Monday, June 11, 2018

CRISPR-edited cells might cause cancer, two studies find

diting cells’ genomes with CRISPR-Cas9 might increase the risk that the altered cells, intended to treat disease, will trigger cancer, two studies published on Monday warn — a potential game-changer for the companies developing CRISPR-based therapies.
In the studies, published in Nature Medicine, scientists found that cells whose genomes are successfully edited by CRISPR-Cas9 have the potential to seed tumors inside a patient. That could make some CRISPR’d cells ticking time bombs, according to researchers from Sweden’s Karolinska Institute and, separately, Novartis.
Another leading CRISPR scientist, who asked not to be named because of involvement with genome-editing companies, called the new data “pretty striking,” and raised concerns that a potential fatal flaw in some uses of CRISPR had “been missed.”

The Karolinska and Novartis groups tested CRISPR on different kinds of human cells — retinal cells and pluripotent stem cells, respectively. But they found essentially the same phenomenon. Standard CRISPR-Cas9 works by cutting both strands of the DNA double helix. That injury causes a cell to activate a biochemical first-aid kit orchestrated by a gene called p53, which either mends the DNA break or makes the cell self-destruct.CRISPR-edited cells might cause cancer, two studies find
The flip side of p53 repairing CRISPR edits, or killing cells that accept the edits, is that cells that survive with the edits do so precisely because they have a dysfunctional p53 and therefore lack this fix-it-or-kill-it mechanism.
The reason why that could be a problem is that p53 dysfunction can cause cancer. And not just occasionally. P53 mutations are responsible for nearly half of ovarian cancers; 43 percent of colorectal cancers; 38 percent of lung cancers; nearly one-third of pancreatic, stomach, and liver cancers; and one-quarter of breast cancers, among others.
The p53 finding doesn’t mean CRISPR is toast. For one thing, “the two papers present preliminary results,” biochemist Bernhard Schmierer of the Karolinska, co-leader of its study, told STAT. “It is unclear if the findings translate into cells actually used in current clinical studies.”

Net Neutrality Will it affect your EHR cloud access

Net Neutrality Is Officially Dead. Here’s What’s Next. – Mother Jones

Will your EHR cloud service be affected?
The battle is on. The recent FCC ruling will open up the threat of measured ISP services. Despite a federal ruling many states are considering legal opposition to the FCC ruling.

After a drawn-out battle between internet advocates and Trump’s Federal Communications Commission, today marks the official end of net neutrality. Led by current Chairman Ajit Pai, the FCC voted 3-2 in December to repeal the Obama-era open internet rules. The decision went into effect on Monday. 
The fight has also started playing out at the state level.  Three states, including Washington and Oregon, have enacted legislation to enforce net neutrality and governors in six states, including Montana and New York, have signed executive orders
to enforce net neutrality. As of May, legislators in 29 states have introduced bills to ensure net neutrality, according to the National Conference of State Legislatures. In its repeal, the FCC asserted that it alone has the authority to write these types of regulations and that states cannot pass laws inconsistent with federal net neutrality rules, something that could lead to a legal battle down the road.

Advocates have warned that the repeal of the 2015 regulation, which barred internet service providers from creating slow and fast lanes for preferred content, would open the door for ISPs to start charging more for preferred content (paid prioritization), slowing certain content (throttling), and fully blocking content. Advocates often point to the situation in Portugal, where striking net neutrality led to tiered-internet packages that charged more for services like Netflix and Spotify. 
A coalition of nonprofits and tech companies, including the ACLU, National Hispanic Media Coalition, Electronic Frontier Foundation, Netflix, and Reddit have called for an “internet-wide day of action to save Net Neutrality” on July 12th. The group is asking websites to display a “red alert” image that will show what the site would look like without net neutrality. It is also asking users to harness their social media accounts to raise awareness and contact House lawmakers to ask them to overrule the FCC.

Net Neutrality Is Officially Dead. Here’s What’s Next. – Mother Jones

Tuesday, May 29, 2018

Simpler logins, voice recognition ease click fatigue at Yale | AMA Wire

Some of the physician burnout has been attributed to the dysfunctional nature of the physician-EHR interface.

Efforts are now underway by software developers to remedy these shortcomings. It is not impossible, many other industries already have very usable interfaces and GUIs.

Even without major re-design, simple reductions in repetitive keyboard-mouse interactions can achieve a measure of success in time for users.

One aspect is the user id/password sequence which must be completed each time a user logs in. The HIPAA aspect forces a log out whenever the user leaves the workstation, even briefly. The average physician may see 30 to 50 patient encounters/day. 

To improve physician well-being and prevent burnout, Yale School of Medicine started searching for ways to reduce clicks and increase time spent with patients.

“We looked at the kinds of issues we were dealing with and decided this required a systemwide approach,” said AMA member and Yale Medicine Chief Medical Officer Ronald Vender, MD. He is also the associate dean for clinical affairs and a professor of medicine in digestive diseases at Yale.

