatment with dead stem cells may take some homework!

___________________________________________

References:

(1) Berger D, Lyons N, Steinmetz, N. In Vitro Evaluation of Injectable, Placental Tissue-Derived Products for Interventional Orthopedics. Interventional Orthopedics Foundation Annual Meeting. Denver, 2015. https://interventionalorthopedics.org/wp-content/uploads/2017/08/AmnioProducts-Poster.pdf

(2) Becktell L, Matuska A, Hon S, Delco M, Cole B, Fortier L. Proteomic analysis and cell viability of nine amnion-derived biologics. Orthopedic Research Society Annual Meeting, New Orleans, 2018. https://app.box.com/s/vcx7uw17gupg9ki06i57lno1tbjmzwaf

(3) Panero, A, Hirahara, A., Andersen, W, Rothenberg J, Fierro, F. Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison. The American Journal of Sports Medicine, 2019 47(5), 12301235. https://doi.org/10.1177/0363546519829034

(4) Gianakos AL, Sun L, Patel JN, Adams DM, Liporace FA. Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review.World J Orthop. 2017;8(6):491506. Published 2017 Jun 18. doi:10.5312/wjo.v8.i6.491

(5) Kalichman L, Carmeli E, Been E. The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain.Biomed Res Int. 2017;2017:2562957. doi:10.1155/2017/2562957

(6) Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications.J Anat. 2012;221(6):537567. doi:10.1111/j.1469-7580.2012.01564.x

(7) Manchikanti L, Hirsch JA, Falco FJ, Boswell MV. Management of lumbar zygapophysial (facet) joint pain.World J Orthop. 2016;7(5):315337. Published 2016 May 18. doi:10.5312/wjo.v7.i5.315

(8) White, A. A., & Panjabi, M. M. (1978).Clinical biomechanics of the spine. Philadelphia: Lippincott.

(9) Monfett M, Harrison J, Boachie-Adjei K, Lutz G. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Int Orthop.2016 Jun;40(6):1321-8. doi: 10.1007/s00264-016-3178-3.

(10) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain.J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi:10.1186/s40634-017-0113-5

(11) Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease.SICOT J. 2016;2:12. Published 2016 Mar 22. doi:10.1051/sicotj/2016002

(12) Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2017 Jul;17(6):782-791. doi: 10.1111/papr.12526

(13) Pettine KA, Suzuki RK, Sand TT, Murphy MB. Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up. Int Orthop. 2017 Oct;41(10):2097-2103. doi: 10.1007/s00264-017-3560-9.

(14) Centeno C, Markle J, Dodson E, et al. Treatment of lumbar degenerative disc disease-associated radicular pain with culture-expanded autologous mesenchymal stem cells: a pilot study on safety and efficacy.J Transl Med. 2017;15(1):197. Published 2017 Sep 22. doi:10.1186/s12967-017-1300-y

(15) Elabd C, Centeno CJ, Schultz JR, Lutz G, Ichim T, Silva FJ. Intra-discal injection of autologous, hypoxic cultured bone marrow-derived mesenchymal stem cells in five patients with chronic lower back pain: a long-term safety and feasibility study.J Transl Med. 2016;14(1):253. Published 2016 Sep 1. doi:10.1186/s12967-016-1015-5

(16) Sakai D1, Mochida J, Yamamoto Y, Nomura T, Okuma M, Nishimura K, Nakai T, Ando K, Hotta T. Transplantation of mesenchymal stem cells embedded in Atelocollagen gel to the intervertebral disc: a potential therapeutic model for disc degeneration. Biomaterials. 2003 Sep;24(20):3531-41. DOI: 10.1016/s0142-9612(03)00222-9

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Does Stem Cell Therapy Work For Back Pain? - Regenexx

