Journal of Personalized Medicine

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Open AccessArticle

Diffusion of Molecular Diagnostic Lung Cancer Tests: A Survey of German Oncologists

by Julius Alexander Steffen

J. Pers. Med. 2014, 4(1), 102-114; https://doi.org/10.3390/jpm4010102 - 21 Mar 2014

Cited by 2 | Viewed by 6310

This study was aimed at examining the diffusion of diagnostic lung cancer tests in Germany. It was motivated by the high potential of detecting and targeting oncogenic drivers. Recognizing that the diffusion of diagnostic tests is a conditio sine qua non for the [...] Read more.

This study was aimed at examining the diffusion of diagnostic lung cancer tests in Germany. It was motivated by the high potential of detecting and targeting oncogenic drivers. Recognizing that the diffusion of diagnostic tests is a conditio sine qua non for the success of personalized lung cancer therapies, this study analyzed the diffusion of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tests in Germany. Qualitative and quantitative research strategies were combined in a mixed-method design. A literature review and subsequent Key Opinion Leader interviews identified a set of qualitative factors driving the diffusion process, which were then translated into an online survey. The survey was conducted among a sample of 961 oncologists (11.34% response rate). The responses were analyzed in a multiple linear regression which identified six statistically significant factors driving the diffusion of molecular diagnostic lung cancer tests: reimbursement, attitude towards R&D, information self-assessment, perceived attitudes of colleagues, age and test-pathway strategies. Besides the important role of adequate reimbursement and relevant guidelines, the results of this study suggest that an increasing usage of test-pathway strategies, especially in an office-based setting, can increase the diffusion of molecular diagnostic lung cancer tests in the future. Full article

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647 KiB

Open AccessArticle

Cardiovascular Disease Self-Management: Pilot Testing of an mHealth Healthy Eating Program

by Leila Pfaeffli Dale, Robyn Whittaker, Helen Eyles, Cliona Ni Mhurchu, Kylie Ball, Natasha Smith and Ralph Maddison

J. Pers. Med. 2014, 4(1), 88-101; https://doi.org/10.3390/jpm4010088 - 19 Mar 2014

Cited by 28 | Viewed by 12058

Abstract

Cardiac rehabilitation (CR) is crucial in the management of cardiovascular disease (CVD), yet attendance is poor. Mobile technology (mHealth) offers a potential solution to increase reach of CR. This paper presents two development studies to determine mobile phone usage in adults with CVD [...] Read more.

Cardiac rehabilitation (CR) is crucial in the management of cardiovascular disease (CVD), yet attendance is poor. Mobile technology (mHealth) offers a potential solution to increase reach of CR. This paper presents two development studies to determine mobile phone usage in adults with CVD and to evaluate the acceptability of an mHealth healthy eating CR program. Methods: CR attendees were surveyed to determine mobile phone usage rates. A second single-subject pilot study investigated perceptions of a 4-week theory-based healthy eating mHealth program and explored pre-post changes in self-efficacy. Results: 74 adults with CVD completed the survey (50/74 male; mean age 63 ± 10). Nearly all had mobile phones (70/74; 95%) and used the Internet (69/74; 93%), and most were interested in receiving CR by text message (57/74; 77%). 20 participants took part in the healthy eating pilot study. Participants read all/most of the text messages, and most (19/20) thought using mobile technology was a good way to deliver the program. The website was not widely used as visiting the website was reported to be time consuming. Exploratory t-tests revealed an increase in heart healthy eating self-efficacy post program, in particular the environmental self-efficacy subset (Mean = 0.62, SD = 0.74, p = 0.001). Conclusions: Text messaging was seen as a simple and acceptable way to deliver nutrition information and behavior change strategies; however, future research is needed to determine the effectiveness of such programs. Full article

(This article belongs to the Special Issue Mobile Health)

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733 KiB

Open AccessCommentary

DTC-and-Me: Patient, Provider, Proteins and Regulators

by Fintan R. Steele and Larry Gold

J. Pers. Med. 2014, 4(1), 79-87; https://doi.org/10.3390/jpm4010079 - 18 Mar 2014

Cited by 4 | Viewed by 8121

Abstract

The yet-unrealized potential for more “personalized” Direct-to-Consumer (DTC) tests to fundamentally alter the practice and economics of healthcare is undeniable. However, there are also many challenges to be met, including the herculean task of ensuring that the information provided by such tests is [...] Read more.

The yet-unrealized potential for more “personalized” Direct-to-Consumer (DTC) tests to fundamentally alter the practice and economics of healthcare is undeniable. However, there are also many challenges to be met, including the herculean task of ensuring that the information provided by such tests is scientifically sound and, ideally, medically actionable. We consider recent events in DTC testing and suggest a “thought experiment” of an approach that could ultimately meet the needs of patients, providers and regulatory authorities. Full article

(This article belongs to the Special Issue Bringing Personalized Medicine into Clinical Practice 2013)

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Open AccessArticle

Predicting “Heart Age” Using Electrocardiography

by Robyn L. Ball, Alan H. Feiveson, Todd T. Schlegel, Vito Starc and Alan R. Dabney

J. Pers. Med. 2014, 4(1), 65-78; https://doi.org/10.3390/jpm4010065 - 07 Mar 2014

Cited by 22 | Viewed by 8062

Abstract

Knowledge of a patient’s cardiac age, or “heart age”, could prove useful to both patients and physicians for better encouraging lifestyle changes potentially beneficial for cardiovascular health. This may be particularly true for patients who exhibit symptoms but who test negative for cardiac [...] Read more.