Those issues included EHR inefficiencies that had a significant impact on job satisfaction, physician engagement and the health and well-being of Yale faculty. Physicians were unhappy, working too many hours and bringing homework at night and on weekends.

After the initial phase of targeting EHR use and functionality, a series of discussions with IT leadership took place with Allen Hsiao, MD, the chief medical information officer at Yale, and Lisa Stump, the chief information officer, to better address physician burnout.

“One of the things we realized is that there is still a limitation to the keyboard-and-mouse user interface,” said Dr. Hsiao. “Anything we can do to tackle that can make a big difference and help take clicks away for physicians to complete their work.”

Yale Medicine linked together strategies to address physician burnout and improve the user experience with EHRs by adding new features such as voice recognition and easier login identification.

Eliminating a "daily annoyance"

The first initiative aimed at cutting clicks was to implement a solution that eliminates repetitive typing of the physician’s username and password. It allows physicians to use their badges to tap in and out of the system throughout the day after a one-time login at the start of their shift.

“This was a daily annoyance for our doctors,” said Dr. Vender. “It had a disproportionate effect above and beyond the time with just the annoyance factors. Addressing this psychologically, as well as time savings has been a huge win.” The move has saved physicians between six and 20 minutes daily. That’s about 20 to 140 logins per physician each day.

Natural Language Processing and AI (Artificial Intelligence) is increasingly useful and accurate. Due to the limitations of the keyboard-and-mouse user interface, Dr. Hsiaoimplemented speech recognition for physicians. Through voice-recognition software that connects directly to the EHR, physicians have experienced a 50 percent reduction in the time it takes to complete and close encounters.

“Physicians have been thrilled about it,” he said. “Now we’re trying to figure out how they can use it at home because they love it so much.”

Between 30 and 40 percent of Yale physicians are using voice-recognition software, and about 100 new clinicians each week are signing up to use it.

“This has turned out to be a huge win. Even doctors who feel like they can do a very good job and didn’t require voice recognition—once they begin to utilize it, they find that it is even better,” Dr. Vender said.

And because the voice-recognition technology is three times faster than previous options and has improved quality for physicians, the average time to close an encounter is down by eight hours a week.

Dr. Vender also recommends physicians use voice recognition while the patient is in the room. This real-time note taking allows the patient to understand what the physician is writing in their notes and provides instant feedback. This can be reassuring and a confidence builder for patients.

The third major initiative is a pilot using virtual scribes in which 50 physicians are participating. With voice recognition and the virtual scribes, physician time on the computer on nights and weekends has significantly lessened, Dr. Vender said.

Other Yale initiatives related to well-being include physician-patient communication training, a resiliency development course, support for meditation programs, mindfulness courses and workshops from the Yale Stress Center, and weekly drop-in meditation sessions through Being Well at Yale.

At one time physicians would spend time dictating and transcribing notes after a patient encounter (or even during one). The use of NLP and EHR is not much different from what was previously done.

Simpler logins, voice recognition ease click fatigue at Yale | AMA Wire

Friday, May 25, 2018

Algorithms, Scoring Metrics, Privacy and more in today’s Healthcare business world–The Healthcare Algo Cartel - Medical Quack

This is a video of a recent presentation I did at the 74th Annual AAPS (American Association of Physicians and Surgeons) meeting.  I don’t do too much blogging anymore as I don’t want to be confused with all the “junk” news out there but thought this is worth a look and listen for all.
The presentation was initially intended for a physician crowd, but after I thought about it, consumers can learn a lot from this as well.  We have too many folks today choosing “virtual” values and getting lost in the real world and don’t realize what goes on behind the scenes, and it’s a lot, things you can’t see rising from corporate America to gain control of us lesser valued serfs it seems.Optum_moneyball
Every direction you turn today, somebody is mining up some behavior data and scoring you today, so we have so many scores, and many of them secret, who knows what value some big corporation or government is putting on our head today?  I’ve been writing about this for years and unfortunately we have gone beyond just good production software that helps us in life and in doing our jobs into a somewhat digital caste system.  I used to write software and this is my attempt here to let the average consumer know more about what’s really taking place out there.  I thought the Obama administration was getting way too virtual, but it seems the new Trump administration is just as bad with not seeing the real world and embracing virtual world values as well, so I guess it doesn’t matter which person or party is in control out there today, they don’t like the ugly real world and keep pushing virtual values on all of us to keep consumers in the dark.
I call it a “One Trick Algo” world and that’s what you’re getting too often out there today, some algorithms and computer code, written by corporate America to profit that tricks you into things you would rather not do if you knew the whole story.  I call this “Operation Perception Deception”, which was a post I wrote back in 2015 and sadly it’s getting bigger every day.  So take a look and see what’s going on behind the scenes in healthcare, and don’t deceive yourself too badly with virtual values as people can’t seem to be able to tell the difference anymore.  BD

Algorithms, Scoring Metrics, Privacy and more in today’s Healthcare business world–The Healthcare Algo Cartel - Medical Quack