A stunningly powerful novel of man's will to survive against all odds, by the winner of the 1998 Nobel Prize for Literature. This is a shattering work by a literary master.The Boston GlobeA New York Times Notable Book of the Year A Los Angeles Times Best Book of the Year A city is hit by an epidemic of "white blindness" which spares no one. Authorities confine the blind to an empty mental hospital, but there the criminal element holds everyone captive, stealing food rations and raping women. There is one eyewitness to this nightmare who guides seven strangersamong them a boy with no mother, a girl with dark glasses, a dog of tearsthrough the barren streets, and the procession becomes as uncanny as the surroundings are harrowing. A magnificent parable of loss and disorientation and a vivid evocation of the horrors of the twentieth century, Blindness has swept the reading public with its powerful portrayal of man's worst appetites and weaknessesand man's ultimately exhilarating spirit.

Originally posted here:
Blindness by Jos Saramago, Paperback | Barnes & Noble

Color Blind Test | Test Color Vision by Ishihara Test for Colorblindness

Color Blind Test info: Around the world, approximately 1 in 12 men and 1 in 200 women are affected by color blindness. This fairly common condition often goes undiagnosed, because patients do not realize they arent seeing colors like other people do. yet testing for color blindness is simple and doesnt even require a trip to the doctor. You can do it easily online using your computer. Simply look at the symbols below and enter the numbers that you can see. You will get an instant result that will help you know whether or not you are struggling with color blindness.How does the Color Blind Test work? This test, known as the Ishihara Test, makes numbers out of dots that are a different color than the dots surrounding them. Someone who is color blind sees all of these dots as the same color, whereas someone with normal vision can distinguish the different colors. Ishihara Test a type of Color Blind Test is a fast and simple way to determine whether or not you are struggling.Color Blind Test or the Ishihara test contains of a number of colored plates, known as Ishihara plates. All of the plates contains a circle of dots appearing in random order of color and size. Most people will view the images differently (mostly Arabic numbers). Those with certain types of color blindness will see different numbers from those not affected by color blindness.A color code happens when there is some information in the color of items being analysed. These codes cannot be easily explained by those who have color blindness. This is the main reason as to why, color should not be the sole criteria to provide information. The ideal way to to avoid color coding or color differences is to use Good graphic design to give information. This not only helps the color blind people, but is also helpful to the normal vision people.External info: Ishihara test Wikipedia

Look at the pictures below, and enter the numbers that you see in the corresponding boxes.

Are you concerned about your results? Did you struggle to see several of the numbers? Did you find yourself guessing instead of confidently entering the answers? If the test shows that you may be color blind, and you feel that color blindness is affecting your everyday life, then there is good news for you. Color blindness treatment is available to help you see the full range of colors that other people see.

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The number pictured above is actually ' + rightanswer + '. ' + addinfo + '

Everyone should see the number 12 including people that are color blind.

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Color Blind Test | Test Color Vision by Ishihara Test for ...

The hoopoe said: 'Your heart's congealed like ice;When will you free yourself from cowardice?Since you have such a short time to live here,What difference does it make? What should you fear?The world is filth and sin, and homeless menMust enter it and homeless leave again.They die, as worms, in squalid pain; if weMust perish in this quest, that, certainly,Is better than a life of filth and grief.If this great search is vain, if my beliefIs groundless, it is right that I should die.So many errors throng the world - then whyShould we not risk this quest? To suffer blameFor love is better than a life of shame.No one has reached this goal, so why appealTo those whose blindness claims it is unreal?I'd rather die deceived by dreams than giveMy heart to home and trade and never live.We've been and heard so much - what have we learned?Not for one moment has the self been spurned;Fools gather round and hinder our release.When will their stale, insistent whining cease?We have no freedom to achieve our goalUntil from Self and fools we free the soul.To be admitted past the veil you mustBe dead to all the crowd considers just.Once past the veil you understand the WayFrom which the crowd's glib courtiers blindly stray.If you have any will, leave women's stories,And even if this search for hidden gloriesProves blasphemy at last, be sure our questIs not mere talk but an exacting test.The fruit of love's great tree is poverty;Whoever knows this knows humility.When love has pitched his tent in someone's breast,That man despairs of life and knows no rest.Love's pain will murder him and blandly askA surgeon's fee for managing the task -The water that he drinks brings pain, his breadIs turned to blood immediately shed;Though he is weak, faint, feebler than an ant,Love forces him to be her combatant;He cannot take one mouthful unawareThat he is floundering in a sea of care. Farid Attar, The Conference of the Birds

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Blindness Quotes (211 quotes) - goodreads.com

It's logical to think that you see whenever your eyes are open. But the reality is that attention plays a major role in visual perception. One of the primary reasons why you may fail to notice things like obvious bloopers in movies, for example, is a psychological phenomenon known as inattentional blindness. When you focus hard on one thing, such as the actions of the main character in a film, you might not notice unexpected things entering your visual field.

The term "inattentional blindness" was first coined by psychologists Arien Mack, Ph.D., and Irvin Rock, Ph.D., who observed the phenomenon during their perception and attention experiments. "Because this inability to perceive, this sighted blindness, seemed to be caused by the fact that subjects were not attending to the stimulus but instead were attending to something else...we labeled this phenomenon inattentional blindness (IB)," they explained.

One of the best-known experiments demonstrating inattentional blindness is the "invisible gorilla test" carried out by Christopher Chabris, Ph.D. and Daniel Simons, Ph.D. In this experiment, researchers asked participants to watch a video of people tossing a basketball, and the observers were told to count the number of passes or to keep track of the number of throws versus bounce passes. Afterward, the participants were asked if they had noticed anything unusual while watching the video. In most of the tests, approximately 50 percent of the participants reported seeing nothing out of the ordinary.

But in reality, something odd had happened. In some instances, a woman dressed in a gorilla suit strolled through the scene, turned to the camera, thumped her chest, and walked away. While it may seem impossible that the participants missed such a sight since their attention was focused elsewhere and on a demanding task, the gorilla basically became invisible.

Rather than focusing on every tiny detail in the world around us, we tend to concentrate on things that are most important, relying on our existing schemas to "fill in the blanks." This is highly economical. As our attentional, cognitive, and processing resources are limited, this allows us to dedicate them to what matters most, while still allowing us to have complete, seamless experiences.

One of the reasons why people so often "miss the gorilla," so to speak, is simply because the stimulus lacks what is known as ecological validity. A gorilla showing up in the middle of a basketball game is unlikely to happen in a real-world setting, so we are less likely to notice it. It is essentially ruled out as a component that will help you better understand or carry out the task at hand.

That said, while we do sometimes fail to miss things in the world around us, we are generally pretty good at noticing information that is relevant to us, such as a car speeding toward us or a deer jumping out of the trees into the road. Of course, this is not always the case.

We all experience inattentional blindness from time to time, such as in these potential situations:

There are certain factors that can affect inattentional blindness. Drs. Simons and Chabris did an experiment similar to the invisible gorilla experiment, but in this one, the participants had to count the number of passes made by either the team in black or the team in white.

Out of the participants who were counting passes made by the white team, only 42 percent saw the gorilla, but for the participants who counted passes made by the black team, 83 percent saw the gorillawho was also dressed in black, illustrating the impact of similarity between the unexpected stimulus (gorilla) and task-relevant stimuli (members of the black team).

In the "Encyclopedia of Human Memory, psychologist Kristin Mauldin notes that inattentional blindness is similar to change blindness, which is when you miss a change in a stimulus that was there before. In inattentional blindness, you miss a new stimulus, often because of your own expectations.

A Word From Verywell

Though it is not possible to avoid all instances of inattentional blindness, it's important to remember this very natural occurrenceparticularly when you are in a disagreement with someone about the full scope of a situation. Your brain is sophisticated enough to help you register and interpret visual cues that it thinks will provide you with the most value. But, in its efforts, visual informationboth important and notcan sometimes get overlooked.

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Inattentional Blindness in Psychology - Verywell Mind