Knowledge of a patient’s cardiac age, or “heart age”, could prove useful to both patients and physicians for better encouraging lifestyle changes potentially beneficial for cardiovascular health. This may be particularly true for patients who exhibit symptoms but who test negative for cardiac pathology. We developed a statistical model, using a Bayesian approach, that predicts an individual’s heart age based on his/her electrocardiogram (ECG). The model is tailored to healthy individuals, with no known risk factors, who are at least 20 years old and for whom a resting ~5 min 12-lead ECG has been obtained. We evaluated the model using a database of ECGs from 776 such individuals. Secondarily, we also applied the model to other groups of individuals who had received 5-min ECGs, including 221 with risk factors for cardiac disease, 441 with overt cardiac disease diagnosed by clinical imaging tests, and a smaller group of highly endurance-trained athletes. Model-related heart age predictions in healthy non-athletes tended to center around body age, whereas about three-fourths of the subjects with risk factors and nearly all patients with proven heart diseases had higher predicted heart ages than true body ages. The model also predicted somewhat higher heart ages than body ages in a majority of highly endurance-trained athletes, potentially consistent with possible fibrotic or other anomalies recently noted in such individuals. Full article

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Open AccessCommentary

The Use of Registries to Improve Cancer Treatment: A National Database for Patients Treated with Interleukin-2 (IL-2)

by Howard L. Kaufman, Michael K. Wong, Gregory A. Daniels, David F. McDermott, Sandra Aung, James N. Lowder and Michael A. Morse

J. Pers. Med. 2014, 4(1), 52-64; https://doi.org/10.3390/jpm4010052 - 07 Mar 2014

Cited by 10 | Viewed by 8056

Abstract

Registries evaluating un-randomized patients have provided valuable information with respect to a therapy’s utility, treatment practices, and evolution over time. While immunotherapy for cancer has been around for more than three decades, data collection in the form of a registry has not been [...] Read more.

Registries evaluating un-randomized patients have provided valuable information with respect to a therapy’s utility, treatment practices, and evolution over time. While immunotherapy for cancer has been around for more than three decades, data collection in the form of a registry has not been undertaken. The authors believe that establishing a registry to study HD IL-2 immunotherapy, which has been the only systemic therapy producing long term unmaintained remissions for advanced kidney cancer and melanoma for over 20 years, will be an important resource in understanding the impact of immunotherapy with HD IL-2 in a rapidly changing therapeutic environment. Optimizing administration and improving selection of appropriate patients likely to benefit from HD IL-2 immunotherapy are two of many benefits to be derived from this endeavor. Full article

(This article belongs to the Special Issue Feature Paper 2013)

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Open AccessEditorial

Acknowledgement to Reviewers of the Journal of Personalized Medicine in 2013

by JPM Editorial Office

J. Pers. Med. 2014, 4(1), 50-51; https://doi.org/10.3390/jpm4010050 - 27 Feb 2014

Viewed by 4330

Abstract

The editors of the Journal of Personalized Medicine would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2013. [...] Full article

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Open AccessArticle

Physician Attitudes toward Adopting Genome-Guided Prescribing through Clinical Decision Support

by Casey Lynnette Overby, Angelika Ludtke Erwin, Noura S. Abul-Husn, Stephen B. Ellis, Stuart A. Scott, Aniwaa Owusu Obeng, Joseph L. Kannry, George Hripcsak, Erwin P. Bottinger and Omri Gottesman

J. Pers. Med. 2014, 4(1), 35-49; https://doi.org/10.3390/jpm4010035 - 27 Feb 2014

Cited by 38 | Viewed by 9315

Abstract

This study assessed physician attitudes toward adopting genome-guided prescribing through clinical decision support (CDS), prior to enlisting in the Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics pilot pharmacogenomics project (CLIPMERGE PGx). We developed a survey instrument that includes the [...] Read more.

