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Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine.

Berliner L, Lemke HU, vanSonnenberg E, Ashamalla H, Mattes MD, Dosik D, Hazin H, Shah S, Mohanty S, Verma S, Esposito G, Bargellini I, Battaglia V, Caramella D, Bartolozzi C, Morrison P - EPMA J (2014)

Bottom Line: We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient.An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists.The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

View Article: PubMed Central - HTML - PubMed

Affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.

ABSTRACT
Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

No MeSH data available.


Related in: MedlinePlus

A generic PSM template. The DPM is generated when the specific factors and values are entered into the full set of templates (one for each organ system) and the output is analyzed and may be used for prediction.
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Figure 1: A generic PSM template. The DPM is generated when the specific factors and values are entered into the full set of templates (one for each organ system) and the output is analyzed and may be used for prediction.

Mentions: The DPM provides an IT tool needed for collecting, combining, statistically analyzing, validating and processing patient attributes and biomarkers into a comprehensive, understandable, dynamic, real-time view of the patient. Creation and maintenance of a DPM for any given patient is built upon a generic patient-specific model (PSM) which is modified by the addition of actual patient-specific data, thereby providing a multiscalar, precise, personalized representation of the patient[6,7].A general template for a range of attributes included in a generic PSM is presented in Figure 1. The central area of the template represents the current status of the PSM and is divided into three categories: predetermined factors, anatomic factors and physiologic/functional factors. Allowances are made for those influences that have a direct role in altering the PSM—processes, such as ageing, growth and development, diseases and surgical procedures; extrinsic inputs or interventions; and intrinsic mediators. A separate section of the template displays the PSM output that generates the current or working model of the actual patient or the DPM.


Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine.

Berliner L, Lemke HU, vanSonnenberg E, Ashamalla H, Mattes MD, Dosik D, Hazin H, Shah S, Mohanty S, Verma S, Esposito G, Bargellini I, Battaglia V, Caramella D, Bartolozzi C, Morrison P - EPMA J (2014)

A generic PSM template. The DPM is generated when the specific factors and values are entered into the full set of templates (one for each organ system) and the output is analyzed and may be used for prediction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4274760&req=5

Figure 1: A generic PSM template. The DPM is generated when the specific factors and values are entered into the full set of templates (one for each organ system) and the output is analyzed and may be used for prediction.
Mentions: The DPM provides an IT tool needed for collecting, combining, statistically analyzing, validating and processing patient attributes and biomarkers into a comprehensive, understandable, dynamic, real-time view of the patient. Creation and maintenance of a DPM for any given patient is built upon a generic patient-specific model (PSM) which is modified by the addition of actual patient-specific data, thereby providing a multiscalar, precise, personalized representation of the patient[6,7].A general template for a range of attributes included in a generic PSM is presented in Figure 1. The central area of the template represents the current status of the PSM and is divided into three categories: predetermined factors, anatomic factors and physiologic/functional factors. Allowances are made for those influences that have a direct role in altering the PSM—processes, such as ageing, growth and development, diseases and surgical procedures; extrinsic inputs or interventions; and intrinsic mediators. A separate section of the template displays the PSM output that generates the current or working model of the actual patient or the DPM.

Bottom Line: We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient.An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists.The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

View Article: PubMed Central - HTML - PubMed

Affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.

ABSTRACT
Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

No MeSH data available.


Related in: MedlinePlus