This study assessed physician attitudes toward adopting genome-guided prescribing through clinical decision support (CDS), prior to enlisting in the Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics pilot pharmacogenomics project (CLIPMERGE PGx). We developed a survey instrument that includes the Evidence Based Practice Attitude Scale, adapted to measure attitudes toward adopting genome-informed interventions (EBPAS-GII). The survey also includes items to measure physicians’ characteristics (awareness, experience, and perceived usefulness), attitudes about personal genome testing (PGT) services, and comfort using technology. We surveyed 101 General Internal Medicine physicians from the Icahn School of Medicine at Mount Sinai (ISMMS). The majority were residency program trainees (~88%). Prior to enlisting into CLIPMERGE PGx, most physicians were aware of and had used decision support aids. Few physicians, however, were aware of and had used genome-guided prescribing. The majority of physicians viewed decision support aids and genotype data as being useful for making prescribing decisions. Most physicians had not heard of, but were willing to use, PGT services and felt comfortable interpreting PGT results. Most physicians were comfortable with technology. Physicians who perceived genotype data to be useful in making prescribing decisions, had more positive attitudes toward adopting genome-guided prescribing through CDS. Our findings suggest that internal medicine physicians have a deficit in their familiarity and comfort interpreting and using genomic information. This has reinforced the importance of gathering feedback and guidance from our enrolled physicians when designing genome-guided CDS and the importance of prioritizing genomic medicine education at our institutions. Full article

(This article belongs to the Special Issue Bringing Personalized Medicine into Clinical Practice 2013)

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587 KiB

Open AccessArticle

Barriers and Motivators for Referral of Patients with Suspected Lynch Syndrome to Cancer Genetic Services: A Qualitative Study

by Yen Y. Tan and Lisa J. Fitzgerald

J. Pers. Med. 2014, 4(1), 20-34; https://doi.org/10.3390/jpm4010020 - 18 Feb 2014

Cited by 17 | Viewed by 6662

Abstract

This article explores the views of general practitioners and specialists on their referral of patients with suspected Lynch syndrome to cancer genetic services. Using a purposive maximum variation sampling strategy, we conducted semi-structured interviews face-to-face with 28 general practitioners and specialists in public [...] Read more.

This article explores the views of general practitioners and specialists on their referral of patients with suspected Lynch syndrome to cancer genetic services. Using a purposive maximum variation sampling strategy, we conducted semi-structured interviews face-to-face with 28 general practitioners and specialists in public or private hospitals and specialist clinics between March and August 2011. General practitioners and specialists were recruited in a major metropolitan area in Australia. Interview transcripts were reviewed by two independent researchers, and thematic analysis was performed using NVivo10 software. The main barriers and motivators identified were: (1) clinician-related (e.g., familiarity with Lynch syndrome and family history knowledge); (2) patient-related (e.g., patients’ interests and personal experience with cancer); and (3) organizational-related (e.g., access to services, guidelines and referral pathway). Referral of patients with suspected Lynch syndrome to cancer genetic services is motivated and hindered by a range of individual, interpersonal and organizational factors. In order to improve the care and quality of life of patients and family with suspected Lynch syndrome, further research is needed to develop supportive tools for clinicians. Full article

(This article belongs to the Special Issue Bringing Personalized Medicine into Clinical Practice 2013)

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Open AccessArticle

Design and Implementation of a Randomized Controlled Trial of Genomic Counseling for Patients with Chronic Disease

by Kevin Sweet, Erynn S. Gordon, Amy C. Sturm, Tara J. Schmidlen, Kandamurugu Manickam, Amanda Ewart Toland, Margaret A. Keller, Catharine B. Stack, J. Felipe García-España, Mark Bellafante, Neeraj Tayal, Peter Embi, Philip Binkley, Ray E. Hershberger, Wolfgang Sadee, Michael Christman and Clay Marsh

J. Pers. Med. 2014, 4(1), 1-19; https://doi.org/10.3390/jpm4010001 - 08 Jan 2014

Cited by 19 | Viewed by 9498

Abstract

We describe the development and implementation of a randomized controlled trial to investigate the impact of genomic counseling on a cohort of patients with heart failure (HF) or hypertension (HTN), managed at a large academic medical center, the Ohio State University Wexner Medical [...] Read more.

We describe the development and implementation of a randomized controlled trial to investigate the impact of genomic counseling on a cohort of patients with heart failure (HF) or hypertension (HTN), managed at a large academic medical center, the Ohio State University Wexner Medical Center (OSUWMC). Our study is built upon the existing Coriell Personalized Medicine Collaborative (CPMC^®). OSUWMC patient participants with chronic disease (CD) receive eight actionable complex disease and one pharmacogenomic test report through the CPMC^® web portal. Participants are randomized to either the in-person post-test genomic counseling—active arm, versus web-based only return of results—control arm. Study-specific surveys measure: (1) change in risk perception; (2) knowledge retention; (3) perceived personal control; (4) health behavior change; and, for the active arm (5), overall satisfaction with genomic counseling. This ongoing partnership has spurred creation of both infrastructure and procedures necessary for the implementation of genomics and genomic counseling in clinical care and clinical research. This included creation of a comprehensive informed consent document and processes for prospective return of actionable results for multiple complex diseases and pharmacogenomics (PGx) through a web portal, and integration of genomic data files and clinical decision support into an EPIC-based electronic medical record. We present this partnership, the infrastructure, genomic counseling approach, and the challenges that arose in the design and conduct of this ongoing trial to inform subsequent collaborative efforts and best genomic counseling practices. Full article

(This article belongs to the Special Issue Bringing Personalized Medicine into Clinical Practice 2013)

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J. Pers. Med., Volume 4, Issue 1 (March 2014) – 9 articles , Pages 1-